Varicose veins of the lower extremities in modern medicine

Modern health care faces many different challenges, but despite the rapid advances in medicine, there are diseases that continue to affect millions of people. Varicose veins of the lower extremities ICD 10 - I83 is just such a problem that practically cannot be solved with time.

Prevalence in numbers

The disease has become widespread in various developed countries, such as USA, France, Belgium, Germany, etc. The number of patients with this diagnosis is almost a quarter of the population of each country.

Half of all patients are older than 55 years, and the other part are able-bodied workers, most often employed in production. As each VD disease progresses, complications arise, patients lose their jobs due to disability, so the problem becomes not only medical, but also economic and social. The appearance of varicose veins can be related to the age of the patient. In people older than 70 years, varicose veins of the lower extremities are more common than in people before retirement.

In four out of a hundred patients over 80 years old, varicose veins take on a form aggravated by accompanying pathologies, in the form of trophic ulcers, various dermatitis or eczema. Also at this age, other diseases of the cardiovascular and bronchopulmonary system appear, which excludes the possibility of surgical intervention.

Important!At the first symptoms of the disease, it is better to consult a doctor; the younger the patient, the lower the risks if surgical treatment is required.

The origin of the disease

Despite the fact that the disease progresses gradually, there are still etiological factors for the appearance of varicose veins.

So, what are the causes of varicose veins:

• heredity;
• endocrinological reasons;
• mechanical factor;
• infection;
• intoxication;
• non-specific inflammatory process;
• factors contributing to venous hypertension.

Complaints and symptoms

It is strange that at the very beginning of the disease, visible disorders appear that are often ignored. By exchanging defects of small blood vessels with a minor external disorder that will "go away by itself", patients provoke the development of the disease.

Further symptoms develop progressively:

• feeling of tiredness/heaviness in the legs;
• swelling in the area of the feet;
• night cramps;
• numbness, tingling, "pins and needles" feeling;
• pain in the area of varicose veins.

The diagnosis of varicose veins is an important condition at any stage of the disease

Disease at any stage requires diagnosis; it is the diagnosis that suggests which treatment option is most acceptable to the patient. Clinical and instrumental diagnostic methods are used in tandem. Depending on the course of the disease, all methods or only a part of them can be used.

Methods of clinical examination - examination and interview

Clinical methods are used not only for varicose veins, but also for any other disease:

1. History taking. The anamnesis includes all the basic facts about his life (age, heredity, bad habits, type of main job).
2. Definition of complaints. Complaints may indicate how far the varicose veins have progressed by the time of examination. The duration of the disease becomes an important condition. When did the first symptoms of leg disease appear?
3. Inspection.During the examination, the doctor should pay attention not only to the blood vessels, but also to the condition of the skin, in order to rule out the presence of complications and accompanying pathologies. It is also important to determine the degree of damage, the temperature at the site of varicose veins, as well as the tension and elasticity of the vessel.

A phlebologist is the first doctor who should examine your feet.

Instrumental test methods are a prerequisite

To prescribe treatment, one examination will not be enough. Dilated veins of the lower extremities require mandatory instrumental diagnosis. During instrumental research methods, the focus of varicose lesions, the length of the damaged vessel, the insufficiency of venous valves, the speed of blood flow, etc. are determined.

This:

1. Ultrasound.A standard B-mode study provides a complete picture of the anatomical structure and location of the blood vessel, as well as those adjacent to it. Ultrasound also detects pathologies of the vein wall.
2. Doppler ultrasound.The study determines the speed of blood flow, which identifies the pathologies of the valves in the vessel.
3. X-ray contrast venography. A more complex type of diagnosis using X-rays. The procedure is rarely used due to possible complications.
4. Computed tomographic venography. It is carried out in the same way as X-ray contrast, with the introduction of a contrast agent into the lumen of the vessel. A CT image, unlike an X-ray, is three-dimensional.
5. MRI.The method is justified and informative, and is carried out without the use of contrast or other drugs. However, this method is still expensive, so it is used extremely rarely.

Note!In patients who are allergic to iodine, contrast agents cannot be given, in which case magnetic resonance imaging may be required.

Diagnosis according to classification

Like other diseases, varicose veins are divided into classes, taking into account many factors:

External manifestations	telangiectasia; Varicose veins; edema; Hyperpigmentation; Ulcer in the healing phase; The ulcer is in an active stage.
Cause of disease	congenital; Unknown etiology; Acquired (injuries, etc. ).
Anatomical location of veins	Superficial; Deep; Varicose veins that perforate are distinguished separately.
Disease mechanism	Throwing into nearby vessels; Obstruction of venous blood.

The most common reason for contacting a specialist is varicose veins of the lower extremities of the 2nd degree, when the external manifestations of the disease become significant. Perhaps, if the disease is not manifested externally, then the detection of varicose veins would occur in the later stages.

Note!The concept of "internal varicose veins of the lower extremities" is used only colloquially, which means varicose veins of deep veins, which can only be diagnosed by instrumental methods.

To treat or not to treat, that is the question

The gradual progression of the disease sooner or later leads patients to the idea that treatment is necessary. It is often the doctor's task to convince the patient to start treatment in the initial stages of the disease. The course of treatment can be different and depends on many factors (age, symptoms, degree of illness, etc. ).

Therefore, treatment can be aimed at:

• improving the quality of life; aesthetic surgical interventions.
• prevention of complications; influence on microcirculation.
• elimination of symptoms; hemodynamically significant treatment.

In one way or another, treatment is always chosen by a specialist (phlebologist, vascular surgeon). In the treatment of varicose veins, complexity is important, so you cannot limit yourself to only surgical intervention, or only to therapeutic and preventive physical training. It is important to follow all the doctor's instructions.

Lifestyle Tips

Varicose veins obligate patients to abandon factors that cause complications. Sometimes such a measure is necessary, because untreated varicose veins greatly affect the quality of life.

Do-it-yourself treatment is a useless exercise, however, you should pay attention to your lifestyle so that varicose veins do not progress so quickly.

What to do for varicose veins:

• Women must give up high-heeled shoes;
• Give up bad habits, especially smoking;
• Move, if you have to sit or stand for a long time, try to change your position;
• Avoid tight/tight clothing and shoes;
• Avoid exposure to high temperatures (sunbathing, hot wax, baths, saunas);
• Control your weight;
• Do not lift heavy objects;
• Take a contrast shower;
• Walk, run, swim more often;
• Keep your legs elevated whenever possible (sleeping, resting).

Compression therapy

Regardless of the etiology, patients with varicose veins should wear medical hosiery or apply elastic bandages.

1. The most appropriate use is knitwear, socks or knee-high socks, made of a special material, they usually do not cause discomfort. The level of compression of medical socks should be recommended by the doctor. The only downside to a compression garment is its cost.

   Note!The brands of manufacturers of medical knitwear can be different, so you have to choose carefully. Make sure that the elastic on knee socks or stockings is not too tight.

2. As an alternative, patients often prefer to use short, medium or long elastic bandages. The choice of stretch depends on the stage of the disease and should be recommended by a doctor. The first few uses can be a bit difficult as you will have to control the tension level of the bandage yourself.

Compression therapy is used daily, wearing underwear or bandages greatly eases the load on the legs throughout the day.

Physical education and sports as treatment

Varicose veins require movement, so therapeutic and preventive physical education is an important component. Of course, it is better not to perform exercises blindly, but to choose a set of exercises with an expert. Some health facilities offer group exercise therapy classes.

The most common exercise therapy exercises do not require special training and are available regardless of age; for clarity, a set of exercise therapy exercises:

• Tighten and relax thigh muscles (10 times);
• Inhale, lift the abdominal wall, exhale, retract the stomach (4 times);
• Bend and straighten the legs in the ankle joint (10 times);
• Inhaling, raise your arms through the sides, while exhaling, lower them (4 times);
• Bend and straighten the toes (15 times);
• Raise your arms up as you inhale and lower as you exhale.

Even from this small set of exercises, it is clear that anyone can do them, regardless of age. It is important to take your time and do everything at a slow pace, without holding or speeding up your breathing.

Athletes can also perform this set of exercises before the main training session. It is especially important if the patient plays any sport that is not recommended for varicose veins.

Sport, as an alternative to exercise for varicose veins of the lower extremities, is also suitable, but it is necessary to consult a doctor and a personal trainer. Some exercises will have to be excluded from training.

Athletes are sometimes simply forced out of their professional careers, especially in jumping, powerlifting and heavyweight boxing. Those who like to swim, run and walk, in turn, can continue with this.

Medicines, after being prescribed by a doctor

The goals of pharmacology in the treatment of varicose veins are different, namely:

• improvement of vein tone;
• microcirculation correction;
• improvement of lymphatic drainage;
• prevention of thrombotic complications;
• suppression of the development of complications.

That is why all medicines must be prescribed by a doctor. In this sense, there is a guarantee of successful treatment of the disease.

Drug treatment is applied in different stages: during the preparation of the patient for the upcoming operation, in the postoperative period, as well as in cases of obvious contraindications for the operation. Medicines can be systemic or local and are used in tandem and separately.

Treatment of phlebosclerosis

Phlebosclerosis also refers to pharmacological treatment methods, however, its use is often unjustified, because the positive effect does not apply to all patients. The method is mainly used for correction in an aesthetic sense.

It should be noted that the use of this method is full of recurrences and complications, so the procedure is performed by surgeons who have undergone special training.

Physiotherapy in the treatment of varicose veins

Physiotherapy methods are not the main treatment for varicose veins, but they are successfully used to alleviate the symptoms of the disease. D'arsonval, electrophoresis, barotherapy, magnetotherapy for varicose veins of the lower extremities are used only under the supervision of a doctor, because each physiotherapy has a number of indications and contraindications.

All physiotherapy procedures are not applied continuously, but in courses of 10-20 days. In most cases, physiotherapy allows delaying the progression of the disease, but it is not the main method of treatment, and it certainly cannot be used as monotherapy.

Surgical treatment

Despite numerous methods of therapy, surgery remains practically the most basic and significant. Vascular surgeons operate successfully on many patients.

Traumatic venectomies became a thing of the past as modern minimally invasive methods became available. Brunner's approach, Müller dissection and mini-phlebectomy with Varadi hooks facilitate the treatment of patients with varicose veins and often take one day.

Of course, there are contraindications for surgical intervention, and the main group are patients older than 75 years who have disorders of tissue trophy, disorders of microcirculation and/or lymphatic drainage or excessive lesions of venous vessels. There are special instructions for performing operations on such patients. Sometimes you have to give up surgery altogether, and sometimes doctors still operate with combined phlebectomy.

Drug treatment

The treatment regimen for varicose veins is determined by the doctor. Conservative methods and surgical methods are used for this, it all depends on the stage of disease development, as well as the presence of complications.

The simultaneous use of drugs and ointments allows you to alleviate the symptoms of pathology and achieve good results in treatment. Currently on the shelves of pharmacies there is a large selection of drugs that are effective in the fight against pathology in the early stages of development.

Treatment of varicose veins on the legs with drugs is effective.

Important!Only a doctor can prescribe medications, dosage and method of their administration.

Sclerotherapy

Sclerotherapy is one of the best methods of treating varicose veins today. Specially applied drugs allow you to destroy vein stagnation from the inside. After some time, it will begin to stick and dissolve, and blood circulation will be transferred to healthy veins.

The treatment is carried out in a course that includes up to six sessions for each painful leg. You can notice a positive result no earlier than two weeks. However, patients should be prepared for pain and tingling.

Soon the unpleasant symptoms will disappear, the diseased veins will disappear. The dosage of the drug is selected taking into account the individual characteristics of the patient.

Complications and side effects are extremely rare. A properly performed procedure gives a high chance of recovery.

Echosclerotherapy is the same as sclerotherapy, the difference is in the use of an ultrasound scanner. This method is preferred because the movement of the syringe can be monitored and the medication will be distributed evenly.

Foam sclerotherapy is another type of sclerotherapy. Medicines are applied in the form of microfoam, so the procedure enables better results to be achieved. The thing is that the drug is much closer to the walls of the veins and does not mix with the blood.

Surgical methods of treatment

Surgical treatment of varicose veins is used only if conservative methods do not achieve the desired result. Patients are given local anesthesia and can go home after a few hours.

There is practically no hematoma and no intoxication characteristic of general anesthesia. The obtained result lasts for several years.

Phlebectomy is a type of surgery performed under local surgery. Two small punctures are made to remove the affected vein. Sometimes this method can replace sclerotherapy. After just a few weeks, the patient will be able to return to his usual lifestyle.

Laser treatment is the gentlest method of treatment and can only be performed by a qualified specialist. Using an ultrasound scanner, a fiber optic cable is inserted into the vein.

The procedure is controlled by special devices. The laser beam causes the plasma to boil, the diseased vein closes and does not participate in blood circulation. The price of such an intervention is high, so it is not available to everyone.

Darsonvalization

With the help of the D'arsonval device, it is possible to normalize blood circulation, as well as eliminate congestion in diseased veins. The increased tone gradually decreases, the tone of the veins increases. Patients get relief from pain and itching.

Full lymph circulation, as well as full blood circulation, allows the tissues to receive adequate nutrition, and the amount of oxygen in them increases. Veins either narrow or widen; gymnastics can increase their elasticity.

The device moves from bottom to top. Lymph and blood flow from the ankle to the thigh and the blockage stops. To achieve the desired result, it is necessary to go through the entire treatment, which includes at least twenty procedures.

Home Remedies

Advice!Varicose veins can also be effectively treated with home remedies.

The most common ways are the use of medicinal plants. You can buy them at the pharmacy or collect them yourself in the summer.

White acacia

An alcoholic tincture is prepared on the basis of the flowers of the plant. Soak cotton swabs in it and wipe the affected areas several times a day.

Sagebrush

Collect fresh herbs and grind them in a mortar. Separate a spoonful of herbs and mix with the same amount of sour cream. Apply the resulting mixture to painful places and apply a bandage on top. After two hours, remove the dressing. Repeat the manipulations for five days, take a short break, and then repeat the treatment.

Kalanchoe

Wash the Kalanchoe leaves, place them on a paper towel and let them dry. Chop the leaves and put them in a glass jar. Cover with alcohol and let it stand for seven days with occasional stirring. Strain the tincture and massage the painful veins for several months in a row.

Apple vinegar

Dissolve two tablespoons of vinegar in a glass of water and drink it twice a day. It is recommended to rub undiluted apple cider vinegar into painful areas twice a day. After a month, the veins will begin to shrink.

Cream

Grind part of the garlic, add two parts of butter. Put the resulting cream in its pure form on painful places, cover with parchment paper and apply a bandage. Leave the compress all night, wash off in the morning, and wrap your legs with an elastic bandage. Repeat the procedures during the month.

Garlic

In order to consolidate the results of the treatment, you can take garlic internally. Mix 250 grams of chopped garlic and 350 grams of honey, let it stand for five days. Take one tablespoon three times a day.

Tomato

Cut fresh tomatoes into slices, apply to the problem area and wrap with a bandage. Keep the compress on for four hours, then remove and wash your feet. The course of treatment is two weeks, then there is a ten-day break and it is repeated.

Prevention

It is much easier to prevent the disease than to fight it later, which is why prevention is necessary. If you have a hereditary predisposition to varicose veins, you must pay double attention to your health.

First of all, you need to give up bad habits and follow the above recommendations. Your diet should include foods rich in vitamins.

vitamin E

The vitamin is found in many foods: lettuce, vegetable oil, legumes. It is necessary to strengthen the walls of the veins, as well as increase their elasticity. Vitamin C has exactly the same property.

Copper

Food rich in copper helps the synthesis of elastin. Seafood is included here. To maintain your body weight, you must give up sugary foods.

To prevent varicose veins, you must follow the following rules:

1. It is not recommended to put too much stress on your legs during the day. People who work in a standing position must spend several minutes per hour in a sitting position. Ideal: take a horizontal position, raise your legs above your head and hold for twenty minutes.
2. If you work in a sitting position, you need to get up for a few minutes once an hour and spend that time standing. This will increase the speed of blood movement through the veins. Periodically rotate your feet in different directions.
3. Lifting heavy objects is not recommended.
4. Massage your feet daily with a stream of cold water.
5. Do not overuse visits to saunas and baths.

Effective methods of treating varicose veins can achieve good results. Patients quickly return to their full lives.

How complicated is the disease?

Complications of varicose veins are always unpredictable, although they develop gradually. Without medical supervision and therapeutic treatment, the risk of developing complications becomes many times greater.

1. Trophic ulcers with ascending and descending varicose veins.They are most often found on the lower third of the leg on the inside, however, they can also be noticed on the outside, although this manifestation occurs quite rarely. The deeper the trophic ulcer, the greater the risk of bleeding.
2. Thrombophlebitis.It can occur with any type of varicose veins, and the appearance of such a complication directly depends on the coagulation properties of the blood. This complication can be prevented by using laboratory monitoring.
3. Eczema.It appears due to a violation of tissue trophism. Eczema and trophic ulcers can appear together or separately.
4. Bleeding from varicose veins of the lower extremities.This type of complication can appear against the background of deep trophic ulcers, as described above; such bleeding will be external. Internal (subcutaneous) bleeding with prolonged course of varicose veins was observed.

What is important to know about varicose veins

Varicose veins become a test for patients, because the more they ignore it, the more aggressive the disease will behave. The course of varicose veins depends not only on the doctor's instructions, but also on how carefully the patient follows them. Varicose veins are a chronic disease, and even after surgery, the treatment often does not stop.

What the doctor advises must be done and respected, whether it is a magnet for varicose veins of the lower extremities, drugs or exercise therapy. It is a complex treatment that gives a positive result, and you must not neglect a single, most important point.