Varicose veins most often affect the venous system of the legs. External manifestations (prominent nodular blue veins, swelling) are not only a cosmetic problem, but signs of a serious disease that worsens over time.
What are varicose veins: definition of the disease
The word "varicose veins" comes from the Latin varix - "swelling". The name fully reflects the pathological process: the walls of the veins become thinner, and in some areas, expansions (porous edemas) - nodules - are formed.
The first case of varicose veins is recorded in a document from 86 BC BC: Roman general Gaius Marius complained of pain in his legs due to "blue swollen veins".
The main reason for the development of varicose veins (varicose veins, varicose veins) is the increase in pressure in the system of superficial vessels. This is facilitated by certain diseases, hormonal changes and a sedentary lifestyle.
At first, even under the influence of these factors, the vessels function normally, but gradually they deform, change their structure and can no longer fully transport blood.
Varicose veins can develop in almost any part of the body, but most often appear in the lower extremities. Therefore, when it comes to varicose veins, by default the problem of the legs is meant.
Code for varicose veins in ICD-10
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.
I83 - varicose veins of the lower extremities:
- I83. 0 - varicose veins of the lower extremities with ulcers;
- I83. 1 - varicose veins of the lower limbs with inflammation;
- I83. 2 - varicose veins of the lower limbs with ulcers and inflammation.
85 - varicose veins of the esophagus:
- I85. 0 - varicose veins of the esophagus with bleeding;
- I85. 9 - varicose veins of the esophagus without bleeding.
I86 - varicose veins of other locations:
- I86. 0 - varicose veins of the sublingual veins;
- I86. 1 - varicose veins of the scrotum (anatomical formation in men - container for the testicles and their appendages);
- I86. 2 - varicose veins of the pelvis;
- I86. 3 - varicose veins of the vulva (external genitals of a woman);
- I86. 4 - varicose veins of the stomach.
O22. 0 - varicose veins of the lower extremities during pregnancy.
In our country, 30 million people suffer from various forms of varicose veins. One third of them have complications - trophic ulcers. An open defect of the skin or mucous membrane that occurs due to impaired blood circulation and tissue innervation.
The mechanism of development of varicose veins
The body's pathological reactions are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels will help to understand how and why the disease develops.
How blood moves through the body
There are two types of vessels in the human body - veins and arteries. Blood flows through arteries from the heart to all organs and tissues. This occurs at high pressure (70–120 mm Hg) and at high speed.
Blood flows through the veins from organs and tissues, it is directed to the heart under low pressure (0–20 mm Hg).
The walls of veins are less thick and elastic than the walls of arteries and, unlike arteries, do not contain such a developed muscle layer. Therefore, varicose veins are possible only in veins, but not in arteries.
Arterial and venous human circulatory system. Veins are indicated in blue, arteries in red.
The low pressure in the veins is necessary to transport the blood from the periphery to the center. But at the same time, on the way to the heart, the blood flow encounters an obstacle - the force of gravity. This force forces the blood back through the veins.
You can often hear that varicose veins are mankind's retribution for walking upright. After all, the longest distance blood has to travel in the body, overcoming gravity, is the path from the legs to the heart. The movement of blood through the veins is ensured by the contractions of the heart, the muscular pump of the surrounding muscles and the negative pressure in the chest during inspiration.
In healthy vessels, the backflow of blood is prevented by valves on the inner walls of the veins. The valves act like one-way swinging doors—they open and allow blood to flow toward the heart, and immediately close if gravity tries to push the blood back.
Not only do the valves help the veins deliver blood to the heart, but so do the muscles that surround the vessels. By contracting and relaxing, muscles help move blood through the veins. This mechanism works only when a person is moving. When standing or sitting for a long time, the muscle pump practically does not work.
The short ends of the venous valves always face the direction of the blood flow - towards the heart
How failure occurs and diseases arise
The increase in pressure in the venous system disrupts the functioning of their valve apparatus and leads to a reverse flow of blood through the vessels. Due to this, as well as due to stagnation of excess blood, weakness of the valvular apparatus (for example, in connective tissue diseases), the lumen of the veins expands, the walls are deformed, they become thinner and locally bag-like protrusions - nodules are formed.
The process is similar to inflating a balloon: if you don't let the air out, the balloon inflates more and more.
On the left there is normal blood flow; on the right - multidirectional blood flow due to impaired functioning of the venous valves, vascular deformation
There are superficial and deep veins in the legs. 85–90% of the total volume of blood passes through the deep, only 10–15% through the superficial. The walls of the deep veins are thicker and more adapted to increased blood volume. And the superficial veins of the legs are thinner and are more prone to varicose veins.
In the pelvis and lower parts of the esophagus there are large venous plexuses that can also undergo varicose transformation. In the veins of the small pelvis, the mechanism of disease development is the same as in the lower limbs. But varicose veins of the esophagus occur for another reason: due to portal hypertension - increased pressure in the portal vein system, which develops in cirrhosis of the liver, hepatitis, parasitic liver lesions, fatty hepatosis, etc.
Causes of varicose veins
A number of factors contribute to the development of varicose veins in the legs. The main ones arevalvular insufficiencyandheredity. It is known that a quarter of patients had close relatives suffering from one of the forms of varicose veins.
Overweight. The more extra pounds a person has, the greater the load on the venous system. Over time, the veins cease to cope with such pressure: the lumen of the vessels increases and the valves of their walls cease to close completely. As a result, blood stagnates and varicose veins develop.
Pregnancy. Hormonal changes occur in the woman's body, body weight, intra-abdominal pressure and the volume of circulating blood increase - this leads to impaired outflow, causes stretching of the vein walls and changes in the functioning of the valve apparatus.
After childbirth, the diameter of varicose veins decreases, but does not always return to its original value. In subsequent pregnancies, the risk of developing varicose veins increases.
Age. Varicose veins often affect people after 50 years. The older a person is, the more the venous valves wear out, while the recovery processes slow down and the mechanism of pathological expansion of the veins - development of varicose veins - is triggered.
Venous refluxVenous reflux Return of blood through the veins due to resistance to blood flow, from the Latin refluo - "to flow back". occurs in 10-15% of students aged 12-13. The disease is "rejuvenated" due to a sedentary lifestyleand overweight.
Varicose veins of the lower extremities develop more quickly if there are additional risk factors.
Risk factors that contribute to the development of varicose veins in the legs:
- lack of physical activity - when moving, the muscles stimulate blood flow through the veins, and without movement, blood circulation in the veins can be difficult;
- smoking - chemicals contained in tobacco smoke damage the walls of blood vessels, as a result of which their lumen narrows, blood flow becomes difficult and stagnation occurs, which leads to varicose veins;
- professions that involve prolonged standing or sitting - hairdressers, surgeons, cooks, waiters, drivers, office workers are at risk;
- menopause - in women aged 40-50, the production of sex hormones (estrogen and progesterone) decreases and at the same time the tone of the venous wall decreases. This increases the likelihood of varicose veins.
Women suffer from varicose veins 3-4 times more often than men. This is due to hormonal fluctuations (menstrual cycle, pregnancy, menopause).
During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva
Varicose veins can appear not only on the lower limbs, but also on other parts of the body.
The main causes of varicose veins in different places
Varicose veins of the esophagus
Changes in the veins of the esophagus with an uneven increase in their lumen, bulging of the wall and the development of nodular curvature of the vessels. It often leads to a life-threatening complication - bleeding.
Reasons:
- cirrhosis
- liver cancer
- other diseases that cause increased pressure in the portal vein system - it collects blood from the abdominal organs
Varicose veins of the scrotum (varicocele)Pathological dilatation of the veins of the pampiniform plexus of the testis. It manifests itself with varicose veins in the scrotum and impaired blood flow
Reasons:
- congenital incompetence of the valves of the testicular veins (usually the left)
- mechanical compression of the testicular vein (inguinal hernia)
Varicose veins of the small pelvis
It is characterized by dilation of the ovarian veins and intrapelval venous plexuses of different diameters. The condition is also known as pelvic congestion syndrome
Reasons:
- polycystic ovary syndrome
- two or more pregnancies
- hormonal dysfunction
Varicose veins of the vulva
Varicose veins of the pelvis, which affect the vessels of the labia and perineum
Reasons:
- compression of the retroperitoneal vessels by the uterus during pregnancy
- significant physical activity
- tumors of the uterus and ovaries
Varicose veins of the sublingual veins (sublingual varicose veins)
Asymptomatic damage to the veins located under the tongue. It manifests itself as a slight bulging of the blood vessels and a change in color from deep blue to purple
Reasons:
- hypertension
- smoking
- old age
Varicose veins of the stomach
An isolated change in the veins of the stomach or in combination with varicose veins of the esophagus
Reasons:
- cirrhosis
- portal hypertension syndrome - increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thrombosis, abnormalities in the development of veins)
Symptoms of varicose veins
In rare cases, only the aesthetic side of the disease is manifested - bluish veins. Most patients suffering from varicose veins of the legs report at least one or more unpleasant symptoms.
Symptoms of varicose veins of the lower extremities:
- fatigue, soreness or a feeling of heaviness in the legs - this is due to stagnation of blood and its pressure on the surrounding tissues;
- burning, tingling or pulsation in the legs - a reaction to the slowing of blood flow and overflow of the venous system of the lower extremities;
- night muscle cramps in the legs - painful spasms occur due to blood stagnation and accumulation of metabolic products in the tissues;
- swelling of the legs and ankles - due to stagnation in the veins, the liquid part of the blood seeps into the subcutaneous tissue through the altered vascular wall;
- itching of the skin around the damaged veins - dilated and altered blood vessels do not provide normal blood circulation and nutrition to the skin, due to which it dries and thickens.
Unpleasant sensations in the legs in patients with varicose veins intensify in the evening, especially after prolonged sitting or standing.
The appearance of altered veins is not always proportional to the severity of symptoms. Thus, veins that are barely visible to the eye and affected by varicose veins can cause severe discomfort, while nodules and thickened veins can cause minimal concern.
Varicose veins affect different veins: from small vessels of the skin to large saphenous veins
Symptoms of other types of varicose veins largely depend on the underlying cause of the disease. Often, patients do not complain about anything, and the doctor identifies the problem only during an examination. This happens, for example, with varicose veins of the sublingual veins.
In some cases, as with varicose veins of the esophagus or stomach, the pathology immediately manifests itself as a life-threatening complication - bleeding.
Classification of venous diseases
In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation formed from the initial letters of the main sections of the classification:
- C — clinic (clinical changes);
- E — etiology (origin of the disease);
- A - anatomy (anatomical localization of varicose veins);
- P - pathogenesis (mechanism of venous blood flow disorders).
Complications of varicose veins on the legs
Usually, varicose veins themselves are not life-threatening. But sometimes the disease can cause complications.
thrombophlebitis- inflammation of the walls of the veins, which is accompanied by the formation of a thrombus (blood clot), closing the lumen of the vessel. It appears as swelling and redness along the affected vein. The patient experiences pain, the skin in the affected area becomes red and hot to the touch.
Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue along the thrombosed vein.
Venous trophic ulcer- an open defect of the skin and soft tissues due to blood stagnation, edema and impaired cellular nutrition. The ulcer appears on the feet and ankles near areas with varicose veins. In the lower parts of the legs, the swelling is more pronounced, which means that the tissues are pressed more than in other areas. Ulcers take a long time to heal and often contain bacteria that increase inflammation.
Trophic ulcers heal very poorly due to impaired blood circulation and tissue nutrition
bleeding- occurs when a vein bursts, dilated due to varicose veins. In the later stages of the disease, the skin over such veins is very thin and dry - a slight injury is enough to break the vessel's integrity and cause bleeding. Spontaneous rupture of a vein in the area of enlarged nodes sometimes occurs.
Diagnosis of varicose veins of the legs
The phlebologist deals with the diagnosis, treatment and prevention of diseases of the veins. The doctor makes a diagnosis based on the patient's complaints, examination and instrumental studies. If the symptoms of varicose veins are pronounced, tests are usually not prescribed: a doctor's examination is sufficient.
The doctor may prescribe laboratory tests in preparation for surgery or to rule out concomitant diseases that affect the condition of the blood vessels.
One of these diseases is diabetes mellitus. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).
For an accurate diagnosis and determination of treatment tactics, you will need a duplex ultrasound scan - the gold standard for diagnosing vascular diseases. The method allows you to evaluate the structure, function, patency of the superficial and deep veins, the consistency of the valves, as well as to determine the direction of the blood flow.
If the secondary nature of varicose veins is suspected (it may occur after deep vein thrombosis), the doctor prescribes venography, CT or MRI venography.
Phlebography is an X-ray test that is used to determine deep vein patency and valve function.
Computed or magnetic resonance venography is used to visualize the venous system in a three-dimensional projection and with very high spatial resolution.
Treatment of varicose veins on the legs
The goal of treating varicose veins is to reduce or eliminate symptoms, improve the appearance of the veins, and prevent complications.
The doctor chooses a treatment method depending on which vessels are affected and how serious the condition of the patient with varicose veins is.
Non-invasive treatments
Noninvasive treatments for varicose veins include compression therapy, drug therapy, and lifestyle changes.
Compression therapy involves wearing special socks, stockings and tights. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the right hosiery.
The compression jersey on the lower legs compresses more than on the upper legs - thus pushing blood to the heart and eliminating stagnation
Effects of compression therapy for varicose veins:
- reduce the manifestations of symptoms - heaviness, fatigue in the legs, night cramps, burning sensation or soreness;
- the severity of edema decreases due to improved blood circulation;
- Healing of trophic ulcers is accelerated because elastic compression improves blood circulation and tissue nutrition.
Drug therapy - the doctor can prescribe phlebotropic drugs (phleboprotectors, venotonics) Biologically active substances that increase venous tone and reduce the severity of vein-specific symptoms. (venotropic) drugs.
The main groups of phlebotropic drugs that are used for varicose veins:
- angioprotectors: improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the likelihood of blood clots;
- antithrombotic agents: reduce the risk of formation of dangerous blood clots (thrombi) in the lumen of blood vessels and promote the dissolution of existing ones;
- bioflavonoids: natural plant compounds that improve venous tone and reduce venous stasis.
Lifestyle changes for varicose veins significantly slow down the development of the disease and, in combination with other recommendations of the attending physician, help to stop the pathological process.
Important guidelines for changing the lifestyle of patients with varicose veins:
- moderate intensity exercise: walking, swimming, water aerobics, leg exercises, yoga. Strengthening the muscles will help normalize blood circulation in the vessels, relieve venous stagnation and edema;
- weight control: thanks to the normalization of body weight, the load on the blood vessels is reduced and the return of blood through the veins to the heart is facilitated;
- giving up bad habits: nicotine and alcohol damage the inner walls of blood vessels and disrupt the regulation of vascular tone. Stopping smoking and alcohol improves the condition of the veins and the function of the valves.
Invasive methods for the treatment of varicose veins
Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure using a special sclerosing solution (sclerosant). The solution is injected into the problem vein through a thin needle, which causes its sclerosing - "sticking". The vein is cut off from the blood circulation and becomes invisible over time; its function is taken over by adjacent veins. Sclerotherapy is performed without hospitalization - after the procedure, the patient can go home.
The sclerotherapy procedure takes 5 to 30 minutes, depending on how many varicose veins need to be filled with sclerosant and how large they are
Endovenous laser thermal obliteration (EVLO). A catheter with a laser light guide is inserted into the vessel through a small incision. The thermal energy of the laser heats the vein and it is obliterated - "sealed". After a few months, the vessel is replaced by connective tissue and disappears. The procedure is performed on an outpatient basis.
Radiofrequency venous obliteration (RFO) is the effect of a high-frequency current on the inner surface of blood vessels. Through a micropuncture, a catheter is inserted into the vein, which is connected to a device that generates radio frequency pulses. Inside the vessel, the radio wave is converted into heat energy that "seals" the vein.
In EVLO, the vein is briefly exposed to high temperature; with RFO, the temperature is lower, but the session is longer. Both procedures are effective and safe.
NTNT obliteration or non-thermal non-tumescent methods:
- venous obliteration using cyanoacrylate glue;
- mechanochemical obliteration, in which mechanical and chemical effects occur simultaneously on the vessel.
NTNT obliteration is the most modern, low-traumatic method for the treatment of varicose veins with a short rehabilitation period.
Phlebectomy is the removal of saphenous veins that have suffered from varicose veins. It can be performed as a stand-alone operation or combined with other techniques. The varicose vein is removed under local anesthesia through small incisions.
Prevention of varicose veins of the legs
You can prevent the development of varicose veins if you follow simple prevention rules in everyday life.
A combination of provoking factors - prolonged sitting with crossed legs, wearing uncomfortable shoes - increases the risk of varicose veins in the legs.
Prevention of varicose veins - what you need to know:
- moderate physical activity (walking, swimming, leg exercises) and resting with elevated feet improves the free movement of blood through the vessels and helps to avoid stagnation in the veins;
- rational nutrition and weight normalization lead to strengthening of blood vessels;
- wearing loose clothing that does not restrict movement helps to improve blood circulation;
- a cool shower in the warm season helps to keep the veins in tone;
- comfortable shoes with low heels (no more than 3 cm) allow you to avoid improper load on the leg and disruption of blood flow;
- a reasonable approach to visiting saunas and steam baths allows you to maintain normal blood flow (prolonged thermal procedures significantly expand the veins, so blood flow slows down).