Varicose veins on the legs

Varicose veins of the legs are characterized by the formation of saccular expansions of the superficial (subcutaneous) veins of the lower extremities, their serpentine curvature, an increase in length due to impaired blood flow through them, and stagnant changes in the lower extremities.

The term "varicose veins" comes from the Latin word varix, which means "twisting, entwining".

Mankind has been familiar with varicose veins since ancient times.When conducting archaeological research during excavations of the Mastaba burial in Egypt from 1595-1580 BC.a mummy was found with signs of varicose veins and treatment of a venous trophic ulcer on the leg.

This disease is rightly considered the price humanity pays for its ability to walk upright.On average, about 15% of men and up to 25% of women (including pregnant women) in economically developed countries suffer from varicose veins in the legs.The risk group includes women, overweight people, people with a profession that involves long-term loading of the lower limbs and whose work requires standing or sitting for a long time.

Classification

Taking into account the factors predisposing to the development of the disease, primary and secondary varicose veins of the legs are distinguished for different reasons.

1. Primarydevelops with varicose veins.In varicose veins, mainly the superficial veins change, while the deep veins have normal structure and function.For a long time, varicose veins of superficial veins appear only as a cosmetic defect, but later, as the disease progresses, venous outflow disorders occur, which leads to painful sensations in the lower extremities, swelling of the feet and legs, darkening of the skin in the lower third of the legs, inflammatory changes and trophic ulcers.Varicose veins are a continuously progressive disease.
2. Secondaryis a complication of the disease of the deep veins, in particular, it develops either as a result of congenital malformations of the venous system (fistulas, congenital dysplasia, etc.), or after spent phlebothrombosis.Phlebothrombosis is a complex process of thrombus formation in the deep main veins of the lower extremities, as a result of which blood flow through the deep veins is disturbed.Over time, the formed blood clot is fixed in the vein, holes appear in it, through which limited blood flow is possible, but the venous valves at the site of the blood clot become scarred and no longer prevent the return flow of blood.As a result of dysfunction of the valves of the deep veins, blood begins to move up and down through them, flows back into the superficial veins, and secondary varicose veins develop.As a result, favorable conditions are created for venous stasis, especially in the lowest parts of the limb - the foot and lower leg.

Symptoms of varicose veins

For most people, varicose veins appear as a cosmetic defect, most often appearing on the inner surface of the legs.Sometimes varicose veins can appear only in the form of a venous network, which is formed when small diameter veins change, most often on the legs and less often on the face or upper limbs.Varicose veins become blue or dark purple in color and have a tortuous course.

Symptoms of varicose veins: fatigue, heaviness, stabbing pain, burning and tingling sensations, throbbing, itching, cramping and restlessness.Also, one of the symptoms can be the appearance of swelling of the legs.As a result of pronounced expansion of varicose veins, a violation of blood supply to the tissues of the lower limbs may develop, skin defects may appear in the form of darkening or redness and inflammation.In extremely advanced cases of varicose veins, trophic ulcers develop.

Diagnosis of varicose veins

To establish the diagnosis, the doctor first examines the patient, paying special attention to the appearance and swelling of the lower extremities.You may also be asked a number of questions about your sensations to clarify the nature of the pain.Another important step is to perform a series of tests to assess the functional state of the superficial and deep veins.Finally, conducting an ultrasound Doppler examination of the main veins of the lower extremities.The ultrasound examination method allows the doctor to see the structure and evaluate the function of the veins of the lower extremities, as well as to identify venous blood clots.

When the first symptoms of the disease appear, you should contact doctors who deal in particular with diseases of blood vessels and veins (general surgeon, vascular surgeon and phlebologist), and if the skin is damaged, you should also visit a dermatologist.You can go to a cosmetology clinic only after visiting specialist doctors on their recommendation.

Prevention of varicose veins

Currently, there is no method that can completely prevent the development of varicose veins.Thanks to prevention, it is possible to improve muscle tone, which helps improve microcirculation in the tissues, as well as improve the condition and function of the veins of the lower extremities and reduce the risk of complications.The traditional and most common methods of prevention are the following:

1. Physical activity.Move more.Your feet should be constantly in motion.During a walk, more favorable conditions are created for blood circulation in the lower limbs.Consult your doctor.It will help you choose the most optimal type and level of physical activity.
2. Control your weight.Being overweight increases the load on the circulatory system and, in particular, on the veins.Also, with excessive salt consumption, edema increases the most as a result of fluid retention in the body.
3. Pay attention to what you wear.Avoid high heels.Your shoes should always be comfortable.When you wear low-heeled shoes, the muscles of the lower extremities work much better, which helps improve venous outflow.You should also avoid wearing uncomfortable and tight pants and skirts.
4. Put your feet up.When you raise your legs, the venous outflow of blood from the lower extremities improves.Try to take several breaks during the day and put your feet up.For example, lie on your back with your feet on a pillow.
5. Avoid prolonged periods of standing or walking.To improve blood circulation, try to change your body position as often as possible.Try to get up and walk around every 30 minutes.
6. Don't sit cross-legged.Sitting cross-legged creates unfavorable conditions for blood flow in both lower limbs.

A good way to prevent varicose veins is to wear socks, knee socks and compression socks.It can also be a good adjunct to the main (medical or surgical) treatment.Pharmacies currently offer a wide range of compression garments to choose from.

Treatment of varicose veins

There are several commonly accepted methods of treating varicose veins in the legs:

1. conservative (drug and compression therapy).
2. surgically.

Conservative treatment

Doctors consider elastic compression to be the most effective conservative means for the treatment and prevention of varicose veins - the use of special compression knitwear (socks, golf, pantyhose).When wearing this knitwear, even pressure is provided on the lower limbs, which promotes normal blood circulation and improves its outflow, while forming an outer frame that supports the weakened vascular walls.As a result, the load on the veins is reduced, the outflow of venous blood is improved, the rate of further progression of the disease is reduced, and the risk of developing thrombosis is reduced.

Modern compression knitwear is divided into two types: therapeutic and preventive.Each medicinal product is marked in mmHg, according to which it is divided into classes from I to IV.At different stages of the disease, compression with a certain strength is used and consultation with a doctor is necessary, because only a doctor can prescribe and choose the right compression stockings, taking into account the nature of the pathology and according to certain individual standards.

With a sedentary lifestyle, as well as with long-term physical activity, during pregnancy or with a hereditary predisposition, it is recommended to wear prophylactic compression stockings and tights.If even minor signs of varicose veins appear, you should immediately contact a specialist clinic.

Drug therapy can reduce the clinical manifestations of the disease - pain, swelling, discomfort, spasms, etc., but it cannot completely stop the progression of the disease, and today it is used only as part of complex therapy during the main surgical treatment.Unfortunately, most of the drugs offered today on the pharmaceutical market for the treatment of varicose veins have a rather low effectiveness, despite the theoretically justified feasibility of use.One of the reasons for this is the low absorption by the body of the medicinal substances that are the basis of these drugs.It is possible that in this situation, increasing the dose of the medicine taken will help, but this is associated with an increased risk of complications and side effects.Another reason for the low effectiveness of these drugs is that their spectrum of action is relatively narrow and is aimed at a specific unit involved in the development and progression of the disease.And to achieve an optimal effect, a complex impact on the disease and the use of several drugs is necessary.The ideal drug for the treatment of venous insufficiency and varicose veins should affect as many pathogenetic links of chronic venous insufficiency as possible, while having a minimum number of side effects and being well absorbed by the body.

Surgical treatment

Today, surgical treatment of varicose veins of the legs does not require a long hospital stay.Thanks to the use of modern invasive methods of treatment, the removal of varicose veins can be performed not only under anesthesia when the patient is completely excluded, but also under local anesthesia, when the patient is clearly conscious, only the pain sensitivity of the lower extremities is excluded.Varicose veins disappear on their own within 3 months after birth without any treatment.

The following methods of surgical treatment are offered:

1. Sclerotherapy.During this procedure, a solution is injected, under the influence of which a scar is formed at the site of the damaged vein.This method is applicable only for varicose veins of small and medium caliber.Sometimes it may take more than one injection of sclerosing solution to make the vein disappear completely.Sclerotherapy is quite effective when performed correctly, low-traumatic, leads to a good therapeutic and cosmetic effect, and a significant advantage is that sclerotherapy is performed under local anesthesia (ie without anesthesia), directly in the doctor's office.
2. Laser surgery.Laser radiation can be used to remove varicose veins of any diameter and, in particular, venous network.The essence of the method is irradiation of the inner surface of the vein with a laser beam.Through a small puncture of the skin and the venous wall, a special device is inserted - a light guide, through which a laser beam is passed under ultrasound control.The inner surface of the vein is irradiated with a laser and then glued.In this method, the doctor directs a laser beam to the vein to be removed, causing a slow discoloration and complete disappearance of the vein.An important advantage of this method is that no incision is made in soft tissue or skin.Using the laser method, it is possible to remove damaged veins and heal trophic ulcers on the lower leg.
3. Surgical removal of varicose veins.During surgical removal, a series of small incisions are made in the skin and soft tissue through which the damaged vein is removed and the insufficient perforating veins in the leg are ligated.When using this technique, anesthesia is a necessary condition.This method is used to remove large varicose veins.
4. Outpatient phlebectomy (removal of varicose veins).This method is suitable for removing veins with a small diameter.In this method, the vein is removed through several small incisions in the skin under local anesthesia.The scars formed after removal are small and almost imperceptible.
5. Endoscopic removal of varicose veins.This method is particularly suitable for the formation of skin defects in the form of ulcers.During this method, a special video micro camera is inserted into the vessel, which allows you to see the inside of the vessel and observe the entire removal procedure.The vein is then removed under observation through this camera.

Thanks to the use of modern treatment methods, it is possible to achieve a complete cure and a good cosmetic effect.But it should be remembered that varicose veins can reappear.

Complications of varicose veins

Sometimes on the skin around varicose veins, changes from pronounced darkening to ulcerative skin defects may appear as a result of impaired blood microcirculation.If these changes occur, you should immediately consult a doctor.

Another more serious complication of varicose veins is the formation of blood clots in the deep and superficial veins.This complication is called thrombophlebitis.When it occurs, acute unbearable pain, swelling and redness appear.In this situation, you should also immediately consult a doctor.

Causes of varicose veins

The true nature of varicose veins is not clear enough.According to most scientists, varicose veins are hereditary, genetically determined.Its main cause is the weakness of the venous wall and the dysfunction of the venous valves.Venous valves arise from the vein wall and usually have 2 leaflets facing the heart.When the valves close normally, blood from the upper part of the vein cannot penetrate into the underlying part.When the function of the valves is impaired and the valves do not close completely, blood moves up and down, causing venous stasis and dilation of the veins located below the valve with impaired function.Initially, a dilated vein appears in the place where there is a valve with impaired function, and blood is ejected in the direction from the deep veins to the external ones, the congested vein is stretched and expanded, which causes the underlying valve to stretch and malfunction, etc.Violations of venous blood flow from the lower limb to the heart gradually develop, as a result of which blood microcirculation in the tissues of the lower limbs is disturbed, which is manifested by edema, increased pigmentation, thrombophlebitis and trophic ulcers.

Factors for the development of varicose veins

Factors contributing to varicose veins may include:

1. Genetic predisposition – thin and weak wall of superficial veins.
2. Increased load on the veins: sedentary work, prolonged standing, wearing uncomfortable shoes with high heels, lifting heavy objects, lack of movement of the muscles of the lower legs.Also, a key factor in the development of varicose veins is pregnancy and childbirth.With sudden physical overexertion, there is a strong increase in hydrostatic pressure in the veins of the lower limbs, which triggers the process of varicose veins.

Risk factors for developing varicose veins also include:

1. Age.With age, the wall of the veins, as well as the valves, become thinner, which leads to a natural disruption of their function.
2. Floor.Women are more likely to suffer from varicose veins.It is possible that this is due to a number of hormonal reactions.Female sex hormones influence the process of relaxation of the venous wall.During pregnancy and childbirth, during the menstrual cycle and during menopause, pronounced hormonal changes occur in the female body, which cannot but affect the function of the venous system.It is also impossible to exclude the influence of taking hormonal contraceptives on the process of varicose veins.
3. obesity.With overweight and obesity, the load on the veins of the lower limbs increases.
4. Pregnancy and childbirth.In pregnant women, the volume load of the body increases, but at the same time the rate of blood flow from the lower extremities to the pelvic cavity in the inferior vena cava system and to the heart decreases.This creates favorable conditions for the development of varicose veins.Changes in the circulatory system in the woman's body ensure the development of the fetus, but at the same time cause the development of varicose veins.As pregnancy progresses or during childbirth, varicose veins can progress not only in the lower extremities, but also in the hemorrhoidal veins around the anus.