Varicose veins in the legs

Varicose veins in the legs are characterized by the formation of saccular expansion of the superficial (subcutaneous) veins on the lower part of the leg, their serpentine tortuosity, increased length due to impaired blood flow through them and stagnant changes in the lower part of the leg.

The term "varicose veins" comes from the Latin word varix, which means "twisted, intertwined."

People have been familiar with varicose veins since ancient times.While conducting archaeological research during the excavation of the Mastaba burial in Egypt from 1595-1580.Mummy BC found with signs of varicose veins and treatment for venous trophic ulcers on the legs.

This disease should be considered the price that humans pay for the 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.High-risk groups include women, people who are overweight, people who have professions that involve long-term stress on the lower limbs, and whose work requires them to stand or sit for long periods of time.

Classification

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

1. maindeveloped with varicose veins.With varicose veins, it is mainly the superficial veins that change, while the deep veins have a normal structure and function.For a long time, varicose veins from superficial veins appear only as a cosmetic defect, but later, as the disease progresses, disturbances in venous outflow occur, resulting in painful sensations on the lower legs, swelling of the legs and feet, darkening of the skin on the lower legs, inflammatory changes and trophic ulcers.Varicose veins are a continuous progressive disease.
2. Secondaryis a complication of deep vein disease, in particular, it develops either as a result of congenital defects of the venous system (fistula, congenital dysplasia, etc.), or after experiencing phlebothrombosis.Phlebothrombosis is a complex process of thrombus formation in the main vein in the lower part of the leg, as a result of which blood flow through the deep vein is interrupted.Over time, the blood clot that forms becomes fixed in the vein, holes appear in it where the blood flow is limited, but the venous valve at the location of the blood clot becomes scarred and no longer prevents the backflow of blood.As a result of dysfunction of the deep vein valves, blood begins to move up and down through them, flowing back into the superficial veins and secondary varicose veins develop.As a result, favorable conditions are created for venous stagnation, especially in the lower limbs - legs and lower legs.

Symptoms of varicose veins

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

Symptoms of varicose veins: fatigue, heaviness, aching pain, burning and tingling, throbbing, itching, cramps and anxiety.Also, one of the symptoms may be the appearance of swollen legs.As a result of significant expansion of varicose veins, a violation of the blood supply to the tissues of the lower leg may develop, skin defects may occur in the form of darkening or redness, and inflammation.In the case of very advanced varicose veins, trophic ulcers develop.

Diagnosis of varicose veins

To establish a diagnosis, the doctor first examines the patient, paying special attention to the appearance and swelling of the lower leg.You may also be asked some 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.And finally, conduct an ultrasound Doppler examination of the main vein of the lower leg.The ultrasound examination method allows the doctor to see the structure and evaluate the function of the lower leg veins, as well as to identify venous blood clots.

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

Prevention of varicose veins

Currently, there is no method that will really prevent the development of varicose veins.Thanks to prevention, it is possible to increase muscle tone, which helps improve microcirculation in the tissues, as well as improve the condition and function of the lower leg veins, and reduce the risk of complications.The traditional and most widespread methods of prevention are as follows:

1. Physical activity.Move more.Your feet should always be moving.When walking, better conditions are created for blood circulation in the lower part of the legs.Consult your doctor.He 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 especially on the veins.Also, with excessive salt consumption, edema increases most significantly due to fluid retention in the body.
3. Watch what you wear.Avoid high heels.Your shoes should always be comfortable.When wearing low-heeled shoes, your lower limb muscles work better, which helps increase venous outflow.You should also avoid wearing pants and skirts that are uncomfortable and tight.
4. Raise your legs.When you raise your legs, the outflow of venous blood from the bottom of the legs improves.Try to rest a few times throughout 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 every 30 minutes.
6. Do not sit cross-legged.Sitting cross-legged creates unfavorable conditions for blood flow in both lower extremities.

To prevent varicose veins, a good remedy is to wear socks, knee socks and socks with a compression effect.It can also be a good addition to the main treatment (drugs or surgery).Currently, pharmacies offer a wide variety of compression garments to choose from.

Treatment of varicose veins

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

1. conservative (medicine and compression therapy).
2. surgery.

Conservative treatment

Doctors consider elastic compression as the most effective conservative way to treat and prevent varicose veins - the use of special compression socks (socks, golf, tights).When wearing this knitwear, uniform pressure is ensured on the bottom of the leg, which promotes normal blood circulation and increases its outflow, while forming, as it were, an outer frame that supports the weak vascular walls.As a result, the load on the veins is reduced, the outflow of venous blood is improved, the rate of further development of the disease is reduced, and the risk of developing thrombosis is reduced.

Modern compression socks are divided into two types: therapeutic and preventive.Each medical product is marked in mmHg, according to which it is divided into classes from I to IV.At different stages of the disease, compression of a certain strength is used and it is necessary to consult a doctor, 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.

If you have a sedentary lifestyle, as well as during prolonged physical activity, during pregnancy or with hereditary predisposition, it is recommended to wear preventive compression stockings and tights.If small signs of varicose veins appear, you should immediately contact a specialized clinic.

Drug therapy can reduce the clinical manifestations of the disease - pain, swelling, discomfort, spasms, etc., but cannot completely stop the progression of the disease and is used today only as part of complex therapy during primary surgical treatment.Unfortunately, most of the drugs offered on the pharmaceutical market today for the treatment of varicose veins have a relatively 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 ingredients underlying these drugs.It is possible that in this situation, increasing the dose of the drug 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 aimed at a specific link involved in the development and progression of the disease.And to achieve an optimal effect, a complex effect on the disease and the use of several drugs are 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, the surgical treatment of varicose veins in the legs does not require a long stay in the hospital.Thanks to the use of modern invasive treatment methods, the removal of varicose veins can be performed not only under anesthesia with the patient completely turned off, but also under local anesthesia, when the patient is in a clear consciousness, only the pain sensitivity in the lower part of the leg is turned off.Varicose veins disappear on their own within 3 months after delivery without any treatment.

The following surgical treatment methods are available:

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 only applicable for small and medium caliber varicose veins.Sometimes, not one, but several injections of the sclerosing solution may be needed for the vein to disappear completely.Sclerotherapy is quite effective when performed correctly, is low-traumatic, leads to good therapeutic and cosmetic effects, 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 mesh.The essence of this method is to illuminate the inner surface of the vein with a laser beam.Through a small puncture in the skin and vein 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, then it is glued together.When using this method, the doctor aims a laser beam at the vein that needs to be removed, slowly changing color and completely disappearing the vein occurs.An important advantage of this method is that no incision is made into soft tissue or skin.Using the laser method, it is possible to eliminate damaged veins and heal trophic ulcers of the lower legs.
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 inadequate leg vein is 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 of small diameter.With this method, the vein is removed through several small incisions in the skin under local anesthesia.The scar formed after removal is small and almost invisible.
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 microcamera is inserted into the vessel, which allows you to see the vessel from the inside 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

Occasionally, a change from significant darkening to ulcerative skin lesions may occur in the skin around varicose veins as a result of impaired blood microcirculation.If these changes occur, you should immediately see a doctor.

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

Causes of varicose veins

The true nature of varicose veins is not clear enough.According to most scientists, varicose veins are hereditary, genetically determined.The main cause is weakness of the vein wall and venous valve dysfunction.Venous valves originate from the vein wall and usually have 2 leaflets oriented towards the heart.With the normal closing of the valve, blood from the upper part of the vein cannot penetrate the underlying part.When the function of the valve is impaired and the valve does not close completely, blood moves up and down, resulting in venous stagnation and dilation of the veins located below the valve with impaired function.Initially, varicose veins appear in places where there is a valve with impaired function, and blood is released in the direction from the inner vein to the outer, the overfilled vein stretches and expands, which leads to stretching and disruption of the underlying valve function, and so on.Disruption in the venous outflow of blood from the lower part to the heart gradually develops, as a result of which the microcirculation of blood in the tissues of the lower part of the leg is disturbed, which is manifested by edema, increased pigmentation, thrombophlebitis and trophic ulcers.

Factors in the development of varicose veins

Factors that contribute to varicose veins may include:

1. Genetic predisposition - thin and weak walls of superficial veins.
2. Increased load on the tendons: sedentary work, long standing, wearing uncomfortable shoes with high heels, lifting heavy objects, lack of movement of the lower leg muscles.Also, the trigger factor for the development of varicose veins is pregnancy and childbirth.With sudden physical fatigue, there is a strong increase in hydrostatic pressure in the veins of the lower legs, which triggers the process of varicose veins.

Risk factors for developing varicose veins also include:

1. Age.With age, the walls of the veins, as well as the valves, become thinner, which leads to a natural disruption of their function.
2. The floor.Women are more likely to have varicose veins.It is possible that this is due to some hormonal reaction.Female sex hormones affect the relaxation process of the vein walls.Significant hormonal changes in the female body occur during pregnancy and childbirth, during the menstrual cycle and during menopause, which inevitably affect the functioning 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 lower leg veins increases.
4. Pregnancy and childbirth.In pregnant women, the total load in the body increases, but at the same time, the rate of blood outflow from the lower part of the leg to the pelvic cavity into the inferior vena cava system and to the heart decreases.Therefore, favorable conditions are created 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 it causes the development of varicose veins.As pregnancy progresses or during childbirth, varicose veins may develop not only in the lower legs, but also in the hemorrhoids around the anus.