Varicose veins

Varicose veins of the lower extremities are usually asymptomatic in humans. Usually, the only problem with this pathology is the aesthetic defects of the legs caused by the prominent superficial veins. In this case, the disease may be accompanied by increased pain or sensitivity of the leg skin. According to the severity of the disease, provide patients with non-drug, drug or surgical treatment. To learn more about the initial symptoms of varicose veins, the nature of the course, and effective treatment and prevention methods, please read our materials.

what is this

Varicose veins are a pathology that only humans suffer from. Animals do not have this problem, which suggests that the disease is related to the upright posture. When a person stands up, the main part of the circulating blood begins to be below the level of the heart. In this case, all conditions create conditions for the deterioration of blood circulation in the opposite direction, leading to stagnation.

According to statistics, 80% of people in developed countries have venous system diseases. In addition, more and more people are discovering similar problems when they are young. It is possible that one of the reasons for varicose veins to "become youthful" is a sedentary lifestyle, which will only lead to stagnation.

Interestingly, in the age group under 20, men and women have the same frequency of varicose veins. However, after the age of 20, women begin to dominate the morbidity structure. This is due to pregnancy and childbirth, which is a serious factor in the development of venous disease.

Characteristics, causes and mechanisms of varicose veins

The exact cause of varicose veins in the lower extremities is still unclear. It is currently believed that the disease is caused by congenital or acquired defects in the venous valve organs of the lower extremities.

In order to make the ascending blood through the vein flow unimpeded, the coordination of the venous valve is necessary. These valves are only open for upward flow of blood. However, for valve defects, partially decreased blood flow is also possible. This is the development process of venous insufficiency, manifested as edema, leg muscle spasm and venous vasodilation.

Leukocytes may also be involved in the pathogenesis of varicose vein development. This issue is currently being actively studied. It is speculated that with the long-term accumulation of white blood cells in the vascular tissue (especially in the area of the valve device), the inflammatory process will develop and spread along the venous bed.

Because the venous valve is subjected to constant mechanical stress, inflammation develops particularly quickly in the area of the venous valve device.

The vast majority of people in developed countries now live a sedentary lifestyle. But why not everyone has varicose veins? Consider the main risk factors leading to this pathology:

• genetic factors. . . Although the specific genetic mechanism associated with the development of varicose veins has not yet been determined, most experts agree that such factors exist. At the same time, there are strong objections to the inheritance of varicose veins. For example, this is the prevalence of varicose veins among people of African descent and African immigrants who go to the United States to live. If the prevalence of varicose veins in sedentary Africans is about 0. 5%, then this figure reaches 20% among immigrants. These figures show that at least genetic factors are not the only factor in the development of the disease, and most likely will not prevail.
• obesity. . . People who are overweight and obese are at risk. It is important to note that obesity can cause varicose veins, which is not only due to increased blood vessel pressure, but also related to the risk of other diseases that affect blood vessels (diabetes, hypertension, etc. ).
• pregnant. . . This is one of the most obvious factors in the development of varicose veins of the lower extremities. In this case, the main risk factors are increased circulating blood volume and compression of the retroperitoneal vein by the developing fetus in the uterus. According to epidemiological studies, the second and subsequent pregnancies will significantly increase the likelihood of varicose veins. After the first pregnancy, the possibility of varicose veins in the legs is still very low.
• hormone imbalance. . . Hormones are involved in the pathogenesis of most diseases. These pathologies include varicose veins. This is especially true for women who are taking hormonal contraceptives and using hormone replacement therapy to treat certain diseases (such as osteoporosis) or who are in premenopause. It has been established that female sex hormones (especially estrogen and progesterone) reduce vascular tone and destroy collagen fibers. Therefore, the vein wall is pathologically dilated.
• lifestyle. . . A person's lifestyle has a great influence on the course of the disease. A sedentary lifestyle and work related to standing or sitting for long periods of time (for example, security guards, drivers, office workers, service personnel, etc. ) can lead to the development of varicose veins. You should also pay attention to nutrition. Lack of enough vegetables and fruits in the diet can worsen the condition of the blood vessel walls.

Stages of varicose veins of the lower extremities

Currently, several classifications of varicose veins of the lower extremities are used. The international classification CEAP adopted in 1994 is considered universally accepted. CEAP is an abbreviation, where each letter corresponds to the name of a classification category:

• C (clinical)-The clinical category of the disease (type of affected veins, pigmentation, eczema, presence of trophic ulcers).
• E (Cause)-The cause of the disease (congenital, primary, secondary).
• A (Anatomy)-Pathological anatomical location (superficial vein or perforating vein).
• P (pathophysiology)-The type of disease (venous reflux, obstruction or a combination of both).

The course of the disease is divided into six stages:

• Zero stage. . . the earliest stage of varicose veins, at this stage, even doctors cannot reliably make a diagnosis. At this stage, there are no external signs of disease. Ultrasound diagnosis does not show the presence of pathology. At the same time, people in stage zero worry about swelling, a feeling of heaviness in the legs, and cramps, which indicate vascular problems.
• The first stage. . . Already in the first stage of the disease, spider veins can be seen on the surface of the skin of the legs, with a diameter of less than 1 mm. The diameter of medium-sized veins can be increased to 3 mm. At this stage, doctors are not always able to establish a correct diagnosis, because the presence of these asterisks does not always indicate varicose veins.
• second stage. . . At this stage, veins can appear and disappear depending on the situation. For example, after sitting for a long time, standing or lifting heavy objects, veins will appear obviously. The diameter of varicose veins at this stage is 3 mm or more. Blood clots usually form in the second stage.
• The third stage. . . If leg swelling appears and disappears in the first few stages of the disease, then the edema becomes permanent in the third stage. The swelling of the legs is most severe at night.
• The fourth stage. . . At this stage, significant nutritional changes occur. In particular, the tissue nutrition near the affected vein is destroyed. The patient’s skin will experience changes such as liposclerosis (inflammation of the fatty tissue under the skin), eczema, and darkening or discoloration of the skin. For the fourth stage of the disease, pigment changes are characteristic. For example, the skin of the affected blood vessel area may turn brown or even black, which indicates the pigment concentration in that area. The opposite is also possible. When the pigment does not enter the affected area due to pathological processes, this can lead to a pale skin tone. If varicose veins are not treated at this stage, the problem will only worsen as trophic ulcers develop.
• The fifth stage. . . At this stage of the disease, in addition to the above symptoms, trophic ulcers will appear and heal quickly. If no treatment is taken, ulcers will appear again and again.
• Sixth stage. . . There is a non-healing trophic ulcer. The temperature of the affected area has risen significantly, and pus may ooze from the wound.

You should not wait for the final stage of development-you should go to the doctor for the second stage to record and track the development of the disease. Sometimes the symptoms improve on their own, and sometimes they progress quickly. Therefore, it is important to monitor the situation in order to take timely action.

symptom

Consider the main symptoms of varicose veins in the lower extremities at different stages of the disease:

• pain. . . This is the earliest sign of the disease. Since pain is a non-specific symptom, it cannot be diagnosed based on this symptom alone. For varicose veins of the lower extremities, the pain is usually located in the trunk of the vein.
• Feet on legs. . . Also suitable for early symptoms, while the veins in the skin are not yet visible. Usually, the sensation of heat is accompanied by throbbing pain.
• Muscle cramps and itching. . . is disturbed most often at night.
• Swelling of the legs. . . In the early stages of the disease, the swelling is mild and transient. Usually, they appear at night and disappear in the morning. However, as the disease progresses, the severity will increase and it will become permanent.
• Skin discoloration. . . Usually, with varicose veins, the skin of the lower limbs will turn black. In the affected vein area, the skin turns brown. In the later stages of the disease, eczema and dermatitis may appear. The end stage of varicose veins is characterized by the appearance of trophic ulcers. Initially, these were healing ulcers, but later non-healing wounds formed.
• Vessel Spider. . . In the medical literature, this asterisk is called telangiectasia. In some people, varicose veins may be limited to spider veins and will not develop into larger veins.
• Twisted and dilated veins. . . The most typical signs of varicose veins are twisted and expanded veins on the surface of the legs.

In summer, the symptoms of varicose veins will be more obvious. This is due to the high ambient temperature, which has caused the veins to dilate. Therefore, during the hottest hours, from 10 am to 4 pm, it is best to be in a well-ventilated place.

When to see the doctor

You should consult a doctor at the first symptoms of the disease-pain, swelling or spider veins. Since the early stages of varicose veins are difficult to diagnose, they may be misdiagnosed initially. Patients should carefully monitor the condition of their legs and receive regular observation by a phlebologist.

diagnosis

The diagnosis of varicose veins of the lower extremities is simplified to the following activities:

• External examination of the skin of the legs;
• Doppler ultrasound;
• Duplex vein scan;
• Vein record.

Treatment characteristics

There are conservative and surgical treatments for varicose veins of the lower extremities. Conservative treatment is reduced to the following activities:

• medical treatement. . . This is the intake of drugs that improve the tension of the vein wall. In addition, drugs are prescribed to reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, anticoagulants should also be prescribed.
• Compression therapy. . . This is wearing special compression socks to reduce the load on the legs. The advantage is that the load can be evenly distributed, even if it is heavy physical exertion. When using compression garments, congestion and swelling can be avoided.
• Remedial gymnastics and lifestyle changes. . . It is recommended that patients exercise to relieve leg tension. It is important to avoid sitting or standing for long periods of time. If you have to stand or sit for long periods of time at work, you need to rest more frequently.

If the conservative treatment of varicose veins does not bring the expected results, a decision is made whether to perform surgical intervention. In most cases, these are minimally invasive interventions and include:

• Sclerotherapy-Introduce the substance that adheres to the wall of the affected blood vessel into the vein. This treatment leads to reabsorption of spider veins.
• Laser coagulation-Introduce the laser light guide into the vein and irradiate the blood vessel wall with laser light, which will also cause adhesion of the blood vessel wall and further absorption of the blood vessel.
• Radiofrequency ablation-Use high-frequency current to glue the veins.
• Phlebectomy-Remove 90% of affected veins that have worsened blood circulation.

In some countries/regions, you can undergo surgery for free under compulsory medical insurance. But not all types of compulsory insurance business can be seen everywhere. In any case, help is provided, but it is necessary to determine whether it is conventional removal or laser removal.

Contraindications for patients with varicose veins

• Sedentary lifestyle. . . It is important to avoid sitting or standing for long periods of time. Physical exercise will help avoid venous congestion.
• Running and strenuous exercise. . . For sports activities, it is important not to overdo it. If you have varicose veins, walking is definitely better than running.
• Unbalanced and unhealthy diet. . . You need to give up junk food, even if it seems healthy. You should limit your intake of sweets, semi-finished products, thick broth and bacon. But eating more vegetables and fruits is a good idea.
• Hot tub and shower. . . For people with vascular problems in their limbs, overheating and prolonged water procedures are contraindicated.

Complications of varicose veins

Varicose veins can be complicated by trophic ulcers, phlebitis (inflammation of the veins), and deep vein thrombosis. The latter is the formation of thrombus in the deep veins that threaten human life.

in conclusion

Usually, the symptoms of varicose veins in the lower extremities do not appear immediately. Different people have different performances. For example, sometimes this pathology does not show edema or local temperature rise or pain. This does not mean that there is no disease at all. Prompt medical attention will significantly slow down or even prevent the progression of the disease and prevent nutritional changes.