Varicose veins or varicose veins of the lower limbs is of primary veins varicose transformation of superficial veins of the lower limbs, in which they appear "cones" or "nodes" in the foot.
Varicose veins disease is very widespread throughout the world. The frequency reaches 60% of the adult population depending on the country. It is interesting to note that the inhabitants of the african continent and the Asia-Pacific region suffer from varicose veins much less than of the inhabitants of the european countries and the UNITED states.
Due to the lack of a digit causes of varicose veins of the lower limbs agreed to talk about its risk factors, that is, of what increases the likelihood of developing this malocclusion (the property or characteristic of the human body, some effect on the body). Common risk factors of the disease they consider the age, female gender, obesity and heredity. Typical is the "portrait" of a patient with the symptoms of varicose veins — a woman in a state of menopause, with an excess of body mass index, with a couple of pregnancies and births in the history.
The symptoms of varicose veins of the veins of the legs
In the vast number of cases, varicose disease, you can recognize it despite having no special medical training. Unequivocal objective sign of malocclusion — the emergence of "cones" or "nodes" on the lower limbs, with the skin on them are usually not in any special color. Blue of vienna, usually, are not the disease in its literal sense, even if it often lead to patients (often women) of some of the problems of an aesthetic nature.
However, in cases of varicose veins can be accompanied by a change of color of the skin due to eczema venous, which manifests itself in a variety of skin rashes itchy (bubbles, beams), and redness.
These features, together with swelling of the feet, which does not disappear during the night, bear witness to the formation of chronic venous insufficiency.
With regard to the subjective symptoms of varicose veins, it should be noted their lack of specificity. The complaints may indicate the disease, but can be a symptom of overload of the venous system of the lower limbs. Often patients concerned about the gravity, the feeling of fullness to human and non-localized, not very annoying pain in the calves. Sometimes complain of pain in the area of varicose veins and increased fatigue of the legs.
Burning sensation, tingling, muscle cramps during the night or restless legs syndrome (unpleasant sensations in the legs at rest, when you want to their movement, to relieve this discomfort) often meet with malocclusion and neurological, for example, syndrome, radicular, and should be considered with caution.
The pathogenesis of varicose veins of the veins of the legs
The pathogenesis of varicose veins of the lower limbs is quite complex and versatile. An important role in the mechanism of the development of the disease plays in the corruption of the wall and valves of the veins. Because of their malfunctioning is formed by a return current of blood (reflux), then there's the defeat of the endothelium (the internal flooring of the ship), which is accompanied by inflammation.
Next in the pathological process are included the middle and inner layers of the venous wall: occurs by proliferation of the connective tissue with the muscular veins, and then his atrophy, which leads to the progressive destruction of the collagen frame of the ship. These phenomena violate the property of elastic of vienna, contribute to further expand its level and the spiral of tightening in length. Is interrupted, similar changes are observed in the venous valves.
It is necessary to note that visible venous "cones" and "knots" are usually the result of the invisible presence of the source of varicose veins — great saphenous vein. In most cases, this is a great, less small, vienna the hypodermic. The above changes in the pool of these veins and lead to veins disease.
Complications of varicose veins of the veins of the legs
Complications of varicose vein disease should be classified as trophic disturbances (ulcers, venous), thrombosis of modified veins (venous thrombosis) and bleeding of the varicose veins "cones" and "nodes".
Trophic disturbances are a consequence of the progression of the disease, in the absence of his treatment, for this often takes years and decades. Begin with manifestations of the skin — hyperpigmentation (brown spots, one dark), eczema venous and skin (leather trimmings).
The localization of these changes — shin, even if venous eczema can occur in the field all the varicose veins, including and on the thigh. Depending on the source of varicose veins (great or small saphenous veins) trophic disturbances may be localized both on the outer surface of the lower third of the tibia, respectively. The result of eating disorders soft tissues need education venous wounds on the spot the previous changes. The ulcers are single or multiple, with the correct side dishes, desserts and edges, also the bottom. Observed lack of a detachable, often in character. The appearance of ulcers accompanied by itching and pain. For venous ulcers of the worthy of note is long (months) and the frequent recurrence.
Thrombophlebitis or thrombosis of the superficial veins, not to be confused with deep venous thrombosis. In the second case the situation is much more serious. However, when thrombotic defeat varicose veins symptoms are very unpleasant. In the area of thrombosis of vienna in the form morbid thread gasket, for he is the typical redness, local rise of temperature and increased sensitivity, sometimes the seal limits the movement of a limb. The clinical picture is more like an ulcer or an abscess.
Thrombophlebitis can be particularly dangerous, if you take upward the forecast and it passes with a system of the surface to the deep. In this case you may develop such as pulmonary embolism and deep vein thrombosis.
Bleeding of the varicose veins of the varicose veins seem to be very scary, because due to the high venous pressure jet of blood strong enough. In some cases, this can result in a substantial loss of blood.
The diagnosis of varicose veins of the veins of the legs
The diagnosis of varicose veins of the lower limbs usually does not involve particular difficulties. The key to a symptom of the disease, the presence of venous thrombosis "cones" and/or "nodes." Even if the excessive development of the subcutaneous adipose tissue of the lower limbs to see them is hard.
For further confirmation of the diagnosis using a variety of methods of diagnostic above, at the level of which is duplex ultrasonography (USD). Lets you quickly, accurately and safely determine the source of the varicose veins, to assess the size and structure of the ship, the function of the venous valves, the scale of distribution of the reverse current of blood and to reveal the presence of blood clots. Is interrupted you are looking for deep and superficial venous system. Make the search must be in the upright position, or, if the patient's condition does not allow, sitting with the down the feet. The research is in the supine position can lead to errors in the definition of backflow and blood clots.
To further evaluate the function of the valves and the flow of reverse current of blood to apply:
- compression pressure test on the different segments of the lower limbs;
- the test voltage (test, Valsalva);
- simulation of the foot;
- welcome Parana — easy to attempt removal of the patient from a state of equilibrium with the aim of call of tension in the muscles of the calf.
Total ultrasonic research of the duplex of the veins of the lower limbs is necessary to fix in the form of the results and of the graphics image, drawing a "vein map". The results of the research are of invaluable help in the planning of further treatment. However, the need to take into account only in an aggregate form with the clinical data, because the changes of the ultrasound image in the absence of objective evidence of the disease (varicose veins) should be considered to be functional (i.e. not associated with the malocclusion of the veins). It is also worth to note that ultrasound is not necessarily in possession, if the diagnosis is clear and if the patient is not going to cure varicose veins.
There are other methods of diagnosis:
- doppler ultrasound — Doppler ultrasound (not to be confused with the USD);
- plethysmography;
- radiopaque venography;
- radiola venography;
- computed tomography (CT);
- magnetic resonance imaging (MRI);
- thermal imaging;
- intravascular ultrasound study (IVUS) — a new method.
Treatment of varicose veins of the veins of the legs
The primary goal of treatment of varicose veins of the lower limbs is the removal of all the not work properly the veins. This is only possible with the help invasive. There are three ways:
- Removal — combined flebectomia, short stripping, the dissection, incontinence of veins the perforators;
- "Bonding" — sclerotherapy, mechanochemical obliteration, cyanoacrylate fuming obliteration;
- "Beer" — therapy endovenous laser or radiofrequency obliteration.
To achieve the objectives of the treatment, you must perform two tasks: eliminate the source of the varicose veins (the so-called vertical reflux) and remove varicose veins. For a long time the most commonly used method was combined flebectomia. The application technique consists of two phases:
- Ligation anastomosis — the place of connection of the great saphenous vein with the common femoral vein (crossectomy);
- The removal of the barrel saphenous vein with the help of the probe (stripping).
This is a different intervention radicalism and has some disadvantages, inherent in any operation: the frequent need for anesthesia, the presence of incisions and sutures, tangible period of rehabilitation and an increase, compared to other methods, the risk of complications.
However, about twenty years ago there was a "phlebology revolution". She made possible the generalization of ultrasound and the appearance of an elegant technical — endovenous thermal obliteration. Its essence is the impact of high temperature on the vein wall from the inside. This is achieved by means of a laser (EVLO) or exposure to radio waves (RFO), "saarialho" the land of vienna.
Vienna when this stops working, and then gradually reabsorbed. This method allows, without cuts, fast, efficient, safe and aesthetically pleasing eliminate the vertical reflux without the need for further rehabilitation. As a prominent representative of "office surgery", intravenous therapy, thermal obliteration, ten years is considered to be the best method of treatment of varicose veins in all over the world.
Sclerotherapy (bonding concerned to vienna with the introduction into it of a special substance) also found wide application in the resolution of varicose veins. However, to get the desired result it is necessary a careful selection of the patients because of an increased risk of relapse of the disease.
Methods of treatment of the conservatives, including the rate of therapy, phlebotrophic drugs and local dosage forms (gels, ointments), are only of ancillary nature, acting primarily on the symptoms of varicose veins, not by eliminating its source.
Prognosis. Prevention
Taking into consideration the methods of treatment, the prognosis for varicose veins good luck. Even if it is more, apparently, in the run of cases, resolution of the laplace transform of the veins leads to a rapid improvement of the condition of the patient.
However, the treatment schedule is very important to make an assessment of its risks, because every intervention, however, carries the potential for adverse events. The duty of the physician to reduce the probability of occurrence. Before any manipulation is necessary to discuss with the patient all of the moments relatively the intervention and obtain her signature on the informed consent.
All adverse events can be divided into risks associated with the surgery, including the anesthesia, and the risks of the patient.
The risks of an operation may be small, for example, inflammation (phlebitis) in the "as welded" or sklerozirovanie veins, accompanied by a seal projection, and light from the pain syndrome. It can appear on the skin with very low sensitivity, and hyperpigmentation of the skin. All these phenomena are temporary and usually pass fairly quickly without any consequences.
A major complications include deep vein thrombosis, allergic and toxic reactions on anaesthetic. You rarely encounter, however, for the individual patient, which is similar complication, the case is 100%, even if the statistics in 1 case out of 10000 transactions.
The prevention of venous thrombosis is first of all based on the count its risk to the so-called scale-point system using the table of Goats. It contains a variety of risk factors, that have their alcohol content. Account of each factor and the excretion of total score determines the degree of risk and, consequently, its prevention. The main tools for the prevention of venous thromboembolic complications in the following:
- to minimize trauma operations;
- the early activation of the patient;
- compression stockings;
- pharmacological prevention, that is, the assignment according to the testimony of anticoagulant drugs to thin the blood.
And with regard to the prevention of varicose veins, then it simply does not exist, because it is not yet clear the main reason for malocclusion, which could have an impact and, therefore, prevent the onset of the disease. Associated and frequent enough to variceal relapse after any type of surgery. However, considering all the benefits to minimally invasive treatment, this is not a significant problem. Keep the legs in order quite simple, the important thing is time to go considering