Varicose veins are a pathological expansion of the lumen of the veins caused by the thinning of their walls and a decrease in tone. In an advanced stage, the venous nodes swell under the skin and may become inflamed periodically. Varicose veins are not only an aesthetic defect. The symptom indicates impaired blood circulation, which worsens the quality of tissue and organ nutrition and increases the risk of blood clots. Diagnosis and treatment at an early stage can slow the development of the pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that includes any disturbances in the structure and functioning of the venous system. These can be congenital anomalies, genetically determined, as well as pathological changes that appeared under the influence of external factors.
Varicose veins affect approximately 60% of adults worldwide, mostly Europeans. Mostly women suffer from varicose veins. This is due to the presence of a connection between the tone of the vascular walls and hormonal levels.
Types of varicose veins
Varicose veins are usually understood as enlargement of the veins in the legs, but pathological changes can also affect other parts of the body. Depending on the location, there are:
- varicose veins of the rectum (hemorrhoids);
- expansion of the veins of the esophagus;
- varicose veins of the spermatic cord in men (varicocele);
- varicose veins of the lower extremities.
Sometimes reticular varicose veins are isolated separately. It consists of vascular networks and stars that are visible under the skin. It occurs mainly on the legs, but can appear under the breasts, on the abdomen and on other parts of the body. The disease is diagnosed when the saphenous veins of the reticular bed dilate into the reticular layer of the dermis. It occurs in 50% of women. Nodule formation is not characteristic.
Types of varicose veins of the extremities according to the CEAP classification (stages of development):
- C0 - no signs;
- C1 – appearance of varicose veins and stars;
- C2 – varicose veins;
- C3 – swelling of the legs appears, indicating the development of venous insufficiency;
- C4 – trophic changes in the form of hyperpigmentation, lipodermatosclerosis (thickening of the skin of the lower third of the leg);
- C5 – healing of venous ulcers;
- C6 – non-healing venous ulcers.
Symptoms
The main symptoms of varicose veins of the lower extremities include:
- heaviness in legs (calves), swelling, worse in the evening;
- increased leg fatigue;
- painful pain in the calves that occurs after a long stay in a static position, standing or sitting.
With the development of pathology, bluish and twisted veins begin to swell under the skin, sometimes swollen to bumps. A sign of chronic venous insufficiency is a change in skin color associated with impaired tissue trophism (nutrition). Widespread eczema-like rashes, itchy blisters and nodules appear. Swelling of the legs does not go away even after a night's rest.
Signs of the reticular form of varicose veins are limited to the subcutaneous vascular pattern. Heaviness in the calves and mild itching in the area of enlarged blood vessels may occur. Trophic disorders are usually not observed.
Reasons for the development of varicose veins
Reticular varicose veins occur due to the replacement of collagen type 1 in the walls of blood vessels with collagen type 3. As a result, their contractility worsens - after they have expanded, the vessels no longer return to their original state. The cause of the thinning of the vascular wall is the excessive activity of enzymes that destroy extracellular matrix proteins and elastin.
In women, the hormone progesterone helps to reduce the tone of the smooth muscle fibers of the vascular walls. Estrogen lowers the level of antithrombin, increases blood coagulation and provokes the development of stagnant processes.
The main cause of varicose veins of the extremities, accompanied by the appearance of nodes and lumps, is a malfunction of the valve mechanisms. Valves are folds formed by the inner lining of the veins. Normally, they work only in one direction: they open under the pressure of blood flow and do not let it back. If the valve mechanism weakens, blood flows back (reflux), causing the vein walls to expand and the lining to become inflamed. Then, the pathological process spreads to the deeper layers of the venous wall. His muscle fibers begin to be replaced by scar fibers, and atrophy occurs. The walls no longer contract and their collagen structures are destroyed. The vein twists in a spiral.
Increased pressure in the vessels provokes a malfunction of the muscular-venous pump. This is a system that regulates the pumping of blood to the muscles during exercise and relaxation ("peripheral heart"). The result is congestion and venous insufficiency.
Provocative factors are:
- heredity: in most cases, varicose veins are provoked by mutations in the genes responsible for the structure of valves and venous walls;
- excess weight;
- sedentary lifestyle;
- increased load on the venous system of the extremities due to standing work;
- pregnancy and childbirth, menopause, hormonal imbalance.
Varicose veins can be caused by poor leg mobility due to uncomfortable shoes, as well as by bad habits: smoking, alcohol abuse.
Diagnosing
The main methods for diagnosing varicose veins include a visual examination by a vascular surgeon, during which he assesses the condition of superficial and deep veins and identifies signs of tissue malnutrition. The patient is then sent for additional diagnosis.
- Duplex ultrasound scan. It allows you to assess the condition of the valves, the strength and direction of blood flow, the size of blood vessels and identify the presence of blood clots.
- Study of valve functions: compression tests, simulated walking, Parana maneuver.
- X-ray contrast venography is an X-ray with a contrast agent injected into the vein. It helps to assess valve function, vein patency and detect blood clots.
To clarify the diagnosis, the doctor can prescribe CT, MRI, thermography, radiophlebography, intravascular ultrasound, blood tests for coagulation, etc.
Expert opinion
Varicose veins are more than just unsightly veins that poke out under the skin. Complications of varicose veins are extremely unpleasant.
- Trophic disorders. Large brown spots appear on the legs or thighs and later develop into large, non-healing ulcers that itch and cause pain.
- Thrombophlebitis is an inflammation of the venous walls, accompanied by the deposition of thrombotic masses on them. The thrombosed vein becomes red, thickens, hurts and the temperature around it rises. It looks like an abscess. It threatens the spread of infection throughout the body.
- Bleeding. Hemorrhage from a ruptured varicose vein can occur both internally and externally. Bleeding is intense and requires calling an ambulance.
- Thromboembolism. A blood clot that forms inside an enlarged vein can break off and block vital arteries, such as the pulmonary artery. This condition often leads to immediate death.
Timely diagnosis will help prevent serious consequences of varicose veins and identify the causes that provoked them.
Treatment of varicose veins
The specific treatment of reticular varicose veins includes several areas.
- Compression therapy - wearing supportive knitted garments (socks, tights) of class A and I to prevent blood flow.
- Pharmacotherapy - taking phlebotonic drugs to increase the tone of the veins. These drugs will not remove external signs, but will eliminate subjective symptoms in the form of heaviness, swelling and pain.
- Phlebosclerosis is the adhesion of small vessels by introducing sclerosing substances into them. Microsclerotherapy allows you to get rid of vascular networks.
- Laser therapy - allows you to eliminate small defects left after microsclerotherapy. During the procedure, the doctor applies a beam of light to the affected areas.
An important part of therapy is therapeutic exercises, weight loss, wearing comfortable shoes and regular physical activity.
For the surgical treatment of varicose veins, accompanied by the appearance of nodes, two methods are used: classic phlebectomy and endovenous thermal obliteration. The first method is considered obsolete. It involves ligation of the joint of the vein with the common femur and removal of the affected part of the trunk. The method is characterized by increased trauma and a high risk of relapse.
Thermal obliteration is a gentle, minimally invasive treatment method. Through a small incision, the doctor inserts a laser catheter into the vein, turns on the radiation and slowly withdraws it. As the laser moves, it seals the vein by increasing its temperature. Then, it gradually resolves.
Preventing
To prevent the development or recurrence of varicose veins, people at risk should:
- minimize the static load on the legs;
- eat rationally and, if necessary, take venotonics as prescribed by your doctor;
- wear compression stockings when standing in a static position for a long time.
It is beneficial to give your body regular cardio exercises to train the heart and blood vessels.
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During the recovery period after surgery, the patient should wear compression stockings, minimize the load on the legs, avoid overheating and take medications prescribed by the doctor. The total rehabilitation time depends on the extent of the intervention and the presence of complications.