Varicose veins are a disease of the veins, manifested by their dilation, elongation with formation of nodules and thinning of the vein wall. It can affect several vessels, but it occurs more frequently in the lower extremities.
In advanced cases, it leads to trophic disorders in the affected area, development of ulcers, eczema, and even necrosis and gangrene. Therefore, it is important to make the correct diagnosis in time and start treatment.
How do varicose veins develop?
The exact causes of this disease are not known. But the mechanism of how varicose veins start is well understood.
The venous network of the lower extremities is represented by deep and peripheral veins, as well as communicating (perforating) vessels that connect them. Normally, blood flows through the veins toward the heart, from peripheral to deep vessels.
This is done due to muscle pumping (contraction of the muscles of the lower extremities), the tone of the vascular wall and the work of the venous valves. The circulatory system is regulated by the vasomotor center of the brain.
But in case of violations of at least one of these links, a reverse outflow of blood occurs. At the same time, the peripheral vessels expand, the valves stop closing, causing even more stasis of blood in the peripheral circulation.
Under arterial pressure, the venous wall continues to expand, causing the vessels to elongate and form knots. Valvular insufficiency increases, edema develops.
The compression of the peripheral nerves sends a signal to the brain about the need to increase the tone of the vascular wall. This increases blood pressure in the deep vessels and blood rushes out of them into the peripheral ones, causing them to expand further. A vicious circle is closing.
What causes varicose veins?
The true cause of varicose veins is unknown. But it has been proven that a series of factors and physiological conditions contribute to its development.
What:
- Pregnancy (due to compression of the veins in the abdominal cavity by the pregnant uterus, blood circulation in the lower extremities is difficult);
- Obesity;
- sedentary lifestyle;
- Genetic predisposition (weak valves or decreased tone of the vascular walls);
- Violation of hormonal balance (leads to increased blood viscosity and difficulty in its outflow);
- Condition after operations (due to increased blood clotting and bed rest);
- Professions associated with a long stay in an upright position (on the legs).
In one of these situations, it is necessary to take preventive measures to avoid the development of varicose veins. Especially if there are already clinical manifestations.
Symptoms of varicose veins
The first signs of varicose veins are:
- Pain and heaviness in the lower extremities;
- Swelling of the legs in the evening;
- The appearance of spider veins on the skin;
- Visible tense veins under the skin;
- Burning and itching sensation in the affected area;
- Cramps in the muscles of the lower limbs, especially at night.
Pain with varicose veins occurs and intensifies at the end of the day. They have a bursting and painful character. At the beginning of the disease, they disappear after rest, and therefore patients do not go to the doctor for a long time.
On examination, edema, pastiness of the legs, telangiectasias are revealed, tense, often painful venous trunks are palpated. In the photo you can see how the skin on the legs with varicose veins looks.
In the severe decompensation stage, weakness, dizziness, and fainting may occur. At the same time, trophic disorders are noted on the skin, ulcers, dermatitis and eczema develop. With a timely visit to the doctor, serious manifestations of varicose veins can be prevented.
Types of varicose veins
There are the following types of varicose veins:
- Varicose veins of the lower extremities (the most common variant);
- Varicose veins of the upper extremities;
- Varicose veins of the small pelvis (including varicose veins of the uterus);
- Varicose veins of internal organs (esophagus, stomach, intestines, etc. );
- Varicose veins on the face.
The most studied type are varicose veins of the lower extremities. It occurs more frequently, and it is usually he who is referred to when talking about this disease. Most patients don't know if internal varicose veins exist and how they manifest until they find them.
Stages of development of varicose veins:
| disease stage | Clinical manifestations |
|---|---|
| 1 stage | There are no symptoms, varicose veins are detected only during instrumental examination. |
| 2 stages | Heavy legs syndrome, transient edema, spider veins on the skin |
| 3 stages | Persistent edema, pigmentation disorders in the skin, tense and dense veins and nodules are visible, trophic disorders in the form of eczema |
| 4 stages | There are trophic ulcers, dermatitis, necrosis. |
The smaller the stage, the easier the treatment and the better the prognosis for recovery.
Diagnosis of varicose veins
To make a diagnosis, in addition to examination data and characteristic complaints, a laboratory and instrumental examination of the patient is required.
laboratory diagnosis
What tests should be taken for varicose veins:
- Complete blood count with extended formula.
- Blood coagulation tests:
- coagulation time;
- prothrombin test;
- determination of antithrombin III, protein S and C;
- determination of the level of homocysteine;
- study of the APTT index;
- determination of the level of the D-dimmer;
- determination of von Willebrand factor activity, etc.
- Blood biochemistry.
- Hormone analysis.
- General urinalysis.
- functional testing.
Determination of the state of the blood coagulation system is of decisive importance for the choice of treatment tactics and the prognosis of the development of the disease.
Instrumental diagnosis of varicose veins
Of the instrumental research methods used:
- ultrasound examination of veins;
- dopplerography;
- vein duplex ultrasound (combination of ultrasound and dopplerography);
- angiography;
- photoplethysmography (PPG);
- phlebography;
- venous occlusal plethysmography (VOP).
With this type of study, the thickness of the vascular wall is measured, the state of the venous valves, the presence or absence of reverse blood flow in the veins, etc. are studied. With the help of instrumental methods, it is possible not only to make the correct diagnosis, but also to accurately determine the stage of the disease.
Varicose vein treatment
The fight against varicose veins includes medical (conservative and surgical treatment) and non-pharmacological methods. The choice of a specific option depends on the stage of the disease and the degree of its external manifestations.
Conservative treatment of varicose veins
The therapy of this disease involved surgeons and phlebologists. At the first signs of the disease, you should contact the doctors of these specializations. They will confirm the diagnosis and prescribe how to treat varicose veins in this case.
In conservative therapy, the following groups of drugs are used:
- antiplatelet agents to thin the blood and prevent blood clots;
- direct and indirect acting anticoagulants to improve the rheological properties of blood and prevent its thickening;
- phlebotonics to strengthen the vascular wall, herbal preparations with horse chestnut extract;
- anti-inflammatory drugs if necessary (in the presence of inflammation in the vascular wall or surrounding tissues).
Most of these drugs are available both for oral administration (in tablets and capsules) and for external use (in the form of ointments, gels, creams). The doctor will tell you which form is best for this patient, depending on the specific clinical situation.
Surgical treatment of varicose veins
Conservative therapy will help to completely cure the disease only in the early stages. In advanced cases and with symptoms of decompensation, surgical treatment of varicose veins is necessary.
Surgical intervention may consist of removing the entire vein or just the affected area through incisions along the vessel or in the inguinal fold and popliteal fossa (depending on the specific vein and its location). But whenever possible, doctors try to perform a less traumatic procedure that causes coagulation of the affected vessel, which leads to its complete obstruction.
Options for replacement operations:
- sclerotherapy (introduction through a catheter into the lumen of the vessel of special sclerosing drugs that cause tight adhesions in it with their subsequent replacement with connective tissue);
- endovasal laser coagulation (coagulation of the internal cavity of the vessel with a laser pulse);
- radiofrequency coagulation (gluing of the walls of a vein as a result of exposure to a pulse of high-frequency current);
- miniphlebectomy (removal of a vein or its section through several skin punctures).
When coagulation is carried out in different ways, the result is the same: after gluing the walls of the vessel, its cavity will gradually fill with connective tissue with the development of a complete obstruction. In this case, the movement of blood will continue through healthy vessels, bypassing coagulated ones. Schemes for carrying out such operations can be seen in the video in this article.
Surgical methods have an indisputable advantage - the probability of recurrence after them is very low. In terms of risk versus efficacy, less traumatic procedures are better. But the price for them in clinics is quite high.
Non-pharmacological treatment of varicose veins
It is quite possible to strengthen the walls of blood vessels with varicose veins without the use of tablets.
From non-pharmacological means for this use:
- therapeutic exercises (to stimulate muscle pumping);
- compression stockings and elastic bandages (compression of the lower extremities stimulates the expulsion of blood from the vessels, normalizes the functioning of the venous valves, strengthens the vascular wall).
The use of compression stockings is recommended for all people at risk, especially:
- pregnant women;
- work all day on your feet;
- to all people during long flights in airplanes;
- patients taking drugs that promote blood coagulation;
- people with a sedentary lifestyle.
Prevention of varicose veins
Prevention of varicose veins is best started before they appear. In addition, the recommended measures will help prevent other cardiovascular diseases.
Prevention instructions:
- give up all bad habits;
- carefully monitor your diet (exclude fatty, fried, smoked, sweets);
- strictly monitor your weight;
- lead an active lifestyle (more walking, running, biking, rollerblading, etc. );
- wear comfortable shoes with small heels;
- daily contrast shower;
- At the end of the day, rest for 15 minutes with your legs elevated.
These measures will also help with identified varicose veins, to prevent further progression of the disease and the development of complications.
Many are interested in whether it is possible to play sports with varicose veins. The attending physician will give the exact answer to this question, but in most cases you can go in for sports, excluding their heavy types associated with energy loads.
Varicose veins are a common disease. Women suffer from it 4 times more often than men, which is associated with the peculiarities of the hormonal background, pregnancy and a large list of female professions, which involve spending the entire working day on your feet.
But timely prevention will help prevent the development of varicose veins in both men and women. The main thing is not to neglect the advice of a doctor and not to forget about the regularity of preventive measures.