The word "varicose veins" comes from the Latin varix, varicis - bloating. The first mention of the treatment of varicose veins is found in the ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffers from chronic diseases of the veins of the lower extremities. Its complications in the form of dermatitis, cellulite, bleeding, thrombosis and trophic ulcers often lead to long-term disability, sometimes causing disability.
The structure and function of the venous system
The way our veins work is a complex process. To understand this, you need initial knowledge of the structure of the veins. The venous wall consists of three layers. Internal - endothelium, represented by a layer of cells on the membrane of connective tissue. The middle layer is muscular. It consists mainly of circularly arranged smooth muscle cells that appear to be framed by collagen fibers. Superficial veins contain a thicker muscle layer than deep veins. The outer lining of the vein, the so-called adventitia, is a dense tissue of collagen fibers. If we compare the structure of the veins and arteries, then it must be said that the ratio of the lumen of the vessel to the thickness of its wall in the veins is much greater than in the arteries. Veins have much less elastic fibers than arteries.
The main property of the veins, which affects the indicators of blood flow, is the great extensibility of its wall. In particular, with increasing pressure in the vessel, the veins dilate and tend to acquire a round slit shape. The degree of extensibility of the venous wall is quite ephemeral and depends on many other things. It is this factor that does not allow the use of strict mathematical formulas to calculate the movement of blood on them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, the neck.
The venous valves originate from its wall. They usually consist of two valves that are oriented to the heart. In the area of attachment of the valve to the wall, the diameter of the vein is slightly larger. Usually, when the valve flaps close, blood from the top cannot enter the main. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative (some call it physiological) and absolute. The main difference is in the duration of reflux during functional tests. There is also an opinion that there should be no reflux with a normal valve. The valves are distributed unevenly through the veins. There are more of them where the work of the muscle pump is most pronounced - that is, the lower leg.
The main venous system of the lower extremities is represented by the following groups:
- veins of the foot;
- deep veins of the legs and thigh (deep vein system);
- large and small saphenous veins (superficial venous system);
- communicating (perforating) veins - provide communication between superficial and deep veins.
The deep and superficial venous systems together form a "sponge" from which blood flows to the heart when walking. The operation of this system is supported by the operation of a muscle pump located in the lower leg, which creates periodic pressure in the veins.
These systems move the blood column upwards and the valves in the veins prevent backflow.
The flow of blood from the lower extremities through the deep and superficial veins is uneven. About 85-90% of the blood flows through the deep veins and only 10-15% through the subcutaneous veins. Thus, in healthy people, blood flow is carried out by the system of deep, subcutaneous and communicating veins.
Varicose veins are a serious problem
To say that varicose veins is a "disease of the twentieth or twenty-first century" is to deviate from the truth. Varicose veins have long worried people. Even in ancient medical treatises there is a description of varicose veins, in ancient Rome people bandaged their legs with leather "bandages" to get rid of venous insufficiency.If your legs get tired often, this may be the first sign of an initial venous disease. Evening discomfort accompanied by swelling of the foot and ankle, especially after a long stay in the legs, are clear signs of congestion in the veins. Soon, unfortunately, you find the first varicose vein. The altered vessels form a blue-blue or red "pattern" on your legs, "stars", capillary "cobwebs" (telangiectasias), and finally varicose veins and varicose veins.
Heaviness, burning, tingling and itching, pain and swelling, asterisks, swelling of the leg veins - a sharp signal for urgent action to save the beauty and health of your feet.
A question about the condition of your veins should be immediately asked to a specialist - a phlebologist who studies and treats venous diseases.
Venous disease begins harmlessly, but can become a serious problem if left untreated.
Causes of varicose veins
To date, a number of theories have been proposed that explain the causes of varicose veins. The most common are hereditary, mechanical, hormonal, etc. However, they mainly reflect the factors that contribute to the development of the disease or accelerate the appearance of clinical signs of the disease.
Both lower limbs are more commonly affected. However, varicose veins appear in one limb at first and in the other after a while. Varicose veins are more common on the right leg.
Varicose veins of the lower extremities are found only in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the venous wall of the limb. With weakness of the venous wall and impaired function of the valvular apparatus in the main veins, which occurs with their innate inferiority, there is a pathological reverse blood flow. The most common causes of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives, etc. ) - affect the structure and tone of the vascular wall with its gradual weakening and destruction.
- Pregnancy is one of the main risk factors for the development of varicose veins. In addition to hormonal changes, the enlarging uterus and fetus put pressure on the iliac veins and significantly impede blood flow from the lower extremities.
- Obesity is a proven risk factor for varicose veins. This is due to the increasing load on the venous system of the lower extremities.
- Lifestyle: People with prolonged static loads (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wearing tight underwear that compresses the main veins at the level of the groin folds. Women with high heels.
- Heavy physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the abuse of which can also provoke varicose veins.
The essence of varicose veins lies in the fact that as a result of the above reasons there is a gradual dilation of the lumen of the saphenous and perforating veins, which leads to insufficiency of the valvular apparatus (non-closing of the valves). Pathological reflux (return) of blood occurs both from top to bottom and horizontally through the destroyed perforating veins.
Diagnosis of varicose veins
For many years, hands were the only medicine used to examine a patient with varicose veins. X-rays have come to the aid of the surgeon over the last century. However, X-ray examination of the veins is a rather complex procedure that requires voluminous and expensive equipment, and the X-ray contrast agents themselves are by no means safe for the body. With the development of microelectronics and computer technology, previously inaccessible diagnostic methods appeared: Doppler ultrasound, ultrasound angioscanning, plethysmography. The advent of ultrasound duplex scanning has provided new information that has allowed us to re-examine the problems of the causes of the development of varicose veins and to understand the intricacies of the pathological process.
Doppler ultrasound
This is an ultrasound diagnostic technique that allows you to determine the speed and direction of movement of particles (in this case blood cells) in the body. In this way, the doctor is able to understand the direction and speed of blood flow in the vessels of the lower extremities. And when performing a number of physiological tests and the condition of the valvular apparatus of the veins of the lower extremities. Knowledge of the structure of blood flow in the veins of the legs is the main requirement for choosing a method of treatment.
Ultrasound angioscanning
The essence of this method is that an image of the walls of the blood vessels and the blood flowing through them is formed on the monitor screen of an ultrasound scanner. The doctor has the opportunity to monitor the shape of the vessel, the structure of the wall, the condition and the direction of blood flow through this vessel. The method is very informative and much safer than X-ray examination, but it is quite expensive, so it is used only in difficult cases and during research.
Plethysmography
This is a diagnostic method based on determining the electrical resistance of the tissues of the lower extremities. Its essence lies in the fact that the total electrical resistance of the tissues of the human body directly depends on the amount of blood flowing in and out of them and changes over time with each heartbeat. Plethysmography is used to diagnose the general functional state of blood flow in the lower extremities, is used to monitor drug therapy in venous or arterial insufficiency, in the treatment of trophic disorders and to assess the degree of venous insufficiency.
Of course, all these techniques do not preclude a direct examination of the patient by a doctor, clarification of the history of the disease and identification of complaints submitted by the patient. Based on the overall picture of the disease, the doctor chooses a method of treatment.Treatment of varicose veins
In the last 50 years, there has been a qualitative leap in the treatment of varicose veins, as well as in other branches of medicine. Various drugs for the treatment of chronic venous insufficiency have been developed and continue to be developed in recent decades. The surgical technique for treating varicose veins has been significantly improved. The technology of compression sclerotherapy has been developed and practically improved.
So-called sclerosurgery is currently gaining popularity around the world. Sclerosurgery is an intelligent combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can be used only for initial and uncomplicated forms of varicose veins. Varicose vein surgery is also not without problems, varicose vein removal surgery is quite traumatic, requires hospitalization and a long period of rehabilitation. The reasonable combination of these two methods allows you to reduce injuries in the treatment process to a minimum and achieve extremely high quality treatment.
Treatment of varicose veins
Quite often there are cases when the patient has virtually no varicose veins or their number is very small. However, the person suffers from heaviness in the legs, pain, swelling. All these are signs of chronic venous insufficiency. In these cases, as well as when there are significantly enlarged varicose veins, it is necessary to take drugs that improve blood circulation in the legs. Currently in the arsenal of a phlebologist there are several dozen drugs aimed at combating venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should be chosen only by a physician. Despite the obvious simplicity of choosing a venotonic agent, only a physician can determine the full range of therapeutic measures and the appropriateness of using a particular drug.
Compression therapy
Compression therapy has been considered for many years as an adjunct to drug therapy or surgery. Compression treatment of varicose veins has been used since ancient times and only in the last decade elastic compression began to be considered as a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of various brands and special medical compression knitwear.
The global industry produces three types of elastic bandages: short, medium and high stretch. High-elongation dressings (elongation over 140%) are used to prevent thrombotic complications in the postoperative period after abdominal and pelvic surgery, as well as to fix joints after and to prevent sports injuries. Short stretch bandages (less than 70% elongation) are used to treat complex forms of chronic venous insufficiency, deep vein thrombosis, postthrombophlebitis syndrome and lymphatic insufficiency. Medium-elongation dressings (elongation from 70% to 140%) are used in the treatment of varicose veins, chronic venous insufficiency and compression sclerotherapy.
Medical compression stockings include medical compression stockings, knee-high tights. Many people make the mistake of considering various "anti-varicose" and "supportive" high-density T-shirts to be therapeutic. To begin with, it is necessary to determine that medical compression products are never marked in the DEN. DEN is a technical characteristic of the knitted fabric, which is only indirectly related to the pressure created by the product.
Medical T-shirts are classified into several functional compression classes. The class of the product is determined by the pressure that the product creates on the ankle and in the lower third of the lower leg. A person with varicose veins is shown the use of class 2 knitwear of compression. These tights or knee-high will create a pressure of 23-32 mm Hg on the affected leg. Art. That is, it completely equalizes the pressure in the varicose veins and eliminates venous insufficiency. Moreover, medical compression products create the so-called distributed pressure. The pressure they create is gradually reduced when the leg moves from the bottom up by 25-30%, which contributes to the efficient flow of blood and lymph.
It should be immediately noted that the medical jersey is never thin and transparent, the creation of such a high pressure requires a large number of elastic fibers and, accordingly, the knitted fabric is thick. It should also be said that medical tights are never cheap. The technology of knitting a special knitted fabric is much more complex; when knitting it is also necessary to model the profile of the foot to create a distributed pressure.
The ideal approach in compression therapy is the constant and extensive use of elastic bandages and / or compression knitwear by the patient. For example, daily wearing elastic bandages for a month almost completely corresponds to the effectiveness of monthly intake of an effective drug. The use of compression stockings is particularly effective in preventing the development and recurrence of varicose veins. The main advantage of using compression products is their absolute safety for health compared to even the best drugs and they are comparable in price.
Prevention of varicose veins
If you have the initial signs of varicose veins, following fairly simple rules will slow you down and in some cases avoid further development. First of all, do not get carried away by hot baths, saunas, prolonged sun exposure. All of the above reduces venous tone, leading to blood stasis in the lower extremities. Do not wear tight-fitting clothes, socks and stockings with narrow elastic bands, as this will compress the veins. Excess body weight and sports associated with high static load on the legs (tennis, weightlifting, bodybuilding) increase venous pressure. High heels (over 4 cm) - our veins do not like it. Take care of the veins, do not hurt them.
If you feel heavy in your legs after work in the evening, keep your legs raised while you sleep and rest. If your work is accompanied by sitting at a table for a long time or standing for a long time, then you should change the position of your legs more often, step on the ground and rotate your legs. There are special exercises for venous diseases. After showering or bathing, rinse your feet with cold water. There are useful sports - especially swimming, but also walking, cycling, skiing. Do not neglect folk remedies. Useful infusions of cranberry leaves, St. John's wort, cranberry, rose hips. A plant-based diet should be followed. Your doctor may also prescribe a medicine called phlebotonic to increase venous tone and improve microcirculation. Recently, methods to prevent compression and treat varicose veins have also become a completely understandable success due to the emergence of high quality medical products on the market.
A special word for prevention in pregnant women. Varicose veins progress during pregnancy, especially when it is not the first and carrying a baby under 1 year does not contribute to good vascular function. The basis for prevention is the wearing of special compression knitwear, the use of phlebotonics both during pregnancy and after birth. Do not neglect to mention your veins to the gynecologist when you are prescribed a hormonal drug, as these drugs affect the functioning of the veins, reduce their tone.
Do not self-medicate. Talk to your doctor about what to do with your veins. This disease is treated by doctors - phlebologists.