Everything you need to know about varicose veins of the lower extremities

Varicose veins of the lower extremities are characterized by dilation of the superficial veins of the legs, which accompanies the disruption of blood flow in them and the failure of the valves. As a result, the veins increase in length and diameter, acquire a serpentine, cylindrical or saccular appearance, although there is a mixed manifestation of the listed deformations.

Characteristics of the venous system

The appearance and development of varicose veins is directly related to the venous system of the legs, which consists of:

• saphenous veins: small and large;
• deep veins (lower leg and thigh);
• perforating veins, which are the connecting link of the two previous systems.

Usually 90% of the blood is transported to the lower extremities through the deep veins and the remaining 10% through the superficial ones. When it returns to the side of the heart, this mechanism is supported by valves in the walls of the veins. When the next batch of blood arrives, they collide to prevent it from moving from top to bottom under the influence of gravitational force. Muscle contractions push the blood further towards the heart, which allows normal blood flow.

During a long stay of a person in an upright position, blood stasis can develop, which increases the pressure in the veins and causes an increase in their diameter. This process provokes incomplete closure of the valves, as a result of which blood flow is disrupted with its return flow from the heart - reflux.

The valves of the deep veins are most likely to be affected, as they transport the largest amount of blood and therefore experience maximum stress. To reduce the high pressure in them, part of the blood is transported through perforated veins to the superficial ones, which were not originally intended for a large volume. Such a load on the walls of the veins leads to their dilation and the formation of varicose veins.

At the same time, the blood enters the deep veins without stopping, but due to the disruption of their functions and the normal activity of the valves of the perforated veins, the blood is redistributed to the superficial vessels. As a result, a chronic varicose vein develops, which over time is accompanied by painful sensations, swelling and trophic ulcers.

Causes of the disease

Previously, one of the main causes of varicose veins was called a hereditary factor, but today this theory is refuted. Of course, it is possible to trace the frequent manifestations of the disease in some families, but this is more likely due to the peculiarities of life that are given to the family: food culture, passive rest, sedentary work and the like.

The development of varicose veins is based on the presence of reflux in the venous system when blood circulates through the veins in the opposite direction. Additional transport of blood from deep veins to superficial veins is possible due to congenital or acquired degenerative pathology of the valvular apparatus. This causes superficial vessels to overflow with blood and dilate when venous nodules form.

One of the main reasons for the development of varicose veins is considered to be an unhealthy diet, which in some cases leads to obesity. Such people move little, eat mainly processed foods, and the share of plant fiber in the diet is minimized. After all, they are those that are involved in strengthening the walls of veins and blood vessels and prevent prolonged chronic constipation, which significantly increases intra-abdominal pressure and thus provokes varicose veins. It is noted that an increase in body weight of more than 20% increases the risk of disease fivefold.

The main provoking factor for women is the birth of a child, while the risks of varicose veins increase with each subsequent pregnancy. Heavy weight gain and an enlarged uterus put a lot of strain on stagnant legs. This situation is exacerbated by the ever-increasing intra-abdominal pressure and the action of the hormone progesterone, which affects the condition of the elastic fibers in the walls of blood vessels.

Other factors that provoke varicose veins of the lower extremities include:

• sedentary lifestyle, upright during the day (eg hairdressers), long flights or long trips. All this leads to stagnant processes in the lower extremities, when blood accumulates in the superficial veins and is transported weakly to the heart;
• sometimes increases the risk of developing varicose veins in women wearing uncomfortable, tight shoes, especially models with high heels;
• corsets and tight underwear squeeze the inguinal veins and increase intra-abdominal pressure, which is a direct prerequisite for varicose veins;
• high blood pressure;
• smoking, which indirectly leads to thinning of the walls of blood vessels.

Classification of the disease

Varicose veins of the lower extremities are classified depending on the prevalence of venous lesions, their location, as well as the presence of pathological reflux, which is characterized by impaired blood flow. There are 4 forms of varicose veins:

• intradermal and subcutaneous varicose veins (segmental), in which there is no pathological outflow of venous blood;
• segmental varicose veins when reflux occurs through perforating or superficial veins;
• a common form of varicose veins in which reflux occurs through the perforating and superficial veins at the same time;
• varicose veins are characterized by reflux in the deep veins.

Once varicose veins of the lower extremities become chronic, phlebology considers its three stages:

1. Transient edema, periodically occurring against the background of the syndrome of "heavy legs".
2. Constant, constant swelling. Hyperpigmentation and eczema may occur.
3. Venous ulcer of trophic nature.

The latter stage is the most difficult to treat, as it requires prior removal of inflammation and healing of skin tissues.

Stages and symptoms

The disease develops very slowly, sometimes more than a dozen years, while the symptoms will force the patient to seek advice from a phlebologist. In the early stages of varicose veins, its manifestations are often due to fatigue, age or other causes. To fully consider the symptoms of the disease, its manifestations are classified according to the stages of varicose veins:

1. The first stage begins to appear more often at a young age - after 20 years, when there is a feeling of heaviness in the legs, swelling may appear, which completely disappears overnight. On the inside of the lower leg you can see a varicose vein, which manifests itself with a lump of bulge on the skin. At this stage, many people notice small spider veins. In general, the symptoms are subtle and rarely receive the attention they deserve.
2. The second stage is characterized by an increase in the external manifestation of the varicose vein. The disease is already developing against the background of the pathological work of the venous valves, therefore the saphenous veins increase significantly in size and their lengthening can be noted. More often there is heaviness and burning in the legs, they get tired quickly on long walks.
3. The disease is already becoming chronic due to the constant imbalance in venous blood flow. In the evening, patients suffer from swelling near the ankle, which can be very intense. There is heaviness in the legs and cramps may occur at night.
4. In the absence of treatment in the previous stages, chronic insufficiency of the venous system adversely affects the metabolic processes in the skin, especially affecting the areas in the lower leg. Near the ankle you can see darkening of the skin - hyperpigmentation, it thickens and eventually becomes inflamed. The condition described is called lipodermatosclerosis. If you do not start treatment for the venous system at this time, trophic ulcers will soon begin to form.
5. The fifth stage is accompanied by numerous trophic ulcers, some of which periodically heal with the formation of scars.
6. Extensive ulcers open in the area of long-standing trophic disturbances. This condition requires urgent active therapy aimed at both treating varicose veins and healing skin ulcers.

Diagnosis

An external examination of the lower extremities in a vertical and horizontal position of the body, palpation of the veins and a preliminary assessment of the stage of the disease is performed. The patient is sent for a general blood test, which allows you to study the picture of the disease with greater depth:

• at the platelet level will predispose to thrombosis;
• the level of hemoglobin, as well as the number of red blood cells, indicate the degree of blood clotting;
• the increased level of leukocytes can be judged as inflammation, which helps to diagnose thrombophlebitis more quickly.

Be sure to examine the venous system of the legs, for which there are many methods:

• ultrasound dopplerography - USDG;
• phlebography;
• CT phlebography;
• duplex angioscanning - USAS;
• phleboscintiography;
• photoplemography;
• phlebomanometry and the like.

In practice, patients are more often prescribed USAS and USG, as they help to fully examine the venous system of the legs and identify degenerative areas. Other methods may be prescribed additionally if the ultrasound examination does not give a complete vision of the picture of the disease. Some of these methods may have complications such as venous thrombosis, perforation of the vessel wall with a catheter, and allergy to a contrast agent. Consider the most commonly practiced techniques in phlebology:

1. USAS allows to assess the anatomical, hemodynamic and functional pathologies of the venous bed. The obtained data are subject to computer processing, after which the model of the venous system can be viewed on video or printed on paper.
2. Doppler ultrasonography with high accuracy determines the patency of superficial and deep veins, the speed of blood flow. Doppler ultrasonography makes it possible to assess the functioning of the valve apparatus.

After extensive diagnosis, the doctor prepares a patient's phlebocard, which allows you to determine the damaged segments of the venous system, their degree and length. Appropriate treatment is then selected.

Treatment

It is performed comprehensively and is determined based on the symptoms, the degree of development of the disease and the results of the examination. In the initial stages, conservative therapy is prescribed, which consists of:

1. Drug treatment when prescribing a group of drugs:
   • antioprotectors and phlebotonics;
   • anticoagulants;
   • disaggregants
   • topical preparations (ointments, gels);
   • anti-inflammatory drugs.
2. Elastic compression for which compression stockings or bandages are used (rare). Allows you to dose the squeezing of muscles, prevents stagnant processes, improves blood flow through the vessels. Wearing such underwear has the effect of artificially maintaining vascular tone.
3. Physiotherapy methods, among which the best results of treatment have shown electrophoresis, diadynamic currents, laser radiation and magnetic field.
4. Performable physical activity, which should be performed only in compression underwear (except for swimming). Cycling, swimming, jogging are recommended. The phlebologist chooses an individual set of exercises for the lower extremities, which will train the vessels of the legs every day.

In addition, patients are advised to perform contrasting five-minute shower procedures each night, alternating from hot to cold water. Such manipulations improve blood flow and tone blood vessels.

It is important to identify the factor that provokes the disease at the beginning of treatment in order to treat it effectively. And patients who are at risk should visit a phlebologist every 2 years for a preventive examination and do an ultrasound examination of the leg veins.

When conservative treatment does not work or varicose veins are observed at an advanced stage, then surgery is used. Today, varicose veins can be completely cured thanks to the following methods:

1. Phlebectomy. The essence of the operation is to remove the main trunks of the superficial vein to eliminate the pathological separation of blood. Perforating veins are often ligated for the same purpose.
2. Sclerotherapy. It consists of the introduction of sclerosant into the affected area of the vein, which leads to the connection of its walls. Recently, they began to actively use foamed sclerosant for the same purposes according to technology -. Blood flow through the defect area stops and the cosmetic defect in the form of protruding nodes is eliminated. After such an intervention no scars remain, all manipulations are performed on an outpatient basis without subsequent inpatient stay. But sclerotherapy is used only to fuse small branches of venous trunks.
3. Laser coagulation. With the help of a laser beam, the marked area of the vein is heated, the walls of which stick together and the blood flow through it stops. But this technique is shown only for veins with a diameter of expansion less than a centimeter.

Prevention

Preventive measures can be both primary, aimed at preventing the development of varicose veins, and secondary, when it is necessary to reduce the risk of recurrence after surgery or to prevent the deterioration of the disease. Useful tips:

• lead an active lifestyle without much strain on your feet: swimming, walking, cycling;
• keep track of your weight;
• keep both legs raised more often;
• do not wear tight underwear and heels over 4 centimeters;
• use orthopedic insoles;
• take a contrast shower;
• do five-minute prophylactic leg exercises daily;
• wear compression stockings for long walks.

If you notice the slightest suspicion of varicose veins - prominent leg joints, swelling, heaviness, then do not delay a visit to the phlebologist. In fact, over time, this insidious disease can provoke many complications, including thrombophlebitis and thrombosis.