The disease caused by a violation of the structure of the vascular walls, their thinning, with pronounced stagnant processes of blood flow, is called varicose veins. The disease often affects the lower extremities, although it can be localized in the rest of the body. According to the International Classification of Diseases of the Tenth Revision of ICD 10, varicose veins are assigned code 183, which includes four titles describing various manifestations of the disease.
How did varicose veins appear?
The first mention of varicose veins was found in ancient Greek papyri. History and confirmed scientific facts say that varicose veins of the lower extremities were found in the discovered Egyptian mummy - it can be argued that the disease has accompanied humanity throughout its existence.
Exceptional doctors - Avicenna, Hippocrates, Galen tried to treat varicose veins of the lower extremities. In the nineteenth century, painful and traumatic treatments were used, consisting of dissecting the tissues of the thigh and lower leg to damage the subcutaneous veins, followed by a bandage. Of course, in this way it is possible to prevent stagnant blood flow and varicose veins will be eliminated. However, the methods leave terrible, extensive scars on patients' bodies and contribute to damage to nerves, arteries and lymphatic flow.
A little later, the history of the treatment of varicose veins received a positive breakthrough - in 1908 for the first time a metal probe was used as a means of minimally invasive effect on the walls of blood vessels. The discovery of radiography has made it possible to perform more accurate and effective surgeries to remove varicose veins. Now, when the correct diagnosis and treatment of the disease is needed, duplex and triplex scanning, powerful medications, laser therapy and sclerotherapy are used. Surgery is used only in cases where varicose veins can not be eliminated sparingly.
The main causes of the disease
Varicose veins are a great danger, the pathology has become "younger" - before it affected mainly the elderly, now varicose veins are diagnosed in young patients, extremely rarely in children.
Causes of the disease:
- Genetic predisposition.
- Overweight, overweight, obesity.
- Sedentary inactive lifestyle.
- Improper nutrition, poor blood quality.
- Concomitant disease of the cardiovascular system.
- Professional activity.
- Prolonged standing, heavy physical exertion.
- Pregnancy and hormonal changes.
- Individual features of the structure of the vascular system.
- Pathological congenital diseases.
- Wearing shoes with heels, tight clothes.
- Thermal procedures.
Each of the above causes can provoke the development of varicose veins, the consequences are dangerous, including death.
The structure of the venous vessels
To understand what causes varicose veins in the lower extremities, you need to have an idea of the structure of the vascular system and the mechanism of its operation. It represents the set of main (deep and superficial) and connecting perforating (communicating) veins.
The small superficial vein begins in the area of the foot, extends along the back of the lower leg, branches below the knee into two branches, connects with the popliteal vein and the deep femoral vein.
A large superficial subcutaneous vein forms in the ankle area, runs along the surface of the lower leg and knee joint, and connects to the femoral vein. The deep veins are located along the branches of the arteries, and the entire venous system is connected by perforating vessels.
With normal blood flow, oxygenated blood flows directly to the heart, and special venous valves prevent backflow. Varicose veins of the lower extremities suggest strong pressure, the diameter of the venous lumen increases significantly, the valves do not cope with the task, reflux occurs - backflow of blood. Improper blood circulation provokes excessive dilation (stretching) of vascular walls, their thinning, venous obstruction and blood stasis. As a result - bloating, swelling of the veins, the formation of nodules.
Symptoms and clinical picture
Varicose veins can progress for a long time in a latent form, after which the symptoms appear:
- Spider vein formation is a networked accumulation of varicose veins.
- A well-defined pattern of clogged veins protruding under the skin.
- The formation of places of thickening of blood vessels - varicose veins in the form of well-distinguished tubercles on the legs.
- There is a change in the normal color of the skin, cyanosis, blackness, the upper layer (dermis) acquires a loose structure.
- Feeling of pain, heaviness, swelling and fatigue of the legs, reduced mobility, difficulty walking.
- With varicose veins of the lower extremities, the formation of soft tissue swelling is possible.
Neglecting timely treatment leads to serious and dangerous consequences, when a person can be cured only by immediate surgery.
Classification of the disease
Varicose veins according to ICD 10 are classified as ulcerative colitis, inflammation, ulceration and inflammation when these symptoms are absent. According to the International Classification of Chronic Venous Diseases, established in 1994, varicose veins are classified into:
- Intradermal, segmental. No pathological venous discharge was observed.
- Segmental with reverse blood flow, flowing through the superficial and perforating veins.
- It is distributed by backflow of blood through superficial and perforating veins.
- Varicose veins with backflow of blood through the deep veins.
It is usual to divide the disease according to additional signs of the clinical picture:
- On examination or palpation there are no symptoms.
- The reticular veins are pronounced.
- He has varicose veins.
- There is swelling of the soft tissues.
- Disturbance of normal skin color.
- Open lipodermatosclerosis.
- There is a cured ulcer.
- An active ulcer was found.
The symptoms are absent or subjective (the patient's feelings). In addition, varicose veins are classified for reasons: congenital, primary, secondary, with an unknown factor that provoked the development of the disease.
Diagnosis of varicose veins
The predominant way to identify varicose veins is visual examination and palpation of the patient. In order to carefully determine the severity of the disease and to choose the right treatment when examining the medical history and applying palpation, the phlebologist prescribes:
- Complete blood count is the main standard for determining the number of red blood cells and the level of hemoglobin. According to blood clotting, conclusions are drawn about the degree of development of the disease and predisposition to thrombosis.
- Doppler ultrasound. The method consists of ultrasound diagnostics of the speed and direction of blood particles. This allows you to determine in which direction the blood flow is taking place, whether there is a sufficient speed.
- Ultrasonic anioscanning. It is used for visual examination of the vascular walls, their structure, direction and speed of blood flow in real time on the monitor of the ultrasound device.
- Plethysmography. Diagnosis is based on the detection of the electrical resistance of the tissues of the legs. With proper circulation, the parameter should show the normal standard.
- Rheovasographic diagnosis. Based on determining the index of tissue blood supply. The rheographic index helps to determine the stage of varicose veins - compensation, subcompensation or decompensation.
The history of the disease and its study, obtaining comprehensive diagnostic data, allow the doctor to choose the method of treatment.
Conservative drug therapy
This method of treatment involves the appointment of special drugs that have a positive effect on the course of the disease. Conservative treatment of varicose veins is effective in the initial stages, is used as an additional method of treatment in the formation of nodules, ulcers, eczema.
The main groups of prescribed drugs are:
- Phlebotonics and phleboprotectors. Venotonic drugs are standard, suggesting conservative treatment. Promoting the restoration of the structure of the vessel walls, strengthening and toning the blood vessels.
- Means for effective blood thinning. They help to improve the quality of the composition, the blood flows faster through the veins, reduces the risk of blood clots, restores normal blood circulation and relieves pain.
- NSAIDs (anti-inflammatory drugs). Eliminate pain, prevent spasms, effectively relieve inflammation and swelling.
Conservative treatment helps with timely referral to a phlebologist, in the initial stage it is possible to influence the blood composition and the condition of the vessel walls. In complex forms of the disease, drastic measures are needed.
Laser therapy
Laser therapy is recognized as a gentle and least traumatic method when varicose veins of the legs require treatment classified according to ICD 10 code 183. The idea of the method is to use a laser beam that actively affects the vessel walls and promotes their adhesion. An LED connected to a laser device is inserted into the vein by piercing the skin. The beam is selective and has no effect on adjacent healthy tissue. Significant advantages of laser therapy in the treatment of varicose veins:
- Fast positive effect.
- Lack of pain and injury.
- Stable result, long-term remission.
- Restoration of normal blood circulation.
Contraindications for use will be thick or too thin vascular walls, large venous lumens, pregnancy, oncology and other serious comorbidities.
Sclerotherapy for varicose veins
The method is based on the introduction into the vessels affected by varicose veins of special liquid or foam preparations - sclerosants. They replace endothelial cells with fibrous tissues. Needles, syringes and sclerosants are used to perform sclerotherapy.
The treatment technique consists of the following steps:
- perforation of a pathological vein;
- pumping (removing) all the blood from the vessel;
- application of sclerosing preparations;
- applying a suitable bandage or knit compression.
This method gives a lasting result. The procedure is painless, the fusion of vascular tissue with varicose veins is an alternative to surgery.
Performing an operation
The most painful and traumatic way to treat varicose veins is surgery. Indications will be extensive vascular lesions, the presence of varicose veins, dangerous consequences of the disease, such as acute thrombophlebitis.
Phlebectomy is performed under local anesthesia, the pathological vein is ligated, the required number of incisions is made to remove it and it is removed. Surgery is recognized as an effective method of treatment, showing the result in eighty percent of cases. But phlebectomy has a number of side effects: complications of wounds, trauma to the lymph nodes, in extreme cases with damage to the deep nerves, immobilization and damage can occur.
To prevent dangerous complications of varicose veins, which manifest themselves with: nodules, ulcers, bleeding, phlebothrombosis, pulmonary embolism and other serious consequences, you should consult a doctor in the initial stage of varicose veins!