Varicose veins

Varicose veins of the lower extremities are often asymptomatic in humans. Often the only problem with this pathology is the aesthetic defect of the legs caused by bulging superficial veins. In this case, the disease may be accompanied by pain or tenderness of the skin of the feet. Depending on the severity of the disease, the patient is offered non-drug, medical or surgical treatment. Read more about the first symptoms of varicose veins, the nature of its course and effective methods of treatment and prevention, read our material.

What is

Varicose veins are a pathology that only humans suffer from. Animals do not have this problem, which suggests that the disease is associated with upright posture. When a person gets to his feet, the main part of the circulating blood begins to be below the level of the heart. In this case, all conditions are created for the blood to circulate worse in the opposite direction, which leads to stagnation.

According to statistics, some disorders of the venous system are observed in 80% of people in developed countries. In addition, such problems are increasingly found in young people. In all likelihood, one of the reasons varicose veins "rejuvenate" is a sedentary lifestyle that only contributes to stagnation.

Interestingly, in the age group under 20, varicose veins of the lower extremities occur with equal frequency in both men and women. After the age of 20, however, women begin to predominate in the structure of morbidity. This is due to pregnancy and childbirth, which are a serious factor in the development of venous diseases.

Characteristics, causes and mechanism of development of varicose veins

The exact reasons for the development of varicose veins of the lower extremities are not yet known. The disease is currently thought to be caused by congenital or acquired defects in the valvular apparatus of the veins of the lower extremities.

A well-coordinated operation of the venous valves is required for unimpeded ascending blood flow through the veins. These valves open only for blood flowing upwards. However, in case of a valve defect, partial descending blood flow is also possible. This is how venous insufficiency develops, manifested by swelling, cramps in the muscles of the legs and dilation of the venous vessels.

Leukocytes may also be involved in the pathogenesis of varicose vein development. This issue is now being actively explored. It is assumed that with prolonged accumulation of leukocytes in the tissues of the vessels (especially in the area of the valvular apparatus) an inflammatory process develops, which spreads through the venous bed.

Because the venous valves are subjected to constant mechanical stress, inflammation develops particularly rapidly in the area of the venous valve apparatus.

Most people in developed countries now lead a sedentary lifestyle. But then why doesn't everyone have varicose veins? Consider the main risk factors that contribute to the appearance of this pathology:

• Hereditary factors. . . Despite the fact that the specific hereditary mechanisms associated with the development of varicose veins have not yet been identified, most experts agree that such a factor exists. At the same time, there are serious counter-arguments about heredity in the development of varicose veins. For example, it is the spread of varicose veins in ethnic Africans and African immigrants who have moved to the United States. If the prevalence of varicose veins among sedentary Africans is about 0, 5%, then among immigrants this figure reaches 20%. These figures show that at least hereditary factors are not the only ones in the development of the disease and most likely do not predominate.
• obesity. . . People who are overweight and obese are at risk. It is important to note that obesity contributes to varicose veins both due to increased stress on the vessels and in connection with the risk of other diseases affecting the vessels (diabetes, hypertension and others).
• Pregnancy. . . This is one of the most obvious factors in the development of varicose veins of the lower extremities. In this case, the main risk factors are an increase in the volume of circulating blood, as well as compression of the retroperitoneal veins by the developing fetus in the uterus. According to epidemiological studies, the second and subsequent pregnancies lead to a significant increase in the likelihood of developing varicose veins. After the first pregnancy, the likelihood of varicose veins in the legs remains low.
• Hormonal imbalance. . . Hormones are involved in the pathogenesis of most diseases. These pathologies include varicose veins. This problem is especially relevant for women who are taking hormonal contraceptives, as well as those who are using hormone replacement therapy to treat certain diseases (such as osteoporosis) or during the premenopausal period. Female sex hormones (especially estrogens and progesterone) have been found to reduce vascular tone and break down collagen fibers. Thus, the vein wall is pathologically dilated.
• Lifestyle. . . A person's lifestyle has a great influence on the course of the disease. Sedentary lifestyles, as well as work involving prolonged standing or sitting (eg security guards, drivers, office workers, service workers, etc. ), contribute to the development of varicose veins. You also need to pay attention to nutrition. The lack of enough vegetables and fruits in the diet worsens the condition of the walls of blood vessels.

Stages of varicose veins of the lower extremities

Several classifications of varicose veins of the lower extremities are currently used. The international classification CEAP, adopted in 1994, is considered generally accepted. CEAP is an abbreviation where each letter corresponds to the name of a classification category:

• C (clinical)- the clinical class of the disease (the type of affected veins, the presence of pigmentation, eczema, trophic ulcers).
• E (etiological)- the etiology of the disease (congenital, primary, secondary).
• A (Anatomical)- anatomical localization of the pathology (superficial or perforating veins).
• P (pathophysiological)- the type of disorder (venous reflux, obstruction or a combination of both).

The disease process takes place in six stages:

• Zero stage. . . The earliest stage of varicose veins, in which even doctors are unable to reliably diagnose. At this stage there are no external signs of the disease. Ultrasound diagnosis does not show the presence of pathology. At the same time, a person at stage zero is worried about such symptoms as swelling, a feeling of heaviness in the legs, as well as cramps, which indicates the presence of problems with blood vessels.
• First stage. . . At the first stage of the disease, spider veins with a diameter of less than 1 millimeter can be seen on the surface of the skin of the feet. Medium-sized veins can grow up to 3 mm in diameter. At this stage, doctors can not always make the correct diagnosis, as the presence of such asterisks does not always indicate varicose veins.
• Second stage. . . At this stage, the veins may appear and disappear depending on the conditions. For example, veins appear clearly after prolonged sitting, standing, or lifting heavy objects. The diameter of the varicose veins at this stage is 3 mm or more. In the second stage, blood clots often form.
• Third stage. . . If in the previous stages of the disease the swelling of the legs appears and disappears, then in the third stage the swelling becomes permanent. Swelling of the legs is strongest in the evening.
• Fourth stage. . . At this stage, significant trophic changes occur. In particular, tissue nutrition is impaired near the affected veins. The patient develops such skin changes as lipodermatosclerosis (inflammation of the subcutaneous fat), eczema, and darkening or discoloration of the skin. The fourth stage of the disease is characterized by pigment changes. For example, the skin in the area of the affected vessels may become brown and even black, indicating the concentration of pigments in this area. The opposite situation is also possible, when due to a pathological process the pigment does not enter the affected area, which leads to the appearance of a pale skin tone. If at this stage varicose veins are not treated, then the problem will only get worse with the further appearance of trophic ulcers.
• Fifth stage. . . In this stage of the disease, in addition to the above symptoms, trophic ulcers appear, which heal quickly. If you do not take any treatment measures, then the ulcers will appear again and again.
• Sixth stage. . . Non-healing trophic ulcers appear. The temperature in the affected area rises significantly and pus may leak from the wounds.

You should not wait for the development of the last stages - you should go to the doctor for the second to register and monitor the dynamics of the disease. Sometimes the symptoms improve on their own, and sometimes they progress quickly. That is why it is important to monitor the situation in order to take timely action.

Symptoms

Consider the main symptoms of varicose veins of the lower extremities at different stages of the disease:

• Pain. . . This is the earliest sign of the disease. As pain is a non-specific symptom, it is not possible to make a diagnosis based on this symptom alone. In varicose veins of the lower extremities, the pain is often localized along the venous trunks.
• Feet in feet. . . It also applies to early symptoms, while the veins in the skin are still not visible. Often the feeling of warmth is accompanied by throbbing pain.
• Muscle spasms and itching. . . He is most often disturbed at night.
• Swelling of the legs. . . In the early stages of the disease, the swelling is insignificant and transient. As a rule, they appear in the evening and disappear in the morning. However, as the disease progresses, the severity increases and they become permanent.
• Skin discoloration. . . As a rule, in varicose veins the skin of the lower extremities darkens. In the area of the affected veins, the skin becomes brown. In the advanced stages of the disease, eczema and dermatitis appear. The terminal stages of varicose veins are characterized by the appearance of trophic ulcers. Initially, these are healing ulcers, but later non-healing wounds form.
• Vascular spiders. . . In the medical literature, such asterisks are called telangiectasias. In some people, varicose veins may be limited to arachnoid veins without progressing to larger veins.
• Twisted varicose veins. . . The most characteristic sign of varicose veins are twisted varicose veins on the surface of the legs.

In summer, the symptoms of varicose veins become more pronounced. This is due to the high ambient temperature, which already contributes to varicose veins. Therefore, during the hottest hours, from 10 am to 4 pm, it is best to be in a well-ventilated room.

When to go to the doctor

You should consult a doctor at the first symptoms of the disease - pain, swelling or the appearance of spider veins. Because the early stages of varicose veins are difficult to diagnose, a misdiagnosis may initially be made. The patient should closely monitor the condition of the legs and be regularly monitored by a phlebologist.

Diagnosis

Diagnosis of varicose veins of the lower extremities is reduced to the following activities:

• External examination of the skin of the feet;
• Doppler ultrasound;
• Duplex vein scanning;
• Phlebography.

Characteristics of treatment

Varicose veins of the lower extremities are treated with both conservative and surgical methods. Conservative treatment is reduced to the following activities:

• Drug therapy. . . This is the intake of drugs that improve the tone of the venous walls. The patient is also prescribed drugs that reduce the permeability of the capillaries and improve blood microcirculation. If there is a risk of blood clots, then anticoagulants are also prescribed.
• Compression therapy. . . This is wearing special compression stockings that reduce the strain on the legs. The advantage is that it is possible to distribute the load evenly, even during heavy physical activity. When using compression garments, congestion and swelling can be avoided.
• Therapeutic gymnastics and lifestyle changes. . . The patient is advised to do exercises to relieve tension in the legs. It is important to avoid prolonged sitting or standing. If you have to stand or sit for a long time at work, then you need to take breaks more often.

If conservative treatment of varicose veins does not lead to the expected results, then a decision is made to have surgery. Most often, these are minimally invasive interventions, including:

• Sclerotherapy- the introduction into the vein of substances that stick to the walls of the affected vessel. This treatment results in resorption of the spider veins.
• Laser coagulation- introduction of a laser light guide into a vein and irradiation of the walls with a laser, which also leads to sticking of the walls and further resorption of the vessel.
• Radiofrequency ablation- adhesion of veins with the help of high-frequency current.
• Phlebectomy- Removal of the affected veins, in which the blood circulation has deteriorated by 90%.

In some countries, you can get the operation for free, under compulsory medical insurance. But it is not a fact that all types of compulsory insurance operations are provided everywhere. In any case, help will be provided, but it is necessary to understand whether it will be conventional removal or laser.

Contraindications for people with varicose veins

• Sedentary way of life. . . It is important to avoid prolonged sitting or standing. Physical activity will help avoid congestion in the veins.
• Running and vigorous exercise. . . It is important not to overdo physical activity. If you have varicose veins, walking is definitely better than running.
• An unbalanced and unhealthy diet. . . You need to give up junk food, even if your health seems to allow. You should limit the intake of pastries, semi-finished products, as well as rich meat broths and smoked meats. But eating more vegetables and fruits would be a good idea.
• Hot tubs and showers. . . For people with vascular problems in the limbs, excessively hot and prolonged water procedures are contraindicated.

Complications of varicose veins

Varicose veins can be complicated by trophic ulcers, phlebitis (inflammation of the veins) and deep vein thrombosis. The latter is the formation of blood clots in the deep veins that threaten human life.

Conclusion

Symptoms of varicose veins of the lower extremities, as a rule, do not appear immediately. Different people have different sets of manifestations. For example, sometimes in this pathology there is no swelling or no local increase in temperature or pain. This does not mean that there is no disease. A timely visit to the doctor will significantly slow down the progression of the disease or even stop it, preventing the development of trophic changes.