Varicose veins are a disease of the veins, which is manifested by their expansion, elongation with the formation of knots and thinning of the vein wall. It can affect various vessels, but most often occurs in the lower limbs.
In advanced cases, this leads to trophic disorders in the affected area, the 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 appearance of varicose veins is well understood.
The venous network of the lower extremities is represented by deep and peripheral veins, as well as communicating (perforating) vessels connecting them. Normally, blood flows through the veins towards the heart, from the peripheral vessels to the deep vessels.
This is done through the muscle pump (contraction of the muscles of the lower limbs), 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 violation of at least one of these links, a reverse blood outflow occurs. At the same time, the peripheral vessels expand, the valves stop closing, causing even more blood stasis in the peripheral circulation.
Under blood pressure, the vein wall continues to expand, causing the vessels to lengthen and knots to form. Valvular insufficiency increases, edema develops.
Compression of peripheral nerves sends a signal to the brain about the need to increase the tone of the vascular wall. This increases the blood pressure in the deep vessels and blood is forced from them to the peripheral vessels, causing them to expand even more. A vicious circle closes.
What causes varicose veins
The true cause of varicose veins is not known. But it has been proven that a number of factors and physiological conditions contribute to its development.
Such as:
- Pregnancy (due to the compression of the veins of the abdominal cavity by the uterus of the pregnant woman, blood circulation in the lower extremities is difficult);
- Obesity;
- Sedentary lifestyle;
- Genetic predisposition (weak valves or a decrease in the tone of the vascular walls);
- Violation of hormonal balance (leads to increased blood viscosity and difficulty in outflow);
- State after operations (due to increased blood clotting and bed rest);
- Professions associated with a long stay in a standing position (on the legs).
In the event of 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 limbs;
- Swelling of the legs in the evening;
- The appearance of spider veins on the skin;
- Tense veins visible 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 bright and painful character. At the onset of the disease, they disappear after rest, so patients do not go to the doctor for a long time.
On examination, oedemas, pastosity of the legs, telangiectasias are revealed, tense, often painful venous trunks are palpated. How the skin on the legs with varicose veins looks can be seen in the photo.
In the severe decompensation stage, weakness, dizziness and fainting may occur. At the same time, trophic disorders are noticeable on the skin, ulcers, dermatitis and eczema develop. With a timely visit to the doctor, serious manifestations of varicose veins can be avoided.
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 limbs;
- 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 is that of varicose veins of the lower limbs. This occurs most often, and it is usually to him that we refer when talking about this disease. Most patients don't know if internal varicose veins exist and how they manifest until they encounter them.
Stages of development of varicose veins:
| Disease stage | Clinical manifestations |
|---|---|
| 1 step | There are no symptoms, varicose veins are detected only during instrumental examination |
| 2 floors | Heavy legs syndrome, transient edema, varicosities on the skin |
| 3 steps | Persistent edema, disorders of skin pigmentation, visible dense and tense veins and lymph nodes, trophic disorders in the form of eczema |
| 4 steps | 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 establish a diagnosis, in addition to examination data and characteristic complaints, laboratory and instrumental examination of the patient is necessary.
Laboratory diagnosis
What tests should be done for varicose veins:
- Complete blood count with extended formula.
- Blood Coagulation Tests:
- clotting time;
- prothrombin test;
- dosage of antithrombin III, proteins S and C;
- determination of the level of homocysteine;
- study of the APTT index;
- D-dimmer level determination;
- determination of von Willebrand factor activity, etc.
- Blood biochemistry.
- Hormonal analysis.
- General urine analysis.
- functional tests.
Determining the state of the blood coagulation system is of decisive importance for the choice of treatment tactics and the prognosis for the development of the disease.
Instrumental diagnosis of varicose veins
Among the instrumental research methods used:
- ultrasound examination of veins;
- dopplerography;
- duplex ultrasound of veins (combination of ultrasound and dopplerography);
- angiography;
- photoplethysmography (PPG);
- venography;
- venous occlusal plethysmography (VOP).
With these types of studies, 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.
Treatment of varicose veins
The fight against varicose veins includes both medical (conservative and surgical treatment) and non-drug 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 treatment 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;
- anticoagulants of direct and indirect action to improve the rheological properties of blood and prevent its thickening;
- phlebotonics for strengthening the vascular wall, herbal preparations with horse chestnut extract;
- anti-inflammatory drugs if necessary (in the presence of inflammation of 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 with symptoms of decompensation, surgical treatment of varicose veins is necessary.
Surgery may consist of removing the entire vein or just the affected area through incisions along the vessel or in the inguinal crease and popliteal fossa (depending on the specific vein and its location). But whenever possible, doctors try to perform a less traumatic procedure that causes the affected vessel to coagulate, which leads to its complete obstruction.
Options for reserve operations:
- sclerotherapy (introduction through a catheter into the lumen of the vessel of special sclerosing drugs that cause tight adhesions with their subsequent replacement with connective tissue);
- endovasal laser coagulation (coagulation of the internal cavity of the vessel with a laser pulse);
- radiofrequency coagulation (sticking together the walls of a vein as a result of exposure to a high frequency current pulse);
- miniphlebectomy (removal of a vein or its section through several punctures in the skin).
When coagulating in different ways, the result is the same - after gluing the walls of the vessel, its cavity will gradually be filled with connective tissue with the development of complete obstruction. In this case, the movement of blood will continue through healthy vessels, bypassing clotted vessels. Schemes for performing such operations can be seen in the video in this article.
Surgical methods have one indisputable advantage - the probability of recurrence after them is very low. In terms of the risk/benefit ratio, less traumatic procedures are better. But their price in clinics is quite high.
Non-drug treatment of varicose veins
Strengthening the walls of blood vessels with varicose veins is quite possible without the use of tablets.
Non-drug means for this use:
- therapeutic exercises (to stimulate the muscle pump);
- 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).
Wearing compression stockings is recommended for all people at risk, in particular:
- pregnant women;
- work all day standing;
- to all people on long airplane flights;
- patients taking medications that promote blood clotting;
- people with a sedentary lifestyle.
Prevention of varicose veins
Prevention of varicose veins is better to start before it appears. 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, sweet);
- strictly control your weight;
- lead an active lifestyle (more walking, running, cycling, rollerblading, etc. );
- wear comfortable low-heeled shoes;
- daily contrast shower;
- at the end of the day, rest 15 minutes with your legs elevated.
These measures will also help identified varicose veins - to prevent the progression of the disease and the development of complications.
Many wonder 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 play sports, excluding its heavy types associated with power 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 long list of female professions, which involve spending the whole 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.