varicose veins

Varicose veins in the legs (varicose veins) are a common disease manifested by persistent and irreversible expansion and elongation of superficial veins and disruption of their function due to the development of a pathological process in the venous wall and congenital insufficiency. or acquired from the valve. apparatus.

According to the World Health Organization, varicose veins are found in one in five adults on the planet. The first signs of varicose veins (venous reflux) are detected in 10-15% of children and adolescents aged 12 to 13 years.

Causes of varicose veins in the legs.

• Hereditary predisposition (congenital weakness of vascular valves). If your parents had signs of weakness of the venous wall in any vessel (legs, groin, esophagus, rectum), then with a high degree of probability, symptoms of varicose veins may appear in you.
• Poor circulation in the lower extremities during pregnancy and childbirth (compression of the abdominal veins by the developing fetus with increased pressure in the veins of the legs, hormonal changes causing a decrease in the tone of the veins).
• Obstruction of blood flow during prolonged standing (varicose veins of the lower extremities are more common among salespeople, teachers, waiters, surgeons) and in a sitting position (managers, accountants, office workers, drivers, etc. )
• Heavy physical work, sports training associated with weight lifting (for athletes, loaders, builders, regular visitors to gyms and fitness clubs)
• Long-term use of contraceptive medications with a high content of female sex hormones.
• Hormonal changes in the body, accompanied by a decrease in the tone of venous vessels (adolescence, pregnancy, menopausal disorders in old age).
• Factors such as excess weight, chronic cough, constipation, and the habit of wearing tight clothing and shoes interrupt venous flow and often cause varicose veins.

Why do varicose veins appear during pregnancy?

In women, varicose veins of the lower extremities are observed 3-5 times more often than in men and occur quite often for the first time during pregnancy. In 80% of cases, varicose veins develop first in the left leg and then in the right.

• The appearance of varicose veins is facilitated by hormonal changes in the woman's body during pregnancy, which cause a decrease in the elasticity of the venous wall, its stretching and transformation into a varicose node.
• In the body of a pregnant woman, the volume of blood flow increases significantly. The increase in venous pressure causes thinning of the venous wall and its local expansion (varicose veins).
• The growing fetus causes a corresponding enlargement of the uterus and difficulty in the outflow of blood from the lower extremities through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
• The increase in body weight of a pregnant woman also negatively affects venous flow.

Varicose veins of the lower extremities: symptoms.

Varicose veins develop quite slowly and successively go through several main stages:

• At the first stage, a violation of venous circulation is accompanied by the appearance of individual "spider veins", thinning of the skin, through which, during physical activity, dilated veins in the form of twisted cords begin to appear ( usually in the popliteal fossa), no complaints.
• In the second stage of varicose veins, there is a feeling of heaviness, fatigue in the lower extremities, swelling of the legs at night and after a long walk, a feeling of "tingling" along the legs, night cramps in the legs. calf muscles, upon careful examination, several dilated veins are revealed in the lower legs and sometimes in the foot and thigh.
• The third stage of varicose veins of the lower extremities is characterized by a pronounced bulging of the venous nodes mainly on the inner surface of the leg, the appearance of dark brown or brown spots on the thin, easily wounded skin of the legs. legs and the development of itchy dermatitis and rashes. The swelling in the legs becomes more intense, making walking difficult.
• The fourth stage of varicose veins is the presence of varicose nodules on the foot, leg and thigh, the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose nodules, development of thrombophlebitis).
• Sometimes the fifth stage is also distinguished: there are all the characteristic symptoms of the fourth stage of varicose veins, with the spread of the process to the areas of the groin, buttocks, perineum, the presence of multiple trophic ulcers, the appearance of elephantiasis, frequent exacerbations of thrombophlebitis and appearance of disability.

Complications of varicose veins.

1. Thrombophlebitis of superficial veins.
2. Bleeding when a varicose vein ruptures.
3. Dermatitis, eczema.
4. Trophic ulcers.
5. Deep vein thrombosis (phlebothrombosis) and post-thrombophlebitic disease.
6. Pulmonary embolism (PE).
7. Lymphedema (elephantiasis).

Diagnosis of varicose veins.

It is based on a clinical examination, the performance of functional tests and the performance of instrumental studies of the veins.

• Clinical examination (clarification of complaints, anamnesis, examination, palpation).
• Doppler ultrasound.
• Ultrasonic angioscanning.
• Plethysmography.
• Ascending and descending phlebography.
• Phlebography with radionuclides (radiophlebography).
• Computed tomography and magnetic resonance imaging (CT venography, MR venography).
• Intravascular ultrasound examination.
• Thermography.

Treatment of varicose veins of the lower extremities.

If varicose veins are detected at an early stage, their manifestations can be treated with compression stockings, special therapeutic exercises and traditional treatment methods. But if you visit the doctor late, when varicose veins are visible to the naked eye, your legs hurt and swell, trophic ulcers appear, signs of thrombophlebitis, the only way out is surgical intervention.
At the same time, there is no need to be afraid of surgery, because modern technologies make it possible to get rid of varicose veins of the lower extremities without large incisions, without pain and practically without disturbing a person's usual way of life.

The principle of surgical manipulation is similar for different techniques: pathologically altered superficial leg veins are ligated, excised and excised. In this case, venous circulation in the lower extremities is not disturbed, since the operation does not affect the deep veins, through which approximately 90% of venous blood flows.

Main types of operations for varicose veins.

1. Sclerotherapy. At the initial stage of varicose veins, a good cosmetic result is achieved by introducing special drugs into the problem vein, which cause gradual sclerosis and "glue" the pathologically dilated area of the vessel. A medicinal substance (usually a sclerosant) is injected through a special catheter or a very fine needle into a varicose vein. To achieve a positive result, 3 to 10 injections are required.
2. Phlebectomy. An operation that has been performed for almost a hundred years, but in modern conditions wide incisions have long been abandoned. Manipulation today is carried out using miniature incisions of 3 to 5 millimeters. The pathologically dilated vein is first ligated and cut at the point where it empties into the deep vein and then removed using special probes. This operation lasts approximately 1 to 2 hours, after which the patient remains in the hospital of a medical institution for 1 to 2 days.
3. Miniphlebectomy. The operation is performed under local anesthesia, without incisions, but with the help of small punctures through which the varicose vein is removed. This achieves a good cosmetic effect (stitches are usually not required) and significantly reduces the recovery period after surgery. In some cases, not the entire vein can be removed, but only its pathologically altered section. This intervention is called short stripping.
4. Coagulation of veins with intravenous laser.. The manipulation is carried out under ultrasound control. A special laser light guide is inserted into the pathologically dilated vein and the saphenous vein and its tributaries are burned. After a certain period of time, obliteration and sclerosis of the vein occurs, its complete closure. If necessary, laser coagulation is combined with miniphlebectomy. In this case, the effectiveness of surgical treatment of varicose veins of the lower extremities will be maximum.
5. Radio wave ablation of varicose veins. Obliteration ("gluing") of the lumen of the disturbed vein is achieved by exposure to radio waves of a certain power delivered to the problem area of the vein through a special catheter. The duration of the procedure is about 20 minutes.

After surgical treatment of varicose veins with one of the above methods, it is necessary to limit physical activity for a certain time, wear compression stockings and, if necessary, use medications that have a venotonic effect. This will help restore normal blood circulation in the veins of the lower extremities as soon as possible, avoid possible complications and allow you to quickly return to work and the normal rhythm of life.

In what cases is surgical treatment of varicose veins of the legs undesirable?

• During pregnancy and in the first two months after birth.
• At the initial stage of varicose veins, when there are no complaints yet and there are cosmetic problems ("spider veins" on the legs), you can first try to eliminate them with the help of exercise therapy, compression stockings and traditional methods.
• In old age and in the presence of serious diseases of various organs and systems of the body with dysfunction, when the risk of possible complications increases significantly.
• In the presence of lymphatic drainage disorders, infectious lesions of the skin of the lower extremities, thrombophlebitis, arteriovenous fistulas.

With the correct choice of the most effective method of treatment for varicose veins of the lower extremities in this particular case, the absence of contraindications and compliance with the doctor's recommendations in the postoperative period, a positive result of the surgical intervention will be guaranteed.

Prevention of varicose veins of the lower extremities.

Regime and diet

Compliance with a certain work and rest regimen, as well as nutrition, will in most cases prevent the appearance of varicose veins. To do this you need:

• Avoid clothing that impedes the flow of venous blood.
• Avoid prolonged periods of standing or sitting (taking regular breaks and performing simple gymnastic exercises).
• Avoid strenuous physical activity.
• Lead an active lifestyle (moderate dynamic loads: walking, swimming, cycling every day).
• Drink at least 1. 5-2 liters of liquid per day, your daily diet should include vegetables and fruits, whole grain bread and cereals.
• Avoid visiting baths and saunas and refuse to take hot baths.
• Take a contrast shower (warm - cold) every day.
• Wear comfortable shoes with low heels.

Antiplatelet therapy

An important component of preventive measures for varicose veins of the lower extremities is taking medications that have an antiplatelet effect, that is, preventing the formation of blood clots. These include:

• Acetylsalicylic acid and modern drugs containing it;
• Venotonics of plant origin: extracts from plants such as horse chestnut, hazelnut and mountain arnica are most frequently used;
• Synthetic venotonics. By the way, venotonics not only reduce the formation of thrombi, but also improve venous blood circulation, strengthen the vascular wall and prevent the appearance of expansion areas.

Compression jersey

For many years, bandaging with elastic tubular bandages has been successfully used in the initial stages of varicose veins (when spider veins appear). Now special clothing is produced - compression knitwear, which allows you to select the required size and select the degree of compression depending on the severity of the changes. Wearing stockings and tights initially puts pressure on the tops of the ankles, followed by a decrease in pressure and stimulation of blood flow to the heart. Venous vessels work more efficiently, as a result of which venous congestion is eliminated, swelling disappears, and the formation of thrombi is prevented.

Gym

Special exercises have been developed aimed at eliminating stagnation of venous blood. The key to success here is regularity in carrying out the complex. Let's consider several basic exercises recommended in the presence of risk factors for the development of varicose veins in the lower extremities and in the initial stage of the disease:

• Lying on your back, with your legs on a pillow on a raised platform. Relax and stay in this position for several minutes.
• "Bicycle": lying on your back, legs raised and knees bent. Perform movements that simulate pedaling when riding a bicycle;
• "Scissors": lying on your back, raise your legs and cross them, changing the position of the legs (up - down) for 1 minute;
• The legs are raised and bent at the knee joints. Bend and straighten your feet, imitating walking;
• Lying on your back, bend your left leg and bring your knee to your chest. Wrap your hands around your leg at the ankle joint and gradually stretch your leg, performing massaging movements on the calf muscles. Repeat the exercise with the right leg;
• Stand with your feet together. Get up on tiptoe and lower yourself down (if there are no complications, the exercise can be performed sharply, with your heels touching the floor).

Timely initiation and proper implementation of preventive measures can prevent varicose veins of the lower extremities or minimize its manifestations.