The word "varicose veins" comes from the Latin varix, varicis - bloating. The first mention of the treatment of varicose veins is found in ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffers from chronic diseases of the veins of the lower extremities. Its complications in the form of dermatitis, cellulitis, bleeding, thrombosis and trophic ulcers often lead to long-term disability, sometimes causing disability.
Structure and function of the venous system
How our veins work is a complex process. To understand this, you need a basic knowledge of vein structure. The venous wall consists of three layers. Internal - endothelium, represented by a layer of cells on the connective tissue membrane. The middle layer is muscular. It mainly consists of circularly arranged smooth muscle cells, which are as if they are within collagen fibers. Superficial veins contain a thicker muscle layer than deep veins. The outer sheath of the vein, the so-called adventitia, is a dense tissue of collagen fibers. If we compare the structure of veins and arteries, then it should be said that the ratio of the lumen of a vein and the thickness of its wall in the veins is much larger than in the arteries. Veins have much less elastic fibers than arteries.
The main property of the vein, which thus affects the indicators of blood flow, is the great extensibility of its wall. In particular, when the pressure in the vessel increases, the veins dilate and tend to take on a round shape than the slit shape. The extent to which the venous wall extends is quite short-lived and depends on many other things. It is this factor that does not allow the use of rigorous mathematical formulas to calculate the movement of blood along them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, in the neck.
The venous valves originate from its wall. They usually consist of two valves that are oriented toward the heart. In the area of the valve attachment to the wall, the diameter of the vein is slightly larger. Usually, when the valve flaps are closed, blood from the upper part cannot penetrate into the lower part. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative, (some call it physiological) and absolute. The main difference is in the duration of reflux during functional tests. There is also an opinion that reflux should not occur with a normal valve. The valves are unevenly distributed through the veins. There are more of them where the work of the muscle pump is most pronounced - that is, on the lower leg.
The main venous system of the lower extremities is represented by the following groups:
- foot veins;
- deep veins of leg and thigh (deep vein system);
- large and small saphenous veins (superficial vein system);
- communicating (perforating) veins - provide communication between superficial and deep veins.
The deep and superficial venous system together form a "sponge", from which, as it walks, blood flows to the heart. The operation of this system supports the operation of a muscle pump located in the lower leg, which creates occasional pressure in the veins.
These systems move the blood column upwards and the valves inside the veins prevent backflow.
The outflow of blood from the lower extremities through the deep and superficial veins is uneven. About 85-90% of the blood flows through the deep veins, and only 10-15% through the subcutaneous veins. Thus, in healthy people, blood flow is performed through the system of deep, subcutaneous and communication veins.
Varicose veins are a serious problem
To say that varicose veins are a "disease of the twentieth or twenty-first century" means to deviate from the truth. Varicose veins have been bothering people for a long time. Even in ancient discussions of medicine, there is a description of varicose veins, in ancient Rome, people wrapped their legs in skin "bandages" to get rid of venous insufficiency.If your legs get tired often, this may be the first sign of the onset of venous disease. Evening discomfort, accompanied by swelling of the feet and ankles, especially after a long stay on your feet, are clear signs of congestion of the veins. Soon, unfortunately, you discover the first varicose vein. The altered veins form a blue-blue or red "pattern" on your legs, "stars", capillary "cobwebs" (telangiectasias) and, finally, varicose veins and dilated nodules.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins in the legs - an acute signal for emergency measures to save the beauty and health of the legs.
The question about the condition of your veins should be immediately asked to a specialist - a phlebologist who studies and treats venous diseases.
Vein diseases start harmlessly, but if left untreated, they can become a serious problem.
Causes of varicose veins
To date, a number of theories have been proposed that explain the causes of varicose veins. The most common are hereditary, mechanical, hormonal and so on. However, they generally reflect factors that contribute to the development of the disease or accelerate the appearance of clinical signs of the disease.
Both lower extremities are more commonly affected. However, at first the varicose veins appear on one limb, and after a while on the other. Varicose veins are more common on the right leg.
Varicose veins of the lower extremities occur only in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the venous wall of the limbs. With the weakness of the venous wall and impaired function of the valve apparatus in the main veins, which occurs with their congenital inferiority, there is a pathological reverse blood flow. The most common causes of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives and so on) - affect the structure and tone of the vascular wall with gradual weakening and destruction.
- Pregnancy is one of the main risk factors for developing varicose veins. In addition to hormonal changes, the uterus and fetus, which are enlarging, put pressure on the iliac veins and significantly impede blood flow from the lower extremities.
- Obesity is an already proven risk factor for varicose veins. This is due to the increasing load on the venous system of the lower extremities.
- Lifestyle: People with prolonged static loads (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wearing tight underwear that tightens the main veins at the level of the groin. Women in high heels.
- Heavy physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the abuse of which can also cause varicose veins.
The essence of varicose veins lies in the fact that as a consequence of the above reasons there is a gradual expansion of the lumen of the saphenous and perforating veins, resulting in insufficiency of the valve apparatus (non-closing of the valve valve). Pathological reflux (return) of blood occurs from top to bottom and horizontally through destroyed perforating veins.
Diagnosis of varicose veins
For many years, the hands were the only medical tool to examine a patient with varicose veins. X-rays have come to the aid of the surgeon over the past century. However, X-ray contrast examination of veins is a rather complex procedure that requires bulky and expensive equipment, and X-ray contrast agents themselves are by no means safe for the body. With the development of microelectronics and computer technology, previously unavailable diagnostic methods have appeared: Doppler ultrasound, ultrasound angioscanning, plethysmography. The advent of ultrasound duplex scanning has provided new information that has provided a new perspective on the causes of varicose vein development and an understanding of the intricacies of the pathological process.
Doppler ultrasound
This is an ultrasound diagnostic method that allows you to determine the speed and direction of movement of particles (in this case blood cells) in the body. Thus, the doctor is able to find out the direction and speed of blood flow in the veins of the lower extremities. And when performing numerous physiological tests and the condition of the valvular apparatus of the veins of the lower extremities. Knowing the structure of blood flow in the veins in the legs is the main requirement for choosing a method of treatment.
Ultrasound angioscopy
The essence of this method is that the image of the walls of blood vessels and the blood flowing through them is formed on the screen of the ultrasound scanner monitor in real time. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the condition and direction of blood flow through this vessel. The method is highly informative and much safer than X-ray examination, but it is quite expensive, so it is used only in severe cases and during scientific research.
Pletysmography
This is a diagnostic method based on determining the electrical resistance of lower extremity tissue. Its essence lies in the fact that the total electrical resistance of the tissues of the human body directly depends on the amount of blood flowing from and out of them and changes over time with each heartbeat. Plethysmography is used to diagnose the general functional state of blood flow in the lower extremities, is used to monitor drug therapy for venous or arterial insufficiency, in the treatment of trophic disorders and to assess the degree of venous insufficiency.
Of course, all of these techniques do not preclude a direct examination of the patient by a physician, clarification of the medical history, and identification of the patient’s complaints. Based on the overall picture of the disease, the doctor chooses the method of treatment.
Treatment of varicose veins
A qualitative leap in the treatment of varicose veins has occurred, as in other branches of medicine, in the last 50 years. Over the past decades, various drugs for the treatment of chronic venous insufficiency have been developed and continue to improve. The surgical technique for treating varicose veins has been significantly improved. Compression sclerotherapy technology has been developed and practically improved.
Currently, so-called sclerosurgery is gaining popularity around the world. Sclerosurgery is a smart combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can be used only for initial and uncomplicated forms of varicose veins. Varicose vein surgery is also not without problems, varicose vein removal surgery is quite traumatic, requires hospitalization and a long period of rehabilitation. A reasonable combination of these two methods allows you to reduce the trauma of the treatment process to a minimum and achieve an extremely high quality of treatment.
Medical therapy of varicose veins
There are often cases when the patient has practically no varicose veins or their number is very small. However, the person suffers from heaviness in the legs, pain, swelling. These are all signs of chronic venous insufficiency. In these cases, as well as when there are significantly enlarged varicose veins, it is necessary to take medications that improve blood circulation in the legs. Currently, there are several dozen drugs in the arsenal of phlebologists aimed at fighting venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should be chosen only by a physician. Despite the apparent simplicity of choosing a venotonic agent, only a physician can determine a whole range of therapeutic measures and the appropriateness of using a particular drug.
Compression therapy
Compression therapy has been considered an adjunct to drug therapy or surgery for many years. Compression treatment of varicose veins has been used since ancient times, and only in the last decade elastic compression has begun to be considered a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of various brands and special medical compression stockings.
The global industry produces three types of elastic bandages: short, medium and high stretch. High-elongation bandages (elongation of more than 140%) are used to prevent thrombotic complications in the postoperative period after operations on the abdominal and pelvic organs, as well as to fix the joints after and to prevent sports injuries. Short stretch bandages (elongation less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, postthrombophlebitis syndrome, and lymphatic insufficiency. Medium elongation bandages (elongation from 70% to 140%) are used in the treatment of varicose veins, chronic venous insufficiency and compression sclerotherapy.
Medical compression stockings include medical compression stockings, tights, leggings. Many people make the mistake of considering various "anti-varicose" and "supportive" jerseys of increased density therapeutic. To begin with, it is necessary to establish that medical compression products are never labeled in DENs. DEN is a technical characteristic of a knitted fabric that is only indirectly related to the pressure created by the product.
Medical jerseys are classified into several classes of functional compression. The product class is determined by the pressure that the product creates on the ankle and in the lower third of the lower leg. A person suffering from varicose veins has been shown to use 2nd class compression stockings. These tights or leggings will create a pressure on the sore leg of 23-32 mm Hg. Art. That is, to completely equalize the pressure in varicose veins and eliminate venous insufficiency. Moreover, medical compression products create so-called distributed pressure. The pressure they create gradually decreases when the leg moves from the bottom up by 25-30%, which contributes to the efficient outflow of blood and lymph.
It should be immediately noted that the medical jersey is never thin and transparent, a large amount of elastic fibers is needed to create such a high pressure, and accordingly the knitted fabric is thick. It should also be said that a medical jersey is never cheap. The technology of knitting a special knitted fabric is much more complex; when knitting it is also necessary to model the profile of the leg to create a distributed pressure.
The ideal approach in compression therapy is the constant and extensive use of elastic bandages and / or compression stockings by the patient. For example, daily wearing of elastic bandages for a month almost completely corresponds to the efficiency of monthly intake of an effective drug. The use of compression stockings is especially effective in preventing the development and recurrence of varicose veins. The main advantage of using compression products is their absolute health safety compared to even the best drugs, and they are quite comparable in price.
Prevention of varicose veins
If you have the initial signs of varicose veins, following fairly simple rules will slow you down, and in some cases avoid further development. First of all, don’t get carried away by hot baths, saunas or prolonged sun exposure. All of the above reduces venous tone, leads to blood stagnation in the lower extremities. Do not wear tight-fitting clothing, socks and stockings with narrow elastic bands, as this will compress the veins. Overweight and sports associated with a large static load on the legs (tennis, weightlifting, bodybuilding) increase venous pressure. Heels (over 4 cm) - our veins do not like it. Watch your veins, don’t hurt them.
If you find your legs heavy in the evening after a day at work, keep your legs raised while you sleep and rest. If your job is accompanied by long sitting at a table or standing for a long time, then you should change the position of your legs more often, stand in place and rotate your feet. There are special exercises for venous diseases. After showering or bathing, wash your feet with cold water. There are useful sports - especially swimming, but also walking, cycling, skiing. Do not neglect folk remedies for prevention. Useful infusions of cranberry leaves, St. John's wort, cranberries, rose hips. A plant-based diet should be followed. Your doctor may also prescribe a medication called phlebotonic to increase venous tone and improve microcirculation. Recently, the methods of compression prevention and treatment of varicose veins have become quite an understandable success due to the appearance of high-quality medical products on the market.
A special word on prevention for pregnant women. Varicose veins progress during pregnancy, especially when it is not the first, and carrying a child younger than 1 year does not contribute to good vascular function. The basis for prevention is wearing special compression stockings, the use of phlebotonics both during pregnancy and after childbirth. Do not neglect the gynecologist to mention your veins when you are prescribed a hormonal drug, because these drugs affect the work of the veins, reduce their tone.
Do not self-medicate. Talk to your doctor about what is best to do with your veins. This disease is treated by doctors - phlebologists.