Everything you need to know about varicose veins of the lower extremities

Varicose veins of the lower extremities are characterized by dilation of the superficial veins of the legs, which is accompanied by a violation of blood flow in them and valve failure. As a result, the veins increase in length and diameter, take on a serpentine, cylindrical or baggy appearance, although there are also mixed manifestations of these deformations.

Characteristics of the venous system

The appearance and development of varicose veins is directly related to the venous system of the legs, which consists of:

• saphenous veins: small and large;
• deeply located veins (in the lower leg and thigh);
• perforating veins, which are the connecting link of the two previous systems.

Usually 90% of the blood is transported to the lower extremities by deep veins, and the remaining 10% to the superficial ones. When it returns to the side of the heart, this mechanism is supported by valves in the walls of the veins. When the next meal of blood arrives, they slam to prevent it from moving from top to bottom under the influence of gravitational force. Muscle contractions push the blood further to the heart, allowing normal blood flow.

Long stay of a person in an upright position can develop blood stagnation, which increases the pressure in the veins and causes an increase in their diameter. This process provokes incomplete closing of the valve flaps, as a result of which the blood flow is disturbed by the return flow from the heart - reflux.

The valves of the deep veins will most likely be affected, because they carry the largest amount of blood and therefore experience the maximum load. In order to reduce the high pressure in them, a part of the blood is transferred through perforated veins to the superficial ones, which were not originally intended for a large amount. Such a load on the walls of the veins leads to their expansion and the formation of varicose veins.

At the same time, blood enters the deep veins without stopping, but due to the violation of their functions and the normal activity of the valves of the perforated veins, the blood is redistributed to the superficial vessels. As a result, a chronic varicose vein develops, which over time is accompanied by painful feelings, edema and trophic ulcers.

Causes of disease

Previously, one of the main causes of varicose veins was called a hereditary factor, but today this theory has been refuted. Of course, it is possible to follow the frequent manifestations of the disease in some families, but this is more likely due to the peculiarities of life that are shared in the family: diet culture, passive rest, inactive work and the like.

The development of varicose veins is based on the presence of reflux in the venous system, when blood circulates in the veins in the opposite direction. Additional transport of blood from deeply located veins to superficial veins is possible due to congenital or acquired degenerative pathology of the valve apparatus. This causes the superficial vessels to overfill with blood and dilate when venous nodules form.

One of the fundamental reasons for the development of varicose veins is considered to be an unhealthy diet, which in some cases leads to obesity. Such people move little, mostly eat highly processed foods, and the proportion of plant fiber in the diet is minimized. Finally, they are the ones involved in strengthening the walls of veins and blood vessels and preventing long-term chronic constipation, which greatly increases intra-abdominal pressure and thus causes varicose veins. It is observed that an increase in body weight by more than 20% increases the risk of disease fivefold.

The main provocative factor for women is the birth of a child, while the risks of varicose veins increase with each subsequent pregnancy. Strong weight gain and an enlarged uterus create great stress on stagnant legs. This situation is exacerbated by the constant increase in intra-abdominal pressure and the action of the hormone progesterone, which affects the condition of elastic fibers in the walls of blood vessels.

Other factors that provoke varicose veins of the lower extremities include:

• an inactive lifestyle, standing upright during the day (for example, hairdressers), long flights or long trips. All this leads to stagnant processes in the lower extremities, when blood accumulates in the superficial veins and is poorly transmitted to the heart;
• from time to time increases the risk of developing varicose veins in women who wear uncomfortable tight shoes, especially models with high heels;
• corsets and tight underwear compress the inguinal veins and increase intra-abdominal pressure, which is a direct prerequisite for varicose veins;
• High blood pressure;
• smoking, which indirectly leads to thinning of the walls of blood vessels.

Classification of diseases

Varicose veins of the lower extremities are classified depending on the prevalence of venous lesions, their localization, as well as the presence of pathological reflux, which is characterized by impaired blood flow. There are 4 forms of varicose veins:

• intracutaneous and subcutaneous varicose veins (segmental), in which there is no pathological outflow of venous blood;
• segmental varicose veins, when reflux occurs through perforating or superficial veins;
• a common form of varicose veins, in which reflux occurs simultaneously through perforating and superficial veins;
• varicose veins are characterized by reflux in the deep veins.

Once varicose veins of the lower extremities become chronic, phlebology takes into account three degrees:

1. Transient edema, which occurs periodically on the background of "heavy leg" syndrome.
2. Persistent, persistent edema. Hyperpigmentation and eczema may occur.
3. Venous ulcer of trophic nature.

The latter stage is the most difficult to treat, because it requires prior removal of inflammation and healing of skin tissues.

Stages and symptoms

The disease develops very slowly, sometimes more than ten years, until the symptoms that appear force the patient to seek advice from a phlebologist. In the initial stages of varicose veins, its manifestations are often attributed to fatigue, old age or other reasons. In order to fully consider the symptoms of the disease, its manifestations are classified according to the stages of varicose veins:

1. The first stage begins to manifest more often at a young age - after 20 years, when you feel a feeling of heaviness in the legs, edema can appear that completely disappears overnight. On the inside of the lower leg, you can see an enlarged vein manifested by a lumpy bulge in the skin. At this stage, many people notice small spider veins. In general, the symptomatology is subtle and rarely gets the attention it deserves.
2. The second phase is characterized by an increase in the external manifestation of varicose veins. The disease is already developing in the background of the pathological work of the venous valves, so the saphenous veins are noticeably enlarged, and their lengthening can be noticed. There is more often weight and tingling in the legs, they get tired quickly on long walks.
3. The disease is already becoming chronic due to a constant imbalance in the outflow of venous blood. In the evening, patients suffer from edema near the ankle, which can be very intense. The difficulty is in the legs, and cramps can occur at night.
4. In the absence of treatment in the previous stages, chronic insufficiency of the functioning of the venous system negatively affects the metabolic processes in the skin, especially the areas in the lower part of the leg. Darkening of the skin is visible near the ankle - hyperpigmentation, it thickens and eventually becomes inflamed. The disease described is called lipodermatosclerosis. If you do not start venous therapy at that time, then trophic ulcers will start to form.
5. The fifth phase is followed by numerous trophic ulcers, some of which occasionally heal by creating scars.
6. Extensive ulcers open in the zone of long-standing trophic disorders. This condition requires urgent active therapy aimed at both treating varicose veins and healing ulcers on the skin.

Diagnosis

An external examination of the lower extremities in the vertical and horizontal position of the body, palpation of the veins and a preliminary assessment of the stage of the disease are performed. The patient is sent for a general blood test that allows you to study the picture of the disease in more detail:

• at the platelet level the tendency to thrombosis will be reflected;
• hemoglobin levels, as well as the number of red blood cells, indicate the degree of blood clotting;
• Inflammation can be judged by the increased level of leukocytes, which helps to diagnose thrombophlebitis faster.

Be sure to examine the venous system of the legs, for which there are many methods:

• Doppler ultrasound - USDG;
• phlebography;
• CT phlebography;
• duplex angioscanning - USAS;
• fleboscintiography;
• photoplasmography;
• phlebomanometry and the like.

In practice, patients are more often prescribed USAS and USG, because they help to fully study the venous system of the legs and identify degenerative areas. The rest of the method can be additionally prescribed if the ultrasound examination did not give a complete vision of the picture of the disease. Some of these methods can have complications such as venous thrombosis, perforation of the vessel wall with a catheter, and allergy to a contrast agent. Consider the most common practices in phlebology:

1. USAS enables the assessment of anatomical, hemodynamic and functional pathologies of the venous bed. The obtained data are subject to computer processing, after which the model of the venous system can be viewed on video or printed on paper.
2. Doppler ultrasound with high precision determines the patency of superficial and deeply located veins, the speed of blood flow. Doppler ultrasonography allows the evaluation of the operation of the valve apparatus.

After an extensive diagnosis, the doctor makes a phlebocard of the patient that allows you to determine the damaged segments of the venous system, their degree and length. The appropriate treatment is then chosen.

Treatment

It is performed in a comprehensive manner and is determined based on the symptoms, the degree of disease development and the results of the study. In the initial stages, conservative therapy is prescribed, which consists of:

1. Drug treatment when a group of drugs is prescribed:
   • antioprotectors and phlebotonics;
   • anticoagulants;
   • separated
   • topical preparations (ointments, gels);
   • anti-inflammatory drugs.
2. Elastic compression, for which compression stockings or bandages are used (rare). It enables dosing of muscle contraction, prevents stagnant processes, improves blood flow through the veins. Wearing such underwear artificially maintains vascular tone.
3. Physiotherapeutic methods, among which the best treatment results were shown by electrophoresis, diadynamic currents, laser radiation and magnetic field.
4. Feasible physical activity that should be performed only in compression underwear (except for swimming). Cycling, swimming, running are recommended. The phlebologist selects an individual set of exercises for the lower limbs, which will train the veins of the legs on a daily basis.

In addition, patients are advised to perform contrasting five-minute shower procedures every night, alternating between hot and cold water. Such manipulations improve blood flow and tone blood vessels.

At the beginning of treatment, it is important to identify the factor that provokes the disease in order to effectively influence it. And patients who are at risk should visit a phlebologist every 2 years for a preventive examination and ultrasound examination of the veins in the legs.

When conservative treatment does not give results or varicose veins are noticed at an advanced stage, then surgery is used. Today, varicose veins can be completely cured thanks to the following methods:

1. Phlebectomy. The essence of the operation is the removal of the main logs of the superficial vein in order to remove the pathological discharge of blood. Perforated veins are often ligated for the same purpose.
2. Sclerotherapy. It consists in introducing sclerosant into the affected area of the vein, which leads to the connection of its walls. Recently, they began to actively use foam sclerosant for the same purposes according to the technology -. Blood flow through the defective area is stopped and the cosmetic defect in the form of protruding nodules is removed. After such an intervention, no scars remain, all manipulations are performed on an outpatient basis without a subsequent inpatient stay. But sclerotherapy is used only to connect small branches of venous trunks.
3. Laser coagulation. With the help of a laser beam, the marked part of the vein is heated, the walls of which stick together and the flow of blood through it is stopped. But this technique is indicated only for veins with a diameter of less than a centimeter.

Prevention

Preventive measures can be primary, aimed at preventing the development of varicose veins, and secondary when it is necessary to reduce the risk of recurrence after surgery or to prevent a worsening of the course of the disease. Useful tips:

• lead an active lifestyle without much strain on your legs: swimming, walking, cycling;
• watch your weight;
• more often keep both legs raised;
• do not wear tight underwear and heels larger than 4 inches;
• use orthopedic insoles;
• take a shower with a contrast shower;
• do five-minute preventative leg exercises daily;
• wear compression stockings on long walks.

If you notice even the slightest suspicion of varicose veins - prominent nodules on the legs, swelling, heaviness, then do not delay a visit to a phlebologist. Indeed, over time, this insidious disease can cause many complications, including thrombophlebitis and thrombosis.