The disease caused by the violation of the structure of the vascular walls, their thinning, with pronounced stagnant processes of blood flow, is called varicose veins. The disease often affects the lower extremities, although it can be localized in the rest of the body. According to the International Classification of Diseases of the Tenth Revision of ICD 10, varicose veins were assigned code 183, which includes four titles describing different manifestations of the disease.
How did varicose veins appear?
The first mention of varicose veins was found in ancient Greek papyri. History and confirmed scientific facts show that varicose veins of the lower extremities were found in the found Egyptian mummy - it can be claimed that the disease accompanies humanity during its existence.
Top doctors - Avicenna, Hippocrates, Galen tried to treat varicose veins of the lower extremities. In the nineteenth century, painful and traumatic methods of treatment were used, which consisted of dissecting the tissues of the upper leg and lower leg to damage the saphenous veins, followed by bandaging. It was understood that in this way it was possible to prevent stagnant blood flow and remove varicose veins. However, the methods left terrible, extensive scars on the patients' bodies and contributed to damage to nerves, arteries and lymph flow disorders.
Somewhat later, the history of the treatment of varicose veins achieved a positive shift - in 1908, for the first time, a metal probe was used as a means of minimally invasive effect on the walls of blood vessels. The discovery of radiography made it possible to perform more accurate and effective surgical operations to remove varicose veins. Now, when the correct diagnosis and treatment of the disease is needed, duplex and triplex scanning, powerful drugs, laser therapy and sclerotherapy are used. Surgical intervention is used only in cases where varicose veins cannot be removed moderately.
The main causes of the disease
Varicose veins pose a great danger, the pathology has become "younger" - before, mostly older people suffered, now varicose veins are diagnosed in young patients, extremely rarely in children.
Causes of the disease:
- Genetic predisposition.
- Overweight, overweight, obesity.
- Sedentary inactive lifestyle.
- Improper diet, poor blood quality.
- Concomitant disease of the cardiovascular system.
- Professional activity.
- Prolonged standing, heavy physical exertion.
- Pregnancy and hormonal changes.
- Individual features of the structure of the vascular system.
- Pathological congenital diseases.
- Wear heeled shoes, tight clothing.
- Thermal treatments.
Any of the above reasons can cause the development of varicose veins, the consequences of which are dangerous, including death.
Structure of venous vessels
To understand what causes varicose veins of the lower extremities, you need to have an idea of the structure of the vascular system and the mechanism of its work. It represents the totality of the main (deep and superficial) and connecting perforating (communication) veins.
The small superficial vein begins in the area of the foot, extends along the back of the lower leg, branches below the knee into two branches, connects with the popliteal vein, and the deep femoral vein.
In the area of the ankle joint, a large superficial saphenous vein is formed, which extends along the surface of the lower leg and the knee joint and connects with the femoral vein. Deep veins are located along the branches of the arteries, and the entire venous system is connected by perforated veins.
With normal blood flow, oxygenated blood flows directly into the heart, and special venous valves prevent backflow. Varicose veins of the lower extremities imply strong pressure, the diameter of the venous lumen increases significantly, the valves do not cope with the task, reflux occurs - reverse blood flow. Improper blood circulation causes excessive expansion (stretching) of vascular walls, their thinning, venous obstruction and blood stasis. As a result - bloating, swelling of the veins, the formation of nodules.
Symptoms and clinical picture
Varicose veins can progress for a long time in a latent form, then the signs appear:
- The formation of spider veins is a reticular cluster of dilated small veins.
- A well-defined pattern of clogged veins protruding under the skin.
- Formation of blood vessel constriction sites - varicose veins in the form of well-marked tubercles on the legs.
- Change in normal skin color, cyanosis, blackness appears, the upper layer (dermis) gets a loose structure.
- Feeling of pain, heaviness, bloating and fatigue of the legs, reduced mobility, difficulty walking.
- With varicose veins of the lower extremities, it is possible to create soft tissue swelling.
Neglecting timely treatment leads to serious and dangerous consequences, when a person can be cured only by immediate surgical intervention.
Classification of diseases
Varicose veins according to ICD 10 are classified into a disease with ulcer, with inflammation, with ulcer and inflammation, when these signs are not present. According to the International Classification of Chronic Venous Diseases, created in 1994, varicose veins are classified into:
- Intradermal, segmental. No pathological venous discharge is observed.
- Segmentally with reverse blood flow, it occurs through superficial and perforated veins.
- It is distributed by reverse blood flow through superficial and perforated veins.
- Varicose veins with reverse blood flow through deep veins.
It is common to divide the disease according to additional signs of the clinical picture:
- There are no symptoms on examination or palpation.
- Reticular veins are pronounced.
- There are varicose veins.
- There is swelling of the soft tissues.
- Violation of normal skin color.
- Lipodermatosclerosis detected.
- There is a healed ulcer.
- An active ulcer was detected.
Symptoms are absent or subjective (patient feelings). In addition, varicose veins are classified for reasons: congenital, primary, secondary, with an unknown factor that caused the development of the disease.
Diagnosis of varicose veins
The predominant way to identify varicose veins is visual examination and palpation of the patient. In order to carefully determine the severity of the disease and select the correct treatment, after studying the history of the disease and the application of palpation, the phlebologist prescribes:
- Complete blood count is the main standard for determining red blood cell count and hemoglobin level. According to blood clotting, conclusions are made about the stage of disease development and predisposition to thrombosis.
- Doppler ultrasound. The method consists of ultrasound diagnostics of the speed and direction of blood particles. This allows you to determine in which direction the blood flow is conducted, whether there is sufficient speed.
- Ultrasound agnoscopic scanning. It is used for visual inspection of vascular walls, their structure, direction and speed of blood flow in real time on the monitor of the ultrasound device.
- Plethysmography. Diagnosis is based on the detection of electrical resistance of the leg tissue. With proper circulation, the parameter should indicate normal standards.
- Rheovasographic diagnostics. Based on determining the index of blood filling with tissue. The rheographic index helps determine the stage of varicose veins - compensation, subcompensation or decompensation.
The history of the disease and its study, the collection of comprehensive diagnostic data, allow the physician to choose the method of treatment.
Conservative drug therapy
This method of treatment involves the appointment of special drugs that have a positive effect on the course of the disease. Conservative treatment of varicose veins is effective in the initial stages, it is used as an additional method of treatment in the formation of nodules, ulcers, eczema.
The main groups of prescribed drugs are:
- Phlebotonics and phleboprotectors. Venotonic drugs that involve conservative treatment are standard. Promote the restoration of the structure of vascular walls, strengthen and tone blood vessels.
- Means for effective blood thinning. They contribute to the improvement of the quality composition, blood flows faster through the veins, reduces the risk of blood clots, restores normal blood circulation and relieves pain.
- NSAIDs (anti-inflammatory drugs). Eliminate pain, prevent cramps, effectively relieve inflammation and swelling.
Conservative treatment helps with timely referral to a phlebologist, in the initial stage it is possible to influence the composition of the blood and the condition of the vascular walls. Drastic measures are needed for complex forms of the disease.
Laser therapy
Laser therapy is recognized as a gentle and least traumatic method when varicose veins of the legs require treatment classified according to ICD 10 at 183. The idea of the method is to use a laser beam that actively affects the vascular walls and promotes their adhesion. . An LED connected to a laser device is inserted into a vein by piercing the skin. The bundle is selective and has no effect on adjacent healthy tissue. Significant advantages of laser therapy in the treatment of varicose veins:
- Fast positive effect.
- Absence of pain and injury.
- Stable result, long-term remission.
- Restoration of normal blood circulation.
Contraindications for use will be thick or too thin vessel walls, large venous lumens, pregnancy, oncology and other serious comorbidities.
Sclerotherapy for varicose veins
The method is based on the introduction into the vessels affected by varicose veins of special liquid or foam preparations - sclerosants. They replace endothelial cells with fibrous tissue. Needles, syringes and sclerosants are used to perform sclerotherapy.
The treatment technique consists of the following steps:
- perforation of the pathological vein;
- pumping out all blood from the vessel;
- administration of a sclerosing composition;
- imposing an appropriate bandage or knit compression.
This method gives lasting results. The procedure is painless, the fusion of vascular tissue with varicose veins is an alternative to surgery.
Performing an operation
The most painful and traumatic way to treat varicose veins is surgery. Indications for performance will be extensive vascular lesions, the presence of varicose veins, dangerous consequences of the disease, for example, acute thrombophlebitis.
Phlebectomy is performed under local anesthesia, the pathological vein is ligated, and the required number of incisions is made to remove it. Surgery is recognized as an effective method of treatment, and the result shows in eighty percent of cases. But phlebectomy has a number of side effects: wound complications, lymph node trauma, in extreme cases with deep nerve damage, immobilization and disability can occur.
To prevent dangerous complications of varicose veins, which manifest themselves: nodules, ulcers, bleeding, phlebothrombosis, pulmonary embolism and other serious consequences, you should consult a doctor in the initial stage of varicose veins!