Varicose veins or varicose veins of the lower limbs is of primary varicose transformation of superficial veins of the lower extremities, in which the compound is "bumps" or "knots" on his feet.
Varicose disease is widely distributed around the world. Its frequency reaches 60 % among the adult population depending on country. Interestingly, the inhabitants of the African continent and the Asia-Pacific region suffer from varicose veins much less than people in European countries and the USA.
In connection with the absence of definite causes of varicose veins of the lower extremities is customary to talk about its risk factors, that is, those that increases the likelihood of developing this pathology (property or characteristic of the human body, any effect on the body). In accordance with the generally accepted risk factors for the disease are age, female gender, obesity and heredity. Typical "portrait" of a patient with symptoms of varicose veins — a woman in a state of menopause, with excessive body mass index that has multiple pregnancies and childbirth in anamnesis.
Symptoms of varicose veins in the legs
In overwhelming majority of cases, varicose veins can be recognized even without special medical education. Ob chiuni a definite sign of pathology — the appearance of "bumps" or "nodes" on the lower limbs, while the skin over them is usually not distinguished by any special color. Blue Vienna, as a rule, is not a disease in its literal meaning, though often bring the patients (most often women) inconvenience of an aesthetic nature.
However, in advanced cases, varicose veins may be accompanied by skin discoloration due to venous eczema, which is manifested in a variety itchy skin rash (vesicles, nodules) and redness.
These signs, along with swelling of the legs, which does not disappear for the night time indicates the formation of chronic venous insufficiency.
As for the subject of eliminating the symptoms of varicose veins, it should be noted their non-specificity. Complaints can indicate the disease, and can be a sign of overload of the venous system of the lower extremities. Most often patients suffer from heaviness, bloating and minor non-localized aching pain in the calves. Sometimes the connection has complaints of pain in the area of varicose veins and fatigue legs.
Burning, tingling, m azow night cramps or restless leg syndrome (unpleasant sensations in the legs at rest, when you need their movement to alleviate this discomfort) was most commonly found in neurological disease, for example, radicular syndrome, and should be taken into account with caution.
Pathogenesis of varicose veins in the legs
Pathogenesis of varicose veins of the lower limbs is quite complex and versatile. The main role in the mechanism of disease development plays damage the walls and valves of veins. As a result of their irregular work formed a reverse flow of blood (reflux), then there is a loss of the endothelium (the inner lining of the vessel), which is accompanied by inflammation.
Later in the pathological process involved the middle and inner layer of the venous wall, there is a proliferation of connective tissue in g atomu layer of the vein, and then it is atrophy that leads to progressive destruction of the collagen of the vessel. These events disrupt the elastic properties of Vienna, contribute to the further extension of the lumen and the helical twist along the length. At the same time similar changes were observed in venous valves.
It should be noted that venous visible "bumps" and "nodes" is usually the result of the presence of an invisible source of varicose veins — the great saphenous vein. In the vast majority of cases this is a large, rarely small saphenous vein. The above changes in the pool of these veins and lead to varicose disease.
Complications of varicose veins in the legs
Complications of varicose veins should include trophic disorders (venous ulcers), thrombosis or varicose changed veins (thrombophlebitis) or bleeding from varicose "bumps" and "nodes".
Trophic disorders are a consequence of disease progression in the absence of treatment, it often takes years and decades. They start with cutaneous manifestations of hyperpigmentation (brown spots), venous eczema and lipodermatosclerosis (seal skin).
The main localization of these changes is the tibia, although venous eczema can be observed in the region of varicose veins, including on the thigh. Depending on the source of varicose veins (great or small saphenous veins) of venous disorders will be localized or inner, or the outer surface of the lower third of the leg, respectively. The result of malnutrition of the soft tissues to serve the formation of venous ulcers at the site of the previous changes. Ulcers are single or multiple, with irregular shape, sloping edges and a flat, smooth bottom. It is noted the allocation of scarce, often purulent character. The sores are accompanied by itching and more. For venous ulcers is remarkable for a long period of existence (of the month) and part recurrence.
Thrombophlebitis or superficial vein thrombosis should not be confused with deep vein thrombosis. Otherwise, the situation is much more serious. However, in thrombotic lesions varicose veins symptoms are quite unpleasant. In the region thrombosed vein painful threadlike forms a seal, it is characterized by redness, warmth and tenderness, sometimes seals will limit the movement of the limb. The clinical picture resembles an ulcer or abscess.
Thrombophlebitis can be especially dangerous if you take upward character and move from the superficial system into the deep. In this case, it may develop as pulmonary embolism and deep vein thrombosis.
Bleeding from varicose veins look very scary, because due to the high venous pressure stream of blood strong enough. In some cases this can lead to significant blood loss.
Diagnosis of varicose veins in the legs
Diagnosis of varicose veins of the lower extremities do not usually cause any problems. A key feature of the disease is the presence of a venous "bumps" and/or "nodes". Although excessive development of the subcutaneous fat of the lower limbs, to see them can be difficult.
To further confirm the diagnosis using various methods of instrumental diagnostics, the leading of which is ultrasonic duplex scanning (USDs). It allows you to quickly, accurately and safely determine the source of varicose veins, to assess the size and structure of the vessel, the function of venous valves, the scale distribution of the return current of blood and to detect the presence of blood clots. At the same time look round and deep and superficial venous system. Conducting research should be in the standing position or, if the patient's condition does not allow, sitting with lowered legs. The study in the supine position can lead to errors in determining reflux and blood clots.
To further evaluate the function of the valves and the length of a return current of blood is used:
- compression test with pressure on different segments of the lower extremities;
- the sample with straining (Valsalva test);
- a simulated walk;
- welcome paraná is easy to attempt the removal of the patient from the equilibrium state with the purpose of calling the tension of calf muscles.
Summary of ultrasonographic duplex study of lower limb veins is necessary to fix in the form of an opinion, and graphics, by drawing a "vein map". The results of the study provide an invaluable aid in planning further treatment. However, they need to be taken into account only in conjunction with clinical data, as changes in the ultrasound pattern in the absence of objective signs of disease (varicose veins) should be considered functional (i.e. not associated with pathology of the veins). It is also worth noting that an ultrasound scan does not necessarily hold if the diagnosis is clear and if the patient does not plan surgical treatment of varicose veins.
There are additional methods of diagnosis:
- Doppler ultrasound — Doppler ultrasound (not to be confused with USDS);
- plethysmography;
- radiopaque venography;
- radiotelegraphy;
- computed tomography (CT);
- magnetic resonance imaging (MRI);
- thermography;
- intravascular ultrasound (IVUS) is a new method.
Treatment of varicose veins in the legs
The primary goal of treatment of varicose veins of the lower extremities is to eliminate all the malfunctioning veins. This is only possible using invasive methods. There are three can:
- Removal of combined phlebectomy short vein Stripping, miniphlebectomy, dissection of perforating veins;
- "Bonding" — sclerotherapy, mechanochemical ablation, cyanoacrylate obliteration;
- "Brewing" — endovenous laser or radiofrequency ablation.
To achieve the goal of treatment must perform two tasks: to remove the source of varicose veins (so-called vertical reflux) and remove varicose Veni. For a long time the most commonly used method was combined phlebectomy. Its technical construction includes two stages:
- Ligation anastomosis — the connection of the unity of the great saphenous vein with the common femoral vein (crossectomy);
- Remove trunk of the saphenous vein with the probe (Stripping).
This intervention is radical and has a number of disadvantages inherent in any operation: frequent need for anesthesia, the presence of incisions and sutures, and a significant rehabilitation period and increased in comparison with other methods the risk of complications.
However, about twenty years ago there was a "phlebology revolution." It became possible thanks to the widespread adoption of ultrasound scanning and the appearance of fine techniques — endovenous thermal ablation. Its essence lies in the effects of high temperatures on the wall of the vein from the inside. This is achieved by laser radiation (EVLO) or RFR (RFO), "safariways" Prout Veni.
Vienna this immediately ceases functioning, and then gradually resolves. This method allows you to without incision, fast, efficient, safe and aesthetically pleasing vertical to eliminate reflux without the need for further rehabilitation. Being a bright representative of "office surgery", endovenous thermal ablation for ten years is considered the most optimal method of treatment of varicose veins worldwide.
Sclerotherapy (bonding affected Vienna by entering a special substance) also found wide use in the elimination of varicose veins. However, to achieve the desired result requires careful selection of patients due to increased risk of disease recurrence.
Conservative treatments including compression therapy, phlebotrophic drugs and local medicinal forms (gels, ointments), are purely auxiliary in nature, affecting mostly the symptoms of varicose veins without eliminating its sources.
Forecast. Prevention
Taking into account modern methods of treatment, the prognosis of varicose veins is favorable. Even in the most seemingly advanced cases to remove the varicose transformed veins leads to a rapid improvement of the patient's condition.
However, when planning treatment it is important to assess its risks, as any intervention still carries potential adverse effects. A duty of the physician is to minimize their likelihood. Before any manipulation should be discussed with the patient all aspects regarding the intervention and to obtain his signature on informed consent.
All adverse events can be divided into risks associated with surgery, including anaesthesia and the risks to the patient.
The risks of surgery can be small, for example, inflammation (phlebitis) in the "brewed" or sklerozirovanie veins, which is accompanied by the seal projection and moderate pain. Can hook up to appear in skin areas with reduced sensitivity, and hyperpigmentation of the skin. All these side effects are temporary and usually pass fairly quickly without any consequences.
To big complications include deep vein thrombosis, allergic and toxic reactions to anesthetics. They occur very rarely, but for the individual patient who had a similar complication, the case is 100%, even statistically, 1 in 10,000 operations.
Prevention of venous thrombosis, primarily based on the calculation of risk in the so-called scale-point system using the table Caprini. It contains various risk factors, which have a gradation. Account of each factor and excretion of the total score determines the degree of risk and therefore its prevention. The main means of prevention of venous thromboembolism following:
- minimizing the morbidity of the operation;
- early activation of the patient;
- compression stockings;
- pharmacological prophylaxis, that is, the assignment according to the testimony of anticoagulants — drugs that thin the blood.
As for the prevention of varicose veins, it simply does not exist, since it is still not clear the main cause of the pathology, which can be changed and thus to prevent its onset. Associated with this, and quite often the recurrence of varicose veins after any type of intervention. However, given all the advantages of a minimally invasive treatment, this is not a significant problem. To maintain the legs quite simple, the main time to turn to considering the