All veins in the human body are divided into deep, superficial and perforated. Deep vessels carry out almost all the work (90%) in transporting blood to the heart, and perforated vessels are a kind of bridge between the deep and the superficial. The structure of the veins involves the presence of valves that direct and facilitate the outflow of blood only in the right direction.
For a complete perception of the seriousness of the disease, it is worth noting that its progression threatens with the development of thrombophlebitis, blockage of the pulmonary artery with a thrombus (or thromboembolism), as well as trophic ulcers of the lower leg, lymphostasis (edema of the lower extremities) and many other problems that can lead to the death of the patient.
Varicose veins is a pathological condition in which abnormal expansion of venous vessels is observed. This is due to circulatory disorders, as well as venous valve insufficiency.
The name of the disease in Latin means “bloating.” Actually, just bloating of veins can be seen with the naked eye on the affected area of the body. However, this indicates the dynamic development of the disease and is not a symptom of early varicose veins.
The veins of the legs undergo the most varicose changes, but pathology can also be observed in the vessels of the walls of the large and small pelvis. Very rare cases of this ailment in the vessels of the upper extremities.
It is worth noting that the appearance of the first signs of varicose veins on the legs, as well as their further development (in the absence of treatment) in women is noted several times more often than in men. Moreover, the age indicator does not matter.
Damage to the venous walls can have a bacterial, physical, traumatic, chemical nature of origin.
Based on this, the following provoking factors for the occurrence of such an ailment of the legs can be distinguished:
- sedentary lifestyle;
- professional activity associated with heavy physical exertion or prolonged stay in one position (sitting or standing);
- everyday wearing tight underwear and high-heeled shoes;
- significant increase in body weight;
- period of pregnancy, especially the second and subsequent.
If at least one of these reasons is present in life, then it is worthwhile to immediately eliminate it or at least pay more attention to the condition of the veins on the legs.
Varicose disease of the lower extremities is a pathology of the veins. They lose their former elasticity, begin to expand. The valves, which are necessary for regulating blood flow, gradually fail. As soon as the valves stop functioning properly, significant blood flow problems appear. Varicose veins of the lower extremities are the most common problem faced by phlebologists, although the disease itself can affect other parts of the body.
Until about 2000, in Russia and the CIS countries there were a huge number of different classifications of varicose veins of the legs. However, after a conference in Moscow, a unified system was adopted to designate varicose veins of the lower extremities. It intersected in many ways with the more developed international system that was in effect at that time:
- Stage 1 – a light form with minimal changes that practically do not affect the functionality of the valves.
- Stage 2 – segmental form, when problems with subcutaneous and perforated valves begin.
- Stage 3 is a common variety when the situation with subcutaneous and perforated valves worsens and they stop working.
- Stage 4 – failure of the valves, including deep veins.
The classification does not work alone, therefore, in addition to it, the degree of chronic venous insufficiency is indicated. This makes the indication of the diagnosis more accurate, usually the points of the degree of venous insufficiency coincide with the stage of varicose veins:
- 0 degree – there is no insufficiency.
- Grade 1 is characterized by heaviness in the legs.
- Grade 2 causes edema of the limb, which by the morning almost completely disappears.
- Grade 3 can be determined by constant swelling of the legs, to which the increased temperature of the affected areas, as well as skin spots, are added.
- Grade 4 is the stage at which an ulcer forms on the skin.
In 2004, the unified classification of varicose veins was expanded and supplemented. To date, the number of types of varicose veins of the lower extremities, which is used in the international treatment format, has about 40 points. Among them, there are certain categories related to performance, the severity of the course of the disease, anatomical developmental anomalies, and so on. The final record of the diagnosis in the international format consists of a sequence of alphanumeric designations that are understandable only to a specialist.
Possible complications and consequences
Complications of varicose veins develop mainly in the stage of decompensation. These include:
- phlebitis (inflammation of the dilated vein);
- thrombophlebitis (inflammation of a vein with the formation of blood clots in its lumen);
- bleeding from varicose nodes;
- trophic ulcers;
- pulmonary embolism (pulmonary embolism).
Treatment of varicose veins of the lower extremities
Medicine does not stand still, but develops the latest technology to combat venous disease. Treatment of varicose veins of the lower extremities can be performed by conservative methods (drugs, minimally invasive procedures), surgical intervention, home remedies in combination with massage.
The deterioration of the attractiveness of appearance is not the whole list of possible troubles. Complications and disability can add to it. Modern medicine offers a wide range of non-surgical effects on problem areas, and often it is physiotherapy for varicose veins of the lower extremities that is most effective in the initial stages of the disease:
- The use of creamy preparations, gels, ointments for varicose veins of the lower extremities, these drugs bring noticeable relief. They are easily applied to the surface, do not cause pain and discomfort.
- The use of venotonics – drugs that, with varicose veins of the lower extremities, normalize the functioning of the veins.
- Laser exposure – a method of endovenous laser obliteration of veins (ELOV) is widely used in the fight against varicose veins. The principle of the procedure is to stop the functioning of the problem vein, due to the action of a thermal beam on it. Laser manipulations are performed under local anesthesia, restrictions on actions and an additional stay in the clinic are not required. Immediately after the procedure, the patient has the right to go home.
- Magnetotherapy for varicose veins of the lower extremities is a modern auxiliary method that promotes blood thinning, stimulates blood circulation and, as a result, helps to remove toxins from tissues and saturates them with oxygen.
- Radio frequency exposure – radio frequencies work similarly to a laser. They exclude the problem vessel from the bloodstream, thereby eliminating the risk of possible complications;
- Sclerotherapy – involves the introduction of a special drug into the diseased vein, which favors the gluing of the walls of the vessel and its elimination from the bloodstream after some time.
It is worth noting that a preliminary consultation with a doctor and a special study are required.
Varicose disease of the lower extremities is a pathological condition that is characterized by the development of deformation of the muscular, serous and mucous membranes of the blood vessels of the venous type. Varicose disease of the lower extremities develops as an independent disease and is accompanied by the development of a number of symptomatic symptoms characteristic of it.
With the complete absence of therapeutic measures, severe health consequences can form, up to the complete loss of the affected limb. Symptom correction and pathogenetic treatment are prescribed for each patient individually, depending on the degree of damage and the severity of structural changes in the walls of blood vessels.
In modern clinical practice, there are several options for therapeutic measures against varicose veins of the lower extremities. As statistics show, this pathology often affects the female population of the planet than the male.
In the treatment of patients with varicose veins, three main methods are used.
Conservative therapy involves the use of the following methods of treatment:
- Normalization of physical activity throughout the day, compensation of work and rest and rationing of motor activity throughout the day.
- Regularly conducting specially designed, individual physical exercises.
- Medication is carried out using drugs. The mechanism of action, which is aimed at restoring normal muscle tone in the walls of venous vessels.
For the relief of pain, patients are shown the use of non-steroidal anti-inflammatory drugs (for example: Ibuprofen, Diclofenac). Convulsive syndrome is stopped by using anticonvulsant drugs (Phenytoin, Carbamazepine), and tissue swelling is eliminated with thiazide diuretic drugs (Acripamide, Indapres). Diuretics will help accelerate the process of excretion of pathologically accumulated fluid from the body.
Compression therapy means a minimally invasive technique, during which sclerosis of the affected areas of the vessels is performed. During this treatment technique, the doctor inserts a needle into the damaged vessel, a syringe attached to which is filled with a foamy liquid. Under the supervision of a doctor, foamy fluid is injected into a vein. Foam fills the entire vascular lumen, and this leads to a spasmodic contraction of its lumen.
After this manipulation, the patient is recommended to wear specialized compression stockings for 3-4 days. After 4 days after the intervention, the vessels are glued together. To prevent recurrence of the disease, patients are recommended to wear compression dressings, this will not only alleviate the main symptomatic signs of the disease, but will also contribute to the formation of dense scars in damaged vessels.
Surgery for varicose veins in the lower extremities occurs in the event of massive vascular lesions and their irreversible structural changes. To date, progress in vascular surgery on the face, there are many methods of surgical intervention in such vascular pathology, including plastic surgery to restore the aesthetic appearance of the skin on the affected area.
Operations on deformed vessels are performed using specialized microsurgical equipment, radiological and laser equipment.
In the early stages of pathology, it is possible to perform operations using phototherapy and laser methods to eliminate defects in the valve structures of the veins, but further progression of the disease can lead to radical surgery. Radical surgery involves performing an incision in the area of a damaged vessel, suturing and removing it.
Some patients with trophic changes in the skin and deep tissues of the lower extremities are recommended to perform a skin transplant in the complex, if this is not done, infectious and inflammatory complications may occur after surgery.
After any surgical and minimally invasive interventions, patients are shown the prophylactic use of antibacterial drugs. Antibiotics are prescribed to prevent infection or the spread of infection throughout the human body.
Some patients love the use of folk remedies as a correction of vascular pathology, but most often these methods are carried out in addition to monitoring the attending doctor and this can lead to serious consequences for the patient’s health.
Conservative treatment of varicose veins is mainly prescribed to those people who have clear contraindications for surgical intervention.
Also, such treatment is indicated if the patient has a slight dilatation of the veins, which is an exclusively cosmetic defect. The goal of conservative therapy is also to prevent the further progression of this ailment. For this purpose, patients are recommended to apply bandaging of the legs affected by varicose veins, elastic bandage.
In addition, compression hosiery for varicose veins is indicated. People who are prone to varicose veins or already suffer from this ailment should regularly put their feet on an elevation throughout the day, thus resting for several minutes. There are also special exercises for the lower leg and foot, aimed at activating the muscle-venous pump. This is a periodic extension and flexion in the ankle and knee joints.
The patient should be careful not to tighten the lower leg and thighs with different objects of the toilet, as this can significantly impede the flow of venous blood.
With the help of elastic compression, you can activate the blood flow in the deep veins, prevent edema, reduce the amount of blood in the saphenous veins, promote the body’s metabolic processes and blood microcirculation.
But in order to achieve positive results, it is important to bandage the leg correctly. This process must be done in the morning, not yet getting out of bed. Bandaging starts from the toes to the thigh, with a slight tension on the bandage. In the process of bandaging, you must grab the heel and ankle joint.
Treatment of varicose veins also involves wearing comfortable shoes, which should have a low heel and a stiff outsole. You should not stand for long, allow physical stress, or stay in rooms with high temperature and humidity for a long time. In a dream, it is advisable to keep the legs elevated.
Patients should limit the use of fluid and salt, try to get rid of excess weight. For the treatment of varicose veins, it is periodically necessary to take diuretics, drugs that improve the tone of the veins. In addition, if there is evidence, the patient may be prescribed medications that stimulate microcirculation in the tissues. Therapy for varicose veins can also include non-steroidal anti-inflammatory drugs.
If the patient has an uncomplicated form of the disease, he is shown physical therapy exercises. It is very useful to swim, other water procedures, foot baths with warm water, to which a 5-10% solution of sodium chloride is added.
Very often, local therapies are used in the treatment of varicose veins. But such treatment must be used in combination with other drug methods. Local remedies for varicose veins are released in the form of gels, ointments, creams. Most of these drugs contain heparin or venoactive components.
Pathogenetic features of the development of the disease
As the anatomical features of the veins of the lower extremities indicate, there are two of their main varieties, peripheral and deep vascular plexuses. Depending on what localization of the veins of the lower extremities, there is an outflow of blood from muscle tissue to different levels of depth.
A distinctive feature of venous vessels from arterial vessels is the weak intensity of the development of the muscle layer and the presence of valve structures in their lumen. The low strength of muscle contractions does not allow spontaneous pumping of blood from the lower extremities in the opposite direction. The outflow of blood is produced as a result of contractions of muscle muscles, blood is pushed to the top, and valve structures prevent the reverse regurgitation of blood.
Varicose vein disease develops as a result of a violation of the normal physiological outflow of blood from the muscles of the lower extremities. Violation of the valve apparatus of venous vessels takes part in the pathogenesis of this condition. With damage to the valve structure of the veins of the lower extremities, venous blood is pushed not only upward, but also a reverse current occurs. This pathological process leads to an increase in pressure in the blood vessels and, as a result, the expansion and deformation of their walls.
The deformed surfaces of the membranes of the venous vessels also develop against the background of increased stimulation of the vasomotor center, which puts a big strain on the veins. If pathogenetic mechanisms are not eliminated and treatment is not carried out at an early stage, surgical removal of damaged vessels may be necessary since their walls will no longer be functionally capable.
Varicose veins of the lower extremities refers to diseases, the etiology of which can be very diverse, mainly associated with increased loads on the lower extremities.
The main predisposing factors for the development of the disease include:
- the presence in the history of life of genetic anomalies in the structure of the vascular bed, the presence of a similar pathology in the closest biological relatives;
- during pregnancy, an increase in the load on the lower extremities occurs and compression of the main branches of the vascular bed occurs with an enlarged pregnant uterus. During pregnancy, symptomatic signs of swelling and the appearance of vascular deformities are considered common;
- a sharp or gradual increase in total body weight, obesity of the first, second and third degree. With increased body weight, the risk of developing atherosclerosis of the vessels of the lower extremities and fatty deformation of the venous vessels increases sharply;
- non-observance of an active lifestyle, a long stay in an immobile state, especially in a standing position, pressure on the vascular walls increases, muscle contractility is minimized, the venous pump in this case ceases to function;
- the use of tight clothing leads to compression of the superficial venous vessels and, as a result, an increase in the load on deep veins;
- malnutrition also plays a characteristic role in the development of this pathology. Due to improper mode and quality of nutrition, intestinal absorption function is gradually disrupted. An intestinal digestion disorder leads to impaired absorption of essential nutrients for the body, including vitamins, which are responsible for the active regeneration of the vascular wall;
- hormonal drugs used for therapeutic purposes and as a method of oral contraception.
Prevention of this pathological condition is important not only for people with burdened heredity, but also for people with difficult working conditions and with an increased body mass index.
As a prophylaxis, patients should be provided with an intensive rest regimen, but it is necessary to carry out specialized therapeutic exercises.
Opinions that patients with varicose veins should be deceptive for as long as possible in a horizontal or sitting position should be allowed to contract muscles periodically to improve venous outflow.
It is recommended to practice sports such as running, rollerblading or cycling. With such exercises, the muscles of the limbs will regularly contract and provide contractility of the muscle wall of the veins. With the timely implementation of the necessary measures to correct the underlying disease, the prognosis for recovery will be favorable. Prevention and treatment of the disease should be carried out in a timely manner.
First of all, the visible symptoms of varicose veins in the legs are the appearance of a network of thin veins on the surface of the skin of the legs. Such manifestations mainly occur in the hip area. Such a varicose net is most easily seen in people who suffer from cellulite. Sometimes it is cellulite that becomes a kind of harbinger of varicose veins. Often, fat deposits in cellulite compress the venous vessels, and as a result, blood flow is complicated and varicose veins occur.
Capillary networks on the legs, which appear at the beginning of varicose veins, are called telangiectasias. However, it should be noted that such external manifestations can be both signs of varicose veins and a manifestation of a temporary inflammatory process.
In some cases, the onset of varicose veins is indicated by swelling on the legs. However, this symptom may be a symptom of other diseases (heart failure, kidney stones, kidney stones). Therefore, in this case it is impossible to clearly talk about the development of varicose veins before a diagnosis is established.
The symptom of varicose veins is often also the manifestation of pain in the legs. Pain can be acute, as well as pulling symptoms. Most often with varicose veins, pain in the calves is manifested. It mainly occurs in the afternoon, after a certain load on the legs.
Thus, a person who observes the appearance of a capillary network, periodic manifestations of pain and swelling, should consult a doctor and do the necessary research.
Often, varicose veins give the patient a certain cosmetic discomfort. But besides this, he may experience a feeling of severe heaviness in his legs, cramps may occur at night, trophic changes gradually appear on his legs.
Visually, varicose disease can manifest itself both in not very noticeable “stars” of small vessels, and in very large nodes and plexuses, which are especially distinguished when the patient is in an upright position.
If palpation of the veins is performed, then their elastic elastic consistency is determined, they are easily compressed. Each over the nodes of varicose veins can have a higher temperature than the rest of the sites. If a person takes a horizontal position, then the tension of the veins decreases, and the nodes become less pronounced.
If during the development of the disease a person does not think about how to treat varicose veins, the disease progresses, and gradually the symptoms of fatigue, the constant heaviness of the legs and the sensation of swelling in their tissues attach to the described symptoms, sometimes convulsions may occur. If edema appears, then they disappear after a long rest at night.
The first (compensated) stage
At this stage, the symptoms of varicose veins are extremely mild. Anatomically, the manifestations of varicose veins of the lower extremities in this case represent a relatively small valve insufficiency in the deep veins of the legs. Moreover, all violations of the venous blood flow are compensated by healthy veins that are not affected by the disease.
At this stage, the patient may experience discomfort in the legs with great physical exertion. Symptoms of varicose veins of the lower extremities are manifested by extremely rare swelling. Most often, the patient simply notes the fact that the legs become more tired in the evening. There are no visible symptoms of varicose veins of the lower extremities.
Clinically, this stage of varicose disease of the lower extremities corresponds to class 0 – there are no symptoms of the disease during palpation and examination, the patient does not complain. Varicose veins on the legs can be recognized at this stage if an ultrasound scan with Dopplerography is done, but since there are no complaints, it is rarely prescribed.
This stage of the disease is characterized by more severe symptoms. Changes in the structure of venous valves occurs more deeply, therefore external symptoms of varicose veins develop, but they do not lead to complications. Leg pain with varicose veins appears at this stage. Edema appears almost every evening, especially after prolonged standing on uncomfortable shoes.
At night, the patient notes numbness and cramps – often they are taken for the first signs of varicose veins on the legs. Morning tingling, impaired sensitivity, the appearance of pathological pigmentation are signs of deep vein varicose veins of the lower extremities.
Externally, varicose veins on the legs, the symptoms of which are described above, are manifested by the appearance of a vascular pattern (“stars”) on the skin, a violation of pigmentation. Varicose veins on the legs are often accompanied by a violation of the regeneration of skin injuries – cuts, scratches, bruises heal much longer than usual.
Clinically, four classes correspond to these signs of varicose veins on the legs:
- C1 – the appearance of the first symptoms of varicose veins – telangiectasias and reticular venous vessels (“asterisks” and “reticuli”);
- C2 – a distinct venous pattern on the skin, allowing you to see how the expanded veins appear;
- C3 – edema, often it is this symptom that allows you to identify varicose veins of the deep veins;
- C4a is a subclass of varicose veins of the lower extremities, the symptoms of which affect the course of various processes in the skin – pigmentation, the development of eczema (C4b refers to decompensated varicose veins).
As can be seen from the above, the signs of varicose veins on the legs at this stage are very diverse. The examination involves examination and palpation, ultrasound of the vessels of the lower extremities, a biochemical blood test to identify indicators of coagulation and the risk of thrombosis.
Complications of this stage are swelling of the lower leg and foot, as well as the development of inflammatory complications – phlebitis and thrombophlebitis. Symptoms of these conditions, in addition to noticeable signs of varicose veins, are manifested by signs of poor circulation in the legs.
Methods of treating varicose veins at this stage are the use of drugs that prevent thrombosis, increase blood flow, and strengthen the vascular wall. But these methods reduce the symptoms of varicose veins of the legs, but do not cause a regression of the disease. If therapeutic methods are ineffective, surgical methods are used – descriptions and photos of how to prepare for the operation can be found on the Internet.
Symptoms and treatment of varicose veins at this stage are of the greatest difficulty. If the patient did not pay attention to the first signs of varicose veins on the legs, did not start treatment, then complications of the disease appear. Symptoms of varicose veins on the legs at this stage are especially pronounced – leg pain is almost constant, sometimes so intense that it makes it impossible to move independently. Edema progresses, sometimes so much that lymphatic varicose veins are manifested – the outflow of lymph on the surface of the skin.
The external signs of varicose veins on the legs are noticeable, sometimes ugly in nature – protruding veins, a scattering of dark brown pigmented spots, trophic ulcers, which are often inflamed, and purulent processes occur in them. One of the characteristic signs is varicose eczema. Its first manifestations appear even at the previous stage, but with decompensation it reaches its maximum manifestation.
At this stage, varicose veins on the legs, the symptoms of which are manifested as brightly as possible, pose a serious threat to the patient’s working capacity and sometimes life. Leg pain, edema, paresthesia, impaired sensation of the legs lead to the fact that the patient becomes unable to do the work that he was doing before.
Clinically, varicose veins in the decompensated stage correspond to three functional classes – C4b, which is characterized by dystrophic changes in the subcutaneous tissue, C6 – active trophic ulcer and C5 – healed trophic ulcer. Complications of decompensated varicose veins are trophic ulcers, thrombophlebitis, bleeding and inflammation of ulcers, in severe cases – gangrene.
The treatment of the disease is only operational. A vein in which blood flow is impaired is removed under the supervision of an ultrasound, but even in this case, the symptoms of leg varicose veins do not completely disappear. The operation requires preparation, but is carried out quite quickly, after which the patient can be activated early. In the postoperative period, it is necessary to wear compression anti-embolic underwear, a radical change in lifestyle and nutrition.
Complications that developed as symptoms of varicose veins of the lower extremities are treated depending on the severity. Trophic ulcers without inflammation are treated conservatively with the use of antibiotics, drugs that accelerate wound healing, and others. If the effectiveness of therapeutic measures is low, surgical treatment is used – the ulcer is excised within the limits of healthy tissues, then the skin area is plasticized.
If there is an inflammatory process or bleeding, then surgery is the only effective treatment. After it follows a long postoperative period, which necessarily requires a radical change in the patient’s lifestyle in order to prevent recurrence of the disease.
Despite the severity of the condition, one must not forget about the importance of preventive and conservative measures. Even at such a severe stage, varicose veins must be treated by taking drugs to strengthen the vascular wall, facilitate blood flow, and thin the blood. The doctor should prescribe therapy.
Gels, ointments and creams for external use, effectively eliminating the symptoms of varicose veins of the legs at earlier stages, cannot be used if there are unhealed skin defects, especially inflamed trophic ulcers. Even the presence of small scratches or abrasions is a contraindication to their use.
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