Varicose veins (varicose veins)

Varicose veins most often affect the venous system of the legs. External manifestations (bulging nodular blue veins, swelling) are not just a cosmetic problem, but signs of a serious illness that worsens over time.

What are varicose veins: definition of the disease

The word "varices" comes from the Latin varix - "swelling". The name fully reflects the pathological process: the walls of the veins become thinner and expansions (sac-like swellings) - nodules - form in some areas.

The first case of varicose veins was recorded in a document from 86 BC. C. BC: The Roman general Gaius Marius complained of pain in his legs due to "blue, swollen veins. "

The main reason for the development of varicose veins (varicose veins, varicose veins) is increased pressure in the superficial vessel system. This is facilitated by certain diseases, hormonal changes and a sedentary lifestyle.

At first, even under the influence of these factors, the vessels function normally, but little by little they begin to deform, altering their structure and are no longer able to fully transport blood.

Varicose veins can develop almost anywhere on the body, but they most often appear on the lower extremities. Therefore, when it comes to varicose veins, by default they mean leg problems.

Code for varicose veins in ICD-10

The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.

I83 - varicose veins of the lower extremities:

• I83. 0 - varicose veins of the lower limbs with ulcers;
• I83. 1 - varicose veins of the lower extremities with inflammation;
• I83. 2 - varicose veins of the lower extremities with ulcers and inflammation.

85 - esophageal varices:

• I85. 0 - esophageal varices with bleeding;
• I85. 9 - esophageal varices without bleeding.

I86 - varicose veins in other locations:

• I86. 0 - varicose veins of the sublingual veins;
• I86. 1 - varicose veins of the scrotum (anatomical formation in men - receptacle of the testicles and their appendages);
• I86. 2 - pelvic varicose veins;
• I86. 3 - varicose veins of the vulva (a woman's external genitalia);
• I86. 4 - stomach varicose veins.

O22. 0 - varicose veins of the lower extremities during pregnancy.

In our country, 30 million people suffer from various forms of varicose veins. A third of them have complications - trophic ulcers. An open defect in the skin or mucous membrane that occurs due to impaired blood circulation and tissue innervation.

The mechanism of development of varicose veins

The body's pathological reactions are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels will help understand how and why the disease develops.

How blood moves around the body

There are two types of vessels in the human body – veins and arteries. Blood flows through arteries from the heart to all organs and tissues. This occurs under high pressure (70–120 mm Hg) and at high speed.

Blood flows through the veins of organs and tissues and is directed to the heart under low pressure (0–20 mm Hg).

The walls of veins are less thick and elastic than the walls of arteries and, unlike arteries, they do not contain as developed a muscular layer. Therefore, varicose veins are only possible in veins but not in arteries.

Arterial and venous human circulatory system. Veins are indicated in blue and arteries in red.

Low pressure in the veins is necessary to transport blood from the periphery to the center. But at the same time, on the way to the heart, the blood flow encounters an obstacle - the force of gravity. This force forces blood back through the veins.

You can often hear that varicose veins are humanity's retribution for walking upright. After all, the greatest distance that blood must travel in the body, overcoming gravity, is the path from the feet to the heart. The movement of blood in the veins is guaranteed by the contractions of the heart, the muscular pump of the surrounding muscles and the negative pressure in the chest during inspiration.

In healthy vessels, the reverse flow of blood is prevented by valves in the inner walls of the veins. The valves act like one-way revolving doors - they open and allow blood to flow to the heart, and close immediately if gravity tries to push the blood back out.

It's not just the valves that help the veins carry blood to the heart, but also the muscles that surround the vessels. By contracting and relaxing, muscles help move blood through the veins. This mechanism only works when a person moves. When standing or sitting for a long time, the muscle pump becomes practically inactive.

The cusps of the venous valves always face the direction of blood flow - towards the heart

How failure occurs and disease occurs

An increase in pressure in the venous system disrupts the functioning of the valve apparatus and leads to reverse blood flow through the vessels. Due to this, as well as due to stagnation of excess blood, weakness of the valve apparatus (for example, in connective tissue diseases), the lumen of the veins expands, the walls are deformed, become thinner and similar to local sacs protrusions - we - are formed.

The process is similar to blowing up a balloon: if you don't let the air escape, the balloon inflates more and more.

On the left is normal blood flow; on the right - multidirectional blood flow due to malfunction of venous valves, vascular deformation

There are superficial and deep veins in the legs. 85–90% of the total blood volume passes through the deep ones, only 10–15% through the superficial ones. The walls of deep veins are denser and more adapted to increased blood volume. And the superficial veins in the legs are thinner and more susceptible to varicose veins.

In the pelvis and lower parts of the esophagus there are large venous plexuses, which can also undergo varicose transformation. In the veins of the small pelvis, the mechanism of development of the disease is the same as in the lower extremities. But varicose veins in the esophagus arise for another reason: due to portal hypertension - increased pressure in the portal vein system, which develops with cirrhosis of the liver, hepatitis, parasitic liver lesions, fatty hepatosis, etc.

Causes of varicose veins

Several factors contribute to the development of varicose veins in the legs. The main ones arevalve insufficiencyANDheredity. It is known that a quarter of patients had close relatives who suffered from one of the forms of varicose veins.

Overweight. The more extra pounds a person has, the greater the load on the venous system. Over time, the veins no longer withstand this pressure: the lumen of the vessels increases and the valves in their walls stop closing completely. As a result, blood stagnation and the development of varicose veins occur.

Pregnancy. Hormonal changes occur in a woman's body, body weight, intra-abdominal pressure and the volume of circulating blood increase - this leads to a disruption in the outflow, causes stretching of the walls of the veins and changes in the functioning of the valve apparatus.

After childbirth, the diameter of the dilated veins decreases, but does not always return to its original value. In subsequent pregnancies, the risk of developing varicose veins increases.

Age. Varicose veins generally affect people after the age of 50. The older the person, the more the venous valves wear out, while the recovery processes slow down and the mechanism of pathological expansion of the veins is triggered - the development of varicose veins.

venous refluxVenous refluxReturn of blood through the veins due to resistance to blood flow, from lat. refluo - "to flow backwards". found in 10–15% of school-aged children aged 12–13. The disease "gets younger" due to a sedentary lifestyle and being overweight.

Varicose veins of the lower extremities develop more quickly if there are additional risk factors.

Risk factors that contribute to the development of varicose veins in the legs:

• lack of physical activity - when moving, muscles stimulate blood flow in the veins, and without movement, blood circulation in the veins can be difficult;
• smoking - chemicals contained in tobacco smoke damage the walls of blood vessels, as a result, their lumen narrows, blood flow becomes difficult and stagnation occurs, which leads to the appearance of varicose veins;
• professions that involve standing or sitting for long periods of time - hairdressers, surgeons, cooks, waiters, drivers, office workers are at risk;
• menopause - in women aged 40 to 50 years, the production of sex hormones (estrogen and progesterone) decreases and, at the same time, the tone of the venous wall decreases. This increases the likelihood of varicose veins.

Women suffer from varicose veins 3-4 times more often than men. This occurs due to hormonal variability (menstrual cycle, pregnancy, menopause).

During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva

Varicose veins can occur not only in the lower extremities, but also in other parts of the body.

The main causes of varicose veins in various locations

Esophageal varices

Changes in the veins of the esophagus with an uneven increase in their lumen, protrusion of the wall and the development of nodular tortuosity of the vessels. It often leads to a life-threatening complication - bleeding.

Reasons:

• cirrhosis
• liver cancer
• other diseases that cause increased pressure in the portal vein system - collects blood from the abdominal organs

Varicose veins of the scrotum (varicocele)Pathological dilation of the veins of the pampiniform plexus of the testis. Manifested by varicose veins in the scrotum and impaired blood flow

Reasons:

• congenital incompetence of the valves of the testicular veins (usually the left)
• mechanical compression of the testicular vein (inguinal hernia)

Varicose veins of the pelvis

It is characterized by dilation of the ovarian veins and intrapelvic venous plexuses of various diameters. The condition is also known as pelvic congestion syndrome.

Reasons:

• polycystic ovary syndrome
• two or more pregnancies
• hormonal dysfunction

Varicose veins of the vulva

Varicose veins of the pelvis, which affect the vessels of the labia and perineum

Reasons:

• compression of the retroperitoneal vessels by the uterus during pregnancy
• significant physical activity
• tumors of the uterus and ovaries

Varicose veins of the sublingual veins (sublingual varicose veins)

Asymptomatic damage to the veins located under the tongue. It manifests as a slight protrusion of blood vessels and a change in color from deep blue to purple

Reasons:

• hypertension
• smoke
• old age

Stomach varicose veins

Isolated change in the stomach veins or combined with esophageal varices

Reasons:

• cirrhosis
• portal hypertension syndrome - increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thrombosis, abnormalities in venous development)

Symptoms of varicose veins

In rare cases, only the aesthetic side of the disease appears - bluish veins. Most patients suffering from varicose veins in their legs report at least one or more unpleasant symptoms.

Symptoms of varicose veins of the lower extremities:

• fatigue, pain or heaviness in the legs - this is caused by stagnation of blood and its pressure on the surrounding tissues;
• burning, tingling or pulsation in the legs - a reaction to decreased blood flow and overflow of the venous system of the lower extremities;
• nocturnal muscle cramps in the legs - painful spasms occur due to blood stagnation and the accumulation of metabolic products in tissues;
• swelling of the feet and ankles - due to stagnation in the veins, the liquid part of the blood penetrates into the subcutaneous tissue through the altered vascular wall;
• itchy skin around damaged veins - dilated and altered blood vessels do not provide normal blood circulation and nutrition to the skin, as a result of which it dries up and becomes rough.

Unpleasant sensations in the legs in patients with varicose veins intensify at night, especially after long periods of sitting or standing.

The appearance of altered veins is not always proportional to the severity of the symptoms. Thus, veins that are barely visible to the eye and affected by varicose veins can cause serious discomfort, while nodular and thickened veins can cause minimal concern.

Varicose veins affect different veins: from small skin vessels to large saphenous veins

Symptoms of other types of varicose veins largely depend on the underlying cause of the condition. Often patients do not complain about anything and the doctor identifies the problem only during the examination. This happens, for example, with varicose veins in the sublingual veins.

In some cases, as with varicose veins of the esophagus or stomach, the pathology immediately manifests itself as a life-threatening complication - bleeding.

Classification of venous diseases

In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation formed by the initial letters of the main sections of the classification:

• C — clinical (clinical changes);
• E — etiology (origin of the disease);
• A - anatomy (anatomical location of varicose veins);
• P - pathogenesis (mechanism of venous blood flow disorders).

Complications of varicose veins in the legs

Typically, varicose veins alone are not life-threatening. But sometimes the disease can cause complications.

Thrombophlebitis- inflammation of the walls of the veins, which is accompanied by the formation of a thrombus (blood clot) closing the lumen of the vessel. It manifests as swelling and redness along the affected vein. The patient feels pain, the skin in the affected area becomes red and hot to the touch.

Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue along the thrombosed vein.

Venous trophic ulcer- an open defect of the skin and soft tissues due to blood stagnation, edema and impaired cellular nutrition. The ulcer occurs on the legs and ankles, near areas of varicose veins. In the lower legs, swelling is more pronounced, meaning the tissues are more compressed than in other areas. Ulcers take a long time to heal and often contain bacteria, which increase inflammation.

Trophic ulcers heal very poorly due to impaired blood circulation and tissue nutrition

Bleeding- occurs when a vein ruptures, dilated due to varicose veins. In the more advanced stages of the disease, the skin over these veins becomes very thin and dry – a small injury is enough for the integrity of the vessel to be compromised and bleeding to occur. Sometimes a spontaneous rupture of a vein occurs in the area of varicose nodules.

Diagnosis of varicose veins of the legs

A phlebologist deals with the diagnosis, treatment and prevention of venous diseases. The doctor makes the diagnosis based on the patient's complaints, examinations and instrumental studies. If the symptoms of varicose veins are pronounced, examinations are usually not prescribed: a medical examination is sufficient.

The doctor may prescribe laboratory tests in preparation for surgery or to exclude concomitant diseases that affect the condition of the blood vessels.

One of these diseases is diabetes mellitus. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).

For accurate diagnosis and determination of treatment tactics, you will need duplex ultrasound - the gold standard for diagnosing vascular diseases. The method allows you to evaluate the structure, function, patency of superficial and deep veins, the consistency of the valves, and also determine the direction of blood flow.

If varicose veins of a secondary nature are suspected (may occur after deep vein thrombosis), the doctor prescribes venography, computed tomography venography or magnetic resonance imaging.

Phlebography is an x-ray examination used to determine the patency of deep veins and valve function.

Computerized or magnetic resonance venography is used to visualize the venous system in three-dimensional projection and at very high spatial resolution.

Treatment of varicose veins in the legs

The aim of treating varicose veins is to reduce or eliminate symptoms, improve the appearance of the veins and prevent complications.

The doctor chooses a treatment method depending on the affected vessels and the severity of the patient's condition with varicose veins.

Non-invasive treatments

Non-invasive treatments for varicose veins include compression therapy, drug therapy, and lifestyle changes.

Compression therapy involves the use of special stockings, stockings and tights. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the appropriate mesh.

The compression shirt on the lower legs compresses more than the upper legs - thus pushing blood towards the heart and eliminating stagnation

Effects of compression therapy for varicose veins:

• manifestations of symptoms decrease - heaviness, leg fatigue, night cramps, burning sensation or pain;
• the severity of edema is reduced due to improved blood circulation;
• The healing of trophic ulcers is accelerated because elastic compression improves blood circulation and tissue nutrition.

Drug therapy - the doctor may prescribe phlebotropic medications. Phlebotropic medications (phleboprotectors, venotonics). Biologically active substances that increase venous tone and reduce the severity of venospecific symptoms. medications (venotropics).

The main groups of phlebotropic drugs used for varicose veins:

• angioprotectors: improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the likelihood of blood clots;
• antithrombotic agents: reduce the risk of formation of dangerous blood clots (thrombi) in the lumen of blood vessels and promote the dissolution of existing ones;
• bioflavonoids: natural plant compounds that improve venous tone and reduce venous congestion.

Changes in lifestyle for varicose veins significantly slow down the development of the disease and, in combination with other recommendations from the attending physician, help stop the pathological process.

Important guidelines for changing the lifestyle of patients with varicose veins:

• moderate intensity exercises: walking, swimming, water aerobics, leg exercises, yoga. Strengthening muscles will help normalize blood circulation in the vessels, relieve venous stagnation and edema;
• weight control: thanks to the normalization of body weight, the load on the blood vessels is reduced and the return of blood through the veins to the heart is facilitated;
• giving up bad habits: nicotine and alcohol damage the inner walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of your veins and valve function.

Invasive methods for treating varicose veins

Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure that uses a special sclerosing solution (sclerosant). The solution is injected into the problem vein through a thin needle, which causes its sclerosis - "gluing". The vein is disconnected from the bloodstream and becomes invisible over time, its function is taken over by neighboring veins; Sclerotherapy is performed without hospitalization - after the procedure the patient can go home.

The sclerotherapy procedure takes 5 to 30 minutes, depending on how many varicose veins need to be filled with sclerosant and their size

Intravenous laser thermobliteration (EVLO). A catheter with laser light guidance is inserted into the vessel through a small incision. The thermal energy of the laser heats the vein and it becomes obliterated – "sealed". After a few months, the vessel is replaced by connective tissue and disappears. The procedure is performed on an outpatient basis.

Radiofrequency vein obliteration (RFO) is the effect of high frequency current on the inner surface of blood vessels. Using a micropuncture, a catheter is inserted into the vein, which is connected to a device that generates radiofrequency pulses. Inside the vessel, the radio wave is converted into thermal energy, which "seals" the vein.

With EVLO, the vein is briefly exposed to high temperatures; with RFO, the temperature is lower but the session is longer. Both procedures are effective and safe.

NTNT obliteration or non-thermal, non-intumescent methods:

• venous obliteration with cyanoacrylate glue;
• mechanochemical obliteration, in which mechanical and chemical effects occur simultaneously on the vessel.

NTNT obliteration is the most modern and non-traumatic method of treating varicose veins with a short rehabilitation period.

Phlebectomy is the removal of saphenous veins that have suffered from varicose veins. It can be performed as an independent operation or combined with other techniques. The varicose vein is removed under local anesthesia using small punctures.

Prevention of varicose veins in the legs

You can prevent the development of varicose veins if you follow simple prevention rules in everyday life.

A combination of provoking factors – sitting for long periods with legs crossed, wearing uncomfortable shoes – increases the risk of varicose veins in the legs.

Varicose vein prevention - what you need to know:

• moderate physical activity (walking, swimming, leg exercises) and resting with legs elevated improve the free circulation of blood in the vessels and help prevent stagnation in the veins;
• rational nutrition and weight normalization lead to strengthening blood vessels;
• wearing loose clothing that does not restrict movement helps improve blood circulation;
• a cold shower in the hot season helps keep your veins toned;
• comfortable shoes with low heels (no more than 3 cm) allow you to avoid inappropriate load on the foot and disruption of blood flow;
• A reasonable approach to visiting saunas and Turkish baths allows you to maintain normal blood flow (long-term thermal procedures greatly dilate the veins, so blood flow slows down).