Varicose veins on the legs

Varicose veins on the legs are characterized by the formation of saccular expansions of the superficial (subcutaneous) veins of the lower extremities, their serpentine tortuosity, an increase in length due to impaired blood flow through them and stagnant changes in the lower extremities.

The term “varices” comes from the Latin word varix, which means “twisting, intertwining”.

Humanity has been familiar with varicose veins since ancient times.When carrying out archaeological research during the excavations of the Mastaba cemetery in Egypt from 1595-1580.BC a mummy was found with signs of varicose veins and treatment for a venous trophic ulcer of the leg.

This disease is rightfully considered the price humanity pays for the ability to walk upright.On average, about 15% of men and up to 25% of women (including pregnant women) in economically developed countries suffer from varicose veins in the legs.The high-risk group includes women, people who are overweight, people with a profession that involves prolonged stress on the lower limbs and whose work requires them to stand or sit for long periods of time.

Classification

Taking into account the factors that predispose to the development of the disease, primary and secondary varicose veins on the legs are differentiated for several reasons.

1. Primarydevelops with varicose veins.In varicose veins, it is mainly the superficial veins that change, while the deep veins have normal structure and function.For a long time, varicose veins of superficial veins manifest themselves only as a cosmetic defect, but later, as the disease progresses, disturbances in venous outflow occur, resulting in painful sensations in the lower extremities, swelling of the feet and legs, darkening of the skin in the lower third of the leg, inflammatory changes and trophic ulcers.Varicose veins are a continually progressive disease.
2. Secondaryis a complication of deep vein disease, in particular, it develops as a result of congenital malformations of the venous system (fistulas, congenital dysplasia, etc.) or after suffering phlebothrombosis.Phlebothrombosis is a complex process of thrombus formation in the deep main veins of the lower extremities, as a result of which blood flow through the deep veins is disrupted.Over time, the forming blood clot becomes fixed in the vein, holes appear through which limited blood flow is possible, but the venous valves at the site of the blood clot become scarred and no longer prevent the reverse flow of blood.As a result of dysfunction of the deep vein valves, blood begins to move up and down through them, flows back into the superficial veins, and secondary varicose veins develop.As a result, favorable conditions are created for venous stagnation, especially in the lower parts of the limb - the foot and leg.

Symptoms of varicose veins

In most people, varicose veins appear as a cosmetic defect, most often appearing on the inner surface of the legs.Sometimes varicose veins can only appear in the form of a venous web, which forms when small diameter veins change, more often on the legs and less often on the face or upper extremities.Varicose veins turn blue or dark purple and have a tortuous course.

Symptoms of varicose veins: fatigue, feeling of heaviness, intense pain, burning and tingling sensations, throbbing, itching, cramps and anxiety.Additionally, one of the symptoms may be the appearance of swelling in the legs.As a result of the pronounced expansion of varicose veins, a violation of the blood supply to the tissues of the lower extremities may occur, skin defects in the form of darkening or redness and inflammation may occur.In extremely advanced cases of varicose veins, trophic ulcers develop.

Diagnosis of varicose veins

To establish the diagnosis, the doctor first examines the patient, paying special attention to the appearance and swelling of the lower extremities.You can also answer a series of questions about your sensations to clarify the nature of the pain.Another important step is to perform a series of tests to assess the functional status of the superficial and deep veins.And finally, perform a Doppler ultrasound examination of the main veins of the lower extremities.The ultrasound examination method allows the doctor to see the structure and evaluate the function of the veins of the lower extremities, as well as identify venous blood clots.

When the first symptoms of the disease appear, you should contact doctors who treat diseases of the blood vessels and veins in particular (general surgeon, vascular surgeon and phlebologist) and, if the skin is damaged, you should also consult a dermatologist.Only after visiting specialist doctors on their recommendation can you go to a cosmetology clinic.

Varicose vein prevention

Currently, there is no method that completely prevents the development of varicose veins.Thanks to prevention, it is possible to improve muscle tone, which helps to improve tissue microcirculation, as well as improving the condition and function of the veins in the lower extremities and reducing the risk of complications.The traditional and most widespread prevention methods are the following:

1. Physical activity.Move more.Your legs should be constantly moving.During a walk, more favorable conditions are created for blood circulation in the lower extremities.Consult your doctor.It will help you choose the most appropriate type and level of physical activity.
2. Control your weight.Excess weight increases the load on the circulatory system and, in particular, on the veins.Furthermore, with excessive salt consumption, edema increases more markedly as a result of fluid retention in the body.
3. Pay attention to what you wear.Avoid high heels.Your shoes should always be comfortable.When wearing low-heeled shoes, the muscles in the lower limbs work much better, which helps to improve venous flow.You should also avoid wearing uncomfortable, tight pants and skirts.
4. Raise your feet.When you raise your legs, venous blood flow from the lower extremities improves.Try taking a few breaks throughout the day and put your feet up.For example, lie on your back with your feet propped up on a pillow.
5. Avoid prolonged periods of standing or walking.To improve blood circulation, try to change your body position as often as possible.Try getting up and walking every 30 minutes.
6. Don't sit cross-legged.Sitting with your legs crossed creates unfavorable conditions for blood flow in both lower extremities.

To prevent varicose veins, a good remedy is to wear stockings, knee-high socks and socks with a compression effect.It can also be a good complement to the main treatment (medication or surgery).Nowadays, pharmacies offer a wide variety of compression garments to choose from.

Varicose veins treatment

There are several generally accepted methods for treating varicose veins on the legs:

1. conservative (medication and compression therapy).
2. surgical.

Conservative treatment

Doctors consider elastic compression to be the most effective conservative means of treating and preventing varicose veins - the use of special compression stockings (stockings, golfs, tights).When using this mesh, uniform pressure on the lower extremities is ensured, which promotes normal blood circulation and improves its outflow, while forming, so to speak, an external frame that supports the weakened vascular walls.As a result, the load on the veins is reduced, venous blood flow is improved, the rate of disease progression is reduced and the risk of developing thrombosis is reduced.

Modern compression stockings are divided into two types: therapeutic and preventive.Each medical product is marked in mmHg, according to which it is divided into classes from I to IV.At different stages of the disease, compression of a certain strength is used and a doctor's consultation is necessary, as only a doctor can prescribe and select the correct compression stockings, taking into account the nature of the pathology and in accordance with certain individual standards.

If you have a sedentary lifestyle, as well as during prolonged physical activity, during pregnancy or with a hereditary predisposition, it is recommended to wear preventive compression stockings and tights.If small signs of varicose veins appear, you should immediately contact a specialized clinic.

Drug therapy can reduce the clinical manifestations of the disease - pain, swelling, discomfort, cramps and so on, but it cannot completely stop the progression of the disease and today it is used only as part of complex therapy during the main surgical treatment.Unfortunately, most of the drugs offered today on the pharmaceutical market for the treatment of varicose veins have a rather low effectiveness, despite the theoretically justified feasibility of use.One of the reasons for this is the low absorption by the body of the medicinal substances underlying these medicines.It is possible that in this situation increasing the dose of the medication used will help, but this is associated with an increased risk of complications and side effects.Another reason for the low effectiveness of these medications is that their spectrum of action is relatively narrow and targets a specific link involved in the development and progression of the disease.And to achieve the ideal effect, a complex effect on the disease and the use of several medications are necessary.An ideal drug for the treatment of venous insufficiency and varicose veins should affect as many pathogenetic links of chronic venous insufficiency as possible, while having a minimum number of side effects and being well absorbed by the body.

Surgical treatment

Today, surgical treatment of varicose veins in the legs does not require a long hospital stay.Thanks to the use of modern invasive treatment methods, removal of varicose veins can be carried out not only under anesthesia with the patient completely turned off, but also under local anesthesia, when the patient has clear consciousness, only the pain sensitivity of the lower extremities is turned off.Varicose veins disappear spontaneously within 3 months after giving birth, without any treatment.

The following surgical treatment methods are available:

1. Sclerotherapy.During this procedure, a solution is injected, under the influence of which a scar forms at the site of the injured vein.This method is only applicable for small and medium-sized varicose veins.Occasionally, not one but several injections of sclerosing solution may be necessary for the vein to disappear completely.Sclerotherapy is quite effective when carried out correctly, it is low-traumatic, provides good therapeutic and cosmetic effects, and a significant advantage is that sclerotherapy is carried out under local anesthesia (that is, without anesthesia), directly in the doctor's office.
2. Laser surgery.Laser radiation can be used to remove varicose veins of any diameter and, especially, venous meshwork.The essence of the method is to irradiate the inner surface of the vein with a laser beam.Through a small puncture in the skin and vein wall, a special device is inserted - a light guide, through which a laser beam passes under ultrasound control.The inner surface of the vein is irradiated with a laser and then glued together.When using this method, the doctor directs a laser beam at the vein that needs to be removed, slowly discoloring it and causing the vein to completely disappear.An important advantage of this method is that no incisions are made into the soft tissue or skin.Using the laser method, it is possible to eliminate damaged veins and cure trophic leg ulcers.
3. Surgical removal of varicose veins.During surgical removal, a series of small incisions are made in the skin and soft tissue, through which the damaged vein is removed and the insufficient perforating veins in the leg are ligated.When using this technique, anesthesia is a necessary condition.This method is used to remove large varicose veins.
4. Outpatient phlebectomy (removal of varicose veins).This method is suitable for removing small diameter veins.With this method, the vein is removed through several small incisions in the skin under local anesthesia.The scars formed after removal are small and almost invisible.
5. Endoscopic removal of varicose veins.This method is especially suitable for the formation of skin defects in the form of ulcers.During this method, a special micro video camera is inserted into the vessel, which allows you to see the vessel from the inside and observe the entire removal procedure.The vein is then removed under observation through this camera.

Thanks to the use of modern treatment methods, it is possible to achieve a complete cure and a good cosmetic effect.But you need to remember that varicose veins can reappear.

Complications of varicose veins

Occasionally, changes from pronounced darkening to ulcerative skin defects may occur in the skin surrounding varicose veins as a result of impaired blood microcirculation.If these changes occur, you should consult a doctor immediately.

Another more serious complication of varicose veins is the development of blood clots in the deep and superficial veins.This complication is called thrombophlebitis.When this occurs, sharp and unbearable pain, swelling and redness appear.In this situation, you should also immediately consult a doctor.

Causes of varicose veins

The true nature of varicose veins is not clear enough.According to most scientists, varicose veins are hereditary, genetically determined.Its main cause is weakness of the venous wall and dysfunction of the venous valves.Venous valves originate from the vein wall and normally have 2 leaflets facing the heart.With normal valve closure, blood from the overlying section of the vein cannot penetrate the underlying section.When valve function is impaired and the valves do not close completely, blood rises and falls, resulting in venous stagnation and dilation of the veins located below the valve with impaired function.Initially, a varicose vein appears in the place where there is a valve with impaired function, and blood is discharged towards the deep veins towards the external ones, the filled vein stretches and expands, which leads to stretching and disruption of the function of the underlying valve, and so on.Disturbances in the venous outflow of blood from the lower extremity to the heart develop gradually, as a result of which blood microcirculation is disturbed in the tissues of the lower extremities, which is manifested by edema, increased pigmentation, thrombophlebitis and trophic ulcers.

Factors in the development of varicose veins

Factors that contribute to varicose veins may include:

1. Genetic predisposition – thin and weak wall of superficial veins.
2. Increased load on the veins: sedentary work, standing for a long time, wearing uncomfortable high-heeled shoes, lifting heavy objects, lack of movement in the leg muscles.Additionally, a trigger for the development of varicose veins is pregnancy and childbirth.With sudden physical exertion, there is a strong increase in hydrostatic pressure in the veins of the lower extremities, which triggers the varicose veins process.

Risk factors for developing varicose veins also include:

1. Age.With age, the walls of the veins, as well as the valves, become thinner, which leads to a natural disruption of their function.
2. Floor.Women are more likely to suffer from varicose veins.It is possible that this is due to a series of hormonal reactions.Female sex hormones influence the relaxation process of the venous wall.Pronounced hormonal changes in the female body occur during pregnancy and childbirth, during the menstrual cycle and during menopause, which cannot but affect the function of the venous system.It is also impossible to exclude the influence of the use of hormonal contraceptives on the varicose veins process.
3. Obesity.With overweight and obesity, the load on the veins of the lower extremities increases.
4. Pregnancy and childbirth.In pregnant women, the volume load on the body increases, but at the same time the rate of blood flow from the lower extremities to the pelvic cavity, to the inferior vena cava system and to the heart decreases.Thus, favorable conditions are created for the development of varicose veins.Changes in the circulatory system of a woman's body ensure the development of the fetus, but at the same time cause the development of varicose veins.As pregnancy progresses or during childbirth, varicose veins can progress not only in the lower extremities but also in the hemorrhoidal veins around the anus.