Varicose veins are a disease of the veins, expressed in their expansion, lengthening with the formation of nodules and thinning of the venous wall. It can affect various vessels, but most often occurs in the lower extremities.
In advanced cases, it leads to trophic disorders in the affected area, development of ulcers, eczema and even necrosis and gangrene. That is why it is important to make the correct diagnosis in time and start treatment.
How do varicose veins develop?
The exact causes of this disease are not known. But the mechanism of how varicose veins start is well understood.
The venous network of the lower extremities is represented by deep and peripheral veins, as well as communicating (perforating) vessels that connect them. Normally, blood flows through the veins to the heart, from the peripheral to the deep vessels.
This happens thanks to the muscle pump (contraction of the muscles of the lower limbs), the tone of the vascular wall and the work of the venous valves. The circulatory system is regulated by the vasomotor center in the brain.
But in case of violations in at least one of these connections, there is a backflow of blood. At the same time, the peripheral vessels expand, the valves stop closing, which leads to even greater stagnation of blood in the peripheral circulation.
Under blood pressure, the venous wall continues to expand, resulting in vessel elongation and nodule formation. Valve insufficiency increases, edema develops.
The compression of the peripheral nerves sends a signal to the brain about the need to increase the tone of the vascular wall. This increases the blood pressure in the deep vessels and blood is pushed out of them into the peripheral ones, causing them to expand even more. A vicious circle closes.
What causes varicose veins
The true cause of varicose veins is unknown. But it has been proven that a number of factors and physiological conditions contribute to its development.
As:
- Pregnancy (due to compression of the veins in the abdominal cavity by the pregnant uterus, blood circulation in the lower extremities is difficult);
- obesity;
- Sedentary way of life;
- Genetic predisposition (weak valves or reduced tone of the vascular walls);
- Violation of the hormonal balance (leads to an increase in blood viscosity and difficult outflow);
- Condition after operations (due to increased blood clotting and bed rest);
- Occupations associated with a long stay in a standing position (on the feet).
In the case of one of these situations, it is necessary to take preventive measures to prevent the development of varicose veins. Especially if there are already some clinical manifestations.
Symptoms of varicose veins
The first signs of varicose veins are:
- Pain and heaviness in the lower limbs;
- Swelling of the legs in the evening;
- The appearance of spider veins on the skin;
- Visible tense veins under the skin;
- Burning and itching sensation in the affected area;
- Cramps in the muscles of the lower limbs, especially at night.
Varicose vein pain occurs and worsens by the end of the day. They have an explosive, painful character. At the beginning of the disease, they disappear after rest, and therefore patients do not go to the doctor for a long time.
On examination, edema, pastiness of the legs, telangiectasia, tense venous trunks, often painful, are palpated. What the skin of the legs with varicose veins looks like can be seen in the photo.
In the stage of severe decompensation, weakness, dizziness and fainting may occur. At the same time, trophic disorders of the skin are noticed, ulcers, dermatitis and eczema develop. With a timely visit to the doctor, severe manifestations of varicose veins can be prevented.
Types of varicose veins
There are the following types of varicose veins:
- Varicose veins of the lower extremities (the most common variant);
- Varicose veins of the upper limbs;
- Varicose veins of the small pelvis (including varicose veins of the uterus);
- Dilated veins of the internal organs (esophagus, stomach, intestines, etc. );
- Varicose veins on the face.
The most studied type is varicose veins of the lower extremities. It occurs most often and is usually what is meant when talking about this disease. Most patients do not know if internal varicose veins exist and how they manifest themselves until they encounter them.
Stages of development of varicose veins:
| Stage of the disease | Clinical manifestations |
|---|---|
| 1 stage | There are no symptoms, varicose veins are detected only during an instrumental examination |
| 2 stage | Heavy legs syndrome, transient edema, webbed skin |
| 3 stage | Persistent edema, skin pigmentation disorders, visible dense tense veins and nodes, trophic disorders in the form of eczema |
| 4 stage | There are trophic ulcers, dermatitis, necrosis |
The smaller the stage, the easier the treatment and the better the prognosis for recovery.
Diagnosis of varicose veins
To establish the diagnosis, in addition to the research data and characteristic complaints, a laboratory and instrumental examination of the patient is required.
Laboratory diagnostics
What tests should be taken for varicose veins:
- Complete blood count with extended formula.
- Blood clotting tests:
- clotting time;
- prothrombin test;
- determination of antithrombin III, protein S and C;
- determination of homocysteine level;
- study of the APTT index;
- determination of the D-dimer level;
- determination of von Willebrand factor activity, etc.
- Blood biochemistry.
- Analysis of hormones.
- General analysis of urine.
- functional tests.
Determining the state of the blood coagulation system is crucial for the choice of treatment tactics and the prognosis for the development of the disease.
Instrumental diagnosis of varicose veins
Of the instrumental research methods used:
- ultrasound examination of veins;
- dopplerography;
- ultrasound duplex scan of veins (combination of ultrasound and dopplerography);
- angiography;
- photoplethysmography (PPG);
- phlebography;
- venous occlusal plethysmography (VOP).
In these types of research, the thickness of the vessel wall is measured, the condition of the venous valves, the presence or absence of reverse blood flow in the veins, etc. are examined. With the help of instrumental methods, it is possible not only to make the correct diagnosis, but also to accurately determine the stage of the disease.
Treatment of varicose veins
The fight against varicose veins includes medicinal (conservative and surgical treatment) and non-medicinal methods. The choice of a specific option depends on the stage of the disease and the degree of its external manifestations.
Conservative treatment of varicose veins
The therapy of this disease includes surgeons and phlebologists. At the first signs of the disease, you should contact the doctors of these specializations. They will confirm the diagnosis and prescribe how to treat varicose veins in this case.
The following groups of drugs are used in conservative therapy:
- antiplatelet agents to thin the blood and prevent blood clots;
- anticoagulants with direct and indirect action to improve the rheological properties of blood and prevent its thickening;
- phlebotonics to strengthen the vascular wall, herbal preparations with horse chestnut extract;
- anti-inflammatory drugs, if necessary (in the presence of inflammation in the vascular wall or in the surrounding tissues).
Most of these drugs are available both for oral administration (in the form of tablets and capsules) and for external use (in the form of ointments, gels, creams). The doctor will tell you which form is most suitable for this patient depending on the specific clinical situation.
Surgical treatment of varicose veins
Conservative therapy will help to completely cure the disease only in the early stages. In advanced cases and with symptoms of decompensation, surgical treatment of varicose veins is necessary.
Surgical intervention may consist of removing the entire vein or only the affected area through incisions along the length of the vessel or in the inguinal fold and popliteal fossa (depending on the specific vein and its location). But whenever possible, doctors try to perform a less traumatic procedure that causes coagulation of the affected vessel, leading to its complete blockage.
Possibilities for gentle operations:
- sclerotherapy (introduction through a catheter into the lumen of the vessel of special sclerosing drugs that cause tight adhesions in it with their subsequent replacement by connective tissue);
- endovasal laser coagulation (coagulation of the inner cavity of the vessel with a laser pulse);
- radiofrequency coagulation (gluing of the vein walls as a result of exposure to a high-frequency current pulse);
- miniphlebectomy (removal of a vein or its section through several punctures in the skin).
When performing coagulation in different ways, the result is the same - after sticking the walls of the vessel, its cavity will gradually be filled with connective tissue with the development of complete obstruction. In this case, the movement of blood will continue through the healthy vessels, bypassing the coagulated ones. Schemes for performing such operations can be seen in the video in this article.
Surgical methods have an undeniable advantage - the probability of recurrence after them is very low. In terms of the ratio of risks and effectiveness, less traumatic procedures are better. But the price for them in clinics is quite high.
Non-drug treatment of varicose veins
Strengthening the walls of blood vessels with varicose veins is quite possible without the use of tablets.
Of non-medicinal means for this use:
- therapeutic exercises (to stimulate the muscle pump);
- compression hosiery and elastic bandages (compression of the lower limbs stimulates the discharge of blood from the vessels, normalizes the functioning of the venous valves, strengthens the vessel wall).
Wearing compression stockings is recommended for all people at risk, especially:
- pregnant women;
- work all day straight;
- to all people during long airplane flights;
- patients taking drugs that promote blood clotting;
- people with a sedentary lifestyle.
Prevention of varicose veins
Varicose veins prevention is better to start before they appear. In addition, the recommended measures will help prevent other cardiovascular diseases.
Prevention instructions:
- give up all bad habits;
- carefully monitor your diet (exclude fatty, fried, smoked, sweet);
- strictly control your weight;
- lead an active lifestyle (more walking, running, cycling, rollerblading, etc. );
- wear comfortable shoes with small heels;
- daily contrast shower;
- at the end of the day take a 15 minute break with your feet elevated.
These measures will also help with identified varicose veins - to prevent the further progression of the disease and the development of complications.
Many are interested in whether it is possible to do sports with varicose veins. The attending physician will give the exact answer to this question, but in most cases you can engage in sports, excluding its heavy types related to strength loads.
Varicose veins are a common disease. Women suffer from it 4 times more often than men, which is associated with the peculiarities of the hormonal background, pregnancy and a large list of female occupations that involve spending the entire working day on your feet.
But timely prevention will help prevent the development of varicose veins in both men and women. The main thing is not to ignore the advice of a doctor and not to forget the regularity of preventive measures.