Varicose veins are a disease of the veins, manifested by their expansion, elongation with the formation of nodes and thinning of the venous wall. It can affect different vessels, but most often appears in the lower extremities.
In advanced cases, it leads to trophic disorders in the affected area, the development of ulcers, eczema, even necrosis and gangrene. Therefore, it is important to make an accurate diagnosis and start treatment in time.
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 by communicating (perforating) vessels that connect them. Normally, blood flows through the veins towards the heart, from the peripheral vessels to the deep ones.
This is due to the muscle pump (contraction of the muscles of the lower extremities), 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 an opposite outflow of blood. At the same time, the peripheral vessels expand, the valves stop closing, causing even more blood stasis in the peripheral circulation.
Under blood pressure, the venous wall continues to expand, causing vessels to stretch and nodules to form. Valve insufficiency increases, edema develops.
Compression of 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 the blood is forced away from them to the peripheral ones, causing them to expand even more. A vicious circle is closing.
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.
Like:
- 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 lifestyle;
- Genetic predisposition (weak valves or decreased tone of the vascular walls);
- Violation of hormonal balance (leads to an increase in blood viscosity and difficulty in its exit);
- Post-operative condition (due to increased blood coagulation and bed rest);
- Occupations associated with a long stay in a vertical (standing) position.
In 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 extremities;
- Swelling of the legs in the evening;
- The appearance of spider veins on the skin;
- Visible tense veins under the skin;
- Feeling of burning and itching in the affected area;
- Cramps in the muscles of the lower extremities, especially at night.
Varicose veins pains appear and intensify 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.
The examination reveals edema, pastiness of the legs, telangiectasia, tense, often painful venous trunks 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 appear. At the same time, trophic disorders are visible on the skin, 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 extremities;
- Varicose veins of the small pelvis (including uterine varicose veins);
- Varicose veins of internal organs (esophagus, stomach, intestines, etc. );
- Varicose veins on the face.
The most studied type are varicose veins of the lower extremities. It occurs more often, and is usually what is meant when talking about this disease. Most patients do not know that internal varicose veins exist and how they appear 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 instrumental examination |
| 2 phases | Heavy legs syndrome, transient edema, spider veins on the skin |
| 3 stages | Continuous edema, pigmentation disorders in the skin, dense tense veins and joints are visible, trophic disorders in the form of eczema. |
| 4 stages | 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
In order to establish a diagnosis, in addition to examination data and characteristic complaints, laboratory and instrumental examination of the patient is required.
Laboratory diagnosis
What tests should be done for varicose veins:
- Complete blood count with an extended formula.
- Blood coagulation tests:
- coagulation time;
- prothrombin test;
- determination of antithrombin III, protein S and C;
- determination of homocysteine level;
- APTT index study;
- determining the level of D-dimmer;
- determination of von Willebrand factor activity, etc.
- Blood biochemistry.
- Hormone analysis.
- General analysis of urine.
- functional tests.
Determining the state of the blood coagulation system is of crucial importance for the choice of treatment tactics and the prognosis of the development of the disease.
Instrumental diagnosis of varicose veins
Of the instrumental research methods used:
- ultrasound examination of veins;
- dopplerography;
- duplex ultrasound scanning of veins (combination of ultrasound and dopplerography);
- angiography;
- photoplethysmography (PPG);
- phlebography;
- venous occlusal plethysmography (VOP).
With these types of studies, the thickness of the vascular wall is measured, the state of the venous valves, the presence or absence of reverse blood flow in the veins, etc. are studied. With the help of instrumental methods, it is possible not only to make an accurate diagnosis, but also to accurately determine the stage of the disease.
Treatment of varicose veins
The fight against varicose veins includes medical (conservative and surgical treatment) and non-drug 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 included 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.
In conservative therapy, the following groups of drugs are used:
- antiplatelet agents for thinning the blood and preventing blood clots;
- anticoagulants with direct and indirect action to improve the rheological properties of blood and prevent its thickening;
- phlebotonics for strengthening 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 tablets and capsules) and for external use (in the form of ointments, gels, creams). The doctor will tell you which form is best 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 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, which leads to its complete blockage.
Options for saving operations:
- sclerotherapy (introduction through a catheter into the lumen of the vessel of special sclerotic drugs that cause tight adhesions in it with their subsequent replacement with connective tissue);
- endovasal laser coagulation (coagulation of the internal cavity of the vessel with a laser pulse);
- radiofrequency coagulation (sticking 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 you perform coagulation in different ways, the result is the same - after the adhesion of 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 healthy vessels, bypassing the coagulated ones. Schemes for performing such operations can be seen in the video in this article.
Surgical methods have an indisputable advantage - the possibility 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 the non-drug means for this use:
- therapeutic exercises (to stimulate the muscle pump);
- compression stockings and elastic bandages (compression of the lower extremities stimulates the outflow of blood from the vessels, normalizes the functioning of the venous valves, strengthens the vascular wall).
Wearing compression stockings is recommended for all people at risk, especially:
- pregnant women;
- working all day on your feet;
- for all people during long flights in airplanes;
- patients taking drugs that promote blood coagulation;
- people with a sedentary lifestyle.
Prevention of varicose veins
Prevention of varicose veins is best started before they appear. In addition, the recommended measures will help prevent other cardiovascular diseases.
Guidelines for prevention:
- 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, cycling, etc. );
- wear comfortable shoes with small heels;
- daily contrast shower;
- at the end of the day, rest for 15 minutes 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 play sports with varicose veins. The attending physician will give the correct answer to this question, but in most cases you can engage in sports, excluding its heavy types related to energy 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 women's professions, which involve spending the entire working day on foot.
But timely prevention will help prevent the development of varicose veins for both men and women. The main thing is not to neglect the doctor's advice and not to forget about the regularity of preventive measures.