The word "varicose" comes from the Latin varix, varicis - swelling. The earliest mention of varicose vein treatment is found in the ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffer from chronic diseases of the lower limb veins. Its complications in the form of dermatitis, cellulitis, bleeding, thrombosis, and trophic ulcers often lead to long-term disability, sometimes causing disability.
The structure and work of the venous system
The way our veins work is a complicated process. To understand this, a first knowledge of the structure of the veins is necessary. The venous wall consists of three layers. Internal - endothelium, represented by a layer of cells on the connective tissue membrane. The middle layer is muscular. It mainly consists of circularly positioned smooth muscle cells, which are, as it were, in a frame of collagen fibers. Superficial veins contain a thicker muscle layer than deep veins. The outer sheath of the veins, the so-called adventitia, is a dense tissue of collagen fibers. If we compare the structure of the veins and arteries, then it must be said that the ratio of the lumen of the vessel to the thickness of its wall in the veins is much greater than in the arteries. Veins have much less elastic fibers than arteries.
The main property of the veins, which thus influence the indicators of blood flow, is the great extensibility of its wall. In particular, when the pressure in the vessel increases, the veins dilate and tend to acquire a round shape from a slit. The degree of extensibility of the venous wall is quite ephemeral and depends on many other things. It is this factor that does not allow the use of rigorous mathematical formulas to calculate the movement of blood along them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, in the neck.
The venous valves originate from its wall. They usually consist of two valves, which are oriented towards the heart. In the area of attachment of the valve to the wall, the diameter of the vein is slightly larger. Normally, when the valve flaps close, the blood from the overlying section cannot enter the one below. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative (some call it physiological) and absolute. The main difference is in the duration of reflux during functional tests. There is also an opinion that there should be no reflux with a normal valve. The valves are unevenly distributed in the veins. There are others in which the work of the muscle pump is more pronounced, that is, on the lower leg.
The main venous system of the lower limbs is represented by the following groups:
- foot veins;
- deep veins of the leg and thigh (deep venous system);
- large and small saphenous veins (superficial venous system);
- communicating (perforating) veins - provide communication between superficial and deep veins.
The deep and superficial venous systems together form a "sponge", from which, walking, blood flows to the heart. The work of this system is supported by the work of a muscle pump located in the lower leg, which creates intermittent pressure in the veins.
These systems move the blood column upward and the valves within the veins prevent backflow.
The outflow of blood from the lower limbs through the deep and superficial veins is not uniform. About 85-90% of the blood flows through the deep veins and only 10-15% through the subcutaneous veins. Therefore, in healthy people, the outflow of blood is carried out by the system of deep, subcutaneous and communicating veins.
Varicose veins are a serious problem
To say that varicose veins are "a disease of the 20th or 21st century" is to deviate from the truth. Varicose veins have been bothering people for a long time. Even in the ancient medical treatises there is a description of varicose veins, in ancient Rome they bandaged their legs with leather "bandages" to get rid of venous insufficiency.
If your legs get tired often, this may be the first sign of an early venous system disease. Evening discomfort, accompanied by swelling in the foot and ankle, especially after a long stay on the legs, are clear signs of congestion in the veins. Soon, unfortunately, you discover the first varicose vein. The altered vessels form a blue-blue or red "pattern" on the legs, "stars", capillary "cobwebs" (telangiectasias) and, finally, dilated veins and varicose nodes.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins on the legs: a sharp signal for urgent action to save the beauty and health of the legs.
A question about the condition of the veins should be promptly asked a specialist, a phlebologist who studies and treats venous diseases.
Venous disease begins harmlessly but can become a serious problem if left untreated.
The causes of varicose veins
To date, a large number of theories have been proposed to explain the causes of varicose veins. The most common are hereditary, mechanical, hormonal, and so on. However, they mainly reflect the factors that contribute to the development of the disease or accelerate the appearance of clinical signs of the disease.
Both lower extremities are most often affected. However, at first, the expansion of the veins appears on one limb, and after a while on the other. Varicose veins are most common on the right leg.
Varicose veins of the lower limbs only occur in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the venous wall of the limb. With the weakness of the venous wall and impaired function of the valvular apparatus in the main veins, which occurs with their congenital inferiority, a pathological reverse blood flow occurs. The most common causes of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives, and so on) - affect the structure and tone of the vascular wall with its gradual weakening and destruction.
- Pregnancy is one of the main risk factors for the development of varicose veins. In addition to hormonal changes, the enlarged uterus and fetus put pressure on the iliac veins and significantly impede blood flow from the lower limbs.
- Obesity is a proven risk factor for varicose veins. This is due to the increasing load on the venous system of the lower extremities.
- Lifestyle: People with prolonged static loads (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wear tight-fitting underwear that squeezes the main veins at the level of the inguinal folds. Women wearing high heels.
- Intense physical activity (carrying loads, lifting weights).
- Spa procedures (saunas and baths), the abuse of which can also lead to varicose veins.
The essence of varicose veins lies in the fact that as a result of the above reasons, a gradual expansion of the lumen of the saphenous and perforating veins occurs, as a result of which an insufficiency of the valvular apparatus is formed (failure to close thevalve flaps). Pathological reflux (return) of blood occurs both from top to bottom, and horizontally through the destroyed perforating veins.
Diagnosis of varicose veins
For many years the hands were the only medical tool to examine a patient with varicose veins. X-rays have come to the surgeon's aid in the last century. However, X-ray contrast examination of veins is a rather complicated procedure, which requires bulky and expensive equipment, and the X-ray contrast agents themselves are not safe for the body at all. With the development of microelectronics and computer technology, previously unavailable diagnostic methods appeared: ultrasound doppler, ultrasound angioscanning, plethysmography. The advent of duplex ultrasound has provided new information that has allowed us to take a fresh look at the causes of the development of varicose veins and to understand the intricacies of the pathological process.
Doppler ultrasound
This is an ultrasound diagnostic method that allows you to determine the speed and direction of movement of particles (in this case, blood cells) in the body. Thus, the doctor is able to find out the direction and speed of blood flow in the vessels of the lower extremities. And when carrying out a series of physiological tests and the state of the valvular apparatus of the veins of the lower extremities. Knowledge of the structure of blood flow in the veins of the legs is the main requirement for choosing a method of treatment.
Ultrasound Angioscan
The essence of this method is that an image of the walls of blood vessels and the blood flowing through them in real time is formed on the monitor screen of an ultrasound scanner. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the state and direction of the blood flow through this vessel. The method is highly informative and much safer than X-ray examination, but it is quite expensive, so it is used only in difficult cases and during scientific research.
Plethysmography
This is a diagnostic method based on the determination of the electrical resistance of the tissues of the lower limbs. Its essence lies in the fact that the total electrical resistance of the tissues of the human body directly depends on the amount of blood flowing in and out of them and changes over time with each heartbeat. Plethysmography is used to diagnose the general functional state of blood flow in the lower limbs, is used to monitor drug therapy for venous or arterial insufficiency, in the treatment of trophic disorders, and to assess the degree of venous insufficiency.
Of course, all these techniques do not exclude a direct examination of the patient by a doctor, which clarifies the history of the disease and identifies the complaints made by the patient. Based on the general picture of the disease, the doctor chooses a method of treatment.
Treatment of varicose veins
Over the past 50 years there has been a quantum leap in the treatment of varicose veins, as well as in other branches of medicine. In recent decades, various drugs for the treatment of chronic venous insufficiency have been developed and continue to be improved. The surgical technique for the treatment of varicose veins has been significantly improved. Compression sclerotherapy technology has been developed and practically perfected.
At the moment, the so-called sclerosurgery is gaining popularity all over the world. Sclerosurgery is a clever combination of surgical treatment and sclerotherapy. It is known that sclerotherapy can only be used with initial and uncomplicated forms of varicose veins. Varicose vein surgery is also not without its problems, the operation to remove varicose veins is rather traumatic, requires hospitalization and a long period of rehabilitation. A reasonable combination of these two methods makes it possible to minimize the trauma of the treatment process and achieve an exceptionally high quality of treatment.
Medicinal therapy of varicose veins
Quite often there are cases when a patient has practically no varicose veins or their number is very small. However, the person suffers from heaviness in the legs, pain, swelling. All of these are signs of chronic venous insufficiency. In these cases, as well as in the presence of significantly enlarged varicose veins, it is necessary to take drugs that improve blood circulation in the legs. Currently, in the arsenal of a phlebologist there are several dozen drugs aimed at combating venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should only be selected by a doctor. Despite the seeming simplicity of selecting a venotonic agent, only a doctor can determine the full range of therapeutic measures and the suitability of using a particular drug.
Compression therapy
Compression therapy has been considered for many years as an adjunct to drug therapy or surgery. Compression treatment of varicose veins has been used since ancient times, and only in the last decade has elastic compression begun to be considered a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of various brands and special medical compression stockings.
The global industry produces three types of elastic bandages: short, medium and high elasticity. High-stretch bandages (elongation greater than 140%) are used to prevent thrombotic complications in the postoperative period after interventions on the abdominal and pelvic organs, as well as to fix the joints after and to prevent sports injuries. Short elastic bandages (elongation less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitic syndrome and lymphatic insufficiency. Medium stretch bandages (70% to 140% stretch) are used in the treatment of varicose veins, chronic venous insufficiency and compression sclerotherapy.
Medical compression stockings include medical compression stockings, pantyhose and knee-highs. Many people are wrong, considering various "anti-varicose" and "support" knitwear of higher density as therapeutic. To begin with, it is necessary to determine that medical compression products are never marked in DEN. DEN is a technical feature of a knitted fabric that is only indirectly related to the pressure that is created by the product.
Medical shirts are classified into different functional compression classes. The class of the product is determined by the pressure the product creates on the ankle and in the lower third of the lower leg. A person with varicose veins is shown the use of compression class 2 knitwear. These tights or knee-highs will create a pressure of 23-32mm Hg on the affected leg. Art. , That is, completely equalizes the pressure in varicose veins and eliminates venous insufficiency. In addition, medical compression products create a so-called distributed pressure. The pressure they create gradually decreases as the leg moves from bottom to top by 25-30%, which contributes to the effective outflow of blood and lymph.
It should be noted immediately that medical jersey is never thin and transparent, the creation of such a high pressure requires a large amount of elastic fibers, and consequently the knitted fabric is thick. It must also be said that medical shirts are never cheap. The technology of knitting a special knitted fabric is much more complicated; when knitting, it is also necessary to shape the profile of the leg to create distributed pressure.
The ideal approach in compression therapy is the constant and widespread use of elastic bandages and / or compression stockings by the patient. For example, the daily use of elastic bandages for a month almost completely corresponds to the effectiveness of a monthly intake of an effective drug. The use of compression stockings is particularly effective for preventing the development and recurrence of varicose veins. The main advantage of using compression products is their absolute safety for health, compared to even the best drugs, and in terms of cost they are quite comparable.
Prevention of varicose veins
If you have the first signs of varicose veins, following fairly simple rules will slow down and in some cases prevent its further development. First of all, do not get carried away by hot baths, saunas, prolonged exposure to the sun. All of the above reduces venous tone, leads to stagnation of blood in the lower limbs. Do not wear tight-fitting clothing, stockings and socks with tight elastic bands, as this will compress the veins. Excess body weight and sports associated with a large static load on the legs (tennis, weight lifting, bodybuilding) increase venous pressure. High heels (over 4cm) - our veins don't like it. Take care of the veins, don't hurt them.
If you feel heavy in your legs in the evening after a workday, keep your legs elevated during sleep and rest. If your work is accompanied by a long sitting at the table or standing for a long time, then you should change the position of the legs more often, get into position and rotate your feet. There are special exercises for venous diseases. After showering or bathing, rinse your feet with cold water. There are useful sports: first of all swimming, but also walking, cycling, skiing. Do not neglect folk remedies for prevention. Useful infusions of cranberry leaves, St. John's wort, cranberry, dog rose. A plant-based diet should be followed. The doctor may also prescribe a drug called phlebotonic to increase venous tone and improve microcirculation. Recently, methods of compression prevention and treatment of varicose veins have also become quite understandable success, due to the appearance on the market of high-quality medical products.
A special word on prevention for pregnant women. Varicose veins progress during pregnancy, especially when it is not the first, and carrying a baby younger than 1 year does not contribute to good vascular function. The basis for prevention is the use of special compression stockings, the use of phlebotonics both during pregnancy and after childbirth. Do not neglect to mention your veins to the gynecologist when prescribed a hormonal drug, as these drugs affect the functioning of the veins, reduce their tone.
Do not self-medicate. Talk to your doctor about what is best to do with your veins. This disease is treated by doctors - phlebologists.