Everything you need to know about varicose veins of the lower limbs

Varicose veins of the lower extremities are characterized by the expansion of the superficial veins of the legs, which accompanies the violation of blood flow in them and the failure of the valves. As a result, the veins increase in length and diameter, acquire a serpentine, cylindrical or saccular appearance, although there is also a mixed manifestation of the listed deformities.

Characteristics of the venous system

The emergence and development of varicose veins is directly related to the venous system of the legs, which consists of:

• saphenous veins: small and large;
• veins located deep (in the lower leg and thigh);
• perforating veins, which constitute the link between the two previous systems.

Normally, 90% of the blood is transported to the lower limbs through the deep veins and the remaining 10% through the superficial ones. When it returns to the side of the heart, this mechanism is supported by valves in the walls of the veins. When the next portion of blood arrives, they flap to prevent its movement from top to bottom under the influence of gravitational force. Muscle contractions push blood further towards the heart, allowing normal blood flow.

With a long stay of a person in an upright position, stagnation of blood can develop, which increases the pressure in the veins and causes an increase in their diameter. This process causes incomplete closure of the valve flaps, as a result of which the blood flow is disturbed with its reverse flow from the heart - reflux.

Deep venous valves are more likely to be affected, as they carry the greatest amount of blood and thus experience the greatest load. To lower the high pressure in them, part of the blood is transported from perforated veins to the superficial ones, which were originally not intended for a large volume. Such a load on the walls of the veins leads to their expansion and the formation of varicose veins.

At the same time, the blood enters the deep veins without stopping, but due to the violation of their functions and the normal activity of the valve flaps of the perforated veins, the blood is redistributed to the superficial vessels. As a result, chronic varicose veins develop, which over time are accompanied by painful sensations, edema and trophic ulcers.

Causes of the disease

Previously, one of the main causes of varicose veins was called hereditary factor, but today this theory has been refuted. Of course, it is possible to trace the frequent manifestations of the disease in some families, but this is more likely due to the peculiarities of life that are imparted in the family: food culture, passive rest, sedentary work and the like.

The development of varicose veins is based on the presence of reflux in the venous system, when the blood circulates in the veins in the opposite direction. Additional transport of blood from deep veins to superficial veins is possible due to congenital or acquired degenerative pathology of the valvular apparatus. This causes the superficial vessels to overfill with blood and distend them when venous nodes are formed.

One of the basic reasons for the development of varicose veins is considered to be an unhealthy diet, which in some cases leads to obesity. These people move little, eat mostly highly processed foods, and the proportion of plant-based fiber in the diet is minimized. After all, it is they who are involved in strengthening the walls of veins and blood vessels and preventing chronic prolonged constipation, which greatly increases intra-abdominal pressure and thus provokes varicose veins. Note that an increase in body weight of more than 20% increases the risk of disease five times.

The main provoking factor for women is carrying a baby, while the risks of varicose veins increase with each subsequent pregnancy. Strong weight gain and an enlarged uterus put a strain on the legs, which are stagnant. This situation is aggravated by the constantly increasing intra-abdominal pressure and the action of the hormone progesterone, which affects the state of elastic fibers in the walls of blood vessels.

Other factors that cause lower limb varicose veins include:

• a sedentary lifestyle, standing during the day (e. g. hairdressers), long flights or long journeys. All this leads to stagnant processes in the lower limbs, when blood accumulates in the superficial veins and is poorly transported to the heart;
• sometimes increases the risk of developing varicose veins for women, who wear uncomfortable and tight shoes, especially models with high heels;
• corsets and tight underwear tighten the inguinal veins and increase intra-abdominal pressure, which is a direct prerequisite for varicose veins;
• high blood pressure;
• smoke, which indirectly leads to a thinning of the blood vessel walls.

Disease classification

Varicose veins of the lower limbs are classified according to the prevalence of venous lesions, their localization and the presence of pathological refluxes, which are characterized by impaired blood outflow. There are 4 forms of varicose veins:

• intracutaneous and subcutaneous (segmental) varicose veins, in which there is no pathological outflow of venous blood;
• segmental varicose veins, when reflux occurs through perforating or superficial veins;
• a common form of varicose veins, in which reflux occurs through the perforating and superficial veins at the same time;
• varicose veins are characterized by reflux in the deep veins.

After the varicose veins of the lower extremities become chronic, phlebology considers its three degrees:

1. Transient edema, which periodically occurs against the background of "heavy legs" syndrome.
2. Persistent and persistent edema. Hyperpigmentation and eczema may appear.
3. Venous ulcer of a trophic nature.

The latter degree is the most difficult to treat, as it requires preliminary removal of inflammation and healing of skin tissues.

Stages and symptoms

The disease develops very slowly, sometimes more than a dozen years pass, until the symptoms that appear will force the patient to seek advice from a phlebologist. In the initial stages of varicose veins, its manifestations are often attributed to fatigue, age or other reasons. To fully consider the symptoms of the disease, its manifestations are classified according to the stages of varicose veins:

1. The first stage begins to manifest itself more often at a young age - after 20 years, when there is a feeling of heaviness in the legs, edema may appear, which completely disappears at night. Inside the lower leg, you can see an enlarged vein, which manifests as a lumpy bump of skin. At this stage, many people notice small varicose veins. In general, the symptoms are subtle and rarely get the attention it deserves.
2. The second stage is characterized by an increase in the external manifestation of the dilated vein. The disease is already developing against the background of the pathological work of the venous valves, so the saphenous veins greatly increase in size, and their lengthening can also be noted. More often there is heaviness and burning in the legs, they quickly get tired with long walks.
3. The disease is already becoming chronic due to the constant imbalance in the outflow of venous blood. In the evening, patients suffer from edema near the ankle, which can be very intense. There is heaviness in the legs and cramps can occur during the night.
4. In the absence of treatment in the earlier stages, chronic failure of the functioning of the venous system adversely affects the metabolic processes of the skin, areas in the lower leg are especially affected. Skin darkening is visible near the ankle - hyperpigmentation, thickens and inflames over time. The condition described is called lipodermatosclerosis. If at this time you do not start therapy with respect to the venous system, trophic ulcers will soon begin to form.
5. The fifth stage is accompanied by numerous trophic ulcers, some of which periodically heal with the formation of scars.
6. In the zone of long-existing trophic disorders, large ulcers open. This condition requires urgent active therapy, aimed at both the treatment of varicose veins and the healing of skin ulcers.

Diagnostics

An external examination of the lower limbs in a vertical and horizontal position of the body, palpation of the veins and a preliminary assessment of the stage of the disease are carried out. The patient is sent for a general blood test, which allows you to study the picture of the disease with greater accuracy:

• platelet level will reflect a predisposition to thrombosis;
• the level of hemoglobin, as well as the number of red blood cells, indicate the degree of blood clotting;
• by the increase in the level of leukocytes, inflammation can be judged, which helps to diagnose thrombophlebitis more quickly.

Be sure to examine the venous system of the legs, for which there are many methods:

• ultrasound dopplerography - USDG;
• phlebography;
• CT phlebography;
• duplex angioscan - USAS;
• phleboscintiography;
• photoplesmography;
• phlebomanometry and the like.

In practice, patients are more often prescribed USAS and USG, as they help to fully study the venous system of the legs and identify degenerative areas. The rest of the methods can be prescribed additionally if the ultrasound examination did not provide a complete view of the picture of the disease. Some of these methods can have complications such as venous thrombosis, vessel wall perforation with a catheter, and contrast agent allergy. Consider the most commonly practiced techniques in phlebology:

1. The USAS allows to evaluate the anatomical, haemodynamic and functional pathologies of the venous bed. The data obtained are processed by computer, after which the model of the venous system can be viewed on video or printed on paper.
2. Doppler ultrasound with high precision determines the patency of superficial and deep veins, the speed of blood flow. Doppler ultrasound allows you to evaluate the functioning of the valve apparatus.

After extensive diagnostics, the doctor draws up the patient's phlebocard, which allows you to determine the damaged segments of the venous system, their degree and length. Next, a suitable treatment is selected.

Treatment

It is carried out comprehensively and is determined based on the symptoms, the degree of development of the disease and the results of the study. In the initial stages, conservative therapy is prescribed, which consists of:

1. Drug treatment when a group of drugs is prescribed:
   • anti-protector and phlebotonic;
   • anticoagulants;
   • disaggregants
   • topical preparations (ointments, gels);
   • anti-inflammatory drugs.
2. Elastic compression, for which compression stockings or bandages are used (rarely). It allows you to dose the squeezing of the muscles, prevents stagnant processes, improves blood flow through the vessels. When wearing such underwear, it has the effect of artificially maintaining the vascular tone.
3. Physiotherapeutic methods, among which the best results of treatment were shown by electrophoresis, diadynamic currents, laser radiation and magnetic field.
4. Physical activity feasible, which should only be done in compression underwear (except for swimming). Cycling, swimming, jogging are recommended. The phlebologist selects an individual set of exercises for the lower limbs, which will train the vessels of the legs every day.

In addition, patients are advised to perform five-minute contrasting procedures in the shower every evening, alternately switching from hot to cold water. Such manipulations improve blood flow and tone blood vessels.

It is important at the beginning of treatment to identify the factor causing the disease in order to effectively influence it. And patients at risk should visit a phlebologist every 2 years for a preventive examination and do an ultrasound examination of the veins in the legs.

When conservative treatment does not give results or varicose veins are observed at an advanced stage, surgical intervention is used. Today, varicose veins can be completely cured thanks to the following methods:

1. Phlebectomy. The essence of the operation is to remove the main trunks of the superficial vein to eliminate the pathological discharge of blood. Perforating veins are often ligated for the same purpose.
2. Sclerotherapy. It consists in the introduction of a sclerosing agent into the affected area of the vein, which leads to the connection of its walls. Recently, they began to actively use foamed sclerosing agent for the same purposes according to the technology -. The blood flow through the defective area stops and the cosmetic defect in the form of protruding nodules is eliminated. After such an intervention, no scars remain, all manipulations are performed on an outpatient basis without a subsequent hospital stay. But sclerotherapy is used only for the fusion of small branches of the venous trunks.
3. Laser coagulation. With the help of a laser beam, the marked section of the vein is heated, the walls of which come together and the blood flow stops. But this technique is only indicated for veins with an expansion diameter of less than one centimeter.

Prevention

Preventive measures can be both primary, aimed at preventing the development of varicose veins, and secondary, when it is necessary to reduce the risk of relapse after surgery or to prevent the worsening of the course of the disease. Helpful tips:

• lead an active lifestyle without heavy loads on the legs: swimming, walking, cycling;
• watch your weight;
• keep both legs raised more often;
• do not wear tight underwear and heels over 4 centimeters;
• use orthopedic insoles;
• take a contrast shower;
• do five-minute leg prevention exercises every day;
• wear compression stockings for long walks.

If you notice the slightest suspicion of varicose veins - prominent nodules on the legs, swelling, heaviness, do not postpone a visit to the phlebologist. Indeed, over time, this insidious disease can cause many complications, including thrombophlebitis and thrombosis.