Varicose veins

Varicose veins of the lower limbs are often asymptomatic in humans. Often the only problem with this pathology is a cosmetic defect in the legs caused by protruding superficial veins. In this case, the disease may be accompanied by pain or increased sensitivity of the skin of the legs. Depending on the severity of the disease, the patient is offered non-drug, drug or surgical treatment. Read more about the first symptoms of varicose veins, the nature of its course and effective methods of treatment and prevention, read our material.

What's this

Varicose veins are a pathology that only people suffer from. Animals do not have this problem, which suggests that the disease is associated with upright posture. When a person stood up, the main part of the circulating blood began to lie below the level of the heart. In this case, all conditions are created for the blood to circulate worse in the opposite direction, which leads to stagnation.

According to statistics, some disorders of the venous system are observed in 80% of people in developed countries. Moreover, more and more often, similar problems are found in people at a young age. In all likelihood, one of the reasons varicose veins "get old" is a sedentary lifestyle, which only contributes to stagnation.

It is noteworthy that in the age group under 20, varicose veins of the lower extremities occur with the same frequency in both men and women. However, after age 20, women begin to predominate in the morbidity structure. This is due to pregnancy and childbirth, which are a serious factor in the development of venous diseases.

Features, causes and mechanism of development of varicose veins

The exact reasons for the development of varicose veins of the lower extremities are still unknown. Currently, it is believed that the disease is caused by congenital or acquired defects of the valvular apparatus of the veins of the lower extremities.

For an unimpeded ascending blood flow through the veins, well-coordinated work of the venous valves is required. These valves only open for blood flowing upward. However, with a valve defect, partial descending blood flow is also possible. This is how venous insufficiency develops, manifested by edema, cramps of the leg muscles and dilation of the venous vessels.

Leukocytes can also be involved in the pathogenesis of the development of varicose veins. This problem is now being actively investigated. It is assumed that with a prolonged accumulation of leukocytes in the tissues of the vessels (in particular, in the area of the valvular apparatus), an inflammatory process develops, spreading along the venous bed.

Since the venous valves are subject to constant mechanical stress, inflammation develops particularly rapidly in the region of the venous valve apparatus.

Now the vast majority of people in developed countries lead a sedentary lifestyle. So why doesn't everyone have varicose veins? Consider the main risk factors that contribute to the onset of this pathology:

• Hereditary factors. . . Despite the fact that the specific hereditary mechanisms associated with the development of varicose veins have not yet been established, most experts agree on the presence of such a factor. At the same time, there are heavy counter arguments regarding heredity in the development of varicose veins. For example, this is the prevalence of varicose veins in ethnic Africans and African immigrants who have left to live in the United States. If the prevalence of varicose veins among sedentary Africans is about 0. 5%, among emigrants this figure reaches 20%. These figures show that hereditary factors, at least, are not the only ones in the development of the disease and, most likely, do not prevail.
• Obesity. . . Overweight and obese people are at risk. It is important to note that obesity contributes to varicose veins both due to increased stress on the vessels, and in connection with the risk of other diseases affecting the vessels (diabetes mellitus, hypertension and others).
• Pregnancy. . . This is one of the most obvious factors in the development of varicose veins of the lower limbs. In this case, the main risk factors are an increase in the volume of circulating blood, as well as compression of the retroperitoneal veins by the developing fetus in the uterus. According to epidemiological studies, second and subsequent pregnancies lead to a significant increase in the likelihood of developing varicose veins. After the first pregnancy, the likelihood of varicose veins in the legs remains low.
• Hormonal imbalance. . . Hormones are involved in the pathogenesis of most diseases. These pathologies include varicose veins. This problem is especially true for women taking hormonal contraceptives, as well as for hormone replacement therapies for the treatment of certain diseases (e. g. osteoporosis) or during the premenopausal period. It has been established that female sex hormones (especially estrogen and progesterone) reduce vascular tone and destroy collagen fibers. Therefore, the wall of the veins is pathologically dilated.
• Lifestyle. . . A person's lifestyle has a great influence on the course of the disease. A sedentary lifestyle, as well as work associated with prolonged standing or sitting (for example, security guards, drivers, office workers, service workers, and others) contribute to the development of varicose veins. You should also pay attention to nutrition. The lack of a sufficient amount of fruits and vegetables in the diet worsens the condition of the blood vessel walls.

Stages of varicose veins of the lower limbs

Currently, several classifications of varicose veins of the lower limbs are used. The CEAP international classification, adopted in 1994, is considered to be generally accepted. CEAP is an abbreviation, where each letter corresponds to the name of a classification category:

• C (Clinician)- the clinical class of the disease (type of veins affected, presence of pigmentation, eczema, trophic ulcers).
• E (Etiological)- the etiology of the disease (congenital, primary, secondary).
• A (Anatomical)- anatomical localization of the pathology (superficial or perforating veins).
• P (pathophysiological)- the type of disorder (venous reflux, obstruction or a combination of both).

The course of the disease takes place in six stages:

• Phase zero. . . The first stage of varicose veins, in which not even doctors are able to reliably establish a diagnosis. At this stage, there are no external signs of the disease. Ultrasound diagnostics does not show the presence of pathology. At the same time, a person in stage zero is concerned about symptoms such as swelling, a feeling of heaviness in the legs and cramps, which indicate the presence of blood vessel problems.
• First stage. . . Already in the first stage of the disease, spider veins are visible on the skin surface of the legs, the diameter of which is less than 1 millimeter. Medium-sized veins can increase in diameter by up to 3 mm. At this stage, doctors are not always able to establish the correct diagnosis, since the presence of such asterisks does not always indicate varicose veins.
• Second phase. . . At this stage, the veins can appear and disappear depending on the condition. For example, veins clearly manifest after sitting, standing or lifting heavy objects for a long time. The diameter of the varicose veins at this stage is 3 mm or more. Blood clots often form in the second stage.
• Third stage. . . If in the earlier stages of the disease, swelling of the legs appeared and disappeared, at the third stage the edema becomes permanent. Swelling of the legs is more severe in the evening.
• Fourth stage. . . Significant trophic changes occur at this stage. In particular, tissue nutrition is disrupted near the affected veins. The patient develops such changes on the skin as lipodermatosclerosis (inflammation of the subcutaneous fatty tissue), eczema, as well as darkening or discoloration of the skin. For the fourth stage of the disease, pigmentary changes are characteristic. For example, the skin in the area of the affected vessels can turn brown and even black, which indicates the concentration of pigments in this area. The opposite situation is also possible, when, due to a pathological process, the pigment does not enter the affected area, which leads to the appearance of a pale skin tone. If the varicose veins are not treated at this stage, the problem will only get worse with the further appearance of trophic ulcers.
• Fifth stage. . . At this stage of the disease, in addition to the above symptoms, trophic ulcers also appear, which heal quickly. If you do not take any measures for treatment, the ulcers will appear again and again.
• Sixth stage. . . Trophic ulcers appear that do not heal. In the affected area, the temperature rises sharply and pus can ooze from the wounds.

You should not wait for the development of the last stages - you should go to the doctor for the second to record and monitor the dynamics of the disease. Sometimes the symptoms improve on their own, sometimes they progress rapidly. Therefore, it is important to monitor the situation in order to act in time.

Symptoms

Consider the main symptoms of varicose veins of the lower extremities at the different stages of the disease:

• Ache. . . This is the first sign of the disease. Since pain is a nonspecific symptom, it is impossible to establish a diagnosis based on this symptom alone. With varicose veins of the lower extremities, pain is often localized along the venous trunks.
• Feet in the legs. . . It also applies to the first symptoms, while the veins of the skin are not yet visible. Often the sensation of heat is accompanied by a throbbing pain.
• Cramps and itching in the muscles. . . Very often disturbed at night.
• Swelling in the legs. . . In the early stages of the disease, the swelling is mild and transient. As a rule, they appear in the evening and disappear in the morning. However, as the disease progresses, the severity increases and they become permanent.
• Skin discoloration. . . As a rule, with varicose veins, the skin of the lower extremities darkens. In the area of the affected veins, the skin turns brown. In the advanced stages of the disease, eczema and dermatitis appear. The terminal stages of varicose veins are characterized by the appearance of trophic ulcers. Initially, these are healing ulcers, but later non-healing wounds form.
• vascular spiders. . . In the medical literature, such asterisks are called telangiectasias. In some people, varicose veins may be confined to spider veins, with no progression to larger veins.
• Twisted dilated veins. . . The most characteristic sign of varicose veins are the twisted dilated veins on the surface of the legs.

In the summer, the symptoms of varicose veins become more pronounced. This is due to the high ambient temperature, which already contributes to the expansion of the veins. Therefore, in the hottest hours, from 10. 00 to 16. 00, it is good to be in a well-ventilated area.

When to see a doctor

You should consult a doctor already at the first symptoms of the disease: pain, swelling or the appearance of varicose veins. Since the early stages of varicose veins are difficult to diagnose, they can initially be misdiagnosed. The patient should carefully monitor the condition of the legs and be regularly observed by a phlebologist.

Diagnostics

Diagnosis of varicose veins of the lower extremities boils down to the following activities:

• External examination of the skin of the legs;
• Doppler ultrasound;
• Duplex venous scan;
• Phlebography.

Characteristics of the treatment

Varicose veins of the lower limbs are treated with both conservative and surgical methods. Conservative treatment boils down to the following activities:

• Pharmacological therapy. . . This is the intake of drugs that improve the tone of the venous walls. In addition, the patient is prescribed drugs that reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, anticoagulants are also prescribed.
• Compression therapy. . . This is the use of special compression stockings, which reduce the load on the leg. The advantage is that it is possible to distribute the load evenly, even with intense physical exertion. When using compression garments, congestion and swelling can be avoided.
• Corrective gymnastics and lifestyle changes. . . The patient is advised to exercise to relieve tension in the legs. It is important to avoid sitting or standing for a long time. If you have to stand or sit for a long time at work, then you need to take breaks more often.

If conservative therapy of varicose veins does not bring the expected results, a decision is made about surgical intervention. Most often these are minimally invasive interventions, including:

• Sclerotherapy- the introduction into the vein of substances that glue the walls of the affected vessel. This treatment leads to the resorption of the spider veins.
• Laser coagulation- introduction of a laser light guide into a vein and irradiation of the walls with a laser, which also leads to gluing of the walls and further resorption of the vessel.
• Radiofrequency ablation- gluing of the veins by high frequency current.
• Phlebectomy- Removal of affected veins, in which blood circulation has deteriorated by 90%.

In some countries, it is possible to get the operation for free, as part of the mandatory medical insurance. But it is not a given that all types of compulsory insurance transactions are provided everywhere. In any case, help will be provided, but it is necessary to find out whether it will be a conventional removal or a laser.

Contraindications for people with varicose veins

• Sedentary lifestyle. . . It is important to avoid sitting or standing for a long time. Physical activity will help avoid congestion of the veins.
• Running and vigorous exercise. . . With physical activity, it is important not to overdo it. If you have varicose veins, walking is definitely better than running.
• Unbalanced and unhealthy diet. . . You have to give up junk food, even if your health seems to allow it. You should limit your intake of sweets, semi-finished products, as well as rich meat broths and smoked meats. But eating more fruits and vegetables would be a good idea.
• Whirlpools and showers. . . For people with vascular problems in the extremities, procedures with excessively hot and prolonged water are contraindicated.

Complications of varicose veins

Varicose veins can be complicated by trophic ulcers, phlebitis (inflammation of the veins), and deep vein thrombosis. The latter is the formation of blood clots in the deep veins that threaten human life.

Conclusion

Symptoms of varicose veins of the lower extremities, as a rule, do not appear immediately. Different people have a different set of manifestations. For example, sometimes with this pathology there is no edema or there is no local increase in temperature or pain. This does not at all mean that there is no disease. A timely visit to a doctor will significantly slow down the progression of the disease or even stop it, preventing the development of trophic changes.