Varicose veins of the lower extremities is a disease characterized by impaired function of the veins in the legs.It can occur without visible signs or have a clear vein pattern - it all depends on the type and stage.An essential part of this disease is the disruption of the venous valves, without which the vein no longer functions properly.This leads to the appearance of enlarged veins and poor blood circulation in the leg.
Causes of varicose veins
Venous blood moves upward, from the toes to the trunk;If the process is disturbed, it gets stuck in the legs.The heart cannot generate enough suction to lift the blood upwards.There are a number of mechanisms, the most important of which is the muscle pump (muscular-venous pump).Valves determine the direction of blood flow - so they move from bottom to top.When the blood tries to flow back due to gravity, the valves close and don't let it through.
When the leg muscles contract, for example when walking, the blood is “pushed out” in the vein and directed towards the body.When the muscles relax, the vein fills with blood that is “sucked in” from below.Failure of the mechanism leads to varicose veins of the lower extremities.
There are several factors that trigger the onset of the disease.They are divided into 2 large groups:
- Hereditary.One of the parents or close relatives has the pathology.This is the cause of varicose veins in 90% of patients.
- Acquired.Occurs due to the adverse effect of provoking factors.
The main culprit is genetics.And other circumstances are already being imposed on him:
- a job that requires standing or sitting for long periods of time (salespeople, office workers, drivers, surgeons);
- Pregnancy as a “hormonal revolution” in a woman's body (veins stretch and become noticeable, after childbirth they are not always restored and with each new pregnancy the situation worsens);
- Diseases of the pelvic organs impede drainage and increase pressure in the veins;
- taking hormonal drugs (which make vascular walls less elastic);
- excessive passion for warming procedures (visiting a bathhouse, sauna);
- increased intra-abdominal pressure (with chronic cough or constipation);
- heavy physical work, carrying heavy loads (loaders, dock workers, construction workers);
- Overweight (more blood volume means more strain on the vessels);
- Injuries that affect veins and reduce blood flow;
- biological factors – age, high growth;
- bad habits (alcohol, cigarettes)
- lack of physical activity;
- Wearing compression clothing.
When lying down, the veins rest and the blood practically flows through them in the direction from the legs to the heart.They enjoy work when their muscles actively support them while walking.When standing and sitting, the veins are exposed to enormous strain.Whether or not they can withstand this stress depends on heredity and the presence of other provoking factors.
Now that we have figured out the reasons, let's move on to the symptoms of varicose veins.
How do varicose veins manifest themselves?
The symptoms of varicose veins in women and men are generally similar, but there are slight differences
The most obvious symptom is presencedilated veins of the lower extremitiesdifferent sizes:
- Up to 1 mm – telangiectasia or spider veins;
- from 1 to 3 mm – reticular (tortuous);
- from 3 mm – varicose veins.
Inadequate functioning of the muscular-venous pump results in swelling of the legs.It begins in the lower third of the leg and rises to the level of the knee joint.
If the legs stand motionless in an upright position for a long time, the blood stagnates and its liquid part “sweats” through the vessel wall into the surrounding tissue.forms of swelling.When lying down, the limbs do not swell because blood circulation occurs naturally and easily.
How do you recognize swelling?Look at the position of the sock elastic.After removal, a trace remains, which means that the fluid is poorly removed and accumulates in the tissues.
Symptoms of edema in varicose veins:
- occur around midday;
- worsens in the evening when standing or sitting for long periods of time;
- pass overnight while a person sleeps;
- Do not move towards the foot.
Venous edema in the legs is usually associatedFeeling of heavinessThis may be felt as a “tension” or “humming” in the calf muscles or throughout the lower leg.
Can often be disturbingnocturnal cramps of the lower extremities.The reason for this is the retention of venous blood, which disrupts the metabolic processes in the muscles.This leads to severe cramps in the calf muscles, which are usually triggered by stretching while sleeping.The leg appears to be cramping badly, which is why the person wakes up.
Dry skin on legsis a consequence of disruptions in tissue nutrition.Toxins that are not removed through the bloodstream disrupt the normal function of cells.The epidermis becomes less elastic and loses moisture, leading to flaking.
Long-term venous insufficiency increases vascular permeability.The liquid part and formed components of the blood “sweat” through the wall into the surrounding tissue and are destroyed there.Blood pigments spread under the skin – this is what it looks like on the outsideHyperpigmentation, darkening of the epidermis with the formation of brown spots.
The process is often accompaniedTissue compaction(hardening), which occurs due to a deterioration in the blood supply and inadequate nutrition over a long period of time.At the same time, the structure of the skin and subcutaneous tissue is rebuilt; they become richer in connective fibers and less elastic.This phenomenon is most commonly observed in the lower third of the lower leg on the inside.
If the disease is not treated, it will worsen.In later stages, trophic ulcers appear.There is a long-term non-healing wound on the inner surface of the lower third of the leg.It can be the size of a five-kopeck coin or surround the entire shinbone.
Complications of varicose veins
Inflammation of saphenous veins, formation and detachment of blood clots, blockage of pulmonary arteries, skin changes, trophic ulcers - all these are complications of varicose veins, consequences of long-term pathology.
Thrombophlebitis- Inflammation of the saphenous veins.A blood clot forms in the superficial vessels, which is accompanied by an inflammatory reaction.A dangerous condition that threatens to spread into deeper veins.Part of the clot can break off and travel through the heart to the lungs and block a pulmonary artery.This condition is called pulmonary embolism (PE).
Treatment of thrombophlebitis is usually carried out on an outpatient basis, but treatment methods depend on the patient's condition and many related factors and are prescribed by a doctor.
Phlebothrombosis– Formation of blood clots in deep veins.The complication leads to constant swelling and pain, which is associated with the detachment of part of the blood clot and the development of a pulmonary embolism.Phlebothrombosis is treated in a hospital with an inpatient stay.
PE (pulmonary embolism)– a condition in which a blood clot breaks off and travels into the pulmonary artery.Thromboembolism puts you at risk of sudden death when a blood clot blocks an artery, causing suffocation, chest pain and pulmonary infarction.
Blockage of the small branches of the pulmonary artery can be asymptomatic but can have serious consequences.A massive pulmonary embolism is only treated in the intensive care unit.
Chronic venous insufficiency (CVI)- the result of a delay in venous blood flow in the legs due to a “collapse” of the valve mechanism.
I describe it schematically like this: The human body consists of cells that need to be nourished.In addition, fresh, oxygen- and nutrient-rich arterial blood reaches all cells and tissues.After the cells have “eaten,” they produce “waste” that is disposed of into the veins.Venous blood is purified, saturated with oxygen and converted into arterial blood.The circle closes.
What happens if you have circulatory problems?Drainage is delayed and waste is not removed.The tissue begins to suffer and turns from normal to bad (diseased).All processes change.Fluid leaks out of the vessel walls and edema forms.Pain occurs.Over time, the intercellular space changes, the subcutaneous tissue becomes coarser and “shrinks,” the skin becomes darker and thicker, and long-term non-healing ulcers develop.
Hyperpigmentation and lipodermatosclerosis– Consequences of chronic VN.These are not life-threatening diseases, but they do affect the quality of life.The feeling of tension in the skin and its unaesthetic appearance cause discomfort.Complications decrease after treatment of varicose veins.
Varicose eczema– Inflammation of the lower leg skin with redness and itching, weeping areas and peeling.Externally, it resembles ordinary eczema, only it is treated differently: without eliminating the underlying disease (venous insufficiency), all ointments are ineffective.
Trophic ulcer– an open wound that does not heal for more than 2 months.Occurs due to impaired tissue nutrition.Poor blood circulation and stagnation limit the nutrient supply to the cells, resulting in their inability to reproduce normally and fill the skin defect with new structures.It is pointless to treat ulcers with ointments alone;To eliminate CVI, an integrated, multi-method approach is required.
Bleeding from varicose veinscan occur with even minor injuries to the shin area and is often serious because the blood pressure in dilated vessels is above normal.Stopping bleeding is easy: place a sterile cloth on the wound and bandage it tightly.Do not use a tourniquet;If the limb is numb or tingling, loosen the bandage.Additionally, lift your leg higher.
diagnosis
The diagnosis begins with a consultation.The doctor finds out whether the problem is actually varicose veins and only that. In my practice there have been cases with varicose vein symptoms, but they had nothing to do with it.Edema is caused by heart failure, lymphedema and allergies.
The clinical picture may not indicate varicose veins, but another disease.Pain in the calf muscles is associated with atherosclerosis of the arteries, osteochondrosis, and flat feet.The causes of trophic ulcers include high blood pressure, skin infections, stroke, and damage to peripheral nerves.
A phlebologist will perform a differential diagnosis and make an accurate diagnosis to find out what is causing your symptoms.A reliable diagnostic method is the duplex study.It helps to clarify the condition of blood vessels and develop individual tactics for patient management.
Computed tomography, MRI venography and venography are rarely used today.
How to treat?
Treatment should always be comprehensive.There are three directions available to the doctor:
First -Compression elastic knitwear.These include knee socks, stockings and tights.They all have different levels of pressure.The type of knitwear and the degree of compression are selected individually depending on the type and stage of the pathology.
I would like to note: if you have tried wearing compression stockings but have not noticed any improvement or your condition has worsened, you need to see a doctor.You may have a disease other than varicose veins;The products may be of poor quality or used incorrectly.It is important to find out why there is no positive momentum.
Second –drug therapy.The spectrum of medications that reduce the manifestations of CVI is large.Some drugs are stronger, others weaker.The doctor selects drugs taking into account the manufacturer, dosage, treatment regimen and duration.
Third -operation.There are different types of operations: phlebectomy (removal of enlarged veins through incisions), miniphlebectomy (removal through punctures), laser obliteration (laser sealing), radiofrequency ablation (heat sealing).Each method has its own advantages and disadvantages, opportunities and limitations.The phlebologist decides which method or combination of methods is right for you.