Varicose veins

Varicose veins of the legs are a common disease that is manifested by permanent and irreversible expansion and lengthening of superficial veins and disruption of their function due to the development of a pathological process in the venous wall and congenital or acquired valvular insufficiency. apparatus.

According to the World Health Organization, varicose veins occur in every fifth adult on the planet. The first signs of varicose veins (venous reflux) are found in 10-15% of children and adolescents aged 12-13 years.

Causes of varicose veins in the legs

• Hereditary predisposition (congenital weakness of vascular valves). If your parents had signs of venous wall weakness in all vessels (legs, groin, esophagus, rectum), then with a high degree of probability, symptoms of varicose veins may appear in you.
• Poor blood circulation in the lower limbs during pregnancy and childbirth (compression of the abdominal veins by the developing fetus with increased pressure in the veins of the legs, hormonal changes causing a decrease in the tone of the veins).
• Impaired blood flow during prolonged standing (varicose veins of the lower extremities are more common in salesmen, teachers, waiters, surgeons) and in a sitting position (managers, accountants, office workers, drivers, etc. )
• Heavy physical work, sports training related to weight lifting (for athletes, loaders, builders, regular visitors to gyms and fitness clubs)
• Long-term use of contraceptives with a high content of female sex hormones.
• Hormonal changes in the body, accompanied by a decrease in the tone of venous vessels (adolescence, pregnancy, menopausal disorders in old age).
• Factors such as excess weight, chronic cough, constipation, the habit of wearing tight clothes and shoes disrupt the venous outflow and often lead to varicose veins.

Why do varicose veins appear during pregnancy?

In women, varicose veins of the lower extremities are observed 3-5 times more often than in men and quite often appear for the first time during pregnancy. In 80% of cases, varicose veins develop first on the left leg and only then on the right.

• The appearance of varicose veins is facilitated by hormonal changes in a woman's body during pregnancy, which leads to a decrease in the elasticity of the venous wall, its stretching and its transformation into a varicose node.
• In the body of a pregnant woman, the volume of blood flow increases significantly. Increased venous pressure leads to thinning of the venous wall and its local expansion (varicose veins).
• The growing fetus causes a corresponding enlargement of the uterus and a difficult outflow of blood from the lower extremities through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
• The increased body weight of a pregnant woman also negatively affects venous outflow.

Varicose veins of the lower extremities: symptoms

Varicose veins develop quite slowly, passing through several main stages in sequence:

• At the first stage, the violation of venous circulation is accompanied by the appearance of separate "spider veins", thinning of the skin, through which, during physical activity, dilated veins begin to appear in the form of twisted ligaments (usually in the popliteal fossa), there are no complaints.
• In the second stage of varicose veins, there is a feeling of heaviness, fatigue in the lower limbs, swelling of the legs in the evening and after a long walk, a feeling of crawling "needles" on the legs, night cramps in the calf muscles, upon careful examination, several varicose veins are foundveins of the lower legs, and sometimes - of the foot and thigh.
• The third stage of varicose veins of the lower limbs is characterized by a pronounced bulging of venous nodes mainly on the inner surface of the legs, the appearance of dark brown or brown spots on the thin, easily wounded skin of the legs, and the development of dermatitis with itching and rashes. The swelling of the legs becomes more intense, which makes it difficult to walk.
• The fourth stage of varicose veins is the presence of enlarged nodes on the foot, leg and thigh, the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose nodes, development of thrombophlebitis).
• Sometimes the fifth stage is also distinguished - there are all the symptoms characteristic of the fourth stage of varicose veins, with the spread of the process in the groin, buttocks, perineum, the presence of multiple trophic ulcers, the appearance of elephantiasis, frequent exacerbations of thrombophlebitis and the occurrence ofdisability.

Complications of varicose veins

1. Thrombophlebitis of superficial veins.
2. Bleeding from rupture of a varicose vein.
3. Dermatitis, eczema.
4. Trophic ulcers.
5. Deep vein thrombosis (phlebothrombosis) and postthrombophlebitis disease.
6. Pulmonary embolism (PE).
7. Lymphedema (elephantiasis).

Diagnosis of varicose veins

It is based on a clinical examination, performing functional tests and conducting instrumental examinations of the veins.

• Clinical examination (clarification of complaints, history taking, examination, palpation).
• Doppler ultrasound.
• Ultrasound angioscan.
• Plethysmography.
• Ascending and descending phlebography.
• Radionuclide phlebography (radiophlebography).
• Computed tomography and MRI (CT venography, MR venography).
• Intravascular ultrasound examination.
• Thermography.

Treatment of varicose veins of the lower extremities

If varicose veins are detected at an early stage, you can deal with its manifestations with the help of compression hosiery, special therapeutic exercises and traditional methods of treatment. But if you visit a doctor late, when varicose veins are visible to the naked eye, your legs hurt and swell, trophic ulcers appear, signs of thrombophlebitis, the only way out is surgical intervention.
At the same time, you should not be afraid of surgery, because modern technologies allow you to get rid of varicose veins of the lower extremities without wide incisions, without pain and practically without disturbing a person's usual way of life.

The principle of surgical manipulation is similar for the different techniques: the pathologically changed superficial veins of the legs are ligated, cut and removed. In this case, the venous circulation in the lower limbs is not disturbed, since the operation does not affect the deep veins, through which about 90% of the venous blood flows.

Main types of operations for varicose veins

1. Sclerotherapy. In the initial stage of varicose veins, a good cosmetic result is achieved by introducing special drugs into the problem vein, causing gradual sclerosis, "gluing" the pathologically enlarged area of the vessel. Through a special catheter or a very thin needle, a medicinal substance is injected into an enlarged vein (usually a sclerosant). 3 to 10 injections are required to achieve a positive result.
2. Phlebectomy. An operation that has been done for almost a hundred years, but in modern conditions wide incisions have long been abandoned. Manipulation these days is done through tiny 3-5 millimeter incisions. The pathologically dilated vein is first ligated and cut at the point where it flows into the deep vein, then removed using special probes. This operation lasts approximately 1-2 hours, after which the patient remains in the hospital at a treatment facility for 1-2 days.
3. Miniphlebectomy. The operation is performed under local anesthesia, without incisions, but with the help of small incisions through which the dilated vein is removed. Thus, a good cosmetic effect is achieved (usually no stitches are required) and the recovery period after the operation is significantly shortened. In some cases, not the entire vein can be removed, but only its pathologically changed part. This intervention is called short stripping.
4. Endovenous laser coagulation of veins. The manipulation is performed under ultrasound control. A special laser light guide is inserted into the pathologically dilated vein and the saphenous vein and its tributaries are burned. After a certain period of time, obliteration and sclerosis of the vein occurs, its complete closure. If necessary, laser coagulation is combined with miniphlebectomy. In this case, the effectiveness of surgical treatment of varicose veins of the lower extremities will be the highest.
5. Radiowave ablation of varicose veins. The removal ("gluing") of the lumen of the changed vein is achieved by exposure to radio waves of a certain power, delivered to the problem area of the vein through a special catheter. The duration of the procedure is about 20 minutes.

After surgical treatment of varicose veins by one of the above methods, it is necessary to limit physical activity for a certain time, wear compression stockings and, if necessary, use drugs that have a venotonic effect. This will help to restore normal blood circulation in the veins of the lower extremities as soon as possible, prevent possible complications and allow you to quickly return to work and the normal rhythm of life.

In what cases is surgical treatment of varicose veins of the legs undesirable?

• During pregnancy and during the first two months after birth.
• In the initial stage of varicose veins, when there are still no complaints and existing cosmetic problems ("spider veins" on the legs), you can first try to remove them using exercise therapy, compression hosiery and traditional methods.
• In old age and in the presence of serious diseases of various organs and systems of the body with dysfunction, when the risk of possible complications is significantly increased.
• In the presence of disorders of lymphatic drainage, infectious lesions of the skin of the lower extremities, thrombophlebitis, arteriovenous fistulas.

With the correct choice of the most effective method of treating varicose veins of the lower extremities in this particular case, the absence of contraindications and compliance with the doctor's recommendations in the postoperative period, a positive result of the surgical intervention will be guaranteed.

Prevention of varicose veins of the lower extremities

Mode and diet

Adherence to a certain regime of work and rest, as well as nutrition, will in most cases prevent the appearance of varicose veins. To do this you need:

• Avoid clothing that restricts venous blood flow.
• Avoid prolonged periods of standing or sitting (take periodic rest breaks and perform simple gymnastic exercises).
• Avoid vigorous physical activity.
• Lead an active lifestyle (moderate dynamic loads - daily walking, swimming, cycling).
• Drink at least 1. 5-2 liters of liquid per day, the daily diet should include vegetables and fruits, whole grain bread and cereals.
• Avoid visiting baths and saunas and refuse to take hot baths.
• Take a contrast shower (warm - cool) every day.
• Wear comfortable shoes with low heels.

Antiplatelet therapy

An important component of preventive measures for varicose veins of the lower extremities is taking drugs that have an antiplatelet effect, i. e. prevent the formation of blood clots. They include:

• Acetylsalicylic acid and modern drugs containing it;
• Venotonics of plant origin - extracts from plants such as horse chestnut, hazelnut, mountain arnica are more often used;
• Synthetic venotonics. By the way, venotonics not only reduce the formation of thrombus, but also improve venous circulation, strengthen the vascular wall, preventing the appearance of areas of expansion.

Compression jersey

For many years, the bandage with elastic tubular bandages has been used successfully in the initial stages of varicose veins (when spider webs appear). Now special clothing is produced - compression knitwear, which allows you to choose the required size and choose the degree of compression depending on the severity of the changes. Wearing socks and tights initially puts pressure on the top of the ankles, followed by a reduction in pressure and stimulation of blood flow up to the heart. Venous vessels work more efficiently, as a result of which venous congestion is eliminated, swelling disappears and the formation of blood clots is prevented.

Gymnastics

Special exercises aimed at eliminating venous blood stagnation have been developed. The key to success here is the regularity of performing the complex. Let's look at a few basic exercises recommended in the presence of risk factors for the development of varicose veins of the lower extremities and in the initial stage of the disease:

• Lie on your back, feet on a pillow on a raised platform. Relax and stay in this position for a few minutes.
• "Bicycle" - lying on your back, legs raised, knees bent. Perform movements that simulate the pedals when riding a bicycle;
• "Scissors" - lie on your back, raise your legs and cross them, changing the position of your legs (up - down) for 1 minute;
• The legs are raised and bent at the knee joints. Bend and straighten your legs, imitating walking;
• Lie on your back, bend your left leg, bring your knee to your chest. Wrap your hands around the ankle joint and gradually straighten your leg, making massaging movements on the calf muscles. Repeat the exercise with the right leg;
• Standing with legs together. Rise up on your toes and lower yourself down (if there are no complications, the exercise can be performed sharply - by hitting the heels on the floor).

Timely initiation and proper implementation of preventive measures can prevent varicose veins of the lower extremities or minimize its manifestations.