Varicose veins are a disease of the veins, manifested by their expansion, elongation with the formation of nodes and thinning of the venous wall. It can affect various vessels, but most often occurs in the lower extremities.
In advanced cases, it leads to trophic disorders in the affected area, the development of ulcers, eczema, and even necrosis and gangrene. Therefore, it is important to make the correct diagnosis in time and start treatment.
How do varicose veins develop?
The exact causes of this disease are not known. But the mechanism of how varicose veins begin is well understood.
The venous network of the lower extremities is represented by deep and peripheral veins, as well as communicating (perforating) vessels connecting them. Normally, blood flows through the veins towards the heart, from peripheral to deep vessels.
This is done due to the muscle pump (contraction of the muscles of the lower extremities), the tone of the vascular wall and the work of the venous valves. The circulatory system is regulated by the vasomotor center in the brain.
But in case of violations at least in one of these links, a reverse outflow of blood occurs. At the same time, the peripheral vessels expand, the valves stop closing, causing even more blood stasis in the peripheral circulation.
Under blood pressure, the venous wall continues to expand, causing the vessels to elongate and knots to form. Valve insufficiency increases, edema develops.
Compression of the peripheral nerves sends a signal to the brain about the need to increase the tone of the vascular wall. This increases the blood pressure in the deep vessels, and the blood from them is forced out into the peripheral ones, causing their expansion even more. A vicious circle is closing.
What causes varicose veins
The true cause of varicose veins is not known. But it has been proven that a number of factors and physiological conditions contribute to its development.
Such as:
- Pregnancy (due to compression of the veins in the abdominal cavity by the pregnant uterus, blood circulation in the lower extremities is difficult);
- Obesity;
- Sedentary lifestyle;
- Genetic predisposition (weak valves or decreased tone of the vascular walls);
- Violation of the hormonal balance (leads to an increase in blood viscosity and difficulty in its outflow);
- Condition after operations (due to increased blood clotting and bed rest);
- Professions associated with a long stay in an upright position (on the legs).
In the event of one of these situations, it is necessary to take preventive measures to prevent the development of varicose veins. Especially if there are already any clinical manifestations.
Symptoms of varicose veins
The first signs of varicose veins are:
- Pain and heaviness in the lower extremities;
- Swelling of the legs in the evening;
- The appearance of spider veins on the skin;
- Visible tense veins under the skin;
- Feeling of burning and itching in the affected area;
- Cramps in the muscles of the lower extremities, especially at night.
Pain with varicose veins occurs and intensifies by the end of the day. They have a bursting, aching character. At the beginning of the disease, they disappear after rest, and therefore patients do not go to the doctor for a long time.
On examination, edema, pastosity of the legs, telangiectasia are revealed, tense venous trunks, often painful, are palpated. What the skin of the legs looks like with varicose veins can be seen in the photo.
In the stage of severe decompensation, weakness, dizziness, and fainting may occur. At the same time, trophic disorders are noticeable on the skin, ulcers, dermatitis and eczema develop. With a timely visit to the doctor, severe manifestations of varicose veins can be prevented.
Types of varicose veins
There are the following types of varicose veins:
- Varicose veins of the lower extremities (the most common variant);
- Varicose veins of the upper extremities;
- Varicose veins of the small pelvis (including varicose veins of the uterus);
- Varicose veins of internal organs (esophagus, stomach, intestines, etc. );
- Varicose veins on the face.
The most studied type is varicose veins of the lower extremities. It occurs most often, and usually it is he who is meant when talking about this disease. Most patients do not know if internal varicose veins exist and how they manifest themselves until they are confronted with them.
Stages of development of varicose veins:
| Stage of the disease | Clinical manifestations |
|---|---|
| 1 stage | There are no symptoms, varicose veins are detected only during instrumental examination |
| 2 stage | Heavy leg syndrome, transient edema, spider veins on the skin |
| 3 stage | Persistent edema, pigmentation disorders on the skin, dense tense veins and nodes are visible, trophic disorders in the form of eczema |
| 4 stage | There are trophic ulcers, dermatitis, necrosis |
The smaller the stage, the easier the treatment and the better the prognosis for recovery.
Diagnosis of varicose veins
To make a diagnosis, in addition to the examination data and characteristic complaints, a laboratory and instrumental examination of the patient is required.
Laboratory diagnostics
What tests should be taken for varicose veins:
- Complete blood count with an extended formula.
- Blood clotting tests:
- clotting time;
- prothrombin test;
- determination of antithrombin III, protein S and C;
- determination of the level of homocysteine;
- study of the APTT index;
- determination of the level of the D-dimmer;
- determination of von Willebrand factor activity, etc.
- Biochemistry of blood.
- Hormone analysis.
- General urine analysis.
- functional tests.
Determination of the state of the blood coagulation system is of decisive importance for the choice of treatment tactics and the prognosis of the development of the disease.
Instrumental diagnosis of varicose veins
Of the instrumental research methods used:
- ultrasound examination of veins;
- dopplerography;
- ultrasound duplex scanning of veins (combination of ultrasound and dopplerography);
- angiography;
- photoplethysmography (PPG);
- phlebography;
- venous occlusal plethysmography (VOP).
With these types of studies, the thickness of the vascular wall is measured, the condition of the venous valves, the presence or absence of reverse blood flow in the veins, etc. are studied. With the help of instrumental methods, it is possible not only to make the correct diagnosis, but also to accurately determine the stage of the disease.
Treatment of varicose veins
The fight against varicose veins includes medical (conservative and surgical treatment) and non-drug methods. The choice of a specific option depends on the stage of the disease and the degree of its external manifestations.
Conservative treatment of varicose veins
Therapy of this disease involved surgeons and phlebologists. At the first signs of the disease, you need to contact the doctors of these specializations. They will confirm the diagnosis and prescribe how to treat varicose veins in this case.
In conservative therapy, the following groups of drugs are used:
- antiplatelet agents for blood thinning and prevention of blood clots;
- anticoagulants of direct and indirect action to improve the rheological properties of blood and prevent its thickening;
- phlebotonics to strengthen the vascular wall, herbal preparations with horse chestnut extract;
- anti-inflammatory drugs if necessary (in the presence of inflammation in the vascular wall or in surrounding tissues).
Most of these drugs are available both for oral administration (in tablets and capsules) and for external use (in the form of ointments, gels, creams). The doctor will tell you which form is best for this patient, depending on the specific clinical situation.
Surgical treatment of varicose veins
Conservative therapy will help to completely cure the disease only in the early stages. In advanced cases and with symptoms of decompensation, surgical treatment of varicose veins is necessary.
Surgical intervention may consist in removing the entire vein or only the affected area through incisions along the vessel or in the inguinal fold and popliteal fossa (depending on the specific vein and its location). But whenever possible, doctors try to carry out a less traumatic procedure that causes coagulation of the affected vessel, which leads to its complete obstruction.
Options for sparing operations:
- sclerotherapy (introduction through a catheter into the lumen of the vessel of special sclerosing drugs that cause tight adhesions in it with their subsequent replacement with connective tissue);
- endovasal laser coagulation (coagulation of the internal cavity of the vessel with a laser pulse);
- radiofrequency coagulation (gluing the walls of a vein as a result of exposure to a high-frequency current pulse);
- miniphlebectomy (removal of a vein or its section through several punctures in the skin).
When carrying out coagulation in different ways, the result is the same - after gluing the walls of the vessel, its cavity will gradually be filled with connective tissue with the development of complete obstruction. In this case, the movement of blood will continue through healthy vessels, bypassing the coagulated ones. Schemes for carrying out such operations can be seen in the video in this article.
Surgical methods have an indisputable advantage - the likelihood of recurrence after them is very low. In terms of the ratio of risks and effectiveness, less traumatic procedures are better. But the price for them in clinics is quite high.
Non-drug treatment of varicose veins
Strengthening the walls of blood vessels with varicose veins is quite possible without the use of tablets.
From non-drug means for this use:
- therapeutic exercises (to stimulate the muscle pump);
- compression hosiery and elastic bandages (compression of the lower extremities stimulates the expulsion of blood from the vessels, normalizes the functioning of venous valves, strengthens the vascular wall).
Wearing compression stockings is recommended for all people at risk, especially:
- pregnant women;
- working all day standing;
- to all people during long flights on airplanes;
- patients taking drugs that promote blood clotting;
- people with a sedentary lifestyle.
Prevention of varicose veins
Prevention of varicose veins is better to start before it appears. Moreover, the recommended measures will help prevent other cardiovascular diseases.
Prevention instructions:
- give up all bad habits;
- carefully monitor your diet (exclude fatty, fried, smoked, sweet);
- strictly control your weight;
- lead an active lifestyle (more walking, running, cycling, rollerblading, etc. );
- wear comfortable shoes with small heels;
- daily contrast shower;
- at the end of the day, take a 15-minute rest with your legs elevated.
These measures will also help with identified varicose veins - to prevent further progression of the disease and the development of complications.
Many are interested in whether it is possible to play sports with varicose veins. The attending physician will give the exact answer to this question, but in most cases you can go in for sports, excluding its heavy types associated with power loads.
Varicose veins are a common disease. Women suffer from it 4 times more often than men, which is associated with the peculiarities of the hormonal background, pregnancy and a large list of women's professions, which involve spending the whole working day on their feet.
But timely prevention will help prevent the development of varicose veins for both men and women. The main thing is not to neglect the advice of a doctor and do not forget about the regularity of preventive measures.