Varicose veins most often affect the venous system of the legs. External manifestations (protruding nodular blue veins, swelling) are not just a cosmetic problem, but signs of a serious disease that worsens over time.
What are varicose veins: definition of the disease
The word "varicose veins" comes from the Latin varix - "swelling". The name fully reflects the pathological process: the walls of the veins become thinner, and expansions (sac-like swellings) - nodes - form in some areas.
The first case of varicose veins was recorded in a document from 86 BC. BC: Roman general Gaius Marius complained of pain in his legs due to "blue swollen veins. "
The main reason for the development of varicose veins (varicose veins, varicose veins) is an increase in pressure in the system of superficial vessels. This is facilitated by certain diseases, hormonal changes and a sedentary lifestyle.
At first, even under the influence of these factors, the vessels function normally, but gradually they become deformed, change their structure and can no longer fully transport blood.
Varicose veins can develop in almost any part of the body, but most often appear in the lower extremities. Therefore, when it comes to varicose veins, by default they mean the problem of the legs.
Code for varicose veins in ICD-10
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.
I83 - varicose veins of the lower extremities:
- I83. 0 - varicose veins of the lower extremities with ulcers;
- I83. 1 - varicose veins of the lower extremities with inflammation;
- I83. 2 - varicose veins of the lower extremities with ulcers and inflammation.
85 - varicose veins of the esophagus:
- I85. 0 - varicose veins of the esophagus with bleeding;
- I85. 9 - varicose veins of the esophagus without bleeding.
I86 - varicose veins of other localizations:
- I86. 0 - varicose veins of the sublingual veins;
- I86. 1 - varicose veins of the scrotum (anatomical formation in men - a receptacle for the testicles and their appendages);
- I86. 2 - varicose veins of the pelvis;
- I86. 3 - varicose veins of the vulva (the external genitalia of a woman);
- I86. 4 - varicose veins of the stomach.
O22. 0 - varicose veins of the lower extremities during pregnancy.
In our country, 30 million people suffer from various forms of varicose veins. A third of them have complications - trophic ulcers. An open defect in the skin or mucous membrane that occurs due to impaired blood circulation and tissue innervation.
The mechanism of development of varicose veins
The pathological reactions of the body are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels will help to understand how and why the disease develops.
How blood moves through the body
There are two types of vessels in the human body - veins and arteries. Blood flows through the arteries from the heart to all organs and tissues. This occurs under high pressure (70–120 mm Hg) and at high speed.
Blood flows through the veins from organs and tissues, it is directed to the heart under low pressure (0–20 mm Hg).
The walls of veins are less thick and elastic than the walls of arteries, and, unlike arteries, do not contain such a developed muscle layer. Therefore, varicose veins are possible only in veins, but not in arteries.
Arterial and venous human circulatory system. Veins are indicated in blue, arteries in red.
Low pressure in the veins is necessary to transport blood from the periphery to the center. But at the same time, on the way to the heart, the blood flow encounters an obstacle - the force of gravity. This force forces the blood to return through the veins.
You can often hear that varicose veins are humanity’s retribution for walking upright. After all, the longest distance that blood must travel in the body, overcoming gravity, is the path from the feet to the heart. The movement of blood through the veins is ensured by contractions of the heart, the muscle pump of the surrounding muscles, and negative pressure in the chest during inhalation.
In healthy vessels, the reverse flow of blood is prevented by valves on the inner walls of the veins. The valves act like one-way swing doors - they open and allow blood to flow to the heart and immediately close if gravity tries to push the blood back out.
It is not only the valves that help the veins deliver blood to the heart, but also the muscles that surround the vessels. By contracting and relaxing, muscles help move blood through the veins. This mechanism only works when a person moves. When standing or sitting for a long time, the muscle pump is practically inactive.
The cusps of the venous valves always face the direction of blood flow - towards the heart
How failure occurs and disease occurs
An increase in pressure in the vein system disrupts the functioning of their valve apparatus and leads to reverse flow of blood through the vessels. Because of this, as well as due to stagnation of excess blood, weakness of the valve apparatus (for example, in diseases of the connective tissue), the lumen of the veins expands, the walls become deformed, become thinner and local sac-like protrusions - nodes - are formed.
The process is similar to inflating a balloon: if you do not allow the air to escape, the balloon inflates more and more.
On the left is normal blood flow; on the right - multidirectional blood flow due to impaired functioning of the venous valves, vascular deformation
There are superficial and deep veins in the legs. 85–90% of the total blood volume passes through the deep ones, only 10–15% through the superficial ones. The walls of the deep veins are denser and more adapted to increased blood volumes. And the superficial veins of the legs are thinner and are more susceptible to varicose veins.
In the pelvis and lower parts of the esophagus there are large venous plexuses, which can also undergo varicose transformation. In the veins of the small pelvis, the mechanism of development of the disease is the same as in the lower extremities. But varicose veins of the esophagus arise for another reason: due to portal hypertension - increased pressure in the portal vein system, which develops with cirrhosis of the liver, hepatitis, parasitic liver lesions, fatty hepatosis, etc.
Causes of varicose veins
A number of factors contribute to the development of varicose veins in the legs. The main ones arevalvular insufficiencyAndheredity. It is known that a quarter of patients had close relatives suffering from one of the forms of varicose veins.
Overweight. The more extra pounds a person has, the greater the load on the venous system. Over time, the veins cease to cope with such pressure: the lumen of the vessels increases, and the valves on their walls cease to fully close. As a result, blood stagnation occurs and varicose veins develop.
Pregnancy. Hormonal changes occur in a woman’s body, body weight, intra-abdominal pressure and the volume of circulating blood increase - this leads to a disruption of the outflow, causes stretching of the walls of the veins and changes in the functioning of the valve apparatus.
After childbirth, the diameter of dilated veins decreases, but does not always return to its original value. With subsequent pregnancies, the risk of developing varicose veins increases.
Age. Varicose veins often affect people after 50 years of age. The older a person is, the more the venous valves wear out, while the recovery processes slow down and the mechanism of pathological expansion of the veins is triggered - the development of varicose veins.
Venous refluxVenous refluxReturn of blood through the veins due to resistance to blood flow, from lat. refluo - "to flow backwards. "found in 10–15% of schoolchildren aged 12–13 years. The disease "gets younger" due to a sedentary lifestyle and excess weight.
Varicose veins of the lower extremities develop faster if there are additional risk factors.
Risk factors that contribute to the development of varicose veins of the legs:
- lack of physical activity - when moving, muscles stimulate blood flow through the veins, and without movement, blood circulation in the veins can be difficult;
- smoking - chemicals contained in tobacco smoke damage the walls of blood vessels, as a result their lumen narrows, blood flow becomes difficult and stagnation occurs, which leads to varicose veins;
- professions that involve standing or sitting for long periods of time - hairdressers, surgeons, cooks, waiters, drivers, office workers are at risk;
- menopause - in women 40–50 years old, the production of sex hormones (estrogen and progesterone) decreases, and at the same time the tone of the venous wall decreases. This increases the likelihood of varicose veins.
Women suffer from varicose veins 3-4 times more often than men. This occurs due to hormonal variability (menstrual cycle, pregnancy, menopause).
During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva
Varicose veins can occur not only in the lower extremities, but also in other parts of the body.
The main causes of varicose veins in various locations
Varicose veins of the esophagus
Changes in the veins of the esophagus with an uneven increase in their lumen, protrusion of the wall and the development of nodular tortuosity of the vessels. Often leads to a life-threatening complication - bleeding.
Reasons:
- cirrhosis
- liver cancer
- other diseases that cause increased pressure in the portal vein system - it collects blood from the abdominal organs
Varicose veins of the scrotum (varicocele)Pathological dilatation of the veins of the pampiniform plexus of the testicle. Manifested by varicose veins in the scrotum and impaired blood flow
Reasons:
- congenital incompetence of the valves of the testicular veins (usually the left one)
- mechanical compression of the testicular vein (inguinal hernia)
Varicose veins of the pelvis
It is characterized by dilation of the ovarian veins and intrapelvic venous plexuses of various diameters. The condition is also known as pelvic congestion syndrome
Reasons:
- polycystic ovary syndrome
- two or more pregnancies
- hormonal dysfunction
Varicose veins of the vulva
Varicose veins of the pelvis, which affects the vessels of the labia and perineum
Reasons:
- compression of retroperitoneal vessels by the uterus during pregnancy
- significant physical activity
- tumors of the uterus and ovaries
Varicose veins of the sublingual veins (sublingual varicose veins)
Asymptomatic damage to the veins located under the tongue. Manifests itself as a slight protrusion of blood vessels and a color change from deep blue to purple
Reasons:
- hypertension
- smoking
- old age
Varicose veins of the stomach
Isolated change in the veins of the stomach or combined with varicose veins of the esophagus
Reasons:
- cirrhosis
- portal hypertension syndrome - increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thrombosis, venous development abnormalities)
Symptoms of varicose veins
In rare cases, only the aesthetic side of the disease appears - bluish veins. Most patients suffering from varicose veins of the legs report at least one or more unpleasant symptoms.
Symptoms of varicose veins of the lower extremities:
- fatigue, soreness or a feeling of heaviness in the legs - this is caused by stagnation of blood and its pressure on surrounding tissues;
- burning, tingling or pulsation in the legs - a reaction to slowing blood flow and overflow of the venous system of the lower extremities;
- night muscle cramps in the legs - painful spasms occur due to stagnation of blood and accumulation of metabolic products in the tissues;
- swelling of the feet and ankles - due to stagnation in the veins, the liquid part of the blood seeps into the subcutaneous tissue through the altered vascular wall;
- itching of the skin around damaged veins - dilated and altered blood vessels do not provide normal blood circulation and nutrition to the skin, so it dries out and becomes rough.
Unpleasant sensations in the legs in patients with varicose veins intensify in the evening, especially after long periods of sitting or standing.
The appearance of altered veins is not always proportional to the severity of symptoms. Thus, veins that are barely noticeable to the eye and affected by varicose veins can cause severe discomfort, while nodular and thickened veins can cause minimal concern.
Varicose veins affect different veins: from small vessels of the skin to large saphenous veins
Symptoms of other types of varicose veins largely depend on the underlying cause of the disease. Often patients do not complain about anything, and the doctor identifies the problem only during examination. This happens, for example, with varicose veins of the sublingual veins.
In some cases, as with varicose veins of the esophagus or stomach, the pathology immediately manifests itself as a life-threatening complication - bleeding.
Classification of vein diseases
In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation formed by the initial letters of the main sections of the classification:
- C — clinic (clinical changes);
- E — etiology (origin of the disease);
- A - anatomy (anatomical localization of varicose veins);
- P - pathogenesis (mechanism of venous blood flow disorders).
Complications of varicose veins on the legs
Typically, varicose veins in and of themselves are not life threatening. But sometimes the disease can cause complications.
Thrombophlebitis- inflammation of the walls of the veins, which is accompanied by the formation of a thrombus (blood clot) closing the lumen of the vessel. It manifests itself as swelling and redness along the affected vein. The patient experiences pain, the skin in the affected area becomes red and hot to the touch.
Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue along the thrombosed vein.
Venous trophic ulcer- an open defect of the skin and soft tissues due to blood stagnation, edema and impaired cell nutrition. The ulcer occurs on the legs and ankles near areas of varicose veins. In the lower parts of the legs, the swelling is more pronounced, which means that the tissues are compressed more than in other areas. Ulcers take a long time to heal, and they often contain bacteria, which increase inflammation.
Trophic ulcers heal very poorly due to impaired blood circulation and tissue nutrition
Bleeding- occurs when a vein ruptures, dilated due to varicose veins. In the later stages of the disease, the skin over such veins is very thin and dry - a minor injury is enough for the integrity of the vessel to be compromised and bleeding to occur. Sometimes spontaneous rupture of a vein occurs in the area of varicose nodes.
Diagnosis of varicose veins of the legs
A phlebologist deals with the diagnosis, treatment and prevention of vein diseases. The doctor makes a diagnosis based on the patient’s complaints, examination and instrumental studies. If the symptoms of varicose veins are pronounced, tests are usually not prescribed: a doctor’s examination is enough.
The doctor may prescribe laboratory tests in preparation for surgery or to exclude concomitant diseases that affect the condition of the blood vessels.
One of these diseases is diabetes mellitus. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).
For an accurate diagnosis and determination of treatment tactics, you will need duplex ultrasound scanning - the gold standard for diagnosing vascular conditions. The method allows you to evaluate the structure, function, patency of the superficial and deep veins, the consistency of the valves, and also determine the direction of blood flow.
If a secondary nature of varicose veins is suspected (may occur after deep vein thrombosis), the doctor prescribes venography, CT or MRI venography.
Phlebography is an X-ray examination that is used to determine the patency of deep veins and valve function.
Computer or magnetic resonance venography is used to visualize the venous system in three-dimensional projection and at very high spatial resolution.
Treatment of varicose veins on the legs
The goal of treating varicose veins is to reduce or eliminate symptoms, improve the appearance of the veins, and prevent complications.
The doctor chooses a treatment method depending on which vessels are affected and how serious the patient’s condition with varicose veins is.
Non-invasive treatments
Non-invasive treatments for varicose veins include compression therapy, medication therapy, and lifestyle changes.
Compression therapy involves wearing special socks, stockings, and tights. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the appropriate knitwear.
Compression jersey in the lower legs compresses more than in the upper legs - thereby pushing blood towards the heart and eliminating stagnation
Effects of compression therapy for varicose veins:
- the manifestations of symptoms decrease - heaviness, fatigue in the legs, night cramps, burning sensation or soreness;
- the severity of edema is reduced due to improved blood circulation;
- The healing of trophic ulcers is accelerated, because elastic compression improves blood circulation and tissue nutrition.
Drug therapy - the doctor can prescribe phlebotropic Phlebotropic drugs (phleboprotectors, venotonics) Biologically active substances that increase venous tone and reduce the severity of venospecific symptoms. (venotropic) drugs.
The main groups of phlebotropic drugs that are used for varicose veins:
- angioprotectors: improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the likelihood of blood clots;
- antithrombotic agents: reduce the risk of the formation of dangerous blood clots (thrombi) in the lumen of blood vessels and promote the dissolution of existing ones;
- bioflavonoids: natural plant compounds that improve venous tone and reduce venous congestion.
Lifestyle changes for varicose veins significantly slow down the development of the disease, and in combination with other recommendations of the attending physician, it helps to stop the pathological process.
Important directions in changing the lifestyle of patients with varicose veins:
- moderate intensity exercises: walking, swimming, water aerobics, leg exercises, yoga. Strengthening muscles will help normalize blood circulation in the vessels, relieve venous stagnation and edema;
- weight control: thanks to normalization of body weight, the load on blood vessels is reduced and the return of blood through the veins to the heart is facilitated;
- giving up bad habits: nicotine and alcohol damage the internal walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of veins and valve function.
Invasive methods for treating varicose veins
Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure using a special sclerosing solution (sclerosant). The solution is injected into the problematic vein through a thin needle, which causes its sclerosis - "gluing". The vein is switched off from the bloodstream and becomes invisible over time; its function is taken over by neighboring veins. Sclerotherapy is carried out without hospitalization - after the procedure the patient can go home.
The sclerotherapy procedure takes from 5 to 30 minutes, depending on how many varicose veins need to be filled with sclerosant and how large they are
Endovenous laser thermoobliteration (EVLO). A catheter with a laser light guide is inserted into the vessel through a tiny incision. The thermal energy of the laser heats the vein, and it becomes obliterated—"sealed. "After a few months, the vessel is replaced by connective tissue and disappears. The procedure is performed on an outpatient basis.
Radiofrequency vein obliteration (RFO) is the effect of high-frequency current on the inner surface of blood vessels. Through a micropuncture, a catheter is inserted into the vein, which is connected to a device that generates radiofrequency pulses. Inside the vessel, the radio wave is converted into thermal energy, which "seals" the vein.
With EVLO, the vein is briefly exposed to high temperature; with RFO, the temperature is lower, but the session is longer. Both procedures are effective and safe.
NTNT obliteration, or non-thermal non-tumescent methods:
- venous obliteration using cyanoacrylate glue;
- mechanochemical obliteration, in which mechanical and chemical effects on the vessel simultaneously occur.
NTNT obliteration is the most modern, low-traumatic method of treating varicose veins with a short rehabilitation period.
Phlebectomy is the removal of saphenous veins that have suffered from varicose veins. It can be performed as an independent operation or combined with other techniques. The varicose vein is removed under local anesthesia through small punctures.
Prevention of varicose veins of the legs
You can prevent the development of varicose veins if you follow simple rules of prevention in everyday life.
A combination of provoking factors—sitting for long periods of time with crossed legs, wearing uncomfortable shoes—increases the risk of varicose veins in the legs.
Prevention of varicose veins - what you need to know:
- moderate physical activity (walking, swimming, leg exercises) and resting with elevated legs improves the free movement of blood through the vessels and helps avoid stagnation in the veins;
- rational nutrition and normalization of weight lead to strengthening of blood vessels;
- wearing loose clothing that does not restrict movement helps improve blood circulation;
- a cool shower in the warm season helps keep veins toned;
- comfortable shoes with low heels (no more than 3 cm) make it possible to avoid improper load on the foot and disruption of blood flow;
- A reasonable approach to visiting saunas and steam baths allows you to maintain normal blood flow (long-term thermal procedures greatly dilate the veins, so blood flow slows down).