Varicose veins on the legs

Varicose veins in the legs are characterized by the formation of saccular expansions of the superficial (subcutaneous) veins of the lower extremities, their serpentine tortuosity, an increase in length due to impaired blood outflow through them and stagnant changes in the lower extremities.

The term “varicose veins” comes from the Latin word varix, which means “twisting, intertwined.”

Humanity has been familiar with varicose veins since ancient times.When conducting archaeological research during excavations of the Mastaba burial in Egypt from 1595-1580.BCa mummy was found with signs of varicose veins and treatment for a venous trophic ulcer of the leg.

This disease is rightfully considered the price humanity pays for the ability to walk upright.On average, about 15% of men and up to 25% of women (including pregnant women) in economically developed countries suffer from varicose veins in the legs.The high-risk group includes women, overweight people, people with a profession that involves long-term stress on the lower limbs, and whose work requires them to stand or sit for long periods of time.

Classification

Taking into account the factors predisposing to the development of the disease, primary and secondary varicose veins in the legs are distinguished for various reasons.

1. Primarydevelops with varicose veins.With varicose veins, it is primarily the superficial veins that change, while the deep veins have normal structure and function.For a long time, varicose veins of the superficial veins manifest themselves only as a cosmetic defect, but later, as the disease progresses, disturbances in venous outflow occur, resulting in painful sensations in the lower extremities, swelling of the feet and legs, darkening of the skin in the lower third of the leg, inflammatory changes and trophic ulcers.Varicose veins are a continuously progressive disease.
2. Secondaryis a complication of deep vein disease, in particular, it develops either as a result of congenital malformations of the venous system (fistulas, congenital dysplasia, etc.), or after suffering phlebothrombosis.Phlebothrombosis is a complex process of thrombus formation in the deep main veins of the lower extremities, as a result of which the blood flow through the deep veins is disrupted.Over time, the forming blood clot becomes fixed in the vein, holes appear in it through which limited blood flow is possible, but the venous valves at the location of the blood clot become scarred and no longer prevent the reverse flow of blood.As a result of dysfunction of the valves of the deep veins, blood begins to move up and down through them, flows back into the superficial veins and secondary varicose veins develop.As a result, favorable conditions are created for venous stagnation, especially in the lowest parts of the limb - the foot and lower leg.

Symptoms of varicose veins

In most people, varicose veins appear as a cosmetic defect, most often appearing on the inner surface of the legs.Sometimes varicose veins can only appear in the form of a venous web, which is formed when veins of small diameter change, most often on the legs and less often on the face or upper extremities.Varicose veins become blue or dark purple in color and have a tortuous course.

Symptoms of varicose veins: fatigue, feeling of heaviness, aching pain, burning and tingling sensation, throbbing, itching, cramps and anxiety.Also, one of the symptoms may be the appearance of swelling of the legs.As a result of pronounced expansion of varicose veins, a violation of the blood supply to the tissues of the lower extremities may develop, skin defects may occur in the form of darkening or redness, and inflammation.In extremely advanced cases of varicose veins, trophic ulcers develop.

Diagnosis of varicose veins

To establish a diagnosis, the doctor first examines the patient, paying special attention to the appearance and swelling of the lower extremities.You may also be asked a number of questions regarding your sensations to clarify the nature of the pain.Another important step is to perform a series of tests to assess the functional state of the superficial and deep veins.And finally, conducting an ultrasound Doppler examination of the main veins of the lower extremities.The ultrasound examination method allows the doctor to see the structure and evaluate the function of the veins of the lower extremities, as well as identify venous blood clots.

When the first symptoms of the disease appear, you should contact doctors who deal with diseases of blood vessels and veins in particular (general surgeon, vascular surgeon and phlebologist), and if the skin is damaged, you should also visit a dermatologist.Only after visiting specialist doctors on their recommendation can you go to a cosmetology clinic.

Prevention of varicose veins

Currently, there is no method that would completely prevent the development of varicose veins.Thanks to prevention, it is possible to improve muscle tone, which helps improve microcirculation in tissues, as well as improve the condition and function of the veins of the lower extremities, and reduce the risk of complications.The traditional and most widespread methods of prevention are as follows:

1. Physical activity.Move more.Your legs should be constantly in motion.During a walk, more favorable conditions are created for blood circulation in the lower extremities.Consult your doctor.He will help you choose the most optimal type and level of physical activity.
2. Control your weight.Being overweight increases the load on the circulatory system and in particular on the veins.Also, with excessive salt consumption, edema increases most pronouncedly as a result of fluid retention in the body.
3. Pay attention to what you wear.Avoid high heels.Your shoes should always be comfortable.When wearing low-heeled shoes, your lower limb muscles work much better, which helps improve venous outflow.You should also avoid wearing uncomfortable and tight trousers and skirts.
4. Raise your feet.When you raise your legs, the venous outflow of blood from the lower extremities improves.Try to take a few breaks throughout the day and put your feet up.For example, lie on your back with your feet on a pillow.
5. Avoid prolonged periods of standing or walking.To improve blood circulation, try to change the position of your body as often as possible.Try to get up and walk every 30 minutes.
6. Don't sit cross-legged.Sitting cross-legged creates unfavorable conditions for blood flow in both lower extremities.

To prevent varicose veins, a good remedy is to wear stockings, knee socks and socks with a compression effect.It can also be a good addition to the main (drug or surgical) treatment.Currently, pharmacies offer a wide range of compression garments to choose from.

Treatment of varicose veins

There are several generally accepted methods of treating varicose veins in the legs:

1. conservative (medication and compression therapy).
2. surgical.

Conservative treatment

Doctors consider elastic compression to be the most effective conservative means of treating and preventing varicose veins - the use of special compression hosiery (stockings, golf, tights).When wearing this knitwear, uniform pressure is ensured on the lower extremities, which promotes normal blood circulation and improves its outflow, while forming, as it were, an outer frame that supports weakened vascular walls.As a result, the load on the veins is reduced, the outflow of venous blood is improved, the rate of further progression of the disease is reduced, and the risk of developing thrombosis is reduced.

Modern compression hosiery is divided into two types: therapeutic and preventive.Each medical product is marked in mmHg, according to which it is divided into classes from I to IV.At different stages of the disease, compression of a certain strength is used and it is necessary to consult a doctor, since only a doctor can prescribe and select the correct compression stockings, taking into account the nature of the pathology and according to certain individual standards.

If you have a sedentary lifestyle, as well as during prolonged physical activity, during pregnancy or with a hereditary predisposition, it is recommended to wear preventive compression stockings and tights.If even minor signs of varicose veins appear, you should immediately contact a specialized clinic.

Drug therapy can reduce the clinical manifestations of the disease - pain, swelling, discomfort, cramps, and so on, but cannot completely stop the progression of the disease and is used today only as part of complex therapy during the main surgical treatment.Unfortunately, most of the drugs offered on the pharmaceutical market today for the treatment of varicose veins have rather low effectiveness, despite the theoretically justified feasibility of use.One of the reasons for this is the low absorption by the body of the medicinal substances underlying these drugs.It is possible that in this situation, increasing the dose of the drug taken would help, but this is associated with an increased risk of complications and side effects.Another reason for the low effectiveness of these drugs is that their spectrum of action is relatively narrow and is aimed at one particular link involved in the development and progression of the disease.And to achieve the optimal effect, a complex effect on the disease and the use of several drugs is necessary.An ideal drug for the treatment of venous insufficiency and varicose veins should affect as many pathogenetic links of chronic venous insufficiency as possible, while having a minimum number of side effects and being well absorbed by the body.

Surgical treatment

Today, surgical treatment of varicose veins in the legs does not require a long hospital stay.Thanks to the use of modern invasive treatment methods, the removal of varicose veins can be carried out not only under anesthesia with the patient completely switched off, but also under local anesthesia, when the patient is in clear consciousness, only the pain sensitivity of the lower extremities is turned off.Varicose veins disappear on their own within 3 months after delivery without any treatment.

The following surgical treatment methods are available:

1. Sclerotherapy.During this procedure, a solution is injected, under the influence of which a scar is formed at the site of the damaged vein.This method is applicable only for varicose veins of small and medium caliber.Occasionally, not one, but several injections of a sclerosing solution may be required for the vein to completely disappear.Sclerotherapy is quite effective when carried out correctly, is low-traumatic, leads to good therapeutic and cosmetic effects, and a significant advantage is that sclerotherapy is carried out under local anesthesia (i.e. without anesthesia), directly in the doctor’s office.
2. Laser surgery.Laser radiation can be used to remove varicose veins of any diameter and, in particular, venous mesh.The essence of the method is to irradiate the inner surface of the vein with a laser beam.Through a small puncture of the skin and vein wall, a special device is inserted - a light guide, through which a laser beam is passed under ultrasound control.The inner surface of the vein is irradiated with a laser, then it is glued together.When using this method, the doctor aims a laser beam at the vein that needs to be removed, slowly discoloring and complete disappearance of the vein occurs.An important advantage of this method is that no incision is made into soft tissue or skin.Using the laser method, it is possible to eliminate damaged veins and heal trophic ulcers of the lower leg.
3. Surgical removal of varicose veins.During surgical removal, a series of small incisions are made in the skin and soft tissue, through which the damaged vein is removed and insufficient perforating veins of the leg are ligated.When using this technique, anesthesia is a necessary condition.This method is used to remove large varicose veins.
4. Outpatient phlebectomy (removal of varicose veins).This method is suitable for removing veins of small diameter.With this method, the vein is removed through several small incisions in the skin under local anesthesia.The scars formed after removal are small and almost invisible.
5. Endoscopic removal of varicose veins.This method is especially suitable for the formation of skin defects in the form of ulcers.During this method, a special video microcamera is inserted into the vessel, which allows you to see the vessel from the inside and observe the entire removal procedure.The vein is then removed under observation through this camera.

Thanks to the use of modern treatment methods, it is possible to achieve a complete cure and a good cosmetic effect.But it should be remembered that varicose veins can appear again.

Complications of varicose veins

Occasionally, changes from pronounced darkening to ulcerative defects of the skin may occur on the skin around varicose veins as a result of impaired blood microcirculation.If these changes occur, you should consult a doctor immediately.

Another more serious complication of varicose veins is the development of blood clots in the deep and superficial veins.This complication is called thrombophlebitis.When it occurs, acute unbearable pain, swelling and redness appear.In this situation, you should also consult a doctor immediately.

Causes of varicose veins

The true nature of varicose veins is not clear enough.According to most scientists, varicose veins are hereditary, genetically determined.Its main cause is weakness of the vein wall and dysfunction of the venous valves.Venous valves originate from the wall of the veins and normally have 2 leaflets oriented towards the heart.With normal closure of the valves, blood from the overlying section of the vein cannot penetrate into the underlying section.When the function of the valves is impaired and the valves do not close completely, the blood moves up and down, resulting in venous stagnation and dilation of the veins located below the valve with impaired function.Initially, a varicose vein appears in the place where there is a valve with impaired function, and blood is discharged in the direction from the deep veins to the external ones, the overfilled vein stretches and expands, which leads to stretching and disruption of the function of the underlying valve, and so on.Disturbances in the venous outflow of blood from the lower extremity to the heart gradually develop, as a result of which microcirculation of blood in the tissues of the lower extremities is disrupted, which is manifested by edema, increased pigmentation, thrombophlebitis and trophic ulcers.

Factors in the development of varicose veins

Factors contributing to varicose veins may include:

1. Genetic predisposition – thin and weak wall of superficial veins.
2. Increased load on the veins: sedentary work, prolonged standing, wearing uncomfortable shoes with high heels, lifting heavy objects, lack of movement of the lower leg muscles.Also, a trigger factor for the development of varicose veins is pregnancy and childbirth.With sudden physical overexertion, there is a strong increase in hydrostatic pressure in the veins of the lower extremities, which triggers the process of varicose veins.

Risk factors for developing varicose veins also include:

1. Age.With age, the wall of the veins, as well as the valves, become thinner, which leads to a natural disruption of their function.
2. Floor.Females are more likely to suffer from varicose veins.It is possible that this is due to a number of hormonal reactions.Female sex hormones influence the process of relaxation of the venous wall.Pronounced hormonal changes in the female body occur during pregnancy and childbirth, during the menstrual cycle and during menopause, which cannot but affect the function of the venous system.It is also impossible to exclude the influence of taking hormonal contraceptives on the process of varicose veins.
3. Obesity.With overweight and obesity, the load on the veins of the lower extremities increases.
4. Pregnancy and childbirth.In pregnant women, the volume load in the body increases, but at the same time, the rate of blood outflow from the lower extremities to the pelvic cavity into the inferior vena cava system and to the heart decreases.Thus, favorable conditions are created for the development of varicose veins.Changes in the circulatory system in a woman’s body ensure the development of the fetus, but at the same time they cause the development of varicose veins.As pregnancy progresses or during childbirth, varicose veins may progress not only in the lower extremities, but also in the hemorrhoidal veins around the anus.