Varicose veins

Varicose veins in the legs (varicose veins) is a common disease that is manifested by the continuous and irreversible expansion and elongation of superficial veins and the disruption of their function due to the development of a pathological process in the venous wall and congenital or acquired insufficiencyof the valve. apparatus.

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

Causes of varicose veins of the legs

• Hereditary predisposition (congenital weakness of vascular valves). If your parents had signs of weakness of the venous wall in any vessel (leg, groin, esophagus, rectum), then with a high degree of probability symptoms of varicose veins may appear in you.
• Poor circulation in the lower extremities during pregnancy and childbirth (compression of the abdominal veins by the developing fetus with increased pressure on the veins of the legs, hormonal changes that cause a decrease in the tone of the veins).
• Obstructed 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 weightlifting (for athletes, loaders, builders, regular visitors to gyms and fitness clubs)
• Long-term use of contraceptive drugs 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 and the habit of wearing tight clothes and shoes disrupt venous flow 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, causing a decrease in the elasticity of the venous wall, its stretching and turning into a varicose joint.
• 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 difficulty in blood flow from the lower extremities through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
• 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 a row:

• In the first stage, a violation of venous circulation is accompanied by the appearance of individual "spider veins", thinning of the skin, through which during physical activity dilated veins begin to appear in the form of twisted cords (usually in the popliteal fossa), notthere are 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 "pins and needles" crawling along the legs, cramps at night. calf muscles, after careful examination, several dilated veins are revealed in the lower legs, and sometimes - in the legs and thighs.
• The third stage of varicose veins of the lower extremities is characterized by pronounced swelling of the venous nodes mainly on the inner surface of the leg, the appearance of dark brown or brown spots on the thin and easily wounded skin of the legs and the development of dermatitis withitching and rash. The swelling of the legs becomes more intense, making it difficult to walk.
• The fourth stage of varicose veins is the presence of varicose veins in the legs, feet and thighs, the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose veins, the development of thrombophlebitis).
• Sometimes the fifth stage is also distinguished - there are all the characteristic symptoms of the fourth stage of varicose veins, with the spread of the process in the areas of the hips, buttocks, perineum, the presence of numerous trophic ulcers, the appearance of elephantiasis, frequent. exacerbations of thrombophlebitis and the onset of disability.

Complications of varicose veins

1. Thrombophlebitis of superficial veins.
2. Bleeding when a varicose vein ruptures.
3. Dermatitis, eczema.
4. Trophic ulcer.
5. Deep vein thrombosis (phlebotrombosis) and postthrombophlebitic disease.
6. Pulmonary embolism (PE).
7. Lymphedema (elephantiasis).

Diagnosis of varicose veins

It is based on a clinical examination, the performance of functional tests and the performance of instrumental studies 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 using compression stockings, special therapeutic exercises and traditional treatment methods. But if you visit the 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 make it possible to remove 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 different techniques: pathologically altered superficial veins of the legs are connected, removed and removed. In this case, the venous circulation in the lower extremities is not disrupted, since the operation does not affect the deep veins, through which about 90% of the venous blood flows.

The 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 problematic vein, causing gradual sclerosis, "sticking" of the pathologically enlarged area of the vessel. A medicinal substance (usually a sclerosant) is injected through a special catheter or very fine needle into a varicose vein. To achieve a positive result, 3 to 10 injections are needed.
2. Phlebectomy. An operation that has been carried out for almost a hundred years, but in modern conditions wide cuts have long been abandoned. Manipulation these days is performed through miniature incisions of 3-5 millimeters. The pathologically dilated vein is first ligated and crossed at the point where it drains into the deep vein and then removed using special probes. This operation takes approximately 1-2 hours, after which the patient stays in the hospital of a medical institution for 1-2 days.
3. Miniphlebectomy. The operation is performed with local anesthesia, without incisions, but with the help of small punctures through which the varicose veins are removed. This achieves a good cosmetic effect (usually no stitches are required) and significantly reduces the recovery period after surgery. In some cases, not the entire vein can be removed, but only its pathologically changed section. 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 enlarged vein and the saphenous vein and its branches are burned. After a certain period of time, there is obliteration and sclerosis of the vein, 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. Radio wave ablation of varicose veins. The disappearance ("gluing") of the lumen of the altered vein is achieved through exposure to radio waves of a certain power that are supplied 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 using one of the above methods, it is necessary to limit physical activity for a certain time, wear compression stockings and, if necessary, use medications that have a venotonic effect. This will help 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 which cases is surgical treatment of varicose veins of the legs undesirable?

• During pregnancy and in the first two months after birth.
• In the initial stage of varicose veins, when there are no complaints and existing cosmetic problems ("spider veins" on the legs), you can first try to eliminate them with the help of exercise therapy, compression stockings 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 increases significantly.
• In the presence of lymphatic drainage disorders, infectious lesions of the skin of the lower extremities, thrombophlebitis, arteriovenous fistula.

With the correct choice of the most effective treatment method for varicose veins of the lower extremities in this particular case, the absence of contraindications and following the doctor's recommendations in the post-operative period, a positive result of the surgical intervention will be guaranteed.

Prevention of varicose veins of the lower extremities

Regime and diet

Compliance with a certain regime of work and rest, as well as food, in most cases will 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 (taking periodic rest breaks and performing simple aerobic exercises).
• Avoid strenuous physical activity.
• Lead an active lifestyle (moderate dynamic loads - daily walking, swimming, cycling).
• Drink at least 1. 5-2 liters of fluids per day; your daily diet should include vegetables and fruits, whole grain bread and cereals.
• Avoid visits to baths and saunas and refuse to take hot baths.
• Take a contrast shower (warm - cold) 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 medications that have an antiplatelet effect, that is, they prevent the formation of blood clots. This includes:

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

Compression jersey

For many years, bandaging with elastic tubular bandages has been successfully used in the initial stages of varicose veins (when spider veins appear). Now special clothing is being 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 first puts pressure on the upper 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 thrombus formation is prevented.

Gymnastics

Special exercises have been developed aimed at eliminating venous blood stagnation. The key to success here is the regularity of performing the complex. Let's consider some 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:

• Lying 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 pedaling when riding a bicycle;
• "Scissors" - lying 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;
• Lying on your back, bend your left leg, bring your knee to your chest. Wrap your hands around the leg at the ankle joint and gradually straighten the leg, performing massaging movements on the calf muscles. Repeat the exercise with the right leg;
• Standing with legs together. Raise yourself on your toes and sit down (if there are no complications, the exercise can be performed harshly - with your heels hitting the floor).

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