Varicose veins are pathological dilation of the veins due to thinning of their walls and decreased tone. In severe stages, venous nodes bulge under the skin and may become periodically inflamed. Varicose veins are not just a cosmetic defect. This symptom indicates impaired blood circulation, which reduces the nutritional quality of tissues and organs and increases the risk of blood clots. Diagnosis and treatment at an early stage can slow down the progression of the pathology and prevent its complications.
About this disease
Varicose veins are a chronic disease that includes any disorder in the structure and function of the venous system. These can be congenital, genetically determined anomalies, as well as pathological changes that arise under the influence of external factors.
Varicose veins affect approximately 60% of adults worldwide, mainly Europeans. Most women have varicose veins. This is due to the presence of a connection between the tone of the vessel walls and the level of hormones.
Types of varicose veins
Varicose veins are commonly understood as varicose veins in the legs, but pathological changes can also affect other parts of the body. Depending on location, there are:
- rectal varicose veins (hemorrhoids);
- esophageal varices;
- varicocele in men (varicocele);
- varicose veins of the lower limbs.
Sometimes reticular varicose veins are isolated. It consists of a network of blood vessels and stars that are visible under the skin. It occurs mainly on the legs, but can appear under the breasts, on the abdomen, and on other parts of the body. The disease is diagnosed when the saphenous veins of the reticular bed dilate in the reticular layer of the dermis. Occurs in 50% of women. The formation of nodes is not characteristic.
Types of varicose veins in the limbs according to CEAP classification (development stage):
- C0 – no signs;
- C1 – appearance of varicose veins and stars;
- C2 – varicose veins;
- C3 – leg swelling appears, indicating the development of venous insufficiency;
- C4 – trophic changes in the form of hyperpigmentation, liposclerosis (thickening of the skin on the lower part of the legs);
- C5 – heals venous ulcers;
- C6 – non-healing venous ulcer.
Symptom
The main symptoms of varicose veins of the lower extremities include:
- heaviness in the legs (calves), swelling, worse in the evening;
- increased leg fatigue;
- pain in the calves that occurs after a long period of time in a static position, standing or sitting.
As the disease progresses, crooked, blue-green veins begin to bulge under the skin, sometimes swelling to the point of clumping. A sign of chronic venous insufficiency is a change in skin color associated with impaired nutritional status (nutrition) of the tissues. Widespread eczematous redness, itchy blisters, and papules appear. Leg swelling does not go away even after a night of rest.
Signs of the reticular pattern of varicose veins are limited to the vascular pattern under the skin. There may be heaviness in the calves and mild itching in the area of dilated blood vessels. Nutritional disorders are usually not observed.
Reasons for the development of varicose veins
Reticular varicose veins occur due to the replacement of type 1 collagen in the walls of blood vessels with type 3 collagen. As a result, their contractility deteriorates - when dilated, the vessels no longer return to their original state. The cause of vessel wall thinning is excessive activity of enzymes that destroy elastic and extracellular matrix proteins.
In women, the hormone progesterone helps reduce the tone of the smooth muscle fibers of the vessel walls. Estrogen reduces the level of antithrombin, increases blood clotting and stimulates the development of stagnant processes.
The main cause of varicose veins in the limbs, accompanied by the appearance of nodes and swelling, is a malfunction of the valve mechanism. Valves are folds formed by the inner lining of the veins. Normally, they work in only one direction: they open under the pressure of blood flow and do not let it return. If the valve mechanism is weakened, blood will flow backward (reflux), causing the vein walls to dilate and the inner lining of the vein to become inflamed. Next, the pathological process spreads into the deeper layers of the vein wall. Its muscle fibers begin to be replaced by scar fibers and muscle atrophy occurs. The walls no longer contract and their collagen structure is destroyed. Veins are twisted in a spiral shape.
Increased intravascular pressure causes failure of the musculovenous pump. This is a system that regulates the pumping of blood to the muscles during exercise and relaxation ("peripheral heart"). The result is venous congestion and insufficiency.
The stimulating factors are:
- heredity: in most cases, varicose veins are provoked by mutations in genes responsible for the structure of the valves and vein walls;
- overweight;
- sedentary lifestyle;
- increased load on the venous system of the limbs due to standing activity;
- pregnancy and childbirth, menopause, hormonal imbalance.
Varicose veins can be caused by poor leg movement due to uncomfortable shoes, as well as bad habits: smoking, alcohol abuse.
Diagnose
The main methods of diagnosing varicose veins include a visual examination by a vascular surgeon, during which he evaluates the condition of the superficial and deep veins and identifies signs of tissue malnutrition. The patient will then be sent for additional diagnostics.
- Double-sided ultrasound scanning. Allows you to evaluate the condition of the valves, the intensity and direction of blood flow, the size of blood vessels and determine the presence of blood clots.
- Study of valve function: compression test, simulated walking, Parana maneuver.
- X-ray contrast venography is an X-ray with contrast material injected into the vein. Helps evaluate valve function, vein patency and detect blood clots.
To clarify the diagnosis, the doctor may prescribe CT, MRI, thermography, radiography, intravascular ultrasound, blood coagulation tests, etc. v.
Expert opinion
Varicose veins are more than just ugly veins protruding under the skin. Complications of varicose veins are extremely unpleasant.
- Nutritional disorders. Large brown spots appear on the legs or thighs, then form large, non-healing ulcers that cause itching and pain.
- Thrombotic phlebitis is inflammation of the walls of veins, accompanied by the deposition of thrombus on them. The thrombosed vein turns red, thickens, hurts, and the surrounding temperature increases. Outwardly it resembles an abscess. Threatens the spread of infection throughout the body.
- Bleed. Hemorrhage from ruptured varicose veins can occur both inside and outside the tissue. Bleeding was severe and an ambulance needed to be called.
- Blood clot. Blood clots that form inside varicose veins can rupture and block important arteries, such as the pulmonary artery. This condition usually leads to immediate death.
Timely diagnosis will help prevent serious consequences of varicose veins and determine the cause of them.
Treatment of varicose veins
Specific treatment of reticular varicose veins includes several areas.
- Compression therapy - wearing supportive hosiery (stockings, tights) class A and I to prevent backflow of blood.
- Pharmacology - use phlebotonic drugs to increase the tone of the veins. These remedies will not eliminate external signs but will eliminate subjective symptoms such as heaviness, swelling, and pain.
- Scleroderma is a condition in which small blood vessels glue together by depositing hardening substances into them. Microvascular therapy allows you to get rid of the vascular network.
- Laser therapy – allows you to remove small imperfections left after micro-therapy. During the procedure, the doctor will shine a beam of light into the affected area.
An important part of therapy is therapeutic exercises, weight loss, wearing comfortable shoes and regular physical activity.
For surgical treatment of varicose veins, accompanied by the appearance of nodes, two methods are used: classic phlebectomy and endovenous thermal ablation. The first method is considered outdated. Involves ligation of the junction of the vein with the common femur and excision of the affected stem. This method is characterized by an increase in trauma and a high risk of recurrence.
Thermal ablation is a gentle, minimally invasive treatment. Through a small incision, the doctor inserts a catheter with a laser into the vein, turns on the radiation, and slowly withdraws it. As the laser moves, it seals the vein by increasing its temperature. Then gradually resolve.
prevent
To prevent the development or recurrence of varicose veins, people at risk need to:
- minimizes static load on the legs;
- Eat properly and, if necessary, take intravenous supplements as prescribed by your doctor;
- Wear compression stockings when standing in a static position for long periods of time.
It will be very helpful if you regularly do cardiovascular exercises for your body to train your heart and blood vessels.
Rehabilitation
During recovery after surgery, patients need to wear compression stockings, minimize the load on the legs, avoid overheating, and take medication as prescribed by the doctor. Total recovery time depends on the extent of the intervention and the presence of complications.