Varicose veins

Varicose veins in the legs (varicose veins) is a common disease manifested by persistent and irreversible expansion and elongation of the superficial veins and dysfunction due to the development of a pathological process in the venous wall and congenital or acquired valvular insufficiency device.

According to the World Health Organization, one in five adults on earth have varicose veins. The first signs of varicose veins (venous reflux) are detected in 10-15% of children and adolescents aged 12-13.

Causes of varicose veins in the legs

• Hereditary predisposition (congenital weakness of the vascular valves). If your parents had signs of weakness of the venous wall in any vessel (legs, groin, esophagus, rectum), you may most likely experience symptoms of varicose veins.
• Poor blood circulation in the lower extremities during pregnancy and childbirth (compression of the abdominal veins by the developing fetus with increased pressure in the leg veins, hormonal changes leading to a decrease in venous tone).
• Circulatory disorders during prolonged standing (varicose veins of the lower extremities are more common in salespeople, teachers, waiters, surgeons) and while sitting (managers, accountants, office workers, drivers, etc. )
• Heavy physical work, sports training related to lifting weights (for athletes, strength athletes, construction workers, regular visitors to gyms and fitness clubs)
• Long-term use of contraceptives with a high content of female sex hormones.
• Hormonal changes in the body, accompanied by a decrease in the tone of the venous vessels (adolescence, pregnancy, menopausal symptoms in old age).
• Factors such as obesity, chronic cough, constipation and wearing tight clothing and shoes disrupt venous drainage 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 appear first on the left leg and only then on the right.

• The appearance of varicose veins is promoted by hormonal changes in a woman's body during pregnancy, which lead to a decrease in the elasticity of the venous wall, its stretching and transformation into a varicose vein node.
• 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 complicates the outflow of blood from the lower extremities through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
• The increased body weight of a pregnant woman also negatively affects venous outflow.

Varicose veins of the lower extremities: symptoms

Varicose veins develop relatively slowly and go through several main stages one after the other:

• In the first stage, a violation of venous circulation is accompanied by the appearance of individual "spider veins", a thinning of the skin, due to which dilated veins protrude in the form of twisted strands during physical activity (usually in the popliteal veins), there are no complaints.
• In the second stage of varicose veins, there is a feeling of heaviness, fatigue in the lower extremities, swelling of the legs in the evening and after a long walk, a tingling sensation in the legs and night cramps. Upon careful examination of the calf muscles, several dilated veins on the lower legs and sometimes alsovisible on the foot and thigh.
• The third stage of varicose veins of the lower extremities is characterized by a pronounced bulging of venous nodes mainly on the inner surface of the leg, the appearance of dark brown or brown spots on the thin, easily damaged skin of the legs and the development of varicose dermatitis with itching and rashes. The swelling in the legs increases and makes walking more difficult.
• The fourth stage of varicose veins is the presence of varicose veins on the foot, leg and thigh, as well as the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose veins, development of thrombophlebitis).
• Sometimes the fifth stage is also distinguished - there are all the symptoms characteristic of the fourth stage of varicose veins, with the process spreading to the groin, buttocks and perineum, the presence of multiple trophic ulcers, the appearance of elephantiasis and frequent exacerbations of thrombophlebitisand 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 ulcers.
5. Deep vein thrombosis (phlebothrombosis) and post-thrombophlebitic disease.
6. Pulmonary embolism (PE).
7. Lymphedema (elephantiasis).

Diagnosis of varicose veins

It is based on a clinical examination, conducting functional tests and conducting instrumental examinations of the veins.

• Clinical examination (clarification of complaints, anamnesis, examination, palpation).
• Doppler ultrasound.
• Ultrasound angioscanning.
• 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 early, you can manage their manifestations using compression stockings, special therapeutic exercises and traditional methods of treatment. However, if you go to the doctor late, when varicose veins are visible to the naked eye, your legs hurt and swell, trophic ulcers appear and signs of thrombophlebitis appear, 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 large incisions, without pain and practically without interference with the usual lifestyle.

The principle of surgical manipulation is similar for different techniques: pathologically altered superficial leg veins are tied, excised and removed. In this case, venous blood circulation in the lower extremities is not disturbed, since the operation does not affect the deep veins, through which about 90% of venous blood flows.

Main types of operations for varicose veins

1. Sclerotherapy. In the initial stages of varicose veins, a good cosmetic result is achieved by the introduction of special drugs into the problem vein, which cause gradual sclerosis and "glue" the pathologically expanded area of the vessel. Through a special catheter or a very thin needle, a medicine (usually aSclerosant) is injected into a varicose vein. To achieve a positive result, 3 to 10 injections are required.
2. Phlebectomy. An operation that has been performed for almost a hundred years, but in modern conditions wide incisions have long been abandoned. Nowadays, manipulation is carried out through miniature cuts of 3-5 millimeters. The pathologically enlarged vein is first tied and cut at the point where it opens into the deep vein and then removed using special probes. This operation lasts about 1-2 hours, after which the patient remains in the hospital of a medical facility for 1-2 days.
3. Miniphlebectomy. The operation is performed under local anesthesia without incisions, but with the help of small punctures through which the varicose vein is removed. This achieves a good cosmetic effect (usually no stitches are required) and significantly shortens the recovery time after surgery. In some cases, not the entire vein is removed, but only the pathologically changed section. This procedure is called brief stripping.
4. Endovenous laser coagulation of veins. The manipulation is carried out under ultrasound control. A special laser light guide is inserted into the pathologically dilated vein and the saphenous vein and its tributaries are burned out. After a certain time, obliteration and sclerosis of the vein occurs, its complete closure. If necessary, laser coagulation is combined with a miniphlebectomy. In this case, the effectiveness of surgical treatment of varicose veins of the lower extremities is the highest.
5. Radio wave ablation of varicose veins. The obliteration ("gluing") of the lumen of the altered vein is achieved by the action of radio waves of a certain power, which are delivered to the problem area of the vein through a special catheter. The duration of the procedure is approximately 20 minutes.

After surgical treatment of varicose veins using any of the above methods, it is necessary to limit physical activity for a certain period of time, wear compression stockings and, if necessary, take medications with a venotonic effect. This will help restore normal blood circulation in the veins of the lower extremities as quickly as possible, prevent possible complications and allow you to quickly return to work and the normal rhythm of life.

In what cases is surgical treatment of varicose veins of the legs undesirable?

• During pregnancy and in the first two months after birth.
• At the initial stage of varicose veins, when there are no symptoms yet and there are 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 with serious illnesses of various organs and systems of the body with functional disorders, the risk of possible complications is significantly increased.
• With lymphatic drainage disorders, infectious skin lesions of the lower extremities, thrombophlebitis, arteriovenous fistulas.

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 compliance with the doctor's recommendations in the postoperative period, a positive result of the surgical intervention is guaranteed.

Prevention of varicose veins of the lower extremities

Regime and diet

Adhering to a certain work and rest routine as well as diet prevents the development of varicose veins in most cases. To do this you need:

• Avoid clothing that restricts venous blood flow.
• Avoid standing or sitting for long periods of time (take regular breaks and perform simple gymnastics exercises).
• Avoid strenuous physical activity.
• Lead an active lifestyle (moderate dynamic loads – daily walking, swimming, cycling).
• Drink at least 1. 5-2 liters of fluid per day; Your daily diet should include vegetables and fruits, whole grain bread and cereals.
• Avoid visiting baths and saunas and refuse hot baths.
• Take a contrast shower (warm – cool) every day.
• Use comfortable, low-heeled shoes.

Antiplatelet therapy

An important part of preventing varicose veins of the lower extremities is taking medications that have an anticoagulant effect, i. e. prevent the formation of blood clots. These include:

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

Compression jersey

In the early stages of varicose veins (when spider veins appear), bandaging with elastic tubular bandages has been used successfully for many years. Special clothing is now being produced - compression knitwear, where you can choose the desired size and degree of compression depending on the severity of the changes. Wearing stockings and tights initially puts pressure on the upper part of the ankles, followed by a decrease in pressure and stimulation of blood flow upward to the heart. Venous vessels work more efficiently, eliminating venous congestion, eliminating swelling and preventing the formation of thrombi.

gymnastics

Special exercises have been developed to eliminate stagnation of venous blood. The key to success here lies in the regularity of the implementation of the complex. Let's consider some basic exercises that are recommended in the presence of risk factors for the development of varicose veins of the lower extremities and in the initial stages of the disease:

• Lying on your back with your legs 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 while riding a bicycle.
• "Scissors" – lie on your back, raise and cross your legs, changing the position of the legs (up – down) for 1 minute;
• The legs are raised and bent at the knee joints. Bend and straighten your feet, imitating walking.
• Lie on your back, bend your left leg and bring your knee to your chest. Place your hands around your leg at the ankle joint and gradually straighten your leg, making massaging movements on the calf muscles. Repeat the exercise with the right leg;
• Stand with your feet together. Stand on tiptoes and lower yourself down (if there are no complications, the exercise can be done quickly - with your heels on the floor).

With the timely initiation and proper implementation of preventive measures, varicose veins of the lower extremities can be prevented or their manifestations can be minimized.