The word "varicose" comes from the Latin varix, varicis - swelling. The first mention of the treatment of varicose veins is found in ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffers from chronic diseases of the veins of the lower extremities. Its complications in the form of dermatitis, cellulitis, hemorrhage, thrombosis and trophic ulcers often lead to long-term disability, sometimes causing disability.
The structure and work of the vein system
The way our veins work is a complicated process. To understand this, you need an initial understanding of the structure of the veins. The venous wall consists of three layers. Internal - endothelium, represented by a layer of cells in the connective tissue membrane. The middle layer is muscular. It consists mainly of circularly located smooth muscle cells, which are, as it were, in a framework of collagen fibers. Superficial veins contain a thicker muscle layer than deep veins. The external vein sheath, the so-called adventitia, is a dense tissue of collagen fibers. If we compare the structure of veins and arteries, then it should be said that the relationship between the lumen of the vessel and its wall thickness in veins is much greater than in arteries. Veins have much less elastic fibers than arteries.
The main property of veins, which influences blood flow indicators, is the great extensibility of their wall. In particular, when the pressure in the container increases, the veins expand and tend to acquire a round shape from a slit. The degree of stretching of the venous wall is quite short-lived and depends on many other things. It is this factor that does not allow the use of rigorous mathematical formulas to calculate the movement of blood along them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, in the neck.
Venous valves originate from its wall. They are normally made up of two valves, which are oriented towards the heart. In the area of attachment of the valve to the wall, the diameter of the vein is slightly larger. Normally, when the valve leaflets close, blood from the overlying section cannot enter the lower section. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative (some call it physiological) and absolute. The main difference is in the duration of the reflux during the bump tests. There is also an opinion that there should be no backflow with a normal valve. The valves are unevenly distributed through the veins. There is more where the work of the muscle pump is more pronounced, that is, in the lower leg.
The main venous system of the lower extremities is represented by the following groups:
- veins of the foot;
- deep veins of the leg and thigh (deep vein system);
- large and small saphenous veins (superficial vein system);
- communicating (perforating) veins: provide communication between the superficial and deep veins.
The deep and superficial venous systems together form a "sponge", from which, when walking, the blood rises to the heart. The work of this system is supported by the work of a muscle pump located in the lower part of the leg, which creates intermittent pressure on the veins.
These systems move the blood column upward and valves within the veins prevent backflow.
The outflow of blood from the lower extremities through the deep and superficial veins is uneven. Approximately 85-90% of the blood flows through the deep veins and only 10-15% through the subcutaneous veins. Therefore, in healthy people, blood outflow is through the deep, subcutaneous and communicating vein system.
Varicose veins are a serious problem
To say that varicose veins are "a disease of the twentieth or twenty-first century" means deviating from the truth. Varicose veins have been a problem for people for a long time. Even in ancient medical treatises, there is a description of varicose veins, in ancient Rome people bandaged their legs with leather "bandages" to get rid of venous insufficiency.
If your legs tire frequently, this may be the first sign of an early disease of the venous system. Night discomfort, accompanied by swelling of the foot and ankle, especially after a long stay in the legs, are clear signs of congestion in the veins. Soon, unfortunately, you discover the first varicose vein. The altered vessels form a blue-blue or red "pattern" on the legs, "stars", capillary "cobwebs" (telangiectasias), and eventually enlarged veins and varicose nodes.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins of the legs - an acute signal of urgent action to save the beauty and health of your legs.
A question about the state of your veins should be immediately asked a specialist, a phlebologist who studies and treats venous diseases.
Vein disease starts out harmless, but it can become a serious problem if left untreated.
Causes of varicose veins
To date, a large number of theories have been proposed to explain the causes of varicose veins. The most common are hereditary, mechanical, hormonal, etc. However, they mainly reflect the factors that contribute to the development of the disease or accelerate the appearance of clinical signs of the disease.
Both lower extremities are more frequently affected. However, at first, varicose veins appear on one limb, and after a while - on the other. Varicose veins are most common on the right leg.
Varicose veins of the lower extremities occur only in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the venous wall of the limb. With the weakness of the venous wall and the impaired function of the valve apparatus in the main veins, which occurs with their congenital inferiority, a pathological reverse blood flow occurs. The most common causes of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives, etc. ) affect the structure and tone of the vascular wall with its gradual weakening and destruction.
- Pregnancy is one of the main risk factors for the development of varicose veins. In addition to hormonal changes, the uterus and the growing fetus put pressure on the iliac veins and significantly impede blood flow to the lower extremities.
- Obesity is already a proven risk factor for varicose veins. This is due to the increased load on the venous system of the lower extremities.
- Lifestyle: people with prolonged static charges (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wear tight underwear that squeezes the main veins at the level of the groin folds. Women with high heels.
- Intense physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the abuse of which can also cause varicose veins.
The essence of varicose veins lies in the fact that, as a result of the above reasons, a gradual expansion of the lumen of the saphenous and perforating veins occurs, as a result of which an insufficiency of the valvular apparatus is formed(do not close the valve leaflets). Pathological reflux (return) of blood occurs both from top to bottom and horizontally through the destroyed perforating veins.
Diagnosis of varicose veins
For many years, the hands were the doctor's only tool for examining a patient with varicose veins. X-rays have come to the surgeon's aid for the past century. However, contrast X-ray examination of veins is quite a complicated procedure, requiring bulky and expensive equipment, and the X-ray contrast agents themselves are not safe for the body. With the development of microelectronics and computer technology, diagnostic methods appeared that were not available before: Doppler ultrasound, ultrasound, angio-scanning, plethysmography. The advent of duplex ultrasound has provided new information that has made it possible to reexamine the problems of the causes of varicose vein development and to understand the complexities of the disease process.
Ultrasound Doppler
This is an ultrasound diagnostic technique that allows you to determine the speed and direction of movement of particles (in this case, blood cells) in the body. Thus, the doctor can find out the direction and speed of blood flow in the vessels of the lower extremities. And when conducting a series of physiological tests and the status of the valve apparatus of the veins of the lower extremities. Knowledge of the structure of blood flow in the veins of the legs is the main requirement for choosing a treatment method.
Ultrasound Angio Scan
The essence of this method is that an image of the walls of the blood vessels and the blood flowing through them is formed on the monitor screen of an ultrasound scanner in real time. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the state and the direction of blood flow through this vessel. The method is very informative and much safer than X-ray examination, but it is quite expensive, therefore it is used only in difficult cases and during scientific research.
Plethysmography
This is a diagnostic method based on determining the electrical resistance of the tissues of the lower extremities. Its essence lies in the fact that the total electrical resistance of the human body tissues depends directly on the amount of blood that enters and leaves them and changes over time with each heartbeat. Plethysmography is used to diagnose the general functional status of blood flow in the lower extremities, it is used to monitor drug therapy for venous or arterial insufficiency, in the treatment of trophic disorders, and to assess the degree of venous insufficiency.
Of course, all these techniques do not exclude a direct examination of the patient by a doctor, clarifying the history of the disease and identifying the complaints presented by the patient. Based on the general picture of the disease, the doctor chooses a method of treatment.
Treatment of varicose veins
In the last 50 years there has been a qualitative leap in the treatment of varicose veins, as well as in other branches of medicine. During the last decades, several drugs have been developed and are being improved for the treatment of chronic venous insufficiency. The surgical technique for the treatment of varicose veins has been significantly improved. The technology of compression sclerotherapy has been developed and practically perfected.
Nowadays, the so-called sclerosurgery is gaining popularity all over the world. Sclerosurgery is a smart combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can be used only for early and uncomplicated forms of varicose veins. Varicose vein surgery is not without problems either, the operation to remove varicose veins is quite traumatic, it requires hospitalization and a long period of rehabilitation. A reasonable combination of these two methods allows you to minimize the trauma of the treatment process and obtain an extremely high quality of treatment.
Medicinal therapy for varicose veins
Very often there are cases when a patient has practically no varicose veins or the number of them is very small. However, the person suffers from heaviness in the legs, pain, swelling. These are all signs of chronic venous insufficiency. In these cases, as well as when there are significantly enlarged varicose veins, it is necessary to take drugs that improve blood circulation in the legs. Currently, in the arsenal of a phlebologist there are several dozen drugs intended to combat venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should only be selected by a physician. Despite the apparent simplicity of the selection of a venotonic agent, only a doctor can determine the full range of therapeutic measures and the advisability of using a particular drug.
Compression therapy
Compression therapy has for many years been considered an adjunct to drug therapy or surgery. Compression treatment of varicose veins has been used since ancient times, and only in the last decade, elastic compression began to be considered as a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of various brands and special medical compression stockings.
The global industry produces three types of elastic bandages: short, medium and high stretch. High-elongation bandages (elongation greater than 140%) are used to prevent thrombotic complications in the postoperative period after operations on the abdominal and pelvic organs, as well as to fix the joints afterwards and to prevent sports injuries. Short stretch bandages (elongation less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitic syndrome, and lymphatic insufficiency. Medium elasticity bandages (elongation 70% to 140%) are used in the treatment of varicose veins, chronic venous insufficiency and compressive sclerotherapy.
Medical compression stockings include medical compression stockings, knee high stockings. Many people are wrong to consider that various higher density "antiviral" and "support" jerseys are therapeutic. To begin with, it is necessary to determine that medical compression products are never marked in the DEN. DEN is a technical characteristic of a knitted fabric that is only indirectly related to the pressure created by the product.
Scrubs are classified into several functional compression classes. The class of the product is determined by the pressure that the product creates on the ankle and lower third of the leg. A person with varicose veins is shown wearing class 2 compression knitwear. These stockings or knee-highs will create a pressure of 23 to 32 mm Hg on the affected leg. Art. , That is, completely equalize the pressure in varicose veins and eliminate venous insufficiency. In addition, medical compression products create so-called distributed pressure. The pressure they create is gradually reduced when the leg is moved from the bottom up by 25-30%, which contributes to the effective outflow of blood and lymph.
It should be noted immediately that the medical t-shirt is never thin and transparent, the creation of such a high pressure requires a large number of elastic fibers, and consequently the knitted fabric is thick. It must also be said that the medical shirt is never cheap. The technology of weaving a special knitted fabric is much more complicated; When knitting, it is also necessary to shape the profile of the leg to create distributed pressure.
The ideal approach to compression therapy is the consistent and widespread use of elastic bandages and / or compression stockings by the patient. For example, the daily use of elastic bandages for a month corresponds almost entirely to the effectiveness of a monthly intake of an effective drug. The use of compression stockings is especially effective in preventing the development and recurrence of varicose veins. The main advantage of using compression products is their absolute safety for health, even compared to the best drugs, and in terms of cost they are quite comparable.
Prevention of varicose veins
If you have the initial signs of varicose veins, following fairly simple rules will slow down and in some cases prevent their further development. First of all, do not get carried away by hot baths, saunas, prolonged exposure to the sun. All of the above reduces venous tone, leads to stagnation of blood in the lower extremities. Do not wear tight clothing, stockings and socks with tight elastic bands, as this will compress the veins. Excess body weight and sports associated with a large static load on the legs (tennis, weight lifting, bodybuilding) increase venous pressure. High heels (more than 4 cm): our veins do not like it. Take care of the veins, do not hurt them.
If your legs feel heavy at night after a day's work, keep your legs elevated while you sleep and rest. If your work is accompanied by prolonged sitting at the table or standing for a long time, then you need to change the position of your legs more often, stand up and rotate your feet. There are special exercises for venous diseases. After showering or bathing, rinse your feet with cold water. There are sports that are useful: first of all, swimming, but also walking, cycling, skiing. Don't neglect home remedies for prevention. Useful infusions of cranberry leaves, St. John's wort, cranberry, rose hips. A plant-based diet should be followed. Your doctor may also prescribe a medicine called a phlebotonic to increase venous tone and improve microcirculation. Recently, compression prophylaxis methods and the treatment of varicose veins have also become quite understandable success, due to the appearance on the market of high-quality medical products.
A few special words about prevention for pregnant women. Varicose veins progress during pregnancy, especially when it is not the first, and carrying a baby under 1 year old does not contribute to good vascular function. The basis for prevention is the use of special compression stockings, the use of phlebotonics both during pregnancy and after childbirth. Do not forget to mention your veins to the gynecologist when prescribing a hormonal medication, as these medications affect the functioning of the veins and reduce their tone.
Don't self-medicate. Talk to your doctor about what is best to do with your veins. This disease is treated by doctors - phlebologists.