Varicose veins

Varicose veins of the lower extremities are usually asymptomatic in humans. Often the only problem with this pathology is an aesthetic defect in the legs caused by protruding superficial veins. In this case, the disease may be accompanied by pain or increased sensitivity of the skin of the legs. Depending on the severity of the disease, the patient is offered surgical, pharmacological or non-pharmacological treatment. Read more about the first symptoms of varicose veins, the nature of their course and effective methods of treatment and prevention, read our material.

What it is

Varicose veins are a pathology that only people suffer. Animals do not have this problem, suggesting that the disease is associated with upright posture. When a person stood up, most of the circulating blood began to settle below the level of the heart. In this case, all conditions are created for the blood to circulate worse in the opposite direction, which leads to stagnation.

According to statistics, some disorders of the venous system are observed in 80% of people in developed countries. Also, with increasing frequency, similar problems are found in people at a young age. In all likelihood, one of the reasons why varicose veins "get younger" is a sedentary lifestyle, which only contributes to stagnation.

Interestingly, in the age group under 20 years, varicose veins of the lower extremities occur with the same frequency in both men and women. However, after the age of 20, women begin to predominate in the morbidity structure. This is due to pregnancy and childbirth, which are a serious factor in the development of venous diseases.

Characteristics, causes and mechanism of development of varicose veins.

The exact reasons for the development of varicose veins of the lower extremities are still unknown. Currently, the disease is believed to be caused by congenital or acquired defects of the valve apparatus of the veins of the lower extremities.

For unobstructed upward blood flow through the veins, well-coordinated work of the venous valves is necessary. These valves only open for blood that flows upward. However, with a valve defect, partial downward blood flow is also possible. This is how venous insufficiency develops, manifested by edema, cramps of the leg muscles, and expansion of the venous vessels.

Leukocytes can also play a role in the pathogenesis of varicose vein development. This topic is being actively studied now. It is assumed that with the prolonged accumulation of leukocytes in the tissues of the vessels (in particular, in the area of the valvular apparatus), an inflammatory process develops that extends along the venous bed.

Since the venous valves are under constant mechanical stress, inflammation develops especially rapidly in the region of the valve apparatus of the vein.

Now, the vast majority of people in developed countries lead a sedentary lifestyle. But why then doesn't everyone have varicose veins? Consider the main risk factors that contribute to the appearance of this pathology:

• Hereditary factors. . . Although the specific inherited mechanisms that are associated with the development of varicose veins have not yet been established, most experts agree on the presence of this factor. At the same time, there are important counterarguments regarding heredity in the development of varicose veins. For example, this is the prevalence of varicose veins in ethnic Africans and African immigrants who went to live in the United States. If the prevalence of varicose veins among sedentary Africans is approximately 0. 5%, among emigrants this figure reaches 20%. These figures show that hereditary factors, at least, are not the only ones in the development of the disease and, most likely, they do not prevail.
• Obesity. . . People who are overweight and obese are at risk. It is important to note that obesity contributes to varicose veins both by increased stress on the vessels, and by the risk of other diseases that affect the vessels (diabetes mellitus, hypertension and others).
• The pregnancy. . . This is one of the most obvious factors in the development of varicose veins of the lower extremities. In this case, the main risk factors are an increase in the volume of circulating blood, as well as compression of the retroperitoneal veins by the developing fetus in the womb. According to epidemiological studies, the second and subsequent pregnancies lead to a significant increase in the probability of developing varicose veins. After the first pregnancy, the probability of varicose veins in the legs remains low.
• Hormonal imbalance. . . Hormones are involved in the pathogenesis of most diseases. These pathologies include varicose veins. This problem is especially true for women taking hormonal contraceptives, as well as those using hormone replacement therapy for the treatment of certain diseases (for example, osteoporosis) or during the premenopausal period. Female sex hormones (estrogens and progesterone in particular) have been established to reduce vascular tone and destroy collagen fibers. Therefore, the wall of the veins is pathologically dilated.
• Lifestyle. . . The lifestyle of a person has a great influence on the course of the disease. A sedentary lifestyle, as well as work associated with standing or sitting for a long time (for example, security guards, drivers, office workers, service workers, and others) contribute to the development of varicose veins. You should also pay attention to nutrition. The lack of a sufficient amount of vegetables and fruits in the diet worsens the condition of the walls of the blood vessels.

Stages of varicose veins of the lower extremities.

Currently, various classifications of varicose veins of the lower extremities are used. The international CEAP classification, adopted in 1994, is considered generally accepted. CEAP is an abbreviation, where each letter corresponds to the name of a classification category:

• C (clinical)- the clinical class of the disease (the type of veins affected, the presence of pigmentation, eczema, trophic ulcers).
• E (etiological)- the etiology of the disease (congenital, primary, secondary).
• A (anatomical)- anatomical location of the pathology (superficial or perforating veins).
• P (pathophysiological)- the type of disorder (venous reflux, obstruction or a combination of both).

The course of the disease takes place in six stages:

• Stage zero. . . The earliest stage of varicose veins, in which even doctors cannot establish a reliable diagnosis. At this stage, there are no external signs of the disease. Ultrasound diagnosis does not show the presence of pathology. At the same time, a person in stage zero is concerned about symptoms such as bloating, a feeling of heaviness in the legs, and cramps, indicating the presence of problems with the blood vessels.
• First stage. . . Already in the first stage of the disease, spider veins are visible on the surface of the skin of the legs, the diameter of which is less than 1 millimeter. Medium-sized veins can increase in diameter up to 3 mm. At this stage, doctors cannot always establish the correct diagnosis, since the presence of such asterisks does not always indicate varicose veins.
• Second stage. . . At this stage, veins can appear and disappear depending on the conditions. For example, veins appear clearly after sitting, standing, or lifting heavy objects for a long time. The diameter of varicose veins at this stage is 3mm or more. Blood clots often form in the second stage.
• Third stage. . . If in the earlier stages of the disease the swelling of the legs appeared and disappeared, in the third stage the edema becomes permanent. Leg swelling is more intense at night.
• Fourth stage. . . At this stage, significant trophic changes occur. In particular, tissue nutrition is disrupted near the affected veins. The patient develops skin changes such as lipodermatosclerosis (inflammation of the subcutaneous fatty tissue), eczema, as well as darkening or discoloration of the skin. For the fourth stage of the disease, pigmentary changes are characteristic. For example, the skin in the area of the affected vessels may turn brown and even black, indicating the concentration of pigments in this area. The opposite situation is also possible, when, due to a pathological process, the pigment does not enter the affected area, which leads to the appearance of a pale skin tone. If varicose veins are not treated at this stage, the problem will only worsen with the further development of trophic ulcers.
• Fifth stage. . . At this stage of the disease, in addition to the above symptoms, trophic ulcers also appear, which heal quickly. If you do not take any steps for treatment, the ulcers will appear again and again.
• Sixth stage. . . Trophic ulcers appear that do not heal. In the affected area, the temperature rises markedly and pus can ooze from the wounds.

You should not wait for the development of the later stages; you need to go to the doctor for the second to record and track the dynamics of the disease. Sometimes the symptoms get better on their own and sometimes they progress quickly. Therefore, it is important to monitor the situation in order to act in time.

Symptoms

Consider the main symptoms of varicose veins of the lower extremities at different stages of the disease:

• Pain. . . This is the first sign of the disease. Since pain is a nonspecific symptom, it is impossible to make a diagnosis based solely on this symptom. With varicose veins of the lower extremities, the pain is often localized along the venous trunks.
• Feet on legs. . . It also applies to the first symptoms, while the veins of the skin are not yet visible. Often the sensation of heat is accompanied by a shooting pain.
• Cramps and itching in the muscles.. . . Very often disturbed at night.
• Swelling in the legs. . . In the early stages of the disease, the swelling is mild and transient. As a general rule, they appear at night and disappear in the morning. However, as the disease progresses, the severity increases and they become permanent.
• Skin discoloration. . . As a general rule, with varicose veins, the skin on the lower extremities darkens. In the area of the affected veins, the skin turns brown. Eczema and dermatitis appear in the advanced stages of the disease. The terminal stages of varicose veins are characterized by the appearance of trophic ulcers. These are initially healing ulcers, but later non-healing wounds form.
• Spider veins. . . In the medical literature, these asterisks are called telangiectasias. In some people, varicose veins can be confined to spider veins, without progression to larger veins.
• Twisted dilated veins. . . The most characteristic sign of varicose veins is twisted, dilated veins on the surface of the legs.

In summer, the symptoms of varicose veins become more pronounced. This is due to the high ambient temperature, which already contributes to the expansion of the veins. So during the hottest hours, from 10 am to 4 pm, it is best to be in a well-ventilated area.

When to see a doctor

You should consult a doctor at the first symptoms of the disease: pain, swelling or the appearance of spider veins. Since the early stages of varicose veins are difficult to diagnose, they can initially be misdiagnosed. The patient should carefully monitor the condition of the legs and be regularly observed by a phlebologist.

Diagnostics

The diagnosis of varicose veins of the lower extremities is reduced to the following activities:

• External examination of the skin of the legs;
• Doppler ultrasound;
• Duplex vein scanning;
• Phlebography.

Treatment characteristics

Varicose veins of the lower extremities are treated conservatively and surgically. Conservative treatment is reduced to the following activities:

• Drug therapy. . . This is the intake of drugs that improve the tone of the venous walls. In addition, the patient is prescribed drugs that reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, anticoagulants are also prescribed.
• Compression therapy. . . This is the use of special compression hosiery, which reduces the load on the leg. The benefit is that it is possible to distribute the load evenly, even with intense physical exertion. When compression garments are worn, congestion and swelling can be avoided.
• Corrective gymnastics and lifestyle changes.. . . The patient is advised to exercise to relieve tension in the legs. It is important to avoid sitting or standing for a long time. If you have to stand or sit for a long time at work, you need to take breaks more often.

If conservative therapy for varicose veins does not produce the expected results, a decision is made about surgical intervention. Most of the time these are minimally invasive interventions, including:

• Sclerotherapy- the introduction into the vein of substances that stick the walls of the affected vessel. This treatment leads to resorption of spider veins.
• Laser coagulation- introduction of a laser light guide into a vein and irradiation of the walls with a laser, which also leads to sticking of the walls and further resorption of the vessel.
• Radiofrequency ablation- gluing of veins with high frequency current.
• Phlebectomy- Removal of the affected veins, in which blood circulation has deteriorated by 90%.

In some countries, you can get the operation for free, under compulsory medical insurance. But it is not a fact that all types of compulsory insurance operations are offered everywhere. In any case, help will be provided, but it is necessary to find out if it will be a conventional or laser removal.

Contraindications for people with varicose veins.

• Sedentary lifestyle. . . It is important to avoid sitting or standing for a long time. Physical activity will help prevent congestion in your veins.
• Running and vigorous exercise. . . With physical activity, it is important not to overdo it. If you have varicose veins, walking is definitely better than running.
• Unbalanced and unhealthy diet. . . You should give up junk food, even if it seems like your health allows it. You should limit the intake of sweets, semi-finished products, as well as rich meat broths and smoked meats. But eating more vegetables and fruits would be a good idea.
• Jacuzzis and showers. . . For people with vascular problems in the extremities, excessively hot and prolonged water procedures are contraindicated.

Complications of varicose veins

Varicose veins can be complicated by trophic ulcers, phlebitis (inflammation of the veins), and deep vein thrombosis. The latter is the formation of blood clots in deep veins that threaten human life.

conclusion

Symptoms of varicose veins of the lower extremities, as a rule, do not appear immediately. Different people have a different set of manifestations. For example, sometimes with this pathology there is no edema or there is no local increase in temperature or pain. This does not at all mean that there is no disease. A timely visit to a doctor will significantly slow down the progression of the disease or even stop it, preventing the development of trophic changes.