Varicose veins - symptoms, diagnosis, treatment

Varicose veins or varicose veins is a disease that affects the veins. Pathology develops most often in the lower extremities. Disorders of venous blood flow in other parts of the body also occur, but less frequently.

Varicose veins are characterized by thinning of the venous wall, pathological varicose veins and the formation of subcutaneous nodes, visible to the naked eye. In addition to the aesthetic defects that accompany varicose veins, the patient is faced with heaviness and severe swelling in the legs, fatigue, and night cramps.

Without timely and competent treatment, pathology leads to the development of phlebitis (inflammation of the venous wall) and thrombophlebitis (inflammation with the formation of a blood clot). Severe stages of varicose veins are accompanied by impaired blood circulation in the limbs, leading to the formation of trophic ulcers.

In order to prevent severe irreversible conditions, the treatment of varicose veins should be started as early as possible. Modern methods of treatment alleviate the physical manifestations of varicose veins and completely eliminate the accompanying aesthetic defects.

The reasons for the development of varicose veins

The cause of the disease is insufficiency of the venous valves of the lower extremities, due to which the outflow of blood is impaired.

The mechanism of development of varicose veins is associated with a complex and developed network of veins of the lower extremities, consisting of superficial and deep veins connected by communication venous vessels. Superficial veins drain blood from the skin and subcutaneous structures, while deep veins drain blood from internal organs. The communicative veins connecting them act as a compensator, equalizing the pressure in the superficial and deep vessels.

Normally, blood moves strictly in one direction - from superficial veins to deep ones, that is, from bottom to top. Since this contradicts the forces of gravity, this movement allows the tone of the muscle fibers of the vessel itself, the movement of the surrounding muscles and the work of the vasomotor center of the brain. If, for any reason, a reverse outflow occurs and the blood returns from the deep veins to the peripheral ones, their expansion and lengthening occurs, the vascular wall becomes thinner, inflamed, cyanotic nodes and dilated veins characteristic of varicose veins are formed.

The disease develops as a reaction to a combination of adverse factors listed below. Causes of varicose veins of the extremities:

  • Genetic predisposition. . . Weakness of the vascular wall associated with a lack of connective tissue can be inherited from generation to generation, which leads to a loss of vascular tone in the lower extremities.
  • Obesity. . . Obesity at any stage increases the risk of developing varicose veins, which is associated with an increase in venous pressure in overweight people.
  • Lifestyle features. . . The risk group consists of people who, due to their occupation, spend most of their time in a sitting position and those who have to stand a lot. Lifting weights is another risk factor.
  • Hormonal disorders. . . Uncontrolled intake of hormonal contraceptives and other drugs based on hormones provokes changes in the state of the venous wall. In women, this reaction can also be observed during pregnancy. In addition to hormonal changes during childbearing, there is an increase in total blood volume and compression of the retroperitoneal veins, which also contributes to the development of varicose veins.

Another factor that affects the likelihood of developing varicose veins is nutrition. Insufficient content of fresh vegetables and fruits in the diet leads to a deficiency of coarse fiber, and as a result - a weakening of the venous wall.

Women suffer from varicose veins much more often than men. According to statistics, this disease is diagnosed on average in 30% of women and 10% of men.

Spider veins and telangiectasias - symptoms of varicose veins

Classification

Phlebologists often use a staged classification of varicose veins:

  • Compensation stage. . . It is not accompanied by characteristic symptoms, and patients are often unaware of the development of pathology. In rare cases, at the stage of compensation, separate dilated veins and spider veins appear on the legs.
  • Subcompensation stage. . . At this stage, the patient is faced with aesthetic defects in the legs in the form of dilated veins. During this period, there is soreness and swelling of the limbs, the appearance of goose bumps in the shins and night cramps of the legs.
  • Decompensation stage. . . This stage of varicose veins is accompanied by eczema, dermatitis, trophic ulcers. The skin changes its color to cyanosis, acquires roughness and shine. Patients are worried about itching and soreness in the lower extremities.

The international system identifies seven types of varicose veins.

The classification of the Congress of Phlebologists, held in 2000, determined the forms of varicose veins as follows:

  • intradermal and subcutaneous segmental varicose veins without pathological veno-venous discharge (telangiectasia and reticular varicose veins);
  • segmental varicose veins with reflux along the superficial and / or perforating veins;
  • widespread varicose veins with reflux in the superficial and / or perforating veins;
  • varicose veins with deep vein reflux.

Chronic venous insufficiency grade:

  • 0 - absent;
  • 1 - "heavy legs" syndrome, transient edema;
  • 2 - varicose veins, persistent edema, hypo- or hyperpigmentation, lipodermatosclerosis, eczema;
  • 3 - venous trophic ulcer (open or healed).

Complications:

  • bleeding;
  • thrombophlebitis;
  • trophic ulcer (indicating the location and stage of the wound process).

Symptoms of varicose veins

The severity of signs depends on the stage and severity of the course of the disease.

In the initial stages, varicose veins are asymptomatic. The first symptoms of varicose veins are manifested by heaviness in the lower extremities, mild soreness of the legs and increased fatigue. There are no vivid manifestations of pathology.

In some cases, individual spider veins - telangiectasias - may appear on the skin. After conducting a physical examination, the doctor, already at the initial stage, may notice local enlargements of the veins, which, when palpated, are defined as soft and have no structural changes.

The first signs of varicose veins that patients can notice on their own:

  • heaviness in the legs and "buzzing" of the legs towards the end of the day;
  • the appearance of spider veins and telangiectasias on the lower extremities;
  • varicose veins visible to the naked eye;
  • the appearance of edema of the legs during prolonged stay in an upright position;
  • soreness in the calf muscles;
  • night cramps of the calf muscles.

Further development of the disease leads to the formation of pasty and edema of the legs, appearing when the patient is in an upright state for a long time, therefore, most patients notice puffiness in the evening. If untreated at this stage, dull pain in the legs increases, and night cramps and itching of the skin are added to them. These signs are the result of impaired blood circulation in the veins of the legs. Pathological enlargement of the veins of the extremities becomes noticeable with the naked eye.

Severe forms of varicose veins are accompanied by bulging veins and venous nodes that appear through the skin. The skin in these areas has an unhealthy color due to hyperpigmentation. The skin is firm and rough.

A symptom of advanced varicose veins is the appearance of trophic ulcers and eczema on the anterior-inner surface of the lower leg.

Those with an increased likelihood of developing varicose veins should pay particular attention to the signals of the body. The risk group includes, first of all, people who have a hereditary predisposition to this disease, that is, those who have suffered from varicose veins in their family. Also in the high-risk zone are women of the older age group and people who are overweight.

Doppler ultrasonography of the veins of the lower extremities for the diagnosis of varicose veins

Diagnosis of varicose veins

Diagnosis of pathology begins with a thorough history taking. Further, a general examination is carried out in a standing position.

Functional tests:

  1. Samples determining valve insufficiency of superficial veins: Schwarz, Hackenbruch-Sikar, Brody - Trendelenburg;
  2. Samples revealing the failure of perforating veins: Pratt-I, three tourniquet test Barrow - Cooper - Sheinis, Talman;
  3. Samples that reveal patency and the state of deep veins: Mayo - Pratt, Delbe - Pertis.

Instrumental diagnostics:

  • Color duplex angioscanning. . . A technique for determining and visualizing blood flow rates in real time. The method is particularly sensitive to vessels with low-velocity blood flow (veins).
  • Doppler ultrasonography of the veins of the lower extremities. . . Doppler ultrasound examination reliably assesses the state of the main venous trunks and detects in the presence of reflux (reflux from deep veins into superficial veins).

In some cases, X-ray and radionuclide research methods are also used, for example, radionucleide phleboscintigraphy.

Treatment methods for varicose veins

The treatment of varicose veins involves the implementation of the following tasks:

  1. elimination of varicose syndrome;
  2. elimination of signs of CVI;
  3. prevention of progress and relapse.

Varicose veins can be treated using three main therapeutic methods:

  • conservative treatment;
  • minimally invasive methods - sclerotherapy, laser photocoagulation, ozone therapy, electrocoagulation, radio wave treatment;
  • surgical treatment.

Symptomatic therapy - the use of ointments, gels, foot massage, remedial gymnastics, hirudotherapy (treatment with leeches). Such treatment helps only at the very beginning of the disease, after the onset of pronounced symptoms, it does not give a pronounced effect.

Contraindications to surgical treatment:

  • old age with severe concomitant conditions;
  • the presence of somatic pathologies that have contraindications for any operations;
  • refusal of the operation.

Such patients are prescribed conservative treatment.

Conservative therapy of varicose veins

Conservative methods are not able to completely cure varicose veins, but they help to improve the patient's condition and can be used as an effective prevention of varicose veins.

Non-operative methods of treatment include a set of measures, including:

  • changing the regime to a more active one;
  • Exercise therapy;
  • the use of special elastic bandages and compression underwear (stockings, tights);
  • the appointment of phlebotonic drugs that increase the tone of the vascular wall.

Compression hosiery is prescribed to be worn for therapeutic and prophylactic purposes. Such underwear - stockings, tights, etc. - contains elastic fibers that tightly compress the limbs, distributing pressure, toning the lymphatic and circulatory systems, keeping the tissues in the desired position.

Varicose veins on ultrasound

Indications for the use of compression hosiery and its effect:

  • Varicose veins. . . Distributes internal pressure in the extremities, reducing the diameter of the veins and forcing venous blood to move to the heart. Wearing stockings and tights is indicated during illness and after removal of varicose veins.
  • Swelling of the lower extremities. . . Helps the movement of lymph, enhances muscle contractions around the lymphatic vessels, squeezes out the stagnant fluid in the tissues.
  • Pregnancy. . . Maintains the tone of the vessels squeezed by the uterus, preventing the development of varicose veins.
  • Prevention of postoperative thrombosis- blockage of veins. After the operation, the patients are assigned to bed rest. This reduces the rate of blood flow and can lead to blood clots. Compression garments prevent complications from occurring.
  • Prevention of varicose veins. . . Recommended for those who are on their feet for a long time.

Medicines for varicose veins in the legs are used externally or orally. External remedies - gels, ointments, creams - act directly on the lesions. Their regular use reduces swelling, pain and heaviness in the legs. Remedies for varicose veins contain: horse chestnut extract, mucopolysaccharide ester of polysulfuric acid, provitamin B5, rutoside, a semi-synthetic derivative of rutin.

Oral preparations are mainly based on an angioprotective, venotonic, lymphatic drainage-improving bioflavonoid, which reduces the permeability of veins and capillaries, has a beneficial effect on blood vessels and reduces edema.

Minimally invasive methods of treatment of different stages of varicose veins

When choosing a technique, the individual characteristics of the organism, the stage of pathology and the patient's chronic diseases are taken into account.

  • Ozone therapy. . . It is prescribed only at the initial stage of varicose veins. It is performed using micro-needles for hypodermic injection. Ozone therapy is indicated for patients with sensitive skin, it has no side effects. The patient is injected with an ozone-oxygen mixture, which causes the affected vein to collapse. The method is painless and non-traumatic. The advantage of the procedure is a short rehabilitation period. The effect is noticeable immediately and lasts for a long time.
  • Electrocoagulation.The method is based on the effect of current on the affected blood vessels - telangiectasia. The disadvantage of this method is the likelihood of scars, scars and age spots.
  • Radio wave surgery. . . After removal of spider veins using high-frequency radio waves, swelling and scars do not appear. Minus - using the method, only a small number of telangiectasias can be removed.
  • Laser photocoagulation. . .A modern highly effective procedure, prescribed if the visible vessels are less than three millimeters in size.
  • Compression sclerotherapy of varicose veins.The method is used in cases where varicose veins are not accompanied by a reverse flow of blood from deep veins into superficial ones, but is associated only with local expansion of the veins of the lower extremities. The essence of the method is the chemical destruction of the inner walls of the vein, followed by aseptic thrombophlebitis and obliteration of the lumen.

Sclerotherapy involves the intravenous injection of a sclerosant into the bed of an enlarged vessel, which is a liquid or elastic foam (a more modern version) that fills the veins and causes them to reflex spasm. After the walls of the enlarged vessel are compressed, compression stockings are put on the legs; they need to be worn for about a month. The tight stocking puts pressure on the walls of the vein, preventing back expansion. As a result, the vascular walls are glued together and the aesthetic defect is eliminated.

The concentration of phlebosclerosants is selected separately for each vein, depending on its size and the degree of neglect of the process.

Complications of the method:

  • early: urticaria over the vessel, allergy, pain syndrome.
  • late: post-injection hyperpigmentation, skin necrosis.

Surgical intervention

If varicose veins are complicated by reflux (throwing) of blood from deep veins into superficial ones, the only effective method of treating varicose veins is the complete removal of the affected vessels.

The main task of the surgical treatment of varicose veins is to eliminate pathological reflux and varicose veins of the saphenous veins.

EVLK, RFO.With laser (EVLK) and radio frequency (RFO) methods of exposure, the vessels are heated and "sealed". The procedure is effective and does not require general anesthesia or hospitalization. Laser coagulation is prescribed under the following conditions:

  • few dilated venous tributaries;
  • the trunk of the great saphenous vein is moderately dilated;
  • the large saphenous vein is enlarged to no more than 10 mm;
  • the affected vein has a smooth course of the trunk - a condition for the unimpeded movement of the fiber.

Phlebectomy. . . Surgical removal of blood vessels that cannot be eliminated without surgery. With this microsurgical technique, the affected vessels are removed through small incisions in the affected limb. The places of micro-incisions and punctures become invisible over time.

The operation is resorted to mainly with advanced forms of the disease, making it impossible to use more gentle techniques. The operation is performed in a hospital setting under local, general or epidural anesthesia. It is impossible to get rid of all the altered vessels with the help of phlebectomy. After removing the largest and heavily affected veins, the small ones are sealed using a laser or sclerotherapy.

The results of the interventions are not immediately visible. To assess the effectiveness, you need to wait several months. The work of the veins is normalized in 87. 7% of cases. The functions of the removed vessels are taken over by healthy veins - collaterals, which practically did not function before.

After treatment, anti-varicose compression garments should be worn and increased stress on the legs should be avoided.

Crossectomy.It is used in combination with endovasal (EVLK, RFO) methods of saphenous vein obliteration and phlebectomy. The choice of method depends on the degree of varicose veins and the consistency of the valves of the great saphenous vein:

  • short - part of the large PV is removed;
  • long - the saphenous vein is removed along its entire length.

In case of horizontal reflux caused by the failure of the perforating veins, phlebectomy is complemented by the dissection of the perforating veins and their ligation according to Linton or Cockett. In the presence of trophic lesions in the Kokket area, the endoscopic method of dissection and minimally invasive access (the posterior surface of the leg) are suitable.

Prevention of varicose veins

To reduce the risks of developing the disease, patients are advised to:

  • Reconsider your lifestyle - you need to move a lot without overstraining your legs.
  • Give up bad habits - smoking, alcohol.
  • Reconsider nutrition - eat more vegetables, fruits, natural cereals, rich in coarse fiber.
  • During pregnancy and when using hormonal agents, use special compression agents - stockings or tights. Do not use hormonal drugs without a doctor's prescription, taking into account contraindications and possible risks.
  • Losing weight - prevention of varicose veins is impossible without normalizing body weight.

Conclusion

Expansion and lengthening of the veins in the legs cannot be eliminated by any home method or by any recipe of traditional medicine. The only way to get rid of these defects is to see a doctor in a timely manner. Attentive attitude to your health, timely identification of the first symptoms of varicose veins and a quick appeal to a qualified doctor.

Today varicose veins are no longer an incurable and hopeless problem for patients. Modern methods of treatment are aimed at improving not only the physical condition of the patient, but also the aesthetic condition of the lower extremities.