Varicose veins - symptoms, diagnosis, treatment

Varicose veins or varicose veins is a disease that affects the veins. Pathology most often develops in the lower limbs. Disorders of venous blood flow to 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 cosmetic defects that accompany varicose veins, the patient faces heaviness and severe swelling in the legs, rapid fatigue and night cramps.

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

In order to prevent serious irreversible conditions, varicose vein treatment must be started as soon as possible. Modern methods of treatment relieve the physical manifestations of varicose veins and completely eliminate the associated cosmetic defects.

The reasons for the development of varicose veins

The cause of the disease is the insufficiency of the venous valves of the lower extremities, as a result of 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 limbs, consisting of superficial and deep veins connected by venous communication 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 to deep veins, 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 blood returns from the deep veins to the peripheral ones, their expansion and lengthening occurs, the vascular wall thins, becomes inflamed, cyanotic nodes and dilated veins are formed characteristic of varicose veins .

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

  • Genetic predisposition. . . Vascular wall weakness 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 limbs.
  • Obesity. . . Obesity at any stage increases the risk of developing varicose veins, which is associated with increased 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. Weight lifting is another risk factor.
  • Hormonal disturbances. . . Uncontrolled intake of hormonal contraceptives and other hormone-based drugs causes changes in the state of the venous wall. In women, this reaction can also be observed during pregnancy. In addition to hormonal changes during pregnancy, there is an increase in the total volume of blood 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 fruits and vegetables in the diet leads to a deficiency of coarse fiber and, consequently, to 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 gradual classification of varicose veins:

  • Compensation phase. . . It is not accompanied by characteristic symptoms, and patients are often unaware of the development of the pathology. In rare cases, in the clearing stage, separate dilated veins and varicose veins appear on the legs.
  • Undercompensation phase. . . At this stage, the patient is faced with cosmetic defects in the legs in the form of dilated veins. During this period, there is pain and swelling in the limbs, the appearance of goosebumps in the shins and nocturnal leg cramps.
  • Phase of decompensation. . . This stage of varicose veins is accompanied by eczema, dermatitis, trophic ulcers. The skin changes color to cyanosis, acquires roughness and luster. Patients are concerned about itching and pain in the lower limbs.

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 secretion (telangiectasias and reticular varices);
  • segmental varicose veins with reflux along the superficial and / or perforating veins;
  • diffuse varicose veins with reflux in superficial and / or perforating veins;
  • varicose veins with deep venous reflux.

Degree of chronic venous insufficiency:

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

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

In some cases, single varicose veins may appear on the skin - telangiectasias. After carrying out a physical examination, the doctor, already in the initial phase, may notice local enlargements of the veins, which, when palpated, are defined as soft and do not show structural alterations.

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

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

Further development of the disease leads to the formation of redness and edema of the legs, which appear when the patient is in a standing position for a long time, so most patients notice swelling in the evening. If left untreated at this stage, dull pain in the legs increases and nighttime cramps and itchy skin are added. These signs are the result of impaired blood circulation in the leg veins. Pathological enlargement of the veins of the extremities becomes noticeable to the naked eye.

Severe forms of varicose veins are accompanied by protruding 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-internal surface of the lower leg.

Those with a higher likelihood of developing varicose veins should pay special attention to the body's signals. 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 area of greatest danger are women of the older age group and people who are overweight.

Doppler ultrasound of the lower limb veins for the diagnosis of varicose veins

Diagnosis of varicose veins

Diagnosis of pathology begins with a thorough medical history. In addition, a general examination is carried out in a standing position.

Functional tests:

  1. Samples determining valvular insufficiency of superficial veins: Schwarz, Hackenbruch-Sikar, Brody - Trendelenburg;
  2. Samples Revealing Failure of Perforating Veins: Pratt-I, Barrow - Cooper - Sheinis Three Tourniquet Test, Talman;
  3. Samples that reveal the patency and state of deep veins: Mayo - Pratt, Delbe - Pertis.

Instrumental diagnostics:

  • Color duplex angioscan. . . A technique for determining and displaying blood flow rates in real time. The method is particularly sensitive to vessels with slow blood flow (veins).
  • Doppler ultrasound of the veins of the lower limbs. . . 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, phleboscintigraphy with radionucleides.

Methods of treatment for varicose veins

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 improve the patient's condition and can be used as an effective prevention of varicose veins.

Non-surgical treatment methods include a number of measures, including:

  • change the regime to a more active one;
  • Physical 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 stockings are prescribed to be worn for therapeutic and prophylactic purposes. Such underwear - stockings, tights, etc. - it contains elastic fibers that tightly compress the limbs, distributing pressure, toning the lymphatic and circulatory system, keeping the tissues in the desired position.

Varicose veins on ultrasound

Indications for the use of compression hosiery and its effect:

  • Varicose veins. . . It distributes internal pressure in the limbs, reducing the diameter of the veins and forcing venous blood to move towards the heart. Wearing stockings and tights is indicated during the illness and after the removal of varicose veins.
  • Swelling of the lower limbs. . . Helps the movement of lymph, improves muscle contractions around the lymphatic vessels, squeezes stagnant fluid into the tissues.
  • Pregnancy. . . Maintains the tone of the compressed vessels from the uterus, preventing the development of varicose veins.
  • Prevention of postoperative thrombosis- blockage of the veins. After the operation, patients are assigned to bed rest. This reduces the speed of blood flow and can lead to blood clots. Compression garments prevent complications from occurring.
  • Prevention of varicose veins. . . Recommended for those who have been standing for a long time.

Medicines for varicose veins of 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 polysulphuric acid, provitamin B5, rutoside, a semi-synthetic derivative of rutin.

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

Minimally invasive methods of treatment of the different stages of varicose veins

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

  • Ozone therapy. . . It is prescribed only in 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 a long time.
  • Electrocoagulation.The method is based on the effect of the current on the affected blood vessels - telangiectasia. The downside to this method is the likelihood of scars, scars, and age spots.
  • Radio wave surgery. . . After removal of spider veins by 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 highly effective modern 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 to superficial veins, 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 sclerosing agent into the bed of an enlarged vessel, which is a liquid or elastic foam (a more modern version) that fills the veins and causes a 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 sock puts pressure on the vein walls, preventing the back from expanding. As a result, the vascular walls are glued together and the cosmetic 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 above 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 to superficial veins, the only effective method of treating varicose veins is the complete removal of the affected vessels.

The main task of 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) exposure methods, the vessels are heated and "sealed". The procedure is effective and does not require general anesthesia or hospitalization. Laser coagulation is prescribed in the following conditions:

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

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

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

The results of the interventions are not immediately visible. To assess the effectiveness, it is necessary to wait several months. The work of the veins is normalized in 87. 7% of cases. The functions of the removed vessels are detected by healthy veins - collateral, which practically did not work before.

After treatment, wear anti-varicose compression garments and avoid increased stress on the legs.

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, the phlebectomy is completed 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 risk of developing the disease, patients are advised to:

  • Reconsider your lifestyle: you have to move a lot without overloading your legs.
  • Give up bad habits: smoking, alcohol.
  • Reconsider nutrition: eat more vegetables, fruits, natural grains, 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

The expansion and lengthening of the leg veins cannot be eliminated by any home method or traditional medicine recipe. The only way to get rid of these defects is to consult a doctor in a timely manner. Attentive attitude to your health, timely detection 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 limbs.