Varicose veins

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

According to the World Health Organization, varicose veins are found in every fifth adult on the planet. The first signs of varicose veins (venous reflux) are detected in 10-15% of children and adolescents aged 12-13.

Causes of varicose veins of the legs

• Hereditary tendency (congenital weakness of vascular valves). If your parents have signs of weakness of the venous wall in any vein (legs, groin, esophagus, rectum), then there is a high probability that you may have symptoms of varicose veins.
• Deterioration of blood circulation in the lower limbs during pregnancy and childbirth (compression of the abdominal vessels by the developing fetus with increased pressure in the veins of the legs, hormonal changes that cause a decrease in the tone of the vessels).
• Violation of blood flow during prolonged standing (varicose veins of the lower extremities are more common among salesmen, teachers, waiters, surgeons) and sitting (managers, accountants, office workers, drivers, etc. ).
• Heavy physical work, sports exercises associated with lifting weights (for athletes, loaders, builders, regular visitors to gyms and fitness clubs)
• Long-term use of contraceptive drugs with a high content of female sex hormones.
• hormonal changes in the body accompanied by a decrease in the tone of venous vessels (adolescence, pregnancy, menopause in old age).
• Factors such as excess weight, chronic cough, constipation, the habit of wearing tight clothes and shoes disrupt the venous flow and often cause varicose veins.

Why do varicose veins occur during pregnancy?

In women, varicose veins of the lower extremities are observed 3-5 times more often than in men, and they occur for the first time quite often during pregnancy. In 80% of cases, varicose veins develop first on the left leg, and then on the right.

• The appearance of varicose veins is facilitated by hormonal changes in a woman's body during pregnancy, which causes a decrease in the elasticity of the venous wall, stretching and turning into a varicose node.
• The volume of blood flow in the body of a pregnant woman increases significantly. Increased venous pressure leads to thinning of the venous wall and its local expansion (varicose veins).
• The growing fetus makes it difficult for the blood from the lower extremities to leave the pelvic veins due to the corresponding expansion of the uterus and increased intra-abdominal pressure and mechanical compression of the veins.
• An increase in the body weight of a pregnant woman also has a negative effect on venous flow.

Varicose veins of the lower extremities: symptoms

Varicose veins develop quite slowly, successively passing through several main stages:

• In the first stage, the violation of venous blood circulation is accompanied by the appearance of individual "spider veins", thinning of the skin, enlarged veins in the form of twisted cords (usually in veins) begin to appear during physical activity. popliteal fossa), no complaints.
• In the second stage of varicose veins, there is a feeling of heaviness, fatigue in the lower limbs, swelling of the legs in the evenings and after a long walk, a feeling of "pins and needles" crawling along the legs, night cramps. the calf muscles, on careful examination, reveal several dilated veins in the lower legs, and sometimes in the leg and thigh.
• The third stage of varicose veins of the lower extremities is characterized by the obvious bulging of the venous nodes, mainly on the inner surface of the leg, and the appearance of dark brown or brown spots on the thin, easily wounded skin of the legs. dermatitis with itching and rash. Swelling of the legs gets stronger and makes it difficult to walk.
• The fourth stage of varicose veins is the presence of varicose nodes in the legs, feet and thighs, the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose nodes, development of thrombophlebitis).
• Sometimes the fifth stage is also distinguished - there are all the symptoms characteristic of the fourth stage of varicose veins, the process spreads to the groin, hips, perineum, the presence of numerous trophic ulcers, the appearance of an elephant, frequent exacerbation. onset of thrombophlebitis and 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 postthrombophlebitis.
6. Pulmonary embolism (PE).
7. Lymphedema (elephant disease).

Diagnosis of varicose veins

It is based on clinical examination, conducting functional tests and instrumental studies of vessels.

• Clinical examination (clarification of complaints, history taking, 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 at an early stage, you can fight its manifestations using compression stockings, special therapeutic exercises and traditional treatment methods. But if you consult a doctor late, when varicose veins are visible to the naked eye, your legs hurt and swell, trophic ulcers appear, signs of thrombophlebitis, the only way out is surgical intervention.
At the same time, you should not be afraid of surgery, because modern technologies allow you to get rid of varicose veins of the lower extremities without wide incisions, painlessly and practically without disrupting a person's usual lifestyle.

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

The main types of surgery for varicose veins

1. Sclerotherapy. At the initial stage of varicose veins, a good cosmetic result is achieved by "gluing" the pathologically enlarged area of the vein, which gradually leads to sclerosis, by introducing special drugs into the problematic vein. A drug (usually a sclerosant) is injected into the varicose vein through a special catheter or a very fine needle. To obtain a positive result, 3 to 10 injections are required.
2. Phlebectomy. An operation that has been performed for about a hundred years, but in modern conditions, wide incisions have long been abandoned. These days, manipulation is performed through miniature incisions of 3-5 millimeters. The pathologically enlarged vein is first closed and cut at the point where it flows into the deep vein, and then removed using special probes. This operation lasts about 1-2 hours, after which the patient stays in the hospital of the medical institution 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. It achieves a good cosmetic effect (usually no sutures are required) and significantly reduces recovery time after surgery. In some cases, not the entire vein, but only its pathologically altered part can be removed. This intervention is called short stripping.
4. Endovenous laser coagulation of veins. Manipulation is performed under ultrasound control. A special laser light guide is inserted into the pathologically dilated vein and the saphenous vein and its branches are burned. After a certain time, obliteration and sclerosis of the vessel occurs, its complete closure. If necessary, laser coagulation is combined with miniphlebectomy. In this case, the effectiveness of surgical treatment of varicose veins of the lower extremities will be the highest.
5. Radio wave ablation of varicose veins. Obliteration ("gluing") of the lumen of the altered vessel is achieved by exposure to radio waves of a certain power delivered to the problem area of the vessel through a special catheter. The duration of the procedure is about 20 minutes.

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

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

• During pregnancy and the first two months after childbirth.
• In the initial stage of varicose veins, if there are no complaints and 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 when there are serious diseases with dysfunction of various organs and systems of the body, the risk of possible complications increases significantly.
• In case of lymphatic drainage disorders, infectious lesions of the skin of the lower extremities, thrombophlebitis, arteriovenous fistulas.

In this case, the correct selection of the most effective treatment method for varicose veins of the lower extremities, the absence of contraindications and following the doctor's recommendations during the postoperative period will ensure a positive result of the surgical intervention.

Prevention of varicose veins of the lower extremities

Mode and diet

Adhering to a certain work and rest regime, as well as nutrition, will prevent the appearance of varicose veins in most cases. To do this you need:

• Avoid clothing that restricts venous blood flow.
• Avoid standing or sitting for a long time (take periodic breaks with rest and perform simple gymnastic exercises).
• Avoid vigorous physical activity.
• Lead an active lifestyle (moderate dynamic loads - daily walking, swimming, cycling).
• Drink at least 1. 5-2 liters of fluid per day, and your daily diet should include vegetables and fruits, whole grain bread and cereals.
• Avoid visiting baths and saunas, refuse to take hot baths.
• Take a contrast shower (hot - cool) every day.
• Wear comfortable shoes with low heels.

Antiplatelet therapy

An important component of preventive measures for varicose veins of the lower extremities is taking drugs with an antiplatelet effect, that is, they prevent the formation of blood clots. These include:

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

Compression form

For many years, bandaging with elastic tube bandages has been successfully used in the early stages of varicose veins (when spider veins appear). Now special clothing is produced - compression knitwear, which allows you to choose the necessary sizes and choose the degree of compression depending on the severity of the changes. Wearing socks and tights first puts pressure on the top of the ankles, then reduces pressure and stimulates blood flow to the heart. Venous vessels work more efficiently, as a result, venous congestion is eliminated, swelling disappears, and thrombus formation is prevented.

Gymnastics

Special exercises aimed at eliminating venous blood stagnation have been developed. The key to success here is the regularity of the execution of the complex. Let's consider a few basic exercises recommended when there are risk factors for the development of varicose veins of the lower extremities and in the initial stage of the disease:

• Lying on your back with your feet 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" - lying on your back, raise your legs and cross them, change the position of your legs (up - down) for 1 minute;
• Legs are raised and bent at the knee joints. Imitating walking, bend and straighten your legs;
• Lying on your back, bend your left leg and bring your knee to your chest. Wrap your hands around your leg at the ankle joint and gradually straighten your leg by massaging the calf muscles. Repeat the exercise with the right leg;
• Stand with your feet together. Raise yourself on your toes and lower yourself (if there are no complications, the exercise can be performed sharply - with your heels touching the floor).

Timely initiation and proper implementation of preventive measures can prevent varicose veins of the lower extremities or minimize its manifestations.