The word "varicose" comes from the Latin varxis, varicis - swelling. The first mention of the treatment of varicose veins is found in ancient Greek papyri.
Varicose veins are a common disease. Up to 40% of the adult population suffers from chronic vascular disease of the lower extremities. Complications in the form of dermatitis, cellulite, bleeding, thrombosis and trophic ulcers often lead to long-term disability, sometimes disability.
Structure and function of the vascular system
The functioning of our arteries is a complex process. To understand this, you need basic information about the structure of blood vessels. The venous wall consists of three layers. Endothelium, represented by a layer of cells in the connective tissue membrane. The middle layer is muscular. It consists mainly of a flat muscle cell arranged in a circle, as if in a frame of collagen fibers. Superficial veins contain a thicker layer of muscle than deep veins. The outer vascular sheath, the so-called adventitia, is a dense tissue made up of collagen fibers. If we compare the structure of blood vessels and vessels, it should be said that the ratio of the vascular lumen to the thickness of the vascular wall is many times greater than that of arteries. Veins have less elastic fibers than arteries.
The main feature that affects the blood flow indicators of the vessels is the large dilation of the wall. Especially when the pressure in the arteries increases, the arteries dilate and tend to take on a round shape from a slit-like shape. The degree of dilation of the venous wall is very temporary and depends on many things. This is a factor that does not allow the use of strict mathematical formulas to calculate the movement of blood along them. The thickness of the venous wall in the leg veins, for example, is greater than in the neck.
Venous valves form from its wall. It consists of two valves that normally point to the heart. The diameter of the vessel is slightly larger in the area where the valve is attached to the wall. Normally, when the flap sheets are closed, they cannot penetrate from the top to the bottom of the blood. 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 the return time during functional tests. There is also the idea that there is no return with a normal lid. Valves are unevenly distributed through the veins. 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 vascular system);
- large and small sapenous vessels (superficial vascular system);
- contact (perforating) vessels - provide a connection between superficial and deep veins.
The deep and superficial venous systems together form a "sponge", and when you walk, blood flows to the heart. The operation of this system is supported by the operation of a muscle pump located in the lower leg, which creates intermittent pressure in the arteries.
These systems move the blood column upwards and the valves inside the arteries prevent backflow.
Bleeding from the lower extremities through deep and superficial veins is uneven. About 85-90% of the blood flows through the deep veins, only 10-15% through the subcutaneous veins. Thus, in healthy people, the outflow of blood is carried out by the deep, subcutaneous and associated vascular system.
Varicose veins are a serious problem
To say that varicose veins are a "disease of the twentieth or twenty-first century" is to deviate from the truth. Varicose veins have been bothering people for a long time. Even in ancient treatises on medicine, there is a description of varicose veins. In ancient Rome, people tied their feet with skin "bandages" to get rid of venous insufficiency.If your legs get tired often, this may be the first sign of an initial disease of the venous system. Evening discomfort, especially accompanied by swelling in the legs and ankles after a long stay in the legs, is a sign of blockage in the arteries. Soon, unfortunately, you discover the first varicose vein. Altered veins form blue-blue or red "patterns", "stars", capillary "spider webs" (telangiectasia) on your feet, and finally, dilated veins and varicose veins.
Violence, burning, tingling and itching, pain and swelling, "stars", swelling of the veins in the legs - a sharp signal for an emergency measure to maintain the beauty and health of your feet.
A question about the condition of your arteries should be immediately asked to a specialist - a phlebologist who studies and treats venous diseases.
Vascular disease starts harmlessly, but can become a serious problem if left untreated.
Causes of varicose veins
To date, many 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 most affected. However, at first the dilation of the veins is seen in one organ, and after a while in the other. Varicose veins are more common in the right leg.
Varicose veins of the lower extremities occur only in humans. This is due to the vertical position of the body, the effect of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the surrounding vascular wall. Pathological reverse blood flow occurs with impaired venous wall function and congenital insufficiency of the main vessels, resulting in dysfunction of the valve apparatus. 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 enlarged uterus and fetus compress the iliac veins, preventing blood flow from the lower extremities.
- Obesity is 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 long-term static load (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wear tight underwear that tightens the main veins at the level of groin wrinkles. Women with high heels.
- Heavy physical activity (carrying a load, lifting weights).
- Thermal procedures (saunas and baths) that can also cause varicose veins.
The essence of varicose veins is that the above causes a gradual expansion of the lumen of the saphenous and perforated vessels, resulting in a failure of the valve apparatus (failure to close the valve leaflets). Pathological reflux of blood (return) occurs both from top to bottom and through horizontally destroyed perforated vessels.
Diagnosis of varicose veins
The only doctor's tool for examining a patient with varicose veins for many years is the hands. X-rays have come to the aid of surgeons in the last century. However, X-ray contrast examination of blood vessels is a very complex procedure, requires voluminous and expensive equipment, and X-ray contrast agents themselves are by no means safe for the body. With the development of microelectronics and computer technology, previously non-existent diagnostic methods emerged: ultrasound Doppler ultrasound, ultrasound angioscanning, plethysmography. The formation of ultrasound duplex scanning has provided new information that allows us to take a new look at the causes of the development of varicose veins and to understand the subtleties of the pathological process.
Doppler ultrasound
This is an ultrasound diagnostic method that allows you to determine the speed and direction of movement of particles in the body (in this case, blood cells). Thus, the doctor can study the direction and speed of blood flow in the vessels of the lower extremities. And when performing a number of physiological tests and the condition of the valve apparatus of the vessels of the lower extremities. Knowing the structure of blood flow in the arteries in the legs is a key requirement for choosing a treatment.
Ultrasound angioscanning
The essence of this method is that in real time on the monitor screen of the ultrasound scanner appears the walls of blood vessels and the image of blood flowing from them. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the condition and direction of blood flow through this vessel. The method is more informative and safer than X-ray examination, but it is very expensive, so it is used only in difficult cases and during scientific research.
Pletismography
This is a diagnostic method based on determining the electrical resistance of the tissues of the lower extremities. Its essence is that the total electrical resistance of the tissues in the human body directly depends on the amount of blood inside and outside and the time change with each heartbeat. Plethysmography is used to determine the general functional status of blood flow in the lower extremities, to monitor drug treatment for venous or arterial insufficiency, to treat trophic diseases, and to assess the degree of venous insufficiency.
Of course, all these methods do not preclude a direct examination of the patient by a doctor, clarification of the medical history and identification of the patient's complaints. Based on the general picture of the disease, the doctor chooses the method of treatment.
Treatment of varicose veins
In the last 50 years, as in other areas of medicine, there has been a qualitative leap in the treatment of varicose veins. In recent decades, various drugs have been developed and improved to treat chronic venous insufficiency. Surgical techniques for the treatment of varicose veins have been significantly improved. Compression sclerotherapy technology has been developed and practically improved.
Currently, the so-called sclerosurgery is popular all over the world. Sclerosurgery is a clever combination of surgical treatment and sclerotherapy. It is known that sclerotherapy can be used only for primary and uncomplicated forms of varicose veins. Varicose vein surgery is not without its problems, and varicose vein removal is very traumatic, requiring hospitalization and a long rehabilitation period. A reasonable combination of these two methods allows you to minimize the trauma of the treatment process and get a very high quality treatment.
Drug treatment of varicose veins
Patients often have virtually no or very few varicose veins. However, people suffer from heaviness, pain and swelling in the legs. All these are signs of chronic venous insufficiency. In these cases, as well as in the presence of significantly enlarged varicose veins, it is necessary to take drugs that improve blood circulation in the legs. Currently, there are several dozen drugs in the arsenal of a phlebologist aimed at combating venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should be chosen only by a physician. Despite the obvious simplicity of choosing a venotonic substance, only a doctor can determine all therapeutic measures and the appropriateness of the use of a particular drug.
Compression therapy
Compression therapy has long been used in addition to medication or surgery. Compression therapy for varicose veins has been used since ancient times, and only in the last decade has elastic compression been adopted as a separate and independent type of treatment - compression therapy. Compression therapy involves the use of medical elastic bandages and special medical compression stockings of various brands.
The global industry produces three types of elastic bandages: short, medium and high stretch. High-stretch bandages (stretch more than 140%) are used in the postoperative period to prevent thrombotic complications after abdominal and pelvic surgery, and to correct and prevent joints after sports injuries. Short stretch bandages (less than 70% stretch) are used to treat complex forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitis syndrome, and lymphatic insufficiency. Medicinal elongation dressings (70% to 140% elongation) are used in the treatment of varicose veins, chronic venous insufficiency, and compression sclerotherapy.
Medical compression stockings include medical compression stockings, tights, and knee pads. Many people are mistaken in thinking that various "anti-varicose" and "support" jerseys with increasing density are therapeutic. To begin with, it is important to determine if medical compression products are ever listed on DENs. DEN is a technical feature of a knitted fabric that is only indirectly related to the pressure created by the product.
Medical forms are classified into several classes of functional compression. The product class is determined by the pressure exerted by the product on the ankle and lower third of the lower leg. A person with varicose veins is shown using compression class 2 knitwear. These tights or knee pads will create an effective foot pressure of 23-32 mm Hg. Art. , That is, it completely equalizes the pressure in varicose veins and eliminates venous insufficiency. In addition, medical compression products create a so-called distributed pressure. As the foot moves from the bottom to the top, the pressure they create gradually decreases, which helps the blood and lymph to flow more efficiently.
It should be noted immediately that the medical form is never thin and transparent, it requires a large amount of elastic fiber to create such high pressure, and therefore the woven fabric is thick. It should also be noted that medical uniforms are never cheap. The technology of weaving a particular knitted fabric is more complicated; it is necessary to model the profile of the foot to create a distributed pressure during weaving.
The ideal approach in compression therapy is the continuous and widespread use of elastic bandages and / or compression stockings. For example, wearing an elastic bandage daily for a month is almost entirely consistent with the effectiveness of the 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 compressive products is the absolute safety for health compared to the best drugs, and they are quite comparable in terms of cost.
Prevention of varicose veins
If you have the initial symptoms of varicose veins, following simple enough rules will slow down and in some cases even prevent its further development. First of all, hot baths, saunas, do not stay in the sun for a long time. All of the above reduces venous tone, causing blood stasis in the lower extremities. Do not wear tight-fitting clothes, socks and socks with tight elastic bands, as this will tighten the veins. Excessive body weight and sports associated with a large static load on the legs (tennis, weightlifting, bodybuilding) increase venous pressure. High-heeled shoes (more than 4 cm) - our veins do not like it. Take care of the arteries, do not damage them.
If you feel heaviness in your legs in the evening after a day of work, lift your legs while sleeping and resting. If your work is accompanied by a long sitting at the table or standing for a long time, you need to change your legs more often, walk in place and turn your legs. There are special exercises for venous diseases. After showering or bathing, wash your feet with cold water. There are useful sports - primarily swimming, but also walking, cycling, skiing. Do not neglect folk remedies for prevention. Useful infusions of lingonberry, St. John's wort, cornflower, hips leaves. An herbal diet should be followed. Your doctor may also prescribe a drug called phlebotonic to increase venous tone and improve microcirculation. Recently, as seen in the market of high-quality medical products, methods of prevention and treatment of varicose veins have become a very understandable success.
A special word about prevention for pregnant women. Varicose veins develop during pregnancy, especially when it is not the first, and carrying a baby under 1 year of age does not help with good vascular function. The key to prevention is to wear special compression stockings and use phlebotonics both during pregnancy and after birth. When prescribing a hormonal drug, do not neglect to tell your gynecologist about your veins, because these drugs affect the work of blood vessels, reduce their tone.
Do not self-medicate. Talk to your doctor about the best thing to do with your veins. This disease is treated by doctors - phlebologists.