Varicose veins

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

What is this

Varicose veins are a pathology that only people suffer from. Animals do not have this problem, which indicates 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 the conditions are created for worse blood circulation 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. In addition, similar problems are more common in young people. Most likely, one of the reasons for the "rejuvenation" of varicose veins is a sedentary lifestyle that only contributes to stagnation.

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

Features, causes and mechanism of development of varicose veins

The exact causes of the development of varicose veins of the lower extremities are still unknown. At present, the disease is believed to be caused by congenital or acquired defects of the valvular apparatus of the vessels of the lower extremities.

A well-coordinated work of venous valves is required for unimpeded blood flow in the arteries. These valves only open for upward flowing blood. However, partially reduced blood flow is also possible with a valve defect. Even venous insufficiency develops, manifested by edema, leg muscle cramps and dilation of venous vessels.

Leukocytes may also be involved in the pathogenesis of varicose veins. This issue is currently being actively studied. It is believed that an inflammatory process develops along the venous bed with prolonged accumulation of leukocytes in the tissues of the vessels (especially in the area of the valve apparatus).

Because venous valves are subjected to constant mechanical stress, inflammation develops especially rapidly in the region of the vascular valve apparatus.

The vast majority of people in developed countries now lead a sedentary lifestyle. So why doesn't everyone have varicose veins? Consider the main risk factors that contribute to the onset of this pathology:

• Hereditary factors. . . Although specific hereditary mechanisms for the development of varicose veins have not yet been established, most experts agree on the existence of such a factor. At the same time, there are serious contraindications to heredity in the development of varicose veins. For example, it is the prevalence of varicose veins in ethnic Africans and African immigrants going to live in the United States. The prevalence of varicose veins among sedentary Africans is about 0. 5%, while among immigrants this figure reaches 20%. These figures show that hereditary factors, at least, are not alone in the development of the disease and most likely do not predominate.
• Obesity. . . Overweight and obese people are at risk. It should be noted that obesity helps varicose veins due to both the increase in vascular tension and the risk of other diseases affecting the arteries (diabetes, hypertension, etc. ).
• Pregnancy. . . This is one of the most obvious factors in the development of varicose veins of the lower extremities. The main risk factors in this situation are an increase in the volume of circulating blood, as well as constriction of the retroperitoneal veins by the developing fetus in the uterus. According to epidemiological studies, second and subsequent pregnancies significantly increase the likelihood of developing varicose veins. After the first pregnancy, the chances of varicose veins in the legs remain 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 for the treatment of certain diseases (eg, osteoporosis) or using hormone replacement therapy in the premenopausal period. Female sex hormones (especially estrogens and progesterone) have been found to reduce vascular tone and destroy collagen fibers. Thus, the vessel wall expands pathologically.
• Life style. . . A person's lifestyle has a great impact on the course of the disease. A sedentary lifestyle, as well as prolonged standing or sitting work (e. g. , security guards, drivers, office workers, service workers, etc. ) contribute to the development of varicose veins. You should also pay attention to nutrition. Lack of adequate vegetables and fruits in the diet worsens the condition of the walls of blood vessels.

Stages of varicose veins of the lower extremities

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

• C (Clinical)- clinical class of the disease (type of affected vessels, pigmentation, eczema, presence of trophic ulcers).
• E (etiology)- Etiology of the disease (congenital, primary, secondary).
• A (Anatomical)- anatomical localization of pathology (superficial or perforated vessels).
• P (pathophysiological)- type of disorder (venous reflux, obstruction or a combination of both).

The course of the disease occurs in six stages:

• Zero stage. . . The earliest stage of varicose veins, even doctors can not make a reliable diagnosis. At this stage, there are no external signs of the disease. Ultrasound diagnosis does not indicate the presence of pathology. At the same time, a person in the zero stage is worried about symptoms such as swelling, heaviness in the legs, as well as cramps, which indicate the presence of problems with blood vessels.
• The first stage. . . Already in the first stage of the disease, spider veins appear on the surface of the skin of the feet with a diameter of less than 1 millimeter. The diameter of medium-sized vessels can increase up to 3 mm. At this stage, doctors are not always able to make a correct diagnosis, because the presence of such stars does not always indicate varicose veins.
• The second stage. . . At this stage, the veins may appear and disappear depending on the conditions. For example, after sitting for a long time, standing on your feet, or lifting heavy objects, the veins are clearly visible. At this stage, the diameter of varicose veins is 3 mm or more. Blood clots often form in the second stage.
• The third stage. . . In the earlier stages of the disease, swelling of the legs was seen, and if it disappeared, the edema became permanent in the third stage. Swelling of the feet occurs most often in the evening.
• The fourth stage. . . Significant trophic changes occur at this stage. In particular, the nutrition of the tissues near the affected vessels is impaired. The patient develops changes in the skin, such as lipodermatosclerosis (inflammation of the subcutaneous adipose tissue), eczema, as well as darkening or discoloration of the skin. The fourth stage of the disease is characterized by pigmentary changes. For example, the skin in the area of the affected veins may turn brown or even black, which indicates the concentration of pigments in this area. The opposite is also possible, due to the pathological process, the pigment does not enter the affected area, which leads to the appearance of pale skin tone. If varicose veins are not treated at this stage, the problem will only get worse with the subsequent appearance of trophic ulcers.
• The fifth stage. . . In addition to the above symptoms, trophic ulcers that heal quickly also appear at this stage of the disease. If you do not take any measures for treatment, then the ulcers will appear again and again.
• The sixth stage. . . Non-healing trophic ulcers appear. The temperature in the affected area rises significantly and pus may leak from the wounds.

You should not wait for the development of the final stages - you should go to the doctor for a second to record and monitor the dynamics of the disease. Sometimes the symptoms improve on their own, and sometimes they progress rapidly. Therefore, it is important to monitor the situation in order to take timely action.

Symptoms

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

• Pain. . . This is the earliest sign of the disease. Because pain is a non-specific symptom, it is not possible to make a diagnosis based on this symptom alone. Pain with varicose veins of the lower extremities is often localized along the venous trunks.
• Feet on feet. . . Although the veins in the skin are not yet visible, they are also associated with early symptoms. Often the feeling of warmth is accompanied by trembling pain.
• Muscle cramps and itching. . . Worries most at night.
• Swelling in the legs. . . In the early stages of the disease, the swelling is small and transient. As a rule, they appear in the evening and disappear in the morning. However, as the disease progresses, the severity increases and they become permanent.
• Skin discoloration. . . As a rule, the skin of the lower extremities darkens with varicose veins. The skin in the area of the affected veins becomes 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. Initially, these are healing wounds, but then the wounds do not heal.
• Vascular spiders. . . In the medical literature, such stars are called teleinjection. In some people, varicose veins may be limited to spider veins without going into larger veins.
• Wrapped dilated veins. . . The most characteristic sign of varicose veins are dilated veins wrapped around 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 helps to dilate the arteries. Therefore, it is best to be in a well-ventilated place during the hottest hours, from 10 am to 4 pm.

When to see a doctor

You should already consult a doctor at the first symptoms of the disease - pain, swelling or the appearance of spider veins. Because varicose veins are difficult to diagnose in the early stages, they can be misdiagnosed at first. The patient should carefully monitor the condition of the feet and be monitored regularly by a phlebologist.

Diagnostics

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

• External examination of the skin of the feet;
• Doppler ultrasound;
• Duplex vessel scanning;
• Phlebography.

Treatment features

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

• Drug therapy. . . This is the taking of drugs that improve the tone of the venous walls. The patient is also 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 wearing of special compression stockings that reduce the load on the foot. The advantage is that even with heavy physical force it is possible to distribute the load evenly. When using compression garments, congestion and swelling can be prevented.
• Therapeutic 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 long periods of time. If you have to stand or sit at work for a long time, then you should take more frequent breaks.

If conservative treatment of varicose veins does not give the expected result, surgery is decided. Often these are minimally invasive interventions, including:

• Sclerotherapy- Intravenous administration of substances that adhere to the walls of the affected vessel. This treatment leads to the resorption of spider veins.
• Laser coagulation- insertion of a laser light guide into the vessel and laser irradiation of the walls, which causes the walls to stick together and the vessel to resorb further.
• Radiofrequency ablation- gluing of vessels using high-frequency current.
• Phlebectomy- Removal of affected vessels with 90% deterioration of blood circulation.

In some countries, you can get the operation for free with compulsory health insurance. But it is not a fact that all types of compulsory insurance operations are carried out everywhere. In any case, help will be provided, but it is necessary to learn whether it will be a normal removal or laser.

Contraindications for people with varicose veins

• Sedentary lifestyle. . . It is important to avoid sitting or standing for long periods of time. Physical activity will help prevent blockages in the arteries.
• Running and strength training. . . It is important not to exceed physical activity. If you have varicose veins, walking is better than running.
• An unbalanced and unhealthy diet. . . Even if it seems that your health allows it, you should avoid harmful foods. You should limit the intake of sweets, semi-finished products, as well as rich meat broths and smoked meats. But it would be a good idea to eat more vegetables and fruits.
• Hot baths and showers. . . Extremely hot and prolonged water procedures are contraindicated for people with vascular problems in the extremities.

Complications of varicose veins

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

The result

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