Varicose veins of the lower extremities are a disease characterized by dysfunction of the veins in the legs. It can proceed without visible signs or have a clear venous pattern - it all depends on the type and stage. An integral part of this disease is a malfunction of the venous valves, the vein of which ceases to function properly. This leads to the appearance of enlarged veins and poor circulation in the leg.
Causes of varicose veins
Venous blood rises from the toes to the body, if the process is disturbed, it persists in the legs. The heart cannot create a sufficient suction force to lift the blood upwards. There are a number of mechanisms, the main one being the muscle pump (musculo-venous pump). Valves determine the direction of blood flow - forcing it to move up and down. If, under the force of gravity, the blood tries to move back, the valves close and will not let it pass.
When the muscles of the legs are contracted, for example when walking, the blood in the vein is "pushed out" and directed to the body. During muscle relaxation, the vein fills with blood, which is "sucked" in from below. A breakdown of the mechanism leads to varicose veins of the lower extremities.
Several factors trigger the onset of the disease. They are divided into 2 large groups:
- Hereditary. Some parents and relatives have a pathology. It is the cause of varicose veins in 90% of patients.
- Acquired. This happens due to the detrimental effects of provoking factors.
The main culprit is genetics. And additional circumstances are already superimposed on it:
- a profession associated with a long standing or sitting position (salespeople, office workers, drivers, surgeons);
- pregnancy as a "hormonal revolution" in the female body (the veins stretch and become noticeable, after childbirth they do not always recover and with each new pregnancy the situation worsens);
- diseases of the pelvic organs hamper drainage and increase pressure in the veins;
- taking hormonal drugs (making the vascular walls less elastic);
- excessive enthusiasm for warm-up procedures (baths, saunas);
- increased intra-abdominal pressure (with chronic cough or constipation);
- difficult physical work, transport of heavy loads (loaders, dockers, builders);
- overweight (more blood volume - more load on the vessels);
- injuries affecting the veins and impairing blood circulation;
- biological factors - old age, high growth;
- bad habits (alcohol, cigarettes)
- lack of physical activity;
- wear tight clothes.
The veins rest when a person is lying down, and blood passes through them practically in the direction of the legs towards the heart. They are happy to work when their muscles are actively helping them while walking. The veins are under tremendous stress when a person is standing or sitting. Whether or not they can carry this burden depends on heredity and the presence of other provoking factors.
We understood the reasons - let's move on to the symptoms of varicose veins.
How do varicose veins manifest themselves?
Symptoms of varicose veins in women and men are generally similar, although there are slight differences.
The most obvious symptom is the presence ofdilated veins of the lower limbsdifferent sizes:
- Up to 1 mm - telangiectasias or spider veins;
- from 1 to 3 mm - reticular (convoluted);
- from 3 mm - varicose veins.
Insufficient work of the musculo-venous pump results in swelling of the legs. It starts in the lower third of the leg and moves up to the level of the knee joint.
If the legs are in an upright position for a long time without movement, the blood stagnates, and its liquid part "sweats" through the wall of the vessel into the surrounding tissues. Pockets form. When lying down, the limbs do not swell, as circulation is natural and easy.
How to understand if there is edema? Look at the location of the elastic on the sock. After removal, a trace remains - this means that the fluid is poorly removed and accumulates in the tissues.
Symptoms of edema with varicose veins:
- get up closer to the middle of the day;
- worse in the evening against a background of prolonged standing or sitting;
- spend the night while the person is asleep;
- do not transfer to the foot.
Venous edema of the legs is usually accompanied byfeeling of heaviness, which can be perceived as a "tension", a "buzzing" in the muscles of the calf or in the whole lower part of the leg.
Can often be disturbednocturnal lower limb cramps. . . The reason for this is the retention of venous blood, which disrupts metabolic processes in the muscles. This causes severe calf muscle spasm, usually triggered by stretching during sleep. The leg seems to have cramps, due to which the person wakes up.
Dry skin on the legsis a consequence of nutritional tissue disorders. Waste that is not eliminated with the bloodstream disrupts the normal functioning of cells. The epidermis becomes less elastic and loses moisture, which leads to peeling.
Prolonged venous insufficiency increases vascular permeability. The liquid part and the blood cells "sweat" through the wall into the surrounding tissues, where they are destroyed. Blood pigments spread under the skin - on the outside it looks likehyperpigmentation, darkening of the epidermis with the formation of brown spots.
The process is often accompanied bytissue densification(induration), which occurs due to deterioration of blood supply and insufficient nutrition for a long time. In this case, the structure of the skin and subcutaneous tissue is rebuilt, they have more connective fibers and less elastic. Most often this phenomenon is observed on the lower third of the lower leg from the inside.
If the disease is not treated, it will get worse. In the later stages, trophic ulcers appear. A long-term, non-healing wound is located on the inner surface of the lower third of the leg. It can be about the size of a five kopeck or encircle the entire tibia.
Complications of varicose veins
Inflammation of the saphenous veins, the formation of blood clots and their separation, blockage of the pulmonary arteries, skin changes, trophic ulcers - all these are complications of varicose veins, the consequences of long-term pathology.
Thrombophlebitis- inflammation of the saphenous veins. A blood clot forms in the superficial vessels, which is accompanied by an inflammatory reaction. A dangerous condition that threatens to penetrate deeper veins. Part of the blood clot can rupture and travel through the heart to the lungs, blocking the pulmonary artery. This condition is called pulmonary embolism (PE).
Usually, thrombophlebitis is treated on an outpatient basis, but the methods of treatment depend on the patient's condition and many associated factors, prescribed by the doctor.
Phlebothrombosis- the formation of blood clots in the deep veins. The complication leads to constant swelling and painful sensations, related to the separation of part of the thrombus and the development of PE. The treatment of phlebothrombosis takes place in a hospital, with hospitalization.
PE (pulmonary embolism)- a condition in which a blood clot ruptures and enters the pulmonary artery. With thromboembolism, there is a risk of sudden death when a blood clot blocks an artery and causes dyspnea, chest pain, and pulmonary infarction.
Blockage of the small branches of the pulmonary artery can be asymptomatic but have serious consequences. Massive PE is treated exclusively in intensive care.
Chronic venous insufficiency (CVI)- the result of a delay in venous blood flow in the legs due to the "breakdown" of the valve mechanism.
I will describe it schematically this way: the human body is made up of cells that need to be nourished. For this, fresh arterial blood, rich in oxygen and nutrients, reaches all cells and tissues. After cells have "eaten", "waste" forms in them, which is thrown into the veins. Venous blood is purified, oxygenated and converted to arterial blood. The circle is closed.
What happens in the event of circulatory disorders? The exit is delayed and the waste is not disposed of. The tissues start to suffer and go from normal to bad (diseased). All processes change. The vascular walls allow fluid to pass, forming an edema. Pain occurs. Over time, the intercellular space changes, the subcutaneous tissue grows and "shrinks", the skin darkens and thickens, long-term non-healing ulcers appear.
Hyperpigmentation and lipodermatosclerosis- the consequences of chronic NV. These are not life-threatening conditions, but they affect the quality of life. The feeling of tension on the skin and its unsightly appearance are uncomfortable. Complications decrease after treatment for varicose veins.
Varicose eczema- Inflammation of the skin on the lower leg with redness and itching, oozing and peeling areas. Externally, it looks like ordinary eczema, but it is treated differently: without eliminating the underlying disease (venous insufficiency), ointments will be ineffective.
Trophic ulcer- an open wound that does not heal for more than 2 months. This happens due to impaired nutrition of the tissues. Poor blood circulation and stagnation restrict the supply of nutrients to the cells, which prevents them from multiplying normally and filling the skin defect with new structures. It makes no sense to treat ulcers with ointments alone; an integrated approach is needed using several methods to eliminate CVI.
Bleeding varicose veinscan occur even with minor injuries in the leg area and is often severe, gimbals dilated vessels, blood pressure is higher than usual. It is easy to stop the bleeding: place a sterile tissue over the wound and bandage it tightly. Do not use tourniquet if the limb is numb or tingling, loosen the bandage. Lift your leg more.
The diagnosis begins with a consultation. The doctor finds out if the case is really in varicose veins and only in this one. In my practice, there were cases with symptoms of varicose veins, but they had nothing to do with it. Edema is triggered by heart failure, lymphedema, and allergies.
The clinical picture may not speak of varicose veins, but of another disease. Pain in the calf muscles is associated with atherosclerosis of the arteries, osteochondrosis, flat feet. The causes of trophic ulcers are hypertension, skin infections, stroke, and damage to peripheral nerves.
A phlebologist will make a differential diagnosis and make an accurate diagnosis, find out what caused your symptoms. A reliable diagnostic method is the duplex examination. It helps to clarify the condition of the blood vessels and to develop individual tactics for managing the patient.
Computed tomography, MRI venography, venography are rarely used today.
How to treat?
Treatment should always be comprehensive. The doctor has three directions at his disposal:
The first iselastic compression jersey. . . This includes knee socks, stockings and tights. They all have varying degrees of pressure. The type of knitting and the degree of compression are selected individually, depending on the nature and stage of the pathology.
I would like to note: if you have tried wearing compression underwear but have not noticed any improvement or the condition has worsened, you need to see a doctor. You may have a disease other than varicose veins, the products may be of poor quality or misused. It is necessary to know why there is no positive trend.
Second -drug therapy. . . The range of drugs that reduce the manifestations of CVI is wide. Some drugs are more powerful, some are weaker. The doctor selects the drugs taking into account the manufacturer, dosage, regimen and duration.
Third -surgical intervention. . . There are several types of operations: phlebectomy (removal of dilated veins by incisions), miniflebectomy (puncture ablation), laser obliteration (laser welding), radiofrequency ablation (heat sealing). Each method has its own advantages and disadvantages, possibilities and limitations. The phlebologist decides which method or combination is right for you.