The main feature of varicose veins of the legs is its vastness. The superficial and deep veins are subject to change to a great extent. Since the legs have a fairly large and prolonged load, the valves of the circulatory system can begin to weaken from childhood. Therefore, detection of varicose veins on the legs often occurs in young people and girls.
In order to effectively treat varicose veins on the legs, the doctor will need to look for the causes of its occurrence. Since even when using radical methods, 80% of patients experience a relapse of varicose veins, special attention should be paid to reducing the influence of the factors provoking varicose veins on the processes. These include:
- hereditary predisposition is in fact an uncontrollable factor, which, nevertheless, can be contained by standard preventive measures;
- physical influences - increased load on the legs (long standing and sitting, the habit of crossing the legs, excess weight, lifting weights);
- physiological effects - hormonal changes and the use of hormonal drugs (most often contraceptives), metabolic disorders, lack of physical activity;
- pathological reasons - chronic diseases of the liver, kidneys, trauma and systematic pulling of the soft tissues of the lower extremities, tumors that compress the veins of the abdominal cavity.
they cannot close completely, so some of the blood remains in the vessels of the legs. The pressure in the veins increases, the walls stretch even more, protrusions are formed, in which blood clots form over time. Thrombosis is dangerous, but far from the only thing that threatens the patient with varicose veins in the legs. The clot can rupture and enter the heart or another organ, causing a heart attack, or block the blood vessels in the limb, causing gangrene.
Depending on the location of these "stretched" veins, doctors distinguish several types of varicose veins on the legs:
- Area. It is expressed by the appearance of a bluish or red varicose mesh on the legs, which first resembles a spider's web, then a plexus of rather thick sinuous lines.
- Deep. It is expressed by the defeat of the vascular plexuses not visible during the external examination. Pain in the veins of the lower extremities with varicose veins of this type is more intense, the risk of complications is higher.
- Combined, when the deep and superficial veins are affected.
Closely related is the establishment of the causes of varicose veins in the legs and its elimination. First of all, it is important to exclude the factors that have the greatest negative impact on the condition of the veins.
When diagnosing venous changes, it is important to differentiate them from other diseases. For example, varicose veins below the knee look like Becker's cyst and are accompanied by similar symptoms.
The appearance of the first signs of varicose veins on the legs occurs in progressive stages, when the venous valves perform less than 50% of their functions. In the first or zero stage of varicose veins, known as the "clearing stage", unpleasant sensations do not occur, as well as visible changes. Detection of the initial stage of varicose veins on the legs occurs with careful examination of the limbs by a phlebologist.
In the second stage of varicose veins, which is known as 'undercompensation', the changes are quite well expressed:
- the contours of the large veins are visible under the skin, but they may not protrude above the surface of the skin;
- on the surface of the skin on the thighs and under the knees, a fine varicose mesh pattern of blue or red capillaries is clearly visible;
- in the evening, the legs become swollen;
- at night, the calf muscles cramp.
This stage of varicose veins of the lower extremities is distinguished by an increase in symptoms, which weaken after rest.
At the final stage of varicose veins, decompensation occurs: the body cannot replenish the oxygen needs of the tissues, and the valves in the veins lose their functions by 90%. The condition of the limbs worsens due to insufficient blood supply. This stage of varicose veins is characterized by a decrease in the ability of tissues to regenerate. The abundance of complications worsens the general condition of the patient. The final stage symptoms of varicose veins persist constantly.
If we are talking about varicose veins in principle, then this term in medicine means a disease of the veins, in which the functions of transporting blood through these vessels are impaired due to their deformation of varying severity. In other words, the veins stretch, dilate, their walls become thinner, the work of the valves located inside is disturbed, etc. All this leads to the fact that the blood moves worse upward, moving to the heart, and its stagnation occurs in the vessels.
Most people think of varicose veins of the lower extremities as the protrusion of individual vessels and the vascular network near the surface of the skin. At the same time, the swollen and deformed veins are clearly visible to the naked eye, and this idea is correct, if we are talking only about aesthetic manifestations.
With regard to deep varicose veins, or more precisely varicose veins, we are talking about similar disorders, but now they affect the venous vessels located in the thickness of the muscle tissue. This means that even at the most severe stage of the pathological process, these veins will not be visible on the surface.
Such a pathological process is dangerous not only for its secret. The deep veins, including the small and large tibias, gastrocnemius, soleus, and others, are much larger. As a result, they let in more blood, take a larger share in the systemic circulation, and their defeat has a stronger effect on the state of human health.
This means that with varicose veins of the deep veins stagnant blood processes are much more serious. In this case, a person may experience severe pain, increased fatigue in the legs, etc. But even more dangerous consequences are that with excessively increased pressure in the veins, their thinned walls may not resist, which threatens to rupture the veins and bleed internally.
Varicose veins deep in the legs
First of all, the visible symptoms of varicose veins in the legs are the appearance of a network of fine veins on the surface of the skin of the legs. Such manifestations mainly occur in the thigh area. These varicose veins are the easiest to see in people who suffer from cellulite. Sometimes it is cellulite that becomes a kind of warning sign of varicose veins. Often, the fatty deposits in cellulite squeeze the venous vessels, and as a result, the blood flow is complicated and varicose veins occur.
The capillaries on the legs that appear at the onset of varicose veins are called telangiectasias. However, it should be borne in mind that these external manifestations can be both signs of varicose veins and the manifestation of a temporary inflammatory process.
In some cases, the appearance of varicose veins is indicated by swelling of the legs. However, such a sign can be a symptom of other diseases (heart failure, kidney stones). Therefore, in this case, it is impossible to speak clearly about the development of varicose veins before the diagnosis is made.
The manifestation of pain in the legs often becomes a symptom of varicose veins. The painful sensations may be sharp and also have signs of tightness. Most often, with varicose veins, pain in the calves occurs. It mainly occurs in the afternoon, after a certain load on the legs.
So, a person who observes the appearance of a capillary network, periodic manifestations of pain and edema, should consult a doctor and the necessary research.
Often, varicose veins give the patient some cosmetic discomfort. But apart from this, he may have a strong feeling of heaviness in the legs, seizures may occur at night, trophic changes gradually appear on the legs.
Visually, varicose veins can manifest as "stars" not particularly visible from small vessels, and as very large nodes and plexuses, which are particularly prominent when the patient is in an upright position.
If the veins are palpated, their elastic elastic consistency is determined, they are easily compressed. Each of the nodes of varicose veins may have a higher temperature than the rest of the areas. If a person takes a horizontal position, the tension in the veins decreases, and the nodes become less pronounced.
If during the development of the disease a person does not think about how to treat varicose veins, the disease progresses, and gradually a feeling of rapid fatigue, constant heaviness of the legs and a feeling of swelling of the tissues sometimes appear cramping. If swelling appears, they disappear after a long night's rest.
It is relatively easy to diagnose this disease. The specialist necessarily examines and questions the patient, examines the anamnesis. In additional studies, the condition of the valves of the main and communicating veins is determined and the level of deep vein patency is assessed. There are a number of different tests that can be used to assess the condition of the veins and the degree of disease development.
If the patient has uncomplicated varicose veins, in most cases, instrumental diagnostic methods are not used.
Conservative treatment of varicose veins is prescribed mainly for people who have clear contraindications to surgery.
In addition, such treatment is indicated if the patient has a slight expansion of the veins, which is an exclusively cosmetic defect. The goal of conservative therapy is also to prevent the further progression of this disease. To this end, patients are advised to apply a bandage to the legs affected by varicose veins with an elastic bandage.
In addition, compression hosiery for varicose veins is presented. People who tend to or already have varicose veins should regularly put their feet on an elevation throughout the day, thus resting for several minutes. There are also special exercises for the lower leg and the foot, aimed at activating the musculo-venous pump. It is a periodic extension and flexion of the ankle and knee joints.
Nutrition for varicose veins of the lower extremities
The history of varicose veins began in the days of Byzantium, ancient Egypt, the Old Testament of Israel, as evidenced by archaeological excavations. At different times people tried to cure this disease, in particular, Avicenna and Hippocrates committed to it. In the second half of the 19th century, Russian and German doctors began to talk about the effectiveness of ligation of the great saphenous vein.
At the beginning of the 20th century, very traumatic operations were carried out, during which the tissues of the thigh and lower leg were deeply dissected, veins were damaged, which were subsequently tied, nerve endings, arteries and lymphatic ducts. Healing took a very long time, leaving large scars visible.
Foreign doctors proposed in 1908 to remove a large saphenous vein and introduced a metal probe in practice, which reduced the trauma of the patient. It was the first step towards minimally invasive surgery.
The breakthrough came when it became possible to take x-rays. It was first done for varicose veins in 1924. At the same time, a contrast medium made from strontium bromide solution was injected into the vein. Then the ultrasound appeared and the technique was further improved.
At the end of the 90s of the 20th century, laser therapy appeared, which became a modern breakthrough in the treatment of varicose veins.
In European countries and the United States, 25% of the population suffers from this disease. In our country, varicose veins have been diagnosed in 30 million people. In addition, women get sick more often than men. According to global statistics, 70-80% of women and 50-60% of men suffer from varicose veins.
The main cause of varicose veins is a genetic predisposition.
There are a number of other provoking factors:
- sedentary lifestyle;
- hormonal imbalance;
- endocrine diseases;
- take oral contraceptives and other hormonal drugs;
- work in hot stores;
- strong physical activity;
- work associated with a long standing or, conversely, sitting position;
- chronic diseases of the bronchi and lungs, accompanied by prolonged cough.
Thrombophlebitis is a potentially fatal disease. With it, blood clots form in the veins, which can rupture and clog the pulmonary vessels, which leads to myocardial infarction. If a large vessel is affected, death is possible.
Venous thrombosis is a blockage of a vessel by a blood clot. It is manifested by pain in the limb, which increases with physical exertion, edema.
Pulmonary embolism - overlap of the lumen of the pulmonary artery by a detached thrombus. Death can occur within the first 30 minutes. If the thrombus is small, a pulmonary infarction occurs, the patient needs resuscitation measures. The condition is accompanied by pneumonia and chronic heart failure.
Trophic ulcers - thickening of the subcutaneous tissue, darkening and thinning of the skin, followed by the appearance of an ulcer. Such ulcers have been around for a long time, do not respond to treatment, and heal very slowly.
In the official classification, it is customary to distinguish three stages of varicose veins:
- I - compensation;
- II - under-compensation;
- III - decompensation.
Sometimes complications are isolated in stage IV.
The most common location. Usually appears at a young age and in women - during pregnancy or after childbirth. In the initial stages, the symptoms are few and nonspecific - leg fatigue, heaviness in the legs, burns, bursts, night cramps. Already at the very beginning of varicose veins, pain appears along the vein, swelling. The ankles, legs and feet are usually affected.
The most common symptom in this case is numbness in the hands. It can be partial and complete, most often during sleep. The patient becomes meteorological, his hands hurt with any change in weather. It becomes difficult to handle even light objects. Then more characteristic symptoms develop - the blood vessels swell, lymph nodes form, the pains begin, intensifying over time, the veins become tortuous, raised.
Groin and pelvis
Manifestations of the disease differ in men and women.
Complete healing of varicose veins is only possible after surgical treatment. This can be done in three ways:
- Phlebectomy - removal of a varicose vessel.
- Sclerotherapy - the introduction of a sclerosant into a varicose vein - a special substance that "sticks" to its walls, stopping blood flow through it. As a result, the vein collapses, even the cosmetic defect disappears.
- Laser coagulation - the walls of the vein are destroyed by heat, as a result of which the venous lumen is "sealed". Such an operation can only be performed if the vein is not dilated by more than 10 mm.
In addition, one of the most modern methods of treating chronic varicose veins is the obliteration of the adhesive veins. You can find a lot of additional information on the net about this procedure.
The main role in drug therapy is played by venotonics, which are taken in tablet form and act systemically. They correct disturbances in the work of blood circulation. As a result, the vessels of the whole organism are healed. Venotonics are also available in the form of gels and ointments, but they are less effective and only work at the site of application for a short time.
Phlebotonics are also used - venotonic drugs. They are indicated for thinning of the walls of blood vessels, reduced elasticity, increased permeability, blood stasis. The drugs strengthen the venous walls, increase their elasticity, remove congestion, reduce swelling and other negative symptoms. An additional property of phlebotonics is the normalization of microcirculation in the affected area.
Antiplatelet agents are used to thin the blood. Medicines are used when it is necessary to reduce the intensity of blood clots. Indicated for patients with increased blood viscosity. Antiplatelet agents can only be used if there is no tendency to bleeding.
To stop the process of thrombus formation, anticoagulants are also prescribed. They destroy blood clots, reduce the viscosity of the blood.
A good helper in the fight against varicose veins is compression hosiery. The principle of operation of these products:
- Throughout the compression stocking, pressure is exerted on the superficial and deep veins.
- The highest pressure is at the bottom, where the veins are narrowed the most, and the blood is flowing fastest.
- The narrowing of the veins increases the efficiency of the valves.
- Swelling, pain, fatigue in the legs pass.
Venous blood rises from the feet to the heart under the influence of blood pressure. If a person is healthy, this mechanism works without problems. In the presence of pathologies, the body is obliged to stimulate this process: it increases the pressure and raises the blood upwards with pushing movements. The result is valve failure.
- Hereditary predisposition - some are susceptible to the occurrence of this disease. They have congenital valve dystrophy, weak vascular walls. For this reason, varicose veins in the legs can be observed even at a young age.
- Hormonal changes - due to dysfunction, blood stagnation occurs. The most dangerous are the period of gestation, puberty and after childbirth. In the female body (especially at this time), the hormones of the corpus luteum predominate. They also have a relaxing effect on the veins.
- Joint diseases - rheumatoid arthritis, osteoporosis and other diseases.
- Wear tight shoes and tight clothing.
- An unbalanced diet is the presence of fatty and high-calorie foods.
- Bad habits - smoking and alcohol abuse.
- Take certain drugs - hormonal contraceptives.
- Overweight - Obesity puts more strain on your legs.
- Chronic liver diseases - cirrhosis, hepatitis.
This disease will not go away on its own. Without proper treatment, the situation will only get worse. The expansion of the veins in the legs can cause the following complications:
- Eczema and dermatitis - redness, small blisters and cracks appear in the leg area.
- Trophic ulcers - simple and numerous "islets" may appear. Most often they cry (clear or bloody fluid constantly appears on their surface). Although these ulcers are shallow, they are very painful.
- Thrombophlebitis - can be accompanied by an increase in body temperature, redness of the skin, painful sensations both when walking and at rest.
- Rupture of the vein - accompanied by heavy bleeding. If such a complication occurs, immediate medical attention is required.
Varicose veins in the legs include the following treatment:
- treatment of varicose veins with leeches;
- folk remedies;
The "golden standard" of diagnosis is ultrasound, which identifies areas of affected veins. If the results of non-invasive diagnostics are doubtful, a surgical study is used - venography, which involves the introduction of a contrast agent into a vein to assess the general condition of the vascular system.
Diagnosis of deep varicose veins
- Initial examination with collection of patient history and complaints.
- Performing an ultrasound of the vessels of the legs.
- Doppler ultrasound for the detection of blood clots.
- Urinalysis and blood chemistry may also be needed.
In the early stages, VVVNK is not very pronounced. People attribute leg pain and other symptoms to ordinary fatigue, hard work, or age. They only see a doctor when there have already been significant changes in the legs - veins or thick swollen knots.
But in most cases, the doctor does not limit himself to a visual examination and orders additional examinations:
- Ultrasonic flowmetry or Doppler analysis, which can detect the speed of blood flow and venous filling.
- In the early stages of VVVNK, tests of Perthes, Sheinis, Troyanov, Prett and others are prescribed, which indicates the development of varicose veins.
- Phlebomanometry, which measures the pressure inside the veins.
- Scanning of veins, according to the results of which it is possible to determine the condition of the valves and venous walls.
- Phlebography. This procedure involves the introduction of a contrast agent inside the veins, followed by an x-ray.
- Echosclerotherapy - the sclerosant is injected into the veins, and then they are scanned.
- Thermography - examination using infrared radiation.
- Computer venography.
- Phleboscintigraphy - examination of lymph nodes and veins using radionuclides.
- Photoplethysmography - examination using photodiodes.
All types of exams are never prescribed at the same time. Usually varicose veins are already quite easy to diagnose by one or two methods, which are determined by the doctor depending on the patient's condition.
The ease of diagnosing varicose veins in the legs is overstated, since the vessels do not always rise to the surface. To confirm the diagnosis, the doctor will need to conduct an external examination and conduct a number of instrumental studies:
- duplex scanning or ultrasound on the lower extremity - with varicose veins it is first used to determine the degree of stretching of the vascular walls, the nature of blood flow in them and the detection of blood clots;
- X-ray of the extremities with contrast - the norm of functional examination of varicose veins of the lower extremities, which allows you to determine the patency of the vessels;
- MRI is the gold standard of modern diagnosis of varicose veins in the lower extremities, which allows you to assess the functionality of venous valves, identify foci of ischemia in soft tissues, detect blood clotsand other pathological changes that have occurred against the background of varicose veins. veins.
To clarify the full picture of the disease, laboratory tests are prescribed: a coagulogram to assess the risk of thrombus formation, a general and biochemical blood test.