In the article you will learn what to do with varicose veins in the legs, how to remove puffiness, features of conservative and surgical treatment, preventive measures.
Varicose veins are a chronic venous pathology, based on a dysfunction of the valve system, which causes stagnation of blood flow with the expansion and inflammation of blood vessels, increased grazing of tissues.
The initial manifestations are the formation of spider veins, swelling of the saphenous veins, the formation of knots, pain in the veins, heaviness in the legs. With the progression of the disease, signs of chronic insufficiency of venous circulation join: swelling of the feet and legs, cramps in the calf muscles, trophic ulcers, thrombophlebitis, ruptures of varicose veins. According to various studies in the field of clinical phlebology, 30 to 40% of women and 10 to 20% of men over the age of 18 suffer from varicose veins.
Usually, speaking of varicose veins, they mean an independent disease - varicose veins of the lower extremities. Varicose veins are manifested by a feeling of heaviness in the legs and their fatigue, edema of the feet and legs, night cramps in the legs, visual subcutaneous veins with the formation of venous nodes.
Why do the veins dilate?
To solve this problem, you have to imagine how the blood, which has successfully supplied oxygen to the tissues of the body, returns to the heart. To overcome the force of gravity, lifting herself from the legs to the chest, she needs assistive mechanisms. First of all, we are talking about the muscles of the lower extremities, which act as a pump: their contraction when walking moves blood to the heart. In addition, the valves located inside the veins play an important role in this process: they prevent the return of blood.
Varicose veins are a disease of the valves that have stopped working. As a result of such a violation, fluid accumulates in the vessels, which leads to their expansion.
In the future, trophic ulcers may develop in the area of deformed veins, and blood clots formed due to stagnation of blood contribute to the emergence of a serious and fatal complication of varicose veins - pulmonary embolism.
Varicose veins of the legs in women and men are common - signs of pathology are observed in more than half of people over 18 years old. At the same time, the number of patients is increasing every year - this is due to the sedentary nature of professional activity.
Often varicose veins of the lower extremities are accompanied by another well-known disease - hemorrhoids. The nature of the onset of both diseases is the same, as are the risk factors that predispose to their development. As with varicose veins, people often ignore the symptoms of hemorrhoids until the last, hoping that the pathology will go away on its own. However, these diseases are irreversible without radical intervention and only progress over time.
The main causes of varicose veins are thought to be: congenital weakness of connective tissue, hormonal changes, prolonged forced sitting or standing. Long legs and tall stature are a risk factor for varicose veins. When a person is standing, the valves in the veins are opened. The higher the column of blood in the vessels, the higher the pressure. Being overweight also increases the pressure in the veins of the legs - fatty deposits, especially in the abdomen, make it difficult for blood to drain. The surges of the female hormones estrogen and progesterone during the monthly cycle relax the venous wall. Hormonal contraceptive drugs can also affect - it would be good to consult a phlebologist before taking them.
Lack of physical activity accelerates the development of varicose veins of the lower extremities. However, experts emphasize the important role of the hereditary factor: if unattractive "stars" and "worms" of the vessels under the skin were observed in your parents, then with a high degree of probability, you and your children will encounter apersonally day this problem. The tendency for varicose veins is passed down through the female line - a gene is associated with the X sex chromosome, which can lead to weakness in the venous wall.
Among other things, varicose veins are more common in smokers, obese people, pregnant women, and those with other chronic diseases of the cardiovascular system. The professions whose representatives are predisposed to varicose veins of the legs are: surgeon, cashier, driver, programmer, flight attendant, loader, salesman, hairdresser, teacher.
The veins of the lower limbs form a branched network, composed of saphenous and deep veins, interconnected by perforating (communicating) veins. Through the superficial veins blood flows from the subcutaneous tissue and skin, through the deep veins - from the rest of the tissues. Communicating vessels serve to equalize the pressure between the deep and superficial veins. Blood normally passes through them only in one direction: from the superficial veins to the deep veins.
The muscular layer of the venous wall is poorly expressed and cannot force blood to flow back up. Blood flow from the periphery to the center is carried out due to the residual blood pressure and the pressure of the tendons located next to the vessels. The most important role is played by the so-called muscle pump. With physical exertion, muscles contract and blood is pressed upward, as venous valves prevent downward movement. Maintaining normal blood circulation and constant venous pressure is influenced by venous tone. The pressure in the veins is regulated by the vasomotor center located in the brain.
Insufficient valves and weakness of the vascular wall lead to the fact that the blood under the action of the muscle pump begins to flow not only upwards, but also downwards, exerting excessive pressure on the walls of the vessels, leading to varicose veins, knot formation and progression of valve failure.
Disturbed blood circulation in the communicating veins. The reflux of blood from the deep vessels to the superficial vessels leads to a further increase in pressure in the superficial veins. The nerves in the walls of the veins send signals to the vasomotor center, which gives the command to increase venous tone. The veins cannot cope with the increased load; they expand, lengthen and gradually become tortuous. Increased pressure leads to atrophy of muscle fibers in the venous wall and the death of nerves involved in regulating venous tone.
There are several classifications of varicose veins. This diversity is due to the polyetiology of the disease and to the many variations in the course of varicose veins.
Classification by stages
On examination, pronounced varicose veins are visible on the legs. Patients complain of a feeling of fullness, paresthesias ("chills") in the shins, nighttime cramps. There is a slight swelling of the feet, ankles and lower legs in the evening. In the morning, the swelling goes away.
Decompensation stage. Dermatitis, eczema join the listed signs. Patients worry about the itching. The skin becomes dry, shiny, tightly adheres to the subcutaneous tissue. Minor bleeding and resulting hemosiderin deposits cause hyperpigmentation.
Classification by shape
The following forms of varicose veins are distinguished:
- Segmental lesions of the subcutaneous and intradermal vessels without reflux.
- Segmental venous lesion with pathological discharge along the superficial or communicative veins.
- Generalized lesion of the veins with pathological discharge in the superficial or communicative veins.
- Generalized venous involvement with abnormal deep venous flow.
There is an internationally recognized classification of varicose veins used by doctors in many countries around the world:
Class 0. There is no sign of varicose veins. Patients complain of heaviness in the legs.
Class 1. The meshes of the veins and varicosities (telangiectasias) are determined visually. Some patients have muscle cramps at night.
Class 2. On examination of the patient, dilated veins are visible.
Class 3. Swelling of the feet, ankles and lower legs appears, which does not go away after a short rest.
Class 4. The examination reveals signs of lipodermatosclerosis (dermatitis, hyperpigmentation of the legs).
Class 5. Surveys are formed.
Class 6. Persistent trophic ulcers develop.
Symptoms and clinical manifestations
Varicose veins, which affect the veins of the lower extremities, are classified in international practice in stages, depending on the neglect of the pathology and the severity of the manifestation. Each stage is diagnosed separately, all of them are characterized by different symptoms, depending on which the method of treatment is selected.
So, the symptoms which are a sign of varicose veins at different stages:
- At the first stage, the saphenous veins of the lower extremities have a barely noticeable pattern and protrude slightly above the skin, a slight redness is noticeable. The doctor complains of heaviness in the legs, swelling in the evening after a hard day. Shoes that are too tight can cause swelling of the feet in the ankle area and cramps are also possible. It should be noted that the often painful sensations can appear much earlier than the visible signs.
- At the second stage, a typical appearance is already observed for diseased veins in the legs: they are clearly visible above the skin and palpable with the fingers, look like knots or pearls. With progression, the saphenous vein of the lower limb becomes visible and takes on a sinuous shape of dark blue or even black hue.
- At the third stage, varicose veins are complicated, there are signs such as trophic changes in the veins of the legs, the skin becomes dry and pale, daily swelling, cramps. Often, the symptoms are manifested by the fact that the legs become covered with a rash, the skin itches and itches.
- Symptoms in the fourth, most severe stage are inflammatory processes in the saphenous veins of the lower extremities, non-healing trophic ulcers, which are already difficult to treat. A key feature of this stage of the disease is the addition of secondary infection and thrombophlebitis. With these manifestations, urgent hospitalization is required, the complex use of treatment methods for the whole organism.
Specialists identify the main risk factors:
- hereditary diseases associated with varicose veins in different parts of the body;
- hormonal disorders can increase blood clotting, decrease the elasticity of the veins in the legs;
- obesity, ascites, which increases the load on the legs, accompanied by the expansion of the walls of the veins;
- pregnancy or lifting heavy objects increases the pressure inside the abdominal cavity, which also contributes to the weakening of the vascular walls and varicose veins;
- no load on the legs, sedentary work is heavy by the expansion of the veins of the legs;
- tight underwear, smaller shoes that constrict the vein, wearing heels, which causes stagnation of blood flow in the veins of the legs;
- Varicose veins are often caused by kidney or cardiovascular disease, which causes edema, seen in the expanding veins of the lower extremities.
The main methods that involve the diagnosis of varicose veins of the legs are:
- External examination of varicose veins of the legs, which should be performed by qualified doctors in the hospital.
- Doppler ultrasound, which can detect thickening of the wall in the veins of the lower limbs. Such diagnostics allow you to unambiguously determine the stage of the violation.
- The duplex scan of the veins of the legs, carried out by a doctor at a specialized clinic, allows you to clearly identify varicose veins. With this method, which combines ultrasound and Doppler examination, it is possible to check what is happening to the veins: the rate of blood circulation, the diameter of the vein in the legs, the functioning of the valves and the condition that characterizes varicose veins.
- Phleboscintigraphic examination, which allows to conduct an analysis with high accuracy and, at the initial stage, to learn about varicose veins of the legs and to take timely preventive measures. It is performed by injecting a special dye subcutaneously, such liquid in the vein is highlighted on the monitor in a contrasting color.
- Occlusal plethysmography.
- With the help of tomographic diagnosis of diseases (MRI, computed tomography), complications accompanying varicose veins can be identified.
- Bandage or tourniquet tests for disease diagnosis are used in combination as a complement to various methods to determine the stage of varicose veins.
Deciphering the results of the diagnosis of varicose veins usually does not require a lot of time. Most procedures last from 10 to 40 minutes, after which the attending physician announces the diagnosis based on the information received. Only an experienced doctor in the clinic should trust the diagnosis, who will be able to deliver a clear and unmistakable diagnosis, since the treatment at different stages involves different methods, principles of treatment and drugs.
In the treatment of patients with varicose veins, three main methods are used:
Conservative therapy includes general recommendations (normalization of physical activity, reduction of static load), physiotherapy exercises, the use of elastic means of compression (compression stockings, elastic bandages), phlebotonic therapy (diosmin +hesperidin, horse chestnut extract).
Conservative therapy cannot lead to complete healing and restore already dilated veins. It is used as a prophylactic agent in preparation for surgery and when surgical treatment of varicose veins is not possible.
With this method of treatment, a special drug is injected into the dilated vein. The doctor through a syringe injects elastic foam into the vein, which fills the affected vessel and causes it to spasm. Then the patient is put on a compression stocking which keeps the vein in a sagging state. After 3 days, the walls of the veins are glued together. The patient wears the stocking for 1 to 1. 5 months until dense adhesions are formed.
The indications for compression sclerotherapy are varicose veins uncomplicated by the reflux of the deep vessels to the superficial vessels via the communicative veins. In the presence of such pathological discharge, the effectiveness of compression sclerotherapy sharply decreases.
The main method of treatment complicated by reflux in the communicative veins of varicose veins is surgery. For the treatment of varicose veins, many surgical techniques are used, including the use of microsurgical techniques, radiofrequency and laser coagulation of the affected veins.
At the initial stage of varicose veins, photocoagulation or removal of spider veins with a laser is performed. With severe varicose veins, phlebectomy is indicated - removal of the altered veins. Nowadays, this operation is increasingly performed using a less invasive technique - miniflebectomy.
Having found varicose veins in yourself, you need to take care to cleanse the body and normalize blood circulation. For this, first of all, the diet is revised. Fresh products of plant origin are most useful for varicose veins:
- Vegetables - cabbage, tomatoes, peppers, herbs.
- Fruits - citrus, apricots, apples, peaches, cherries, cherries, apples.
- Berries - strawberries, gooseberries, currants.
- There are many recipes for traditional medicine using fresh herbal ingredients.
Unfortunately, varicose veins are a chronic disease and therefore "go hand in hand" with a person throughout their life. Without prevention, the disease can lead to the development of more serious complications.
- It is not recommended to take too hot baths, visit the sauna or stay in the sun for a long time in the heat. This leads to a decrease in venous tone, which will definitely lead to congestion in the legs.
- Lead an active lifestyle, which means moving a lot. So, regular exercise will not only help strengthen the blood vessels, but also improve the condition of the body as a whole. Moderate aerobics, swimming, cycling or jogging are great for preventing varicose veins. However, it is contraindicated to practice weight lifting and to lift too heavy objects.
- Weightloss. People with a lot of body fat are more susceptible to this disease because more blood circulates in their body than a person of normal weight. That is why there is a heavy load on the ships. In order for the pressure on the venous vessels to be less, obese people should definitely get rid of extra pounds and adhere to the proper diet. As for the menu, it is advisable to minimize the consumption of too spicy foods. It is recommended to replace animal fats with vegetable oils.
- You should not wear tight clothing, socks or stockings with tight elastic bands, as these can press forcefully on the veins, interfering with blood flow.
- While sitting, you should not cross your legs, as normal blood circulation is also disturbed during this position.
- Prolonged standing also has an extremely negative effect on the condition of the veins. If you have a permanent job, try to move more often. Constant sitting is no less harmful.
- Nutrition must be normalized. So, regular constipation and intestinal dysbiosis can lead to the development of varicose veins. You should include foods high in fiber in your menu, which helps improve gut motility, which is digestion in general.
- Women should wear tight shoes as little as possible, as well as shoes with heels. If you can not refuse such shoes, the heel should not exceed 3-4 feelings of height.
- After strenuous work while standing or sitting, shower your legs with cold water to keep your veins in good shape. Baths with the addition of pine salt are also useful. You can sprinkle your feet with cold water in the morning.
- Prevention of varicose veins consists in giving up bad habits, namely smoking, which has an extremely negative effect not only on the condition of the veins, but also on the entire human body.
- Light massage is considered an excellent preventive measure for this disease. This massage can be performed independently, stroking the skin of the lower extremities from the bottom up, then back for 10 minutes. Such self-massage is very useful in combination with massage procedures on the spine, which are performed by a professional chiropractor or massage therapist.
- Prevention of venous varicose veins also involves taking special drugs that allow you to maintain venous tone.
- Try to get rid of chronic fatigue and frequent stress.
- Doctors advise to avoid overheating and colds.
- In the presence of varicose veins, you need to visit a phlebologist at least 2 times a year, who will monitor the condition of the veins and the stage of development of the disease.
To avoid illnesses, walk more, take a contrast shower, visit the swimming pool. Even if you can't swim, it helps to stand in the water - the water column puts 60-70 mm Hg pressure on the legs. Art. This is enough to pump the stagnant blood through the veins. Gymnastics have the same effect in the evening - raise your legs while lying down, do the "bike" exercise.
In case of venous insufficiency, a preventive jersey should be used (special tight-fitting stockings and tights create a kind of frame around the veins, preventing them from expanding).
By the way, this type of swimsuit is very useful during pregnancy. Even in the first three months, when hormones are already having a negative effect. As the fetus grows, the density of the knitting should be increased. During childbirth, this is also necessary, because at the same time the blood pressure in the veins rises sharply.