Varicose veins on the legs (varicose veins) is a common disease manifested by persistent and irreversible expansion and lengthening of superficial veins and impairment of their function due to the development of a pathological process in the venous wall and congenital or acquired valve insufficiency. device.
According to the World Health Organization, varicose veins are found in every fifth adult on the planet. The first signs of varicose veins (venous reflux) are detected in 10-15% of children and adolescents at the age of 12-13.
Causes of varicose veins on the legs
- Hereditary predisposition (congenital weakness of vascular valves). If your parents had signs of venous wall weakness in any vessel (legs, groin, esophagus, rectum), then with a high degree of probability, symptoms of varicose veins may appear in you.
- Poor circulation in the lower extremities during pregnancy and childbirth (compression of the abdominal veins by the developing fetus with increased pressure in the veins of the legs, hormonal changes that cause a decrease in the tone of the veins).
- Obstruction of blood flow during prolonged standing (dilated veins of the lower extremities are more common in salesmen, teachers, waiters, surgeons) and in a sitting position (managers, accountants, office workers, drivers, etc. )
- Heavy physical work, sports training associated with weight lifting (for athletes, loaders, builders, regular visitors to gyms and fitness clubs)
- Long-term use of contraceptive drugs with a high content of female sex hormones.
- Hormonal changes in the body, accompanied by a decrease in the tone of venous vessels (adolescence, pregnancy, menopausal disorders in old age).
- Factors such as excess weight, chronic cough, constipation and the habit of wearing tight clothes and shoes interfere with venous outflow and often lead to varicose veins.
Why do varicose veins occur during pregnancy?
In women, varicose veins of the lower extremities are observed 3-5 times more often than in men and appear quite often for the first time during pregnancy. In 80% of cases, varicose veins first develop on the left leg, and only then on the right.
- The appearance of varicose veins is facilitated by hormonal changes in a woman's body during pregnancy, which causes a decrease in the elasticity of the vein wall, its stretching and transformation into an enlarged node.
- In the body of a pregnant woman, the volume of blood flow increases significantly. Increased venous pressure leads to thinning of the venous wall and its local expansion (varicose veins).
- The growing fetus causes a corresponding increase in the uterus and impaired blood flow from the lower extremities through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
- The increased body weight of a pregnant woman also negatively affects venous outflow.
Varicose veins of the lower extremities: symptoms
Varicose veins develop quite slowly, passing through several main stages in succession:
- In the first stage, the venous circulation disorder is accompanied by the appearance of individual "spider veins", thinning of the skin, through which dilated veins in the form of twisted cords begin to break through during physical activity (usually in the popliteal fossa), there are no complaints.
- In the second stage of varicose veins, there is a feeling of heaviness, fatigue in the lower extremities, swelling of the legs in the evening and after a long walk, a feeling of "pins and needles" in the legs, night cramps in the lower leg muscles, after a careful examination, several varicose veins on the lower legs are revealed, and sometimes - on the foot and thigh.
- The third stage of varicose veins of the lower extremities is characterized by pronounced bulging of venous nodes mainly on the inner surface of the leg, the appearance of dark brown or brown spots on the thin, easily wounded skin of the legs, and the development of dermatitis with itching and rash. The swelling of the legs becomes more intense, which makes it difficult to walk.
- The fourth stage of varicose veins is the presence of enlarged nodes on the foot, leg and thighs, the appearance of disease complications (chronic venous insufficiency with trophic ulcers, bleeding from damaged enlarged nodes, development of thrombophlebitis).
- Sometimes the fifth stage is also distinguished - there are all the symptoms characteristic of the fourth stage of varicose veins, with the process spreading to the groin, buttocks, perineum, the presence of multiple trophic ulcers, the appearance of elephantiasis, frequent exacerbations. thrombophlebitis and onset of disability.
Complications of varicose veins
- Thrombophlebitis of superficial veins.
- Bleeding when a varicose vein bursts.
- Dermatitis, eczema.
- Trophic ulcers.
- Deep vein thrombosis (phlebothrombosis) and post-thrombophlebitic disease.
- Pulmonary embolism (PE).
- Lymphedema (elephantiasis).
Diagnosis of varicose veins
It is based on a clinical examination, performing functional tests and conducting instrumental studies of veins.
- Clinical examination (clarification of complaints, history taking, examination, palpation).
- Doppler ultrasound.
- Ultrasound angioscanning.
- Plethysmography.
- Ascending and descending phlebography.
- Radionuclide phlebography (radiophlebography).
- Computed tomography and MRI (CT venography, MR venography).
- Intravascular ultrasound examination.
- Thermography.
Treatment of varicose veins of the lower extremities
If varicose veins are detected at an early stage, you can deal with its manifestations using compression stockings, special therapeutic exercises and traditional treatment methods. But if you visit the doctor late, when the varicose veins are visible to the naked eye, the legs hurt and swell, trophic ulcers appear, signs of thrombophlebitis, the only way out is surgical intervention.
At the same time, you should not be afraid of surgery, because modern technologies allow you to get rid of varicose veins of the lower extremities without wide incisions, without pain and practically without disrupting a person's usual lifestyle.
The principle of surgical manipulation is similar for different techniques: pathologically altered superficial leg veins are ligated, cut and removed. In this case, the venous circulation in the lower extremities is not disturbed, because the operation does not affect the deep veins through which about 90% of the venous blood flows.
The main types of varicose vein surgery
- Sclerotherapy. In the initial stage of varicose veins, a good cosmetic result is achieved by introducing special drugs into the problematic vein, causing gradual sclerosis, "gluing" of the pathologically enlarged area of the vessel. A medicinal substance (usually a sclerosant) is injected through a special catheter or very thin needle into the varicose vein. It takes 3 to 10 injections to achieve a positive result.
- Phlebectomy. An operation that has been performed for almost a hundred years, but in modern conditions, wide incisions have long been abandoned. Manipulation these days is carried out through miniature incisions of 3-5 millimeters. The pathologically enlarged vein is first ligated and cut at the point where it flows into the deep vein, and then removed with special probes. This operation lasts approximately 1-2 hours, after which the patient stays in the hospital of a health care facility for 1-2 days.
- Miniphlebectomy. The operation is performed under local anesthesia, without incisions, but with the help of small punctures through which the varicose vein is removed. This achieves a good cosmetic effect (usually no stitches are needed) and significantly reduces the recovery period after surgery. In some cases, the entire vein cannot be removed, but only its pathologically altered part. This intervention is called short stripping.
- Endovenous laser coagulation of veins. Manipulation is carried out under ultrasound control. A special laser light guide is inserted into the pathologically dilated vein and the saphenous vein and its tributaries are burned. After a certain period of time, there is obliteration and sclerosis of the vein, its complete closure. If necessary, laser coagulation is combined with miniphlebectomy. In this case, the effectiveness of surgical treatment of varicose veins of the lower extremities will be the greatest.
- Radiowave ablation of varicose veins. Obliteration ("gluing") of the lumen of the changed vein is achieved by exposure to radio waves of a certain power that are brought to the problem area of the vein through a special catheter. The duration of the procedure is about 20 minutes.
After surgical treatment of varicose veins using one of the above methods, it is necessary to limit physical activity for a certain period of time, wear compression stockings and, if necessary, use drugs that have a venotonic effect. This will help restore normal blood circulation in the veins of the lower extremities as soon as possible, prevent possible complications, and allow you to quickly return to work and a normal rhythm of life.
In which cases is surgical treatment of varicose veins of the legs undesirable?
- During pregnancy and the first two months after birth.
- In the initial stage of varicose veins, when there are still no complaints, and existing cosmetic problems ("spider veins" on the legs), you can first try to eliminate them with the help of exercise therapy, compression stockings and traditional methods.
- In old age and in the presence of severe diseases of various organs and systems of the body with dysfunction, when the risk of possible complications is significantly increased.
- In the presence of lymphatic drainage disorders, infectious lesions of the skin of the lower extremities, thrombophlebitis, arteriovenous fistulas.
The correct selection of the most effective method of treating varicose veins of the lower extremities in this particular case, the absence of contraindications and compliance with the doctor's recommendations in the postoperative period, guarantees a positive result of the surgical intervention.
Prevention of varicose veins of the lower extremities
Regime and diet
Adhering to a specific regime of work and rest, as well as nutrition, will in most cases prevent the appearance of varicose veins. To do this you need:
- Avoid clothing that interferes with venous blood flow.
- Avoid prolonged periods of standing or sitting (taking periodic breaks with rest and performing simple gymnastic exercises).
- Avoid strenuous physical activity.
- Lead an active lifestyle (moderate dynamic loads - daily walking, swimming, cycling).
- Drink at least 1. 5-2 liters of fluid per day, and the daily diet should include vegetables and fruits, whole grain bread and cereals.
- Avoid visits to baths and saunas and refuse hot baths.
- Take a contrast shower (hot - cold) every day.
- Use comfortable shoes with a low heel.
Antiplatelet therapy
An important component of preventive measures for varicose veins of the lower extremities is the use of drugs that have an antiplatelet effect, that is, they prevent the formation of blood clots. This includes:
- Acetylsalicylic acid and modern drugs containing it;
- Venotonics of plant origin - extracts of plants such as wild chestnut, hazelnut, mountain arnica are more often used;
- Synthetic venotonics. By the way, venotonics not only reduce the formation of thrombus, but also improve venous blood circulation, strengthen the vascular wall, preventing the appearance of areas of expansion.
Compression jersey
Bandaging with elastic tubular bandages has been successfully used for many years in the initial stages of varicose veins (when spider veins appear). Now special clothes are produced - compression knitwear, which allows you to choose the required size and choose the degree of compression depending on the severity of the changes. Wearing socks and stockings initially puts pressure on the top of the ankles, followed by a reduction in pressure and stimulation of blood flow upwards towards the heart. Venous vessels work more efficiently, due to which venous congestion is eliminated, swelling disappears and thrombus formation is prevented.
gymnastics
Special exercises have been developed that aim to eliminate venous blood stagnation. The key to success here is the regularity of performing the complex. Let's consider a few basic exercises that are recommended in the presence of risk factors for the development of varicose veins of the lower extremities and in the initial stage of the disease:
- Lying on your back, feet on a pillow on a raised platform. Relax and stay in this position for a few minutes.
- "Bicycle" - lying on your back, legs raised, knees bent. Perform movements that simulate pedaling while riding a bicycle;
- "Scissors" - lying on your back, raise your legs and cross them, changing the position of your legs (up - down) for 1 minute;
- The legs are raised and bent at the knee joints. Bend and straighten your feet, imitating walking;
- Lying on your back, bend your left leg, bring your knee close to your chest. Wrap your hands around the leg in the ankle joint and gradually straighten the leg, performing massaging movements on the calf muscles. Repeat the exercise with the right leg;
- Standing with legs together. Rise on your toes and lower yourself (if there are no complications, the exercise can be performed sharply - hitting the floor with your heels).
Timely initiation and proper implementation of preventive measures can prevent varicose veins of the lower extremities or minimize its manifestations.