Varicose veins on the legs (varicose veins) are a common disease that is manifested by persistent and irreversible expansion and stretching of superficial veins and disruption of their function due to the development of a pathological process in the venous wall and congenital or acquired insufficiency of the valve apparatus.
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 aged 12 to 13 years.
Causes of varicose veins in the legs
- Hereditary predisposition (congenital weakness of vascular valves). If your parents showed signs of weakness of the venous wall 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 abdominal veins by the developing fetus with increased pressure in the leg veins, hormonal changes causing decreased tone of the veins).
- Obstructed blood flow during prolonged standing (varicose veins of the lower extremities are more common among salespeople, teachers, waiters, surgeons) and sitting (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 centers)
- Long-term use of contraceptive medications 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 being overweight, chronic cough, constipation and the habit of wearing tight clothes and shoes disrupt venous flow and often lead to the appearance of 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 quite often occur for the first time during pregnancy. In 80% of cases, varicose veins develop first on the left leg and then on the right.
- The appearance of varicose veins is facilitated by hormonal changes in a woman's body during pregnancy, causing a decrease in the elasticity of the venous wall, its stretching and transformation into a varicose nodule.
- In the body of a pregnant woman, the volume of blood flow increases significantly. The increase in venous pressure leads to thinning of the venous wall and its local expansion (varicose veins).
- The growing fetus causes a corresponding enlargement of the uterus and difficulty in the outflow of blood from the lower extremities through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
- The increase in body weight of a pregnant woman also negatively affects venous outflow.
Varicose veins of the lower extremities: symptoms
Varicose veins develop slowly, going through several main stages in succession:
- At the first stage, the violation of venous circulation is accompanied by the appearance of individual "vein veins", thinning of the skin, due to which, during physical activity, dilated veins begin to appear in the form of twisted cords (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 at night and after a long walk, a feeling of "pins and needles" crawling down the legs, night cramps in the calf muscles, after an examination Careful, several dilated veins are revealed on the lower legs and sometimes on the foot and thigh.
- The third stage of varicose veins of the lower extremities is characterized by pronounced bulging of venous nodules mainly on the inner surface of the leg, the appearance of dark brown or brown spots on the thin, easily injured skin of the legs and the development of itchy dermatitis and rashes. The swelling of the legs becomes more intense, making walking difficult.
- The fourth stage of varicose veins is the presence of varicose nodules on the foot, leg and thigh, the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose nodules, the 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 area, buttocks, perineum, the presence of multiple trophic ulcers, the appearance of elephantiasis, frequent exacerbations of thrombophlebitis and the onset of disability.
Complications of varicose veins
- Thrombophlebitis of superficial veins.
- Bleeding when a varicose vein ruptures.
- 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 clinical examination, carrying out functional tests and carrying out instrumental studies of the veins.
- Clinical examination (clarification of complaints, anamnesis, examination, palpation).
- Doppler ultrasound.
- Ultrasound angioscanning.
- Plethysmography.
- Ascending and descending phlebography.
- Radionuclide phlebography (radiophlebography).
- Computed tomography and magnetic resonance imaging (CT venography, MR venography).
- Intravascular ultrasound examination.
- Thermography.
Treatment of varicose veins of the lower extremities
If varicose veins are detected early, you can deal with their manifestations using compression stockings, special therapeutic exercises and traditional methods of treatment. But if you go to the doctor late, when varicose veins are visible to the naked eye, your legs hurt and swell, trophic ulcers appear, signs of thrombophlebitis, the only way out is surgical intervention.
At the same time, one should not be afraid of surgery, because modern technologies make it possible to eliminate varicose veins in the lower extremities without large incisions, without pain and practically without disturbing a person's usual way of life.
The principle of surgical manipulation is similar for different techniques: pathologically altered superficial leg veins are ligated, excised and removed. In this case, venous circulation in the lower extremities is not disturbed, since the operation does not affect the deep veins, through which about 90% of venous blood flows.
Main types of operations for varicose veins
- Sclerotherapy. At the initial stage of varicose veins, a good cosmetic result is achieved by introducing special drugs into the problem vein, causing gradual sclerosis, "gluing" the pathologically dilated area of the vessel. A medicinal substance (usually a sclerosant) is injected through a special catheter or very fine needle into a varicose vein. To obtain a positive result, 3 to 10 injections are required.
- Phlebectomy. An operation that has been performed for almost a hundred years, but in modern conditions wide incisions have long been abandoned. Manipulation nowadays is carried out through miniature incisions of 3 to 5 millimeters. The pathologically dilated vein is first ligated and crossed at the point where it flows into the deep vein and then removed with special probes. This operation lasts approximately 1 to 2 hours, after which the patient remains in the hospital of a medical institution for 1 to 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 (no stitches are usually required) and significantly reduces the recovery period after surgery. In some cases, not the entire vein can be removed, but only its pathologically altered section. 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, obliteration and sclerosis of the vein occurs, 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 greater.
- Radio wave ablation of varicose veins. Obliteration ("gluing") of the altered vein lumen is achieved through exposure to radio waves of a certain power delivered to the problem area of the vein through a special catheter. The procedure takes 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 time, wear compression stockings and, if necessary, use medications with a venotonic effect. This will help restore normal blood circulation in the veins of the lower extremities as quickly as possible, prevent possible complications and allow you to quickly return to work and the normal rhythm of life.
In what cases is surgical treatment of varicose veins in the legs undesirable?
- During pregnancy and the first two months after birth.
- At the initial stage of varicose veins, when there are no existing complaints and aesthetic problems ("vein veins" on the legs) yet, 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 serious diseases of various organs and systems of the body with dysfunctions, when the risk of possible complications increases significantly.
- In the presence of lymphatic drainage disorders, infectious lesions of the skin of the lower extremities, thrombophlebitis, arteriovenous fistulas.
With the correct choice of the most effective treatment method for varicose veins of the lower limbs in this specific case, in the absence of contraindications and following the doctor's recommendations in the postoperative period, a positive result of the surgical intervention will be guaranteed.
Prevention of varicose veins of the lower extremities
Regimen and diet
Compliance with a certain work and rest regime, as well as nutrition, will, in most cases, prevent the appearance of varicose veins. To do this you need:
- Avoid clothing that impedes the flow of venous blood.
- Avoid prolonged periods of standing or sitting (taking periodic rest breaks and performing simple gymnastics exercises).
- Avoid strenuous physical activities.
- Lead an active lifestyle (moderate dynamic loads - daily walking, swimming, cycling).
- Drink at least 1. 5-2 liters of liquid per day; Your daily diet should include vegetables and fruits, whole grain bread and cereals.
- Avoid going to baths and saunas and refuse to take hot baths.
- Take a contrast shower (hot - cold) every day.
- Wear comfortable shoes with low heels.
Antiplatelet therapy
An important component of preventive measures for varicose veins of the lower limbs is the use of medications that have an antiplatelet effect, that is, they prevent the formation of blood clots. These include:
- Acetylsalicylic acid and modern medicines containing it;
- Venotonics of plant origin - extracts from plants such as horse chestnut, hazelnut, mountain arnica are most 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 shirt
For many years, elastic tubular bandages have been used successfully in the early stages of varicose veins (when spider veins appear). Now special clothing is being produced - compression knitwear, which allows you to select the desired size and select the degree of compression depending on the severity of the changes. Wearing socks and tights initially puts pressure on the top of the ankles, followed by a decrease in pressure and stimulation of upward blood flow to the heart. Venous vessels work more efficiently, as a result of which venous congestion is eliminated, swelling disappears and thrombus formation is prevented.
Fitness
Special exercises have been developed with the aim of eliminating venous blood stagnation. The key to success here is the regularity of performing the complex. Let's consider several basic exercises recommended in the presence of risk factors for the development of varicose veins of the lower limbs and in the initial phase of the disease:
- Lying on your back, legs supported by a pillow on a raised platform. Relax and remain in this position for a few minutes.
- "Bicycle" - lying on your back, legs raised, knees bent. Perform movements that simulate pedaling when 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 and bring your knee to your chest. Wrap your leg with your hands around the ankle joint and gradually straighten the leg, performing massage movements on the calf muscles. Repeat the exercise with the right leg;
- Stand with your feet together. Stand on your toes and lower yourself down (if there are no complications, the exercise can be performed abruptly - with your heels hitting the floor).
Timely initiation and adequate implementation of preventive measures can prevent varicose veins of the lower extremities or minimize their manifestations.