Varicose veins are a pathological expansion of the lumen of the veins caused by a thinning of their walls and a decrease in tone. In advanced stages, the venous lymph nodes swell under the skin and may periodically become inflamed. Varicose veins are not just an aesthetic defect. The symptom indicates impaired blood circulation, which deteriorates the quality of nutrition of tissues and organs and increases the risk of blood clots. Early diagnosis and treatment can slow the development of pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that encompasses any disturbance in the structure and function of the venous system. These can be genetically determined congenital anomalies, as well as pathological changes that have occurred under the influence of external factors.
Varicose veins affect around 60% of adults worldwide, mainly Europeans. Most women suffer from varicose veins. This is due to the presence of a connection between the tone of the vascular walls and hormonal levels.
Types of varicose veins
Varicose veins are usually understood as enlargement of the leg veins, but pathological changes can also affect other parts of the body. Depending on the location, there are:
- varicose veins of the rectum (hemorrhoids);
- dilation of the veins of the esophagus;
- varicose veins of the spermatic cord in men (varicocele);
- varicose veins of the lower limbs.
Sometimes reticular varicose veins are isolated separately. It is made up of vascular networks and stars visible under the skin. It mainly appears on the legs, but can appear under the breasts, on the abdomen and on other parts of the body. The disease is diagnosed when the saphenous veins of the reticular bed are dilated in the reticular layer of the dermis. Occurs in 50% of women. The formation of knots is unusual.
Types of varicose veins of the extremities according to the CEAP classification (stages of development):
- C0 – no sign;
- C1 – appearance of varicose veins and stars;
- C2 – varicose veins;
- C3 – swelling of the legs appears, indicating the development of venous insufficiency;
- C4 – trophic changes in the form of hyperpigmentation, lipodermatosclerosis (thickening of the skin of the lower third of the leg);
- C5 – healing of venous ulcers;
- C6 – non-healing venous ulcers.
Symptoms
The main symptoms of varicose veins of the lower extremities include:
- heaviness in the legs (calves), swelling, worsening in the evening;
- increased leg fatigue;
- aching pain in the calves that occurs after a long stay in a static position, standing or sitting.
As the condition develops, bluish, twisting veins begin to bulge under the skin, sometimes swelling until they form bumps. A sign of chronic venous insufficiency is a change in skin color associated with impaired trophism (nutrition) of tissues. Extensive eczema-like redness, itchy blisters and nodules appear. Leg swelling does not go away even after a night's rest.
The signs of the reticular form of varicose veins are limited to the subcutaneous vascular pattern. Heaviness in the calves and slight itching around dilated blood vessels may occur. Trophic disorders are generally not observed.
Reasons for the development of varicose veins
Reticular varicose veins occur due to the replacement of type 1 collagen in the walls of blood vessels with type 3 collagen. As a result, their contractility deteriorates: after dilating, the vessels no longer return to their original state. origin. The cause of thinning of the vascular wall is excessive activity of enzymes that destroy extracellular matrix proteins and elastin.
In women, the hormone progesterone helps reduce the tone of smooth muscle fibers in the vascular walls. Estrogen reduces the level of antithrombin, increases blood clotting and causes the development of stagnant processes.
The main cause of varicose veins of the extremities, accompanied by the appearance of nodes and bumps, is a malfunction of the valve mechanisms. Valves are folds formed by the inner wall of veins. Normally, they only work in one direction: they open under the pressure of blood flow and do not let it flow back. If the valve mechanism is weakened, blood flows backwards (reflux), causing the walls of the veins to dilate and their inner lining to become inflamed. Then the pathological process spreads to deeper layers of the vein wall. Its muscle fibers begin to be replaced by scar fibers and atrophy occurs. The walls no longer contract and their collagen structures are destroyed. The vein twists into a spiral.
Increased pressure in the vessels causes dysfunction of the musculovenous pump. This is a system that regulates the pumping of blood to the muscles during exercise and relaxation ("peripheral heart"). This results in congestion and venous insufficiency.
The provoking factors are:
- heredity: in most cases, varicose veins are caused by mutations in the genes responsible for the structure of the valves and vein walls;
- excess weight;
- sedentary lifestyle;
- increased load on the venous system of the extremities due to standing work;
- pregnancy and childbirth, menopause, hormonal imbalances.
Varicose veins can be caused by poor foot mobility due to uncomfortable shoes, as well as bad habits: smoking, alcohol abuse.
Diagnosis
The main methods of diagnosing varicose veins include a visual examination carried out by a vascular surgeon, during which he assesses the condition of the superficial and deep veins and identifies signs of tissue malnutrition. The patient is then sent for additional diagnostics.
- Duplex ultrasound scanning. Allows you to assess the condition of the valves, the strength and direction of blood flow, the size of blood vessels and identify the presence of blood clots.
- Study of valve functions: compression tests, simulated walking, Parana maneuver.
- X-ray contrast venography is an X-ray with a contrast agent injected into the veins. Helps assess valve function, vein patency and detect blood clots.
To clarify the diagnosis, the doctor may prescribe CT scan, MRI, thermography, radiophlebography, intravascular ultrasound, blood coagulation tests, etc.
Expert opinion
Varicose veins are more than just unsightly veins protruding under the skin. Complications from varicose veins are extremely unpleasant.
- Trophic disorders. Large brown spots appear on the legs or thighs, then large, non-healing, itchy and painful ulcers form.
- Thrombophlebitis is an inflammation of the venous walls, accompanied by the deposition of thrombotic masses on them. The thrombosed vein turns red, thickens, hurts, and the temperature around it increases. Outwardly, it looks like an abscess. Threats the spread of infection throughout the body.
- Bleeding. Hemorrhage from a ruptured dilated vein can occur both inside and outside the tissue. The bleeding is intense and requires calling an ambulance.
- Thromboembolism. A blood clot that forms inside an enlarged vein can break and block vital arteries, such as the pulmonary artery. This condition often results in instant death.
Timely diagnosis will help prevent serious consequences of varicose veins and identify the causes that provoked them.
Treatment of varicose veins
The specific treatment of reticular varicose veins includes several areas.
- Compression therapy - wearing class A and I support fabrics (socks, tights) to prevent blood reflux.
- Pharmacotherapy - taking phlebotonic drugs to increase the tone of the veins. These remedies will not remove external signs, but they will eliminate subjective symptoms in the form of heaviness, swelling and aching pain.
- Phlebosclerosis is the sticking of small vessels by introducing sclerosing substances into them. Microsclerotherapy allows you to get rid of vascular networks.
- Laser therapy – allows you to eliminate minor defects remaining after microsclerotherapy. During the procedure, the doctor applies a light beam to the affected areas.
An important part of therapy consists of therapeutic exercises, weight loss, wearing comfortable shoes and regular physical activity.
For the surgical treatment of varicose veins, accompanied by the appearance of nodes, two methods are used: classic phlebectomy and endovenous thermal obliteration. The first method is considered obsolete. Includes ligation of the junction of the vein with the common femur and removal of the affected part of the trunk. The method is characterized by increased trauma and high risk of relapse.
Thermal obliteration is a gentle and minimally invasive treatment method. Through a small incision, the doctor inserts a catheter with a laser into the vein, activates the radiation and slowly withdraws it. As the laser moves, it seals the vein by increasing its temperature. Thereafter, this gradually resolves.
Prevention
To prevent the development or recurrence of varicose veins, people at risk should:
- minimize static load on the legs;
- eat rationally and, if necessary, take venotonics prescribed by your doctor;
- wear support stockings when you stay in a static position for a long time.
It is helpful to do cardio exercises regularly for your body to train the heart and blood vessels.
Rehabilitation
During the recovery period after the operation, the patient should wear compression stockings, minimize the load on the legs, avoid overheating and take medications prescribed by the doctor. The total duration of rehabilitation depends on the extent of the intervention and the presence of complications.