Varicose veins are pathological expansion of the lumen of the vessels due to thinning of their walls and decrease in tone. In the advanced stage, venous nodes bulge under the skin and may become inflamed from time to time. Varicose veins are not only an aesthetic defect. The symptom indicates a violation of blood circulation, which worsens the nutritional quality of tissues and organs and increases the risk of blood clots. Diagnosis and treatment at an early stage can slow down the development of the pathology and prevent its complications.
About the disease
Varicose veins is a chronic disease that includes any disorder in the structure and function of the venous system. These can be congenital, genetically determined anomalies, as well as pathological changes caused by external factors.
Varicose veins affect about 60% of adults worldwide, mostly Europeans. Mostly women suffer from varicose veins. This is due to the connection between the tone of the vascular walls and hormonal levels.
Types of varicose veins
Varicose veins are usually understood as dilated veins in the legs, 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 vessels of the esophagus;
- varicose veins of the spermatic cord in men (varicocele);
- varicose veins of the lower extremities.
Sometimes reticular varicose veins are isolated separately. It consists of vascular networks and stars visible under the skin. It mainly occurs on the legs, but can appear under the breasts, abdomen and other parts of the body. The disease is diagnosed when the saphenous veins of the reticular bed are enlarged in the reticular layer of the dermis. It occurs in 50% of women. The formation of nodules is not characteristic.
Types of varicose veins of the extremities according to the CEAP classification (stages of development):
- C0 - no symptoms;
- C1 – appearance of varicose veins and stars;
- C2 - varicose veins;
- C3 - swelling of the legs is visible, 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 - heals 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 pathology progresses, bluish, curved veins begin to bulge under the skin, sometimes swelling to lumps. A sign of chronic venous insufficiency is a change in skin color associated with a violation of tissue trophism (nutrition). Extensive eczema-like redness, itchy blisters and nodules appear. Swelling of the legs does not go away even after a night's rest.
Signs of the reticular form of varicose veins are limited to the subcutaneous vein pattern. Heaviness in the calves and mild itching in the area of enlarged blood vessels may occur. Trophic disorders are usually not observed.
Causes of the development of varicose veins
Reticular varicose veins occur due to the replacement of type 1 collagen with type 3 collagen in the walls of blood vessels. As a result, their contractility deteriorates - expanding, the vessels no longer return to their original state. The reason for the thinning of the vessel wall is the excessive activity of enzymes that destroy extracellular matrix proteins and elastin.
In women, the hormone progesterone helps to reduce the tone of the smooth muscle fibers of the vessel walls. Estrogen reduces the level of antithrombin, increases blood coagulation and causes the development of stagnant processes.
The main reason for varicose veins of the extremities, accompanied by the appearance of knots and bumps, is the failure of valve mechanisms. Valves are folds formed in the inner lining of blood vessels. Normally, they work in only one direction: they open under the pressure of blood flow and do not return it. If the valve mechanism becomes weak, blood flows backwards (reflux), causing the walls of the vessels to expand and their inner lining to become inflamed. Then the pathological process spreads to the deeper layers of the venous 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 is twisted in a spiral.
Increased pressure in the veins causes a malfunction of the musculo-venous pump. This is the system that regulates the pumping of blood to the muscles during exercise and at rest ("peripheral heart"). The result is congestion and venous insufficiency.
The precipitating factors are:
- heredity: in most cases, varicose veins are caused by mutations in genes responsible for the structure of venous valves and walls;
- overweight;
- sedentary lifestyle;
- increased load on the venous system of the extremities due to constant work;
- pregnancy and childbirth, menopause, hormonal imbalance.
Varicose veins can cause poor leg mobility due to uncomfortable shoes, as well as bad habits: smoking, alcohol abuse.
Diagnostics
The main methods of diagnosing varicose veins include a visual examination by a vascular surgeon, during which he evaluates the condition of superficial and deep veins and identifies signs of tissue insufficiency. Then the patient is sent for additional diagnostics.
- Ultrasound duplex scan. It allows you to assess the condition of valves, the strength and direction of blood flow, the size of blood vessels and determine the presence of blood clots.
- Study of valve functions: compression tests, simulated walking, Parana maneuver.
- X-ray contrast venography is X-ray imaging in which contrast material is injected into the veins. It helps to assess valve function, patency of vessels and detect blood clots.
To clarify the diagnosis, the doctor uses CT, MRI, thermography, radiophlebography, intravascular ultrasound, blood tests for coagulation, etc.
Expert opinion
Varicose veins are more than just unsightly veins that poke out from under the skin. Complications of varicose veins are extremely unpleasant.
- Trophic disorders. Large brown spots appear on the legs or thighs, followed by large, non-healing ulcers that itch and hurt.
- Thrombophlebitis is an inflammation of the venous walls, accompanied by the deposition of thrombotic masses on them. A thrombosed vein becomes red, thickens, hurts, and the temperature around it rises. Externally, it looks like an abscess. It threatens to spread the infection throughout the body.
- bleeding. Bleeding from rupture of a varicose vein can occur both inside and outside the tissue. Bleeding is intense and requires an emergency call.
- Thromboembolism. A blood clot that forms inside an enlarged vein can rupture and block vital arteries, such as the pulmonary artery. This condition often leads to sudden death.
Timely diagnosis will help prevent serious consequences of varicose veins and identify the causes that provoke them.
Treatment of varicose veins
Specific treatment of reticular varicose veins covers several areas.
- Compression therapy - wearing class A and I knitwear (socks, tights) to prevent backflow of blood.
- Pharmacotherapy - taking phlebotonic drugs to increase the tone of the vessels. These tools will not eliminate external signs, but they will eliminate subjective symptoms in the form of heaviness, swelling and aching pain.
- Phlebosclerosis is the adhesion of small vessels through the introduction of sclerosing substances. Microsclerotherapy allows you to get rid of vascular networks.
- Laser therapy - allows to eliminate small defects left after microsclerotherapy. During the procedure, the doctor applies a light beam to the affected areas.
An important part of therapy is therapeutic exercises, weight loss, wearing comfortable shoes and regular physical activity.
Two methods are used for surgical treatment of varicose veins accompanied by the appearance of nodes: classic phlebectomy and endovenous thermal obliteration. The first method is considered outdated. It includes closing the joint of the vein with the common femur and removing the affected part of the trunk. The method is characterized by increased trauma and high risk of relapse.
Thermal obliteration is a gentle, minimally invasive treatment method. Through a small incision, the doctor inserts a laser catheter into the vein, turns on the radiation and slowly withdraws it. As the laser moves, it closes the vein by increasing the temperature of the vein. Later it is gradually resolved.
Prevention
To prevent the development or recurrence of varicose veins, people at risk:
- to minimize the static load on the legs;
- eat rationally and, if necessary, take venotonic prescribed by the doctor;
- wear compression stockings when standing in a static position for long periods of time.
Regular cardio exercises are beneficial to your body to exercise 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 rehabilitation period depends on the extent of the intervention and the presence of complications.