Varicose veins (varices)

Varicose veins is a disease, accompanied by thinning of the venous wall, increasing the lumen of the veins and formation of similar knotty extensions. Typically, varicose veins, implying a distinct disease – varicose veins of the lower extremities. Varicose disease is manifested by a feeling of heaviness in the legs and fatigue, edema of feet and legs, night leg cramps, visual saphenous varicose veins with the formation of venous nodes. The main method of diagnosis of varicose veins and its complications is Doppler ultrasound. Treatment can be conservative (drug therapy, sclerotherapy) or surgical.

varicose veins

Varicose veins (varices)

Varicose veins (varices) – pathology of the veins, which is manifested in their expansion and destruction of the valvular apparatus. Primary symptoms are the formation of spider veins, swelling of the subcutaneous veins, formation of nodes, soreness of the veins, heaviness in the legs. With the progression of the disease join the signs of chronic venous insufficiency of blood circulation: swelling of feet and legs, cramps in the calf muscles, trophic ulcers, thrombophlebitis, rupture of varicose veins changed. According to various studies in the field of clinical phlebology, varicose veins suffers from 30 to 40% of women and 10 to 20% of men over the age of 18 years.

Reasons

Varicose veins – polietiologic disease. There are several factors that increase the risk of developing varicose veins:

  1. Genetic predisposition due to weakness of the vascular wall due to failure of the connective tissue.
  2. Pregnancy. It is believed that the varicose veins during pregnancy develops because of the increased blood volume and compression of the retroperitoneal veins of the pregnant uterus.
  3. Overweight. Obesity is a proven risk factor of varicose veins. If the body mass index increases to 27 kg/m2, the risk of developing the disease increases by 33%.
  4. A way of life. The risk of developing varicose veins increases with prolonged sitting or standing, permanent static loads, especially associated with heavy lifting. Adverse effect on course of disease have corsets, contributing to increased intra-abdominal pressure and tight clothing that compresses the main vein in the inguinal folds.
  5. Features power. The likelihood of developing varicose veins increases with low intake of fruits and raw vegetables. The shortage of roughage leads to chronic constipation, and the lack of certain nutrients – to the disruption of reconstructing the structure of the venous wall.
  6. Violations of the hormonal balance. A certain influence on the prevalence of the disease has a widespread means of hormonal contraceptives and hormonal drugs used in the treatment of osteoporosis and menopausal syndrome.

Under certain conditions (certain diseases, congenital defects) can not only expand the veins of the lower extremities. Thus, portal hypertension may cause dilatation of the esophagus. When detected varicocele varicose veins of the spermatic cord, hemorrhoids – varicose veins in the anus and lower part of the rectum. Regardless of the localization process, there is a hereditary predisposition to the development of varicose veins associated with congenital weakness of the vascular wall and the lack of venous valves.

Pathogenesis

The veins of the lower limb form a complex network, which consists of subcutaneous and deep veins, connected by perforating veins. Through the superficial veins of the the outflow of blood from the subcutaneous tissue and skin, through the deep – from the rest of the tissues. Communicantes, the vessels serve for pressure equalization between deep and superficial veins. The blood on them was normal flows in one direction only: from the superficial veins to the deep.

causes of varicose veins

The muscular layer of the venous wall is weak and can not force the blood to move upwards. The flow of blood from the periphery to the centre was financed by residual blood pressure and pressure of the tendons located near the vessels. A crucial role is played by the so-called muscle pump. During exercise, muscles contract and blood is pushed upwards, as the downward movement impeded by the venous valves. To maintain normal blood circulation and a constant venous pressure is affected by venous tone. The pressure in the veins is regulated by vascular locomotor center located in the brain.

Valve insufficiency 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 excess pressure on the walls of blood vessels, leading to varicose veins, formation of nodes and progression of valve insufficiency. Disturbed blood flow in the communicantes, veins. Blood reflux from deep vessels in the surface leads to a further increase in pressure in the superficial veins. Nerves located in the walls of veins, signaling to vasomotor center, which gives the command to increase venous tone. The veins can not cope with the increased load, gradually expanded, elongate, become tortuous. High blood pressure leads to atrophy of the muscle fibers of the vein wall and destruction of the nerves involved in the regulation of venous tone.

Classification

There are several classifications of varicose veins. This diversity is due to polyetiological disease and many variants of varicose veins.

Stepwise classification

Physicians widely used the classification of varicose veins:

  • The compensation stage. There are no complaints. On examination, there are varicose veins on one or two legs.
  • The stage subcompensation. When viewed in visible legs pronounced varicose veins. Patients complain of feeling of fullness, paresthesia ("tingling") in the legs, night cramps. A slight swelling of the feet, ankles and shins in the evening. In the morning the swelling disappear.
  • Stage of decompensation. To join the listed signs of dermatitis, eczema. Patients worried about itching. The skin becomes dry, shiny, tight arctissimum with subcutaneous fat. Small hemorrhages and subsequent deposition of hemosiderin cause hyperpigmentation.

Modern classification reflects the degree of chronic venous insufficiency, a form of varicose veins caused by varicose veins complications.

Classification by forms

There are the following forms of varicose veins:

  • Segmental lesion of the subcutaneous and intradermal vessels without reflux.
  • Segmental venous lesions with abnormal discharge at the surface or communicative veins.
  • Common defeat of veins with abnormal discharge at the surface or communicative veins.
  • Common defeat of pathological venous reset in the deep veins.
International classification

There is a recognised international classification of varicose veins, used by doctors of many countries of the world:

  • Class 0. Signs of varicose veins do not exist. Patients complain of heaviness in the legs.
  • Class 1. Visually determined veins veins and spider veins (telangiectasia). Some patients appear at night muscle cramps.
  • Class 2. On examination, the patient visible dilated veins.
  • Class 3. Edema feet, ankles, and lower legs, not disappearing after a short rest.
  • Class 4. When examination revealed signs of lipodermatosclerosis (dermatitis, hyperpigmentation of the shins).
  • Class 5. Formed preyasi.
  • Class 6. Develop persistent sores.
symptoms of varicose veins

Symptoms of varicose veins

Clinical manifestations of the disease depend on the stage of varicose veins. Some patients even before appearance of visual symptoms of the disease complain of heaviness in the legs, fatigue, local pain in legs. Perhaps the emergence of de telangiectasia. Signs of impaired venous outflow do not exist. Often the disease in the stage of compensation are asymptomatic, and patients do not seek medical attention. The physical examination may reveal local varicose veins, most often in the upper third of the leg. Dilated veins soft, well collapse, the skin over them is not changed.

Patients with varicosity in the stage of subcompensation complain of transient pain, swelling, arising from a long stay in an upright position and disappears in supine position. The physical examination (especially in the second half of the day) may reveal a pasty or slight edema of the ankles.

Patients with varicose veins in the stage of decompensation complain of constant heaviness in the legs, dull pain, fatigue, night cramps. Itching, more pronounced in the evening is a harbinger of trophic disorders. During external examination revealed marked dilatation and global violation of venous hemodynamics. Depositing a large amount of blood in the affected limb in some cases may lead to headaches and fainting due to a drop in blood pressure.

Palpation determined enlarged, tense, veins tight elastic consistency. The walls of the affected veins soldered with the skin. Local depressions in the area of adhesions is talking about migrated periflebity. Visually revealed hyperpigmentation of the skin, lesions cyanosis. Subcutaneous tissue in areas of hyperpigmentation are sealed. Skin rough, dry, its impossible to get in the crease. Marked disgidros (often anhidrosis, rarely hyperhidrosis). Trophic disorders particularly often appear on the front-inner surface of the tibia in the lower third. In the altered areas of developing eczema, which in the subsequent formation of sores.

Diagnosis

Diagnosis is not difficult. To assess the severity of hemodynamic disorders is used angio duplex scan, Doppler ultrasound of lower limb veins. Can be used radionuclide methods of research and rheovasography of the lower extremities.

Treatment of varicose veins

In the treatment of patients with varicose veins, there are three basic techniques:

Conservative therapy of varicose veins

Conservative therapy includes General recommendations (normalization of motor activity, reduction of static load), physiotherapy, the use of means of elastic compression (compression stockings, elastic bandages), treatment phlebotominae. Conservative therapy may not lead to a complete cure and restore the already dilated veins. Used as a preventive measure, during the period of preparation for surgery and in case of impossibility of surgical treatment of varicose veins.

Compression sclerotherapy of varicose veins

In this method of treatment is the introduction into the vein a special drug. The doctor using the syringe enters the vein elastic foam which fills in the affected vessel and causes it to spasm. Then the patient wears a compression stocking that holds the vein in dormientes condition. After 3 days the walls of the vein stick together. The patient wears stockings during 1-1,5 months, has not yet formed dense adhesions. Indications for compression sclerotherapy – varicose veins, not complicated reflux from deep vessels in the surface using a communicative vein. In the presence of such pathological relief the effectiveness of compression sclerotherapy decreases sharply.

treatment of varicose veins

Surgical treatment of varicose veins

The main method of treatment of complicated reflux through the communicative veins of varicose veins is surgery. To treat varicose veins used a lot of operating techniques, including – using microsurgical techniques, radio-frequency and laser coagulation of the affected vein. In the initial stage of varicose veins produce photo coagulation or spider vein removal laser. In severe varicose shown phlebectomy - removal of changed veins. Currently, this operation is increasingly carried out with the use of less invasive techniques - mini phlebectomy. In cases where varicose veins is complicated by a thrombosis of the vein in its entirety and the accession of infection, the operation Troyanov-Trendelenburg.

Prevention

Important preventive role is played by the correct formation of behavioral stereotypes (lying is better than sitting and walking is better than standing). If you have to stay long in standing or sitting, you need to strain the muscles of the shins to make legs sublime or horizontal position. It is useful to engage in certain types of sports (swimming, Cycling). During pregnancy and with the hard work, it is recommended to use means of elastic compression. When the first signs of varicose veins should consult a phlebologist.

15.03.2019