Varicose veins are a pathological expansion of the lumen of veins caused by thinning of their walls and reduced tone. In advanced stages, the venous nodes bulge under the skin and periodic inflammation may occur. Varicose veins are not just an aesthetic defect. The symptom indicates impaired blood circulation, which worsens the quality of nutrition of tissues and organs and increases the risk of blood clots. Early diagnosis and treatment can slow down the development of pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that involves disorders in the structure and function of the venous system. These can be congenital, genetically determined anomalies, as well as pathological changes that arose under the influence of external factors.
About 60% of adults worldwide, especially Europeans, are affected by varicose veins. Women in particular 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 an enlargement of the 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);
- expansion of the esophageal veins;
- 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 that are visible under the skin. It occurs primarily on the legs, but can also occur under the breasts, on the stomach and other parts of the body. The disease is diagnosed when the saphenous veins of the reticular bed in the reticular layer of the dermis are dilated. Occurs in 50% of women. Nodule formation is uncharacteristic.
Types of varicose veins of the extremities according to the CEAP classification (stages of development):
- C0 – no signs;
- C1 – appearance of varicose veins and stars;
- C2 – varicose veins;
- C3 – swelling of the legs occurs, indicating the development of venous insufficiency;
- C4 – trophic changes in the form of hyperpigmentation, lipodermatosclerosis (thickening of the skin in 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:
- Feeling of 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, tortuous veins begin to expand under the skin, sometimes swelling to the point of forming lumps. A sign of chronic venous insufficiency is a change in skin color, which is accompanied by impaired tissue trophy (nutrition). Extensive, eczema-like redness, itchy blisters and nodules appear. Swelling in the legs does not go away even after a night's sleep.
Signs of the reticular form of varicose veins are limited to the subcutaneous vascular pattern. There may be a feeling of heaviness in the calves and slight itching in the area of dilated blood vessels. Trophic disorders are not usually observed.
Reasons for the development of varicose veins
Reticular varicose veins arise due to the replacement of type 1 collagen in the walls of blood vessels with type 3 collagen. This causes their contractility to worsen - the vessels no longer return to their original state after expansion. The cause of thinning of the vascular 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 vascular walls. Estrogen lowers the level of antithrombin, increases blood clotting and provokes the development of stagnant processes.
The main cause of varicose veins of the extremities, which is accompanied by the appearance of nodes and bumps, is a malfunction of the valve mechanisms. Valves are folds formed by the inner lining of veins. Usually they only work in one direction: they open under the pressure of blood flow and do not let it back. If the valve mechanism is weakened, blood flows back (reflux), which causes the walls of the veins to expand and the inner wall of the veins to become inflamed. Next, the pathological process spreads into 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 winds in a spiral.
Increased pressure in the vessels leads to a malfunction of the muscular-venous pump. This is a system that regulates blood transport to the muscles during stress and relaxation ("peripheral heart"). The result is congestion and venous insufficiency.
Provoking factors are:
- Heredity: In most cases, varicose veins are caused by mutations in the genes responsible for the structure of the vein valves and walls.
- obesity;
- sedentary lifestyle;
- increased stress on the venous system of the extremities due to standing work;
- Pregnancy and childbirth, menopause, hormonal imbalances.
Varicose veins can be caused by limited foot mobility due to uncomfortable shoes, as well as bad habits such as smoking, alcohol abuse.
diagnosis
The main methods of diagnosing varicose veins include a visual examination by a vascular surgeon, during which he assesses the condition of the superficial and deep veins and detects signs of tissue malnutrition. The patient is then sent for further diagnostics.
- Ultrasound duplex scanning. Allows you to assess the condition of the valves, the strength and direction of blood flow, as well as the size of blood vessels and determine the presence of blood clots.
- Examination of valve functions: compression tests, simulated walking, Parana maneuver.
- X-ray contrast venography is an X-ray in which a contrast agent is injected into the veins. Helps assess valve function, vein patency and detection of blood clots.
To clarify the diagnosis, the doctor may prescribe CT, MRI, thermography, radiophlebography, intravascular ultrasound, blood coagulation tests, etc.
Expert opinion
Varicose veins are more than just unsightly veins that protrude under the skin. Complications from varicose veins are extremely unpleasant.
- Trophic Disorders. Large brown spots appear on the legs or thighs, later forming large, non-healing ulcers that are itchy and painful.
- Thrombophlebitis is an inflammation of the venous walls, which is accompanied by the deposition of thrombotic masses on them. The thrombosed vein becomes red, thickens, hurts, and the temperature around it rises. Externally it resembles an abscess. There is a risk of the infection spreading throughout the body.
- Bleeding. Bleeding from a ruptured enlarged vein can occur both inside and outside the tissue. The bleeding is severe and requires an ambulance to be called.
- Thromboembolism. A blood clot that forms in a dilated vein can break off and block vital arteries such as the pulmonary artery. This condition often results in immediate death.
Timely diagnosis helps to prevent the serious consequences of varicose veins and identify the causes that provoked them.
Treatment of varicose veins
The specific treatment of reticular varicose veins covers several areas.
- Compression therapy – wearing Class A and I supportive knitwear (socks, tights) to prevent blood backflow.
- Pharmacotherapy – taking phlebotonics to increase venous tone. These remedies do not eliminate external signs, but eliminate subjective symptoms in the form of heaviness, swelling and aching pain.
- Phlebosclerosis is the sticking together of small vessels caused by the introduction of sclerosing substances. Microsclerotherapy allows you to eliminate vascular networks.
- Laser therapy – allows you to eliminate the remaining minor defects after microsclerotherapy. During the procedure, the doctor directs a beam of light to the affected areas.
An important part of therapy includes 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 outdated. Involves ligation of the connection point between the vein and the common femur and removal of the affected part of the trunk. The method is characterized by increased trauma and a high risk of relapse.
Thermal obliteration is a gentle, minimally invasive treatment method. Through a small incision, the doctor inserts a catheter with a laser into the vein, turns on the radiation and slowly withdraws it. As the laser moves, it seals the vein by increasing its temperature. It then gradually dissolves.
prevention
To prevent the development or recurrence of varicose veins, people at risk must do the following:
- minimize static load on the legs;
- eat sensibly and, if necessary, take venotonics as prescribed by your doctor.
- Wear compression socks when standing in a static position for long periods of time.
It is useful to give your body regular cardio exercises to train the heart and blood vessels.
rehabilitation
During the recovery period after surgery, the patient must 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 procedure and the presence of complications.