Varicose veins are pathological expansion of the vein lumen caused by thinning of their walls and reduced tone. In an advanced stage, venous nodes protrude under the skin and can periodically become inflamed. Varicose veins are not only 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. Diagnosis and treatment at an early stage can delay the development of the pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that includes any disorders in the structure and functioning of the venous system. These can be congenital, genetically determined abnormalities, as well as pathological changes that occurred under the influence of external factors.
Varicose veins affect approximately 60% of adults worldwide, mostly Europeans. Most often, women suffer from varicose veins. This is due to the existence of a relationship between the tone of the vascular walls and hormonal levels.
Types of varicose veins
Varicose veins are usually understood as enlargement of the veins of the legs, but pathological changes can affect other parts of the body. Depending on the location, there are:
- varicose veins of the rectum (hemorrhoids);
- expansion of the veins 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 that are visible under the skin. It occurs mostly on the legs, but can appear under the breasts, on the abdomen and other parts of the body. The disease is diagnosed when the saphenous veins of the reticular bed are dilated into the reticular layer of the dermis. It 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 characters;
- C1 – appearance of varicose veins and asterisks;
- C2 – varicose veins;
- C3 – swelling of the legs appears, which indicates 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 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, worse in the evening;
- increased leg fatigue;
- calf pain that occurs after a long stay in a static position, standing or sitting.
As the pathology progresses, bluish, curved veins begin to protrude under the skin, sometimes swollen to the point of lumps. A sign of chronic venous insufficiency is a change in skin color associated with impaired tissue trophism (feeding). Profuse 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 vascular pattern. Heaviness in the calves and slight itching in the area of the dilated blood vessels may occur. Usually no trophic disorders are observed.
Causes of varicose veins
Reticular varicose veins appear due to the replacement of collagen type 1 in the walls of blood vessels with collagen type 3. As a result, their contractility deteriorates - expanding, the vessels no longer return to their original state. The cause of thinning of the vascular wall is the excessive activity of enzymes that destroy the proteins of the extracellular matrix 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 clotting and provokes the development of stagnant processes.
The main cause of varicose veins of the limbs, accompanied by the appearance of nodes and swellings, is a malfunction of the valve mechanisms. Valves are folds formed by the inner lining of veins. Usually they work in only one direction: they open under the pressure of the blood flow and do not let it back. If the valve mechanism is weakened, blood flows back (reflux), which leads to expansion of the vein walls and inflammation of their inner lining. Then the pathological process spreads to the deeper layers of the venous wall. His muscle fibers begin to be replaced by scars and atrophy occurs. The walls no longer contract and their collagen structures break down. The vein twists in a spiral.
The increased pressure in the vessels provokes a malfunction of the musculo-venous pump. This is a system that regulates the pumping of blood to the muscles during exercise and relaxation ("peripheral heart"). The result is congestion and venous insufficiency.
Provocative factors are:
- heredity: in most cases, varicose veins are caused by mutations in the genes responsible for the structure of venous valves and walls;
- overweight;
- sedentary lifestyle;
- increased load on the venous system of the limbs due to work in a standing position;
- pregnancy and childbirth, menopause, hormonal imbalance.
Varicose veins can be caused by poor leg mobility due to uncomfortable shoes, as well as by bad habits: smoking, alcohol abuse.
Diagnosis
The main methods for diagnosing varicose veins include a visual examination by a vascular surgeon, during which he assesses the condition of the superficial and deep veins and identifies signs of tissue malnutrition. After that, the patient is sent for further diagnostics.
- Ultrasound duplex scan. It 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.
- Investigation 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. It helps assess valve function, vein patency, and detect blood clots.
To clarify the diagnosis, the doctor can prescribe CT, MRI, thermography, radiophlebography, intravascular ultrasound, blood tests for coagulation, etc.
Expert opinion
Varicose veins are more than just unsightly veins bulging under the skin. Complications of varicose veins are extremely unpleasant.
- Trophic disorders. Large brown spots appear on the legs or thighs, and later large non-healing ulcers form that are itchy and painful.
- Thrombophlebitis is an inflammation of the venous walls, accompanied by the deposition of thrombotic masses on them. The thrombosed vein turns red, thickens, hurts, the temperature around it rises. Outwardly, it looks like an abscess. It threatens the spread of the infection in the body.
- bleedingHemorrhage from a ruptured varicose vein can occur both inside and outside the tissue. Bleeding is intense and requires an ambulance call.
- Thromboembolism. A blood clot that forms in an enlarged vein can break off and block vital arteries, such as the pulmonary artery. This condition often results in immediate death.
Timely diagnosis will help 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 includes several directions.
- Compression therapy - wearing supportive hosiery (socks, tights) of class A and I to prevent backflow of blood.
- Pharmacotherapy - taking phlebotonic drugs to increase the tone of the veins. These means will not eliminate the external signs, but they will eliminate the subjective symptoms in the form of heaviness, swelling and aching pain.
- Phlebosclerosis is 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 the remaining minor defects after microsclerotherapy. During the procedure, the doctor applies a light beam to the affected areas.
An important part of therapy is therapeutic gymnastics, losing weight, wearing comfortable shoes and regular physical activity.
For 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. It involves ligation of the junction of the vein with the common femur and removal of the affected part of the body. The method is characterized by increased trauma and a high risk of recurrence.
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 raising its temperature. Subsequently, it is gradually resolved.
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 as prescribed by your doctor;
- wear compression socks when standing in a static position for a long time.
It is beneficial to give your body regular cardio exercises to train the heart and blood vessels.
Rehabilitation
During the recovery period after surgery, the patient should wear compression stockings, minimize the load on the legs, avoid overheating and take medications prescribed by the doctor. The total rehabilitation time depends on the extent of the intervention and the presence of complications.