Varicose veins of the lower extremities are a disease characterized by dysfunction of the veins in the legs. It can go on without obvious signs or have a clear venous pattern - it all depends on the type and stage. An integral part of this disease is a malfunction of the venous valves, deprived of which, the vein ceases to function properly. This leads to the appearance of varicose veins and poor circulation in the legs.
Causes of varicose veins
Venous blood moves up, from the toes to the body, if the process is disturbed then it lasts on foot. The heart cannot produce enough suction force to lift blood up. There are a number of mechanisms, the main of which is the muscle pump (musculo-venous pump). The valves set the direction of blood flow - forcing it to move from the bottom up. If, under the force of gravity, the blood tries to bounce back, then the valves close and will not allow it to penetrate.
During the contraction of the leg muscles, for example while walking, the blood in the vein is "squeezed" and directed towards the body. During muscle relaxation, the vein fills with blood, which is "sucked" from below. A breakdown of the mechanism leads to varicose veins of the lower extremities.
There are several factors that cause the onset of the disease. They are divided into 2 major groups:
- Hereditary. Some of the parents and close relatives have a pathology. This is the cause of varicose veins in 90% of patients.
- Acquired Occurs due to the side effects of provocative factors.
The main culprit is genetics. And additional circumstances are already superimposed on it:
- a profession associated with a long standing or sitting position (salesman, office worker, driver, surgeon);
- pregnancy as a "hormonal revolution" in a woman's body (veins stretch and become visible, after childbirth do not always heal and with each new pregnancy the situation worsens);
- diseases of the pelvic organs impede drainage and increase pressure in the veins;
- taking hormonal medications (making the vascular walls less elastic);
- excessive enthusiasm for heating procedures (baths, saunas);
- increased intra-abdominal pressure (with chronic cough or constipation);
- hard physical work, carrying heavy loads (loaders, anchors, builders);
- overweight (more blood volume - more load on the vessel);
- injuries that affect the veins and impair blood circulation;
- biological factors - old age, high growth;
- bad habits (alcohol, cigarettes)
- lack of physical activity;
- wearing tight clothes.
The veins relax when a person is lying down and blood practically flows through them in the direction from the feet to the heart. They are happy to work when their muscles are actively helping them while walking. Veins are under great stress when a person is standing or sitting. Whether they can withstand this burden or not depends on heredity and the presence of other provocative factors.
We understand the reasons - let's move on to the symptoms of varicose veins.
How do varicose veins appear?
The symptoms of varicose veins in women and men are generally similar, although they have slight differences.
The most obvious symptom is the presence ofvaricose veins of the lower extremitiesdifferent sizes:
- Up to 1 mm - telangiectasias or spider veins;
- from 1 to 3 mm - reticular (complex);
- from 3 mm - varicose veins.
Insufficient good work of the musculoskeletal pump is expressed by swelling of the legs. It starts in the lower third of the lower leg and rises to the level of the knee joint.
If the legs are in a vertical position for a long time without movement, then the blood stagnates, and its liquid part "sweats" through the vessel wall to the surrounding tissues. Puffiness is formed. In the supine position, the limbs do not swell, because the circulation is natural and easy.
How to tell if there is edema? Look at the location of the sock elastic. After removal, a trace remains - this means that the fluid is poorly removed and accumulates in the tissues.
Symptoms of varicose veins edema:
- get up closer to the middle of the day;
- worse in the evening against the background of prolonged or sitting;
- spend the night while the person sleeps;
- do not transfer on foot.
Venous edema of the legs is usually accompanied byfeeling of heaviness, which can be perceived as "tension", "buzzing" in the calf muscles or throughout the lower leg.
They can often be worriednight cramps in the lower extremities. . . The reason for this is the retention of venous blood, which disrupts metabolic processes in the muscles. This causes severe spasm of the calf muscles, usually caused by lying down during sleep. The leg appears to be cramped, due to which the person wakes up.
Dry skin on the feetis a consequence of tissue nutritional disorders. Waste that is not removed by the bloodstream disrupts the normal functioning of cells. The epidermis becomes less elastic and loses moisture, which leads to flaking.
Prolonged venous insufficiency increases vascular permeability. The fluid part and the blood cells "sweat" through the wall to the surrounding tissues, where they are destroyed. Blood pigments spread under the skin - from the outside it looks likehyperpigmentation, darkening of the epidermis with the formation of brown spots.
The process is often accompanied bytissue densification(induration), which occurs due to deterioration of blood supply and insufficient nutrition for a long time. In this case, the structure of the skin and subcutaneous tissue is rebuilt, they have more connective fibers and less elastic. Most often, this phenomenon is observed in the lower third of the lower leg from the inside.
If the disease is left untreated, it will get worse. In later stages, trophic ulcers appear. A long-term non-healing wound is located on the inner surface of one lower third of the foot. It can be the size of a five-foot piece or enclose the entire foot.
Complications of varicose veins
Inflammation of the saphenous veins, the formation of blood clots and its separation, blockage of the pulmonary arteries, skin changes, trophic ulcers - all these are complications of varicose veins, the consequences of a long-term pathology.
Thrombophlebitis- inflammation of the saphenous veins. A blood clot forms in the superficial vessels, which is accompanied by an inflammatory reaction. A dangerous condition that threatens to enter the deepest veins. A portion of the blood clot can break down and travel through the heart to the lungs, blocking the pulmonary artery. This condition is called pulmonary embolism (PE).
Thrombophlebitis is usually treated on an outpatient basis, but treatment methods depend on the patient's condition and many accompanying factors, as prescribed by the physician.
Phlebothrombosis- formation of blood clots in deep veins. The complication leads to persistent swelling and painful sensations, filled with the separation of a part of the thrombus and the development of PE. Phlebothrombosis is treated in a hospital, with hospitalization.
PE (pulmonary embolism)- a condition in which a blood clot breaks down and enters the pulmonary artery. With thromboembolism, there is a risk of sudden death when a blood clot blocks an artery and causes dyspnea, chest pain, and pulmonary infarction.
Blockage of small branches of the pulmonary artery can be asymptomatic but have serious consequences. Massive PE is treated exclusively in intensive care.
Chronic venous insufficiency (CVI)- the result of delayed venous blood flow in the leg due to "breakdown" of the valve mechanism.
I will describe it schematically this way: the human body is made up of cells that need to be nourished. For this, fresh arterial blood, rich in oxygen and nutrients, comes to all cells and tissues. Once the cells have "eaten", "waste" is formed in them, which is thrown into the veins. Venous blood is purified, oxygenated and converted into arterial blood. The circle is closed.
What happens in case of circulatory disorders? The exit is delayed and the waste is not thrown away. Tissues begin to suffer and return from normal to bad (sick). All processes change. The vascular walls allow fluid to pass through, forming edema. Pains arise. Over time, the intercellular space changes, the subcutaneous tissue thickens and "shrinks", the skin darkens and thickens, long-term non-healing ulcers appear.
Hyperpigmentation and lipodermatosclerosis- consequences of chronic VN. These are not life-threatening conditions, but they impair the quality of life. The feeling of tension in the skin and its unaesthetic appearance is unpleasant. Complications are reduced after treatment of varicose veins.
Eczema with varicose veins- Inflammation of the skin of the lower leg with redness and itching, crying areas and skin. Outwardly, it resembles ordinary eczema, only it is treated differently: without eliminating the underlying disease (venous insufficiency), any oil will be ineffective.
Trophic ulcer- an open wound that does not heal for more than 2 months. Occurs due to impaired tissue nutrition. Poor blood flow and stagnation limit the supply of nutrients to the cells, which prevents them from multiplying normally and filling the skin defect with new structures. It makes no sense to treat ulcers with oils alone; an integrated approach is needed using several methods to eliminate CVI.
Bleeding from varicose veinscan also occur with minor injuries to the lower leg and is often severe, because the vessels are dilated, blood pressure is higher than usual. Easy to stop bleeding: put a sterile tissue on the wound and bandage it tightly. Do not use the tourniquet if the limb is numb or swollen, loosen the bandage. Raise your leg further.
Diagnosis begins with a consultation. The doctor finds out if the issue is really in the varicose veins and only in it. In my practice, there were cases with varicose vein symptoms, but they had nothing to do with it. Edema is caused by heart failure, lymphedema edema and allergies.
The clinical picture may not speak of varicose veins, but of another disease. Pain in calf muscles is associated with atherosclerosis of arteries, osteochondrosis, flat feet. Causes of trophic ulcers are hypertension, skin infection, stroke and peripheral nerve damage.
A phlebologist will perform a differential diagnosis and make an accurate diagnosis, to find out what caused your symptoms. A reliable diagnostic method is duplex examination. Helps to clarify the condition of blood vessels and develop individual tactics for patient management.
Computed tomography, MRI venography, phlebography are rarely used today.
How to treat?
Treatment should always be comprehensive. The doctor has three instructions available:
The first iselastic sweater with compression. . . This includes knee braces, socks and tights. They all have varying degrees of pressure. The type of knitted fabric and the degree of compression are chosen individually, depending on the nature and stage of the pathology.
I want to point out: if you have tried to wear compression underwear but have not noticed any improvement or the condition has worsened, then you should consult a doctor. You may have a disease other than varicose veins, the products may be of poor quality or misused. It is necessary to find out why there is no positive trend.
The second -drug therapy. . . The range of drugs that reduce the manifestations of CVI is huge. Some medicines are stronger, some are weaker. The doctor chooses the medication, taking into account the manufacturer, its dose, regimen and duration.
The third -surgical intervention. . . There are several types of surgery: phlebectomy (removal of varicose veins through incisions), mini-phlebectomy (removal through drilling), laser dissection (laser welding), radiofrequency ablation (heat sealing). Each method has its own advantages and disadvantages, possibilities and limitations. The phlebologist decides which method or combination of them is right for you.