Varicose veins in the lower extremities are a disease characterized by dysfunction of the veins in the legs. You can proceed without visible 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, without which the vein ceases to function properly. This leads to the appearance of dilated veins and poor circulation in the leg.
Causes of varicose veins
Venous blood rises from the toes to the body; if the process is disturbed, it remains in the legs. The heart cannot create enough suction force to raise the blood. There are several mechanisms, the main one being the muscle pump (muscle-venous pump). The valves define the direction of blood flow - forcing it to move from the bottom up. If, under the force of gravity, the blood tries to return, the valves close and do not let it pass.
During the contraction of the leg muscles, for example, when walking, the blood in the vein is "squeezed" and directed to the body. During muscle relaxation, the vein fills with blood, which is "sucked" underneath. A collapse of the mechanism leads to varicose veins in the lower extremities.
There are several factors that trigger the onset of the disease. They are divided into 2 large groups:
- Hereditary. Some of the parents and close relatives have a pathology. This is the cause of varicose veins in 90% of patients.
- Acquired. It occurs due to the adverse effects of provocative factors.
The main culprit is genetics. And additional circumstances already overlap with it:
- a profession associated with a sitting or long-standing position (salespeople, office workers, drivers, surgeons);
- pregnancy as a "hormonal revolution" in the woman's body (the veins stretch and become noticeable, not always after delivery they recover and with each new pregnancy the situation gets worse);
- pelvic organ disease prevents drainage and increases pressure in the veins;
- taking hormonal medications (making vascular walls less elastic);
- excessive enthusiasm for heating procedures (baths, saunas);
- increased intra-abdominal pressure (with chronic cough or constipation);
- hard physical work, transporting heavy loads (loaders, stevedores, builders);
- excess weight (more blood volume - more load on the vessels);
- lesions 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 rest when the person is lying down and blood practically flows through them towards the legs towards the heart. They are happy to work when their muscles actively assist them while walking. Veins are under enormous stress when a person is standing or sitting. Whether they can bear this burden or not depends on heredity and the presence of other provocative factors.
We find out the reasons - let's move on to the symptoms of varicose veins.
How do varicose veins manifest themselves?
Symptoms of varicose veins in women and men are generally similar, although they have slight differences.
The most obvious symptom is the presence ofdilated veins of the lower extremitiesmany sizes:
- Up to 1 mm - telangiectasias or spider veins;
- from 1 to 3 mm - reticular (convolute);
- 3 mm - varicose veins.
The insufficiently good work of the muscle-venous pump is expressed by the swelling of the legs. It starts at the lower third of the leg and goes up to the level of the knee joint.
If the legs remain in an upright position for a long time without movement, the blood stagnates and its liquid part "perspires" through the vessel wall to the surrounding tissues. The swelling is formed. In the supine position, the limbs do not swell, because circulation is natural and easy.
How to know if there is edema? Note the location of the elastic in the sock. After removal, a trace remains - it means that the liquid is poorly removed and accumulates in the tissues.
Symptoms of edema with varicose veins:
- appear closer to the middle of the day;
- worse at night in the context of standing or sitting for a long time;
- spend during the night while the person sleeps;
- do not transfer to the foot.
Venous edema in the legs is usually accompanied byheavy feeling, which can be perceived as "tension", "tinnitus" in the calf muscles or throughout the lower leg.
It can often be disturbednocturnal cramps of the lower extremities. . . The reason for this is the retention of venous blood, which interrupts the metabolic processes in the muscles. This causes severe spasm of the calf muscles, usually triggered by stretching during sleep. The leg appears to be cramping, so the person wakes up.
Dry skin on legsit is a consequence of nutritional tissue disorders. Waste that is not removed with the bloodstream disrupts normal cell function. The epidermis becomes less elastic and loses moisture, which leads to flaking.
Prolonged venous insufficiency increases vascular permeability. The liquid part and blood cells "sweat" through the wall to the surrounding tissue, where they are destroyed. Blood pigments spread under the skin - from the outside it lookshyperpigmentation, darkening of the epidermis with the formation of brown spots.
The process is usually accompanied bytissue densification(hardening), which occurs due to the deterioration of the blood supply and insufficient nutrition for a long time. In this case, the structure of the skin and subcutaneous tissue is reconstructed, they are left with more connective and less elastic fibers. Most of the time, this phenomenon is observed in the lower third of the inner leg.
If the disease is not treated, it will get worse. In the later stages, trophic ulcers appear. A long-term wound that does not heal is located on the inner surface of the lower third of the leg. It can be approximately the size of a piece of five kopecks or wrap the entire cinnamon.
Complications of varicose veins
Inflammation of the saphenous veins, the formation of blood clots and their separation, blockage of the pulmonary arteries, skin changes, trophic ulcers - these are all complications of the varicose veins, consequences of a long-lasting 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 deeper veins. Part of the blood clot can break off and travel through the heart to the lungs, blocking the pulmonary artery. This condition is called pulmonary embolism (PE).
Usually thrombophlebitis is treated on an outpatient basis, but treatment methods depend on the condition of the patient and many associated factors, prescribed by the doctor.
Phlebothrombosis- the formation of blood clots in the deep veins. The complication leads to constant swelling and painful sensations, charged with the separation of a part of the thrombus and the development of PE. The treatment of phlebothrombosis occurs in a hospital environment, with hospitalization.
PE (pulmonary embolism)- a condition in which a blood clot separates and enters the pulmonary artery. With thromboembolism, there is a risk of sudden death when a blood clot obstructs an artery and causes dyspnea, chest pain and pulmonary infarction.
Blockage of the small branches of the pulmonary artery can be asymptomatic, but it has serious consequences. Massive PE is treated exclusively in intensive care.
Chronic venous insufficiency (CVI)- the result of the delayed venous blood flow in the legs due to the "collapse" of the valve mechanism.
I will describe it schematically as follows: the human body consists of cells that need to be fed. For this, fresh arterial blood, rich in oxygen and nutrients, reaches all cells and tissues. After the cells "ate", "waste" is formed in them, which is released into the veins. Venous blood is purified, oxygenated and converted to arterial blood. The circle is closed.
What happens in case of circulatory disorders? Runoff is delayed and waste is not discarded. The tissues start to suffer and go from normal to bad (sick). All processes change. The vascular walls allow the passage of fluid, forming edema. Pains arise. Over time, the intercellular space changes, the subcutaneous tissue becomes coarse and "shrinks", the skin darkens and thickens, ulcers appear that do not heal in the long run.
Hyperpigmentation and lipodermatosclerosis- the consequences of chronic VN. These conditions are not fatal, but they affect the quality of life. The feeling of tension in the skin and its unsightly appearance are uncomfortable. Complications subside after treatment of varicose veins.
Varicose eczema- Inflammation of the skin of the leg with redness and itching, areas with secretion and flaking. Externally, it resembles a common eczema, only that it is treated differently: without eliminating the underlying disease (venous insufficiency), any ointments will be ineffective.
Trophic ulcer- an open wound that does not heal for more than 2 months. This is due to poor tissue nutrition. The lack of blood flow and stagnation limit the supply of nutrients to cells, which prevents them from multiplying normally and filling the skin defect with new structures. It makes no sense to treat ulcers with ointments alone; an integrated approach is needed using several methods to eliminate CVI.
Bleeding from varicose veinsit can occur even with minor injuries to the lower leg and is often severe, because of dilated vessels, blood pressure is higher than normal. Bleeding is easy to stop: place a sterile tissue on the wound and make a very tight dressing. Do not use a tourniquet if the limb is numb or tingling, loosen the bandage. Lift your leg higher.
The diagnosis starts with a consultation. The doctor finds out if the case is really in the varicose veins and only in them. In my practice, there were cases with symptoms of varicose veins, but they had nothing to do with it. Edema is triggered by heart failure, lymphedema and allergies.
The clinical picture may not speak of varicose veins, but of another disease. Pain in the calf muscles is associated with atherosclerosis of the arteries, osteochondrosis, flat feet. The causes of trophic ulcers are hypertension, skin infection, stroke and damage to peripheral nerves.
A phlebologist will make differential diagnoses and make an accurate diagnosis, find out what caused your symptoms. A reliable diagnostic method is the duplex exam. It helps to clarify the state of the blood vessels and to develop individual tactics for the treatment of the patient.
Computed tomography, magnetic resonance venography and phlebography are rarely used today.
How to treat?
Treatment must always be comprehensive. The doctor has three directions at his disposal:
The first iscompression elastic jersey. . . This includes high tops, socks and tights. They all have varying degrees of pressure. The type of mesh and the degree of compression are selected individually, depending on the nature and stage of the pathology.
I want to note: if you tried to wear compression underwear, but did not notice any improvement or worsening, you need to see a doctor. You may have a disease other than varicose veins, the products may be of poor quality or misused. You need to find out why there is no positive trend.
Second -drug therapy. . . The range of drugs that reduce CVI manifestations is wide. Some drugs are stronger, others are weaker. The doctor selects the drugs taking into account the manufacturer, the dosage, the regimen and its duration.
Third -surgical intervention. . . There are several types of operations: phlebectomy (removal of dilated veins through incisions), miniflebectomy (puncture removal), laser obliteration (laser welding), radiofrequency ablation (heat sealing). Each method has its own advantages and disadvantages, possibilities and limitations. The phlebologist decides which method or combination is right for you.