The main characteristic of the varicose veins in the legs is their vastness. The superficial and deep veins are subject to changes to a large extent. Since the legs have a very large and prolonged load, the valves of the circulatory system can begin to weaken as early as childhood. Therefore, the detection of varicose veins in the legs often occurs in young people and girls.
In order to effectively treat varicose veins in the legs, the doctor will have to discover the causes of their occurrence. Since, even using radical methods, 80% of patients have recurrence of varicose veins, special attention should be given to reducing the influence of factors that cause varicose veins in the processes. These include:
- hereditary predisposition is, in fact, an uncontrollable factor, which, however, can be contained by conventional preventive measures;
- physical influences - increased load on the legs (standing and sitting, habit of crossing the legs, being overweight, lifting weights);
- physiological effects - hormonal changes and use of hormonal drugs (mostly contraceptives), metabolic disorders, lack of physical activity;
- pathological reasons - chronic liver disease, kidneys, trauma and systematic tearing of the soft tissues of the lower extremities, tumors that compress the veins in the abdominal cavity.
they cannot close completely, so some of the blood remains in the vessels in the legs. The pressure in the veins increases, the walls stretch even more, lumps are formed, in which blood clots form over time. Thrombosis is dangerous, but it is far from being the only thing that threatens patients with varicose veins in their legs. The clot can break and enter the heart or other organ, causing a heart attack, or obstruct the vessels of the limb, which causes gangrene.
Depending on the location of these "stretched" veins, doctors distinguish several types of varicose veins in the legs:
- Surface. It is expressed by the appearance of a bluish or red varicose mesh on the legs, which at first resembles a spider's web, and then a plexus of rather thick sinuous lines.
- Deep. It is expressed by the defeat of the vascular plexuses not visible during the external examination. The pain in the veins of the lower limbs with varicose veins of this type is more intense, the risk of complications is greater.
- Combined, when the deep and superficial veins are affected.
Establishing the causes of varicose veins in the legs and their elimination are closely related. First, it is important to exclude the factors that have the greatest negative impact on the condition of the veins.
When diagnosing venous changes, it is important to differentiate them from other diseases. For example, the varicose veins under the knee look the same as Becker's cyst and are accompanied by similar symptoms.
The appearance of the first signs of varicose veins in the legs occurs in progressive stages, when the venous valves perform their functions in less than 50%. In the initial or zero stage of varicose veins, known as the "compensation stage", unpleasant sensations do not appear, as well as visible changes. The detection of the initial stage of varicose veins in the legs occurs with a careful examination of the limbs by a phlebologist.
In the second stage of varicose veins, known as "subcompensation", the changes are very well expressed:
- contours of large veins are visible under the skin, but may not protrude above the surface of the skin;
- on the skin surface of the thighs and under the knees, a pattern of a fine varicose mesh of blue or red capillaries is clearly visible;
- at night, the legs are swollen;
- at night, the calf muscles cramp.
This stage of the varicose veins in the lower extremities is distinguished by the increase in symptoms, which weaken after rest.
In the final stage of varicose veins, decompensation occurs: the body cannot supply the oxygen needs of the tissues and the valves in the veins lose their functions by 90%. The condition of the limbs worsens due to insufficient blood supply. This phase of the varicose veins is characterized by a decrease in the regeneration capacity of the tissues. The abundance of complications worsens the patient's general condition. Symptoms in the final stage of varicose veins persist constantly.
If we speak of varicose veins in principle, this term in medicine means a disease of the veins, in which the functions of blood transport by these vessels are impaired due to their deformation of varying severity. In other words, the veins stretch, expand, their walls become thinner, the work of the valves located inside is interrupted, etc. All of this leads to the fact that the blood flows worse upwards, towards the heart, and its stagnation occurs in the vessels.
Most people imagine the varicose veins in the lower extremities as the protrusion of individual vessels and vascular network close to the surface of the skin. At the same time, swollen and deformed veins are very visible to the naked eye and this idea is correct, if we speak purely of aesthetic manifestations.
As for the deep varicose veins, or more precisely, varicose veins, we are talking about similar disorders, but now they affect the venous vessels located in the thickness of the muscular tissue. This means that even at the most severe stage of the pathological process, these veins do not appear on the surface.
This pathological process is dangerous not only because of its secrecy. The deep veins, including small and large tibia, gastrocnemius, soleus and others, are much larger. As a result, they let in more blood, play a more significant role in systemic circulation, and their defeat has a stronger effect on human health.
This means that with the varicose veins in the deep veins, the stagnant blood processes are much more serious. In this case, a person may experience severe pain, increased fatigue in the legs, etc. However, even more dangerous consequences are that, with an excessive increase in pressure in the veins, their thin walls may not resist, which threatens to rupture them and cause internal bleeding.
Deep varicose veins in the legs
First, the visible symptoms of varicose veins in the legs is the appearance of a network of thin veins on the skin surface of the legs. These manifestations occur mainly in the thigh region. These varicose veins are easier to see in people who suffer from cellulite. Sometimes, it is cellulite that becomes a kind of precursor to varicose veins. Often, the fat deposits in cellulite compress the venous vessels and, as a result, blood flow becomes complicated and varicose veins occur.
Capillary networks in the legs that appear at the beginning of varicose veins are called telangiectasias. However, it must be kept in mind that these external manifestations can be both signs of varicose veins and the manifestation of a temporary inflammatory process.
In some cases, the appearance of varicose veins is indicated by swelling in the legs. However, this sign can be a symptom of other diseases (heart failure, kidney stones). Therefore, in this case, it is impossible to speak clearly about the development of varicose veins before the diagnosis is made.
The manifestation of pain in the legs often becomes a symptom of varicose veins. Painful sensations can be acute and also show signs of attraction. Most of the time, with varicose veins, pain in the calves is manifested. It occurs mainly in the afternoon, after a certain load on the legs.
Thus, whoever observes the appearance of a capillary network, periodic manifestations of pain and edema, should consult a doctor and do the necessary research.
Often, varicose veins cause a certain cosmetic discomfort to the patient. But in addition, he may have a feeling of heavy weight in his legs, seizures may occur at night, trophic changes gradually appear in the legs.
Visually, varicose veins can be manifested by "stars" not particularly noticeable from small vessels and by very large nodules and plexuses, which are especially prominent when the patient is in an upright position.
If the veins are palpated, then their elastic elastic consistency is determined, they are easily compressed. Each of the varicose vein nodules may have a higher temperature than the rest of the areas. If a person takes a horizontal position, the tension in the veins decreases and the nodules become less pronounced.
If, during the development of the disease, the person does not think about how to treat varicose veins, the disease progresses, and gradually a feeling of rapid tiredness, a constant weight in the legs and a feeling of swelling in the colic tissues appears. If the swelling appears, they disappear after a long night's rest.
It is relatively easy to diagnose this disease. The specialist necessarily examines and interviews the patient, examines the anamnesis. In the process of further studies, the condition of the valves of the main and communicating veins is determined, and the level of permeability of the deep veins is assessed. There are several different tests that can assess the condition of the veins and the degree of development of the disease.
If the patient has uncomplicated varicose veins, then, in most cases, instrumental diagnostic methods are not used.
Conservative treatment of varicose veins is mainly prescribed for those people who have clear contraindications for surgical intervention.
In addition, this treatment is indicated if the patient has slight dilation of the veins, an exclusively aesthetic defect. The goal of conservative therapy is also to prevent the progression of this disease. To this end, the patient is instructed to apply bandages to the legs affected by varicose veins with elastic bandages.
In addition, compression stockings for varicose veins are shown. People who have a tendency to varicose veins or are already sick with this disease should regularly put their feet on an elevation throughout the day, thus resting for several minutes. There are also special exercises for the leg and foot, in order to activate the muscle-venous pump. This is the periodic extension and flexion of the ankle and knee joints.
Nutrition for varicose veins in the lower extremities
The history of varicose veins began at the time of Byzantium, Ancient Egypt, Israel of the Old Testament, as evidenced by archaeological excavations. At various times, people have tried to cure this disease, in particular, Avicenna and Hippocrates have endeavored to do so. In the second half of the 19th century, Russian and German doctors began to talk about the effectiveness of the great saphenous vein ligation.
In the early 20th century, very traumatic operations were performed, during which the thigh and leg tissues were deeply dissected, the veins were damaged and then tied, nerve endings, arteries and lymphatic ducts. Healing took a long time, leaving large and visible scars.
Foreign doctors proposed in 1908 the removal of a thick saphenous vein and put in place a metal probe, which reduced the trauma to the patient. This was the first step towards minimally invasive surgery.
The discovery came when it became possible to do X-rays. It was first performed for varicose veins in 1924. At the same time, a contrast based on strontium bromide solution was injected into the vein. Then, the ultrasound appeared and the technique was further improved.
In the late 90s of the 20th century, laser therapy appeared, which became a modern breakthrough in the treatment of varicose veins.
In European countries and the United States, 25% of the population suffers from this disease. In our country, varicose veins have been diagnosed in 30 million people. In addition, women fall ill more often than men. According to global statistics, 70-80% of women and 50-60% of men suffer from varicose veins.
The main cause of varicose veins is a genetic predisposition.
There are several other provocative factors:
- sedentary lifestyle;
- hormonal imbalance;
- endocrine diseases;
- taking oral contraceptives and other hormonal drugs;
- working in hot stores;
- strong physical activity;
- work associated with long stay or, conversely, sitting;
- chronic diseases of the bronchi and lungs, accompanied by prolonged cough.
Thrombophlebitis is a life-threatening condition. With it, blood clots form in the veins, which can rupture and obstruct the pulmonary vessels, which leads to myocardial infarction. If a large vessel is affected, death is possible.
Venous thrombosis is the blocking of a vessel by a blood clot. It is manifested by pain in the limb, which increases with physical effort, edema.
Pulmonary embolism - overlap of the pulmonary artery lumen by a detached thrombus. Death can occur in the first 30 minutes. If the thrombus is small, then a pulmonary infarction occurs, the patient needs resuscitation measures. The condition is accompanied by pneumonia and chronic heart failure.
Trophic ulcers - thickening of the subcutaneous tissue, darkening and thinning of the skin, followed by the appearance of ulcers. These ulcers have been around for a long time, do not respond to treatment and close very slowly.
In the official classification, it is customary to distinguish three stages of varicose veins:
- I - compensation;
- II - undercompensation;
- III - decompensation.
Sometimes complications are isolated in stage IV.
The most common location. It usually appears at a young age and in women - during pregnancy or after childbirth. In the early stages, the symptoms are few and nonspecific - fatigue in the legs, weight in the legs, burning, bursting, night cramps. Already at the beginning of varicose veins, pain appears along the vein, swelling. Ankles, legs and feet are usually affected.
The most common symptom in this case is numbness in the hands. It can be partial and complete, most often during sleep. The patient becomes meteorological, his hands ache and ache with any change in the weather. It becomes difficult to handle even light objects. Then, more characteristic symptoms develop - blood vessels swell, nodules form, the pain begins, intensifying with time, the veins become tortuous, in relief.
Groin and pelvis
The manifestations of the disease differ in men and women.
Complete healing of varicose veins is only possible after surgical treatment. This can be done in three ways:
- Phlebectomy - removal of a varicose vessel.
- Sclerotherapy - the introduction of a sclerosing agent into a varicose vein - a special substance that "sticks" to your walls, interrupting blood flow through it. As a result, the collapse of the vein, even the cosmetic defect disappears.
- Laser coagulation - the walls of the vein are destroyed by heat, as a result of which the venous lumen is "sealed". This operation can only be performed if the vein is not expanded by more than 10 mm.
In addition, one of the most modern methods of treating chronic varicose veins is the obliteration of the adhesive veins. You can find lots of additional information on the net about this procedure.
The main role in drug treatment is played by venotonics, which are taken in the form of pills and act systemically. They correct disturbances in the functioning of the blood circulation. As a result, the vessels throughout the body are healed. Venotonics are also available in the form of gels and ointments, but are less effective and work only at the application site for a short period of time.
Phlebotonics are also used - venotonic drugs. They are indicated for thinning blood vessel walls, reducing elasticity, increasing permeability, blood stasis. The medications strengthen the venous walls, increase their elasticity, eliminate congestion, reduce swelling and other negative symptoms. An additional property of phlebotonics is the normalization of microcirculation in the affected area.
Antiplatelet agents are used to make blood more fluid. Medicines are used when it is necessary to reduce the intensity of blood clots. Indicated for patients with increased blood viscosity. Antiplatelet agents can be used only in the absence of a bleeding tendency.
To stop the thrombus formation process, anticoagulants are also prescribed. They destroy blood clots, reduce blood viscosity.
A good helper in the fight against varicose veins is compression stockings. The operating principle of such products:
- Throughout the compression stocking, pressure is exerted on the superficial and deep veins.
- The greatest pressure is at the bottom, where the veins are narrower and the blood flow is faster.
- The narrowing of the veins increases the efficiency of the valves.
- Swelling, pain, fatigue in the legs pass.
Venous blood rises from the feet to the heart under the influence of blood pressure. If a person is healthy, this mechanism works perfectly. In the presence of pathologies, the body is forced to stimulate this process: it increases the pressure and raises the blood upwards with pushing movements. The result is valve failure.
- Hereditary predisposition - some are susceptible to the occurrence of this disease. They have congenital valve dystrophy, weak vascular walls. For this reason, varicose veins in the legs can be seen at a young age.
- Hormonal changes - due to a malfunction, blood stagnation occurs. The most dangerous are the period of gestation, puberty and after delivery. In the female body (especially at this time), the hormones of the corpus luteum predominate. They also have a relaxing effect on the veins.
- Joint diseases - rheumatoid arthritis, osteoporosis and other diseases.
- Wear tight shoes and very tight clothes.
- An unbalanced diet is the presence of fatty and high-calorie foods.
- Bad habits - smoking and alcohol abuse.
- Taking certain medications - hormonal contraceptives.
- Overweight - obesity puts more pressure on your legs.
- Chronic liver diseases - cirrhosis, hepatitis.
This disease does not go away on its own. Without proper treatment, the situation will only get worse. Expansion of the veins in the legs can cause the following complications:
- Eczema and dermatitis - redness, small blisters and cracks appear on the lower leg.
- Trophic ulcers - simple or numerous "islets" may appear. Most of the time, they are crying (a clear or bloody liquid appears constantly on their surface). Although these ulcers are superficial, they are very painful.
- Thrombophlebitis - may be accompanied by increased body temperature, redness of the skin, painful sensations when walking and at rest.
- Vein rupture - accompanied by profuse bleeding. If such a complication occurs, immediate medical attention is required.
Varicose veins on the legs include the following treatment:
- treatment of varicose veins with leeches;
- folk remedies;
The "gold standard" of diagnosis is ultrasound, which identifies areas of affected veins. If the results of noninvasive diagnoses are doubtful, then a surgical study is used - phlebography, which involves introducing a contrast agent into a vein to assess the general state of the vascular system.
Diagnosis of deep varicose veins
- Initial examination with collection of anamnesis and patient complaints.
- Ultrasound of the vessels in the legs.
- Doppler ultrasonography for the detection of blood clots.
- Urine and blood chemistry tests may also be required.
In the early stages, VVVNK is not very pronounced. People attribute leg pain and other symptoms to common fatigue, hard work or age. They see a doctor only when there are already significant changes in the legs - thick, swollen veins or nodules.
But in most cases, the doctor is not limited to a visual examination and prescribes additional examinations:
- Ultrasonic flowmetry or Doppler analysis, which allows the speed of blood flow and venous filling to be detected.
- In the early stages of VVVNK, tests by Perthes, Sheinis, Troyanov, Prett and others, which indicate the development of varicose veins, are prescribed.
- Phlebomanometry, which measures the pressure inside the veins.
- Scanning of veins, according to the results of which it is possible to determine the state of the valves and venous walls.
- Phlebography. This procedure consists of introducing a contrast agent into the veins, followed by radiography.
- Ecosclerotherapy - the sclerosing agent is injected into the veins and then scanned.
- Thermography - examination using infrared radiation.
- Computerized phlebography.
- Phleboscintigraphy - examination of lymph nodes and veins with radionuclides.
- Photoplethysmography - examination with photodiodes.
All types of exams are never prescribed at once. Usually, varicose veins are easy to diagnose by one or two methods, which are determined by the doctor according to the patient's condition.
The ease of diagnosing varicose veins in the legs is exaggerated, as the vessels do not always come to the surface. To confirm the diagnosis, the doctor will have to perform an external exam and perform a series of instrumental studies:
- duplex scan or ultrasound on the lower limb - with varicose veins, it is used first to determine the degree of elongation of the vascular walls, the nature of the blood flow in them and the detection of blood clots;
- X-ray of the extremities with contrast - standard of functional examination of the varicose veins of the lower extremities, which allows determining the patency of the vessels;
- Magnetic resonance imaging is the gold standard of modern diagnoses of varicose veins in the lower extremities, which allows to assess the functionality of venous valves, identify foci of ischemia in soft tissues, detect blood clots and other pathological changes that have arisen in the context of varicose veins.
To clarify the complete picture of the disease, laboratory tests are prescribed: a coagulogram to assess the risk of thrombus formation, a general and biochemical blood test.