With the article you will learn what to do with varicose veins in the legs, how to remove swelling, characteristics of conservative and surgical therapy, preventive measures.
Varicose veins are a chronic venous pathology, which is based on the malfunctioning of the valve apparatus, which causes stagnation of blood flow with the expansion and inflammation of blood vessels, increasing tissue pastyness.
The initial manifestations are the formation of spider veins, swelling of the saphenous veins, the formation of nodules, pain in the veins, weight in the legs. With the progression of the disease, signs of chronic insufficiency of venous circulation appear: swelling of the feet and legs, cramps in the calf muscles, trophic ulcers, thrombophlebitis, rupture of varicose veins. According to several studies in the field of clinical phlebology, 30 to 40% of women and 10 to 20% of men over 18 years of age suffer from varicose veins.
Usually, speaking of varicose veins, they signify an independent disease - varicose veins in the lower extremities. Varicose veins are manifested by a feeling of heaviness in the legs and fatigue, edema of the feet and legs, night cramps in the legs, visual subcutaneous veins with the formation of venous nodules.
Why do the veins expand?
To deal with this problem, you need to imagine how the blood, which successfully supplied oxygen to the body's tissues, returns to the heart. To overcome the force of gravity, rising from the legs to the chest, she needs assistance mechanisms. First of all, we are talking about the muscles of the lower extremities, which act as a pump: their contraction during walking brings blood to the heart. In addition, the valves located inside the veins play an important role in this process: they prevent the return of blood flow.
Varicose veins are a disease of the valves that have stopped working. As a result of such a breach, the fluid accumulates in the vessels, which leads to its expansion.
In the future, trophic ulcers may develop in the area of deformed veins and blood clots formed due to blood stagnation contribute to the emergence of a serious and deadly complication of varicose veins - pulmonary embolism.
Varicose veins in the legs between women and men are common - signs of pathology are seen in more than half of people over the age of 18. At the same time, the number of patients grows every year - this is due to the sedentary nature of professional activity.
Often, the varicose veins in the lower extremities are accompanied by another well-known disease - hemorrhoids. The nature of the occurrence in both diseases is the same, as are the risk factors that predispose to their development. As in the case of varicose veins, people often ignore the symptoms of hemorrhoids until the end, in the hope that the pathology will disappear on its own. However, these diseases are irreversible without radical intervention and only progress over time.
The main causes of varicose veins are believed to be: congenital weakness of connective tissue, hormonal changes, sitting or standing for long periods. Long legs and tall stature are a risk factor for varicose veins. When a person is standing, the valves in the veins are open. The higher the blood column in the vessels, the greater the pressure. Excess weight also increases the pressure in the leg veins - fat deposits, especially in the abdomen, make it difficult for the blood to drain. The waves of the female hormones estrogen and progesterone during the monthly cycle relax the venous wall. Hormonal contraceptives can also affect - it would be good to see a phlebologist before taking them.
The lack of physical activity accelerates the development of varicose veins in the lower extremities. However, experts emphasize the significant role of the hereditary factor: if unattractive "stars" and "worms" from the vessels under the skin are observed in your parents, then with a high degree of likelihood that you and your children will one day encounter thisproblem. The tendency to varicose veins is transmitted by the female line - a gene is associated with the sexual X chromosome, which can lead to the weakening of the venous wall.
Among other things, varicose veins are more common in smokers, obese people, pregnant women and in people with other chronic diseases of the cardiovascular system. The professions whose representatives are predisposed to varicose veins in the legs are: surgeon, cashier, driver, programmer, stewardess, porter, salesman, hairdresser, teacher.
The veins of the lower extremities form a branched network, consisting of saphenous and deep veins, interconnected by perforating (communicating) veins. Through the superficial veins, blood flows from the subcutaneous tissue and skin, through the deep veins - from the rest of the tissues. The communicating vessels serve to equalize the pressure between the deep and superficial veins. Blood flows through them normally in only one direction: from the superficial to the deep veins.
The muscular layer of the venous wall is poorly expressed and cannot force the blood to rise. The blood flow from the periphery to the center is performed according to the residual blood pressure and the pressure of the tendons located close to the vessels. The most important role is played by the so-called muscle pump. With physical effort, the muscles contract and the blood is compressed upwards, because the venous valves prevent the movement downwards. The maintenance of normal blood circulation and constant venous pressure is influenced by the venous tone. The pressure in the veins is regulated by the vasomotor center located in the brain.
The insufficiency of the valves and the weakening of the vascular wall lead to the fact that the blood under the action of the muscle pump starts to flow not only upwards, but also downwards, exerting excessive pressure on the walls of the vessels, leading to the appearance of varicose veins, thenodule formation and progression of valve insufficiency.
Interrupted blood flow in the communicating veinsThe reflux of blood from the deep vessels to the superficial vessels leads to a further increase in pressure in the superficial veins. The nerves located in the walls of the veins send signals to the vasomotor center, which gives the command to increase venous tone. The veins are unable to withstand the increased load; they gradually expand, lengthen and become tortuous. The increase in pressure leads to atrophy of the muscle fibers of the venous wall and to the death of the nerves involved in the regulation of venous tone.
There are several classifications of varicose veins. This diversity is due to the polyethiology of the disease and the many variants of the course of the varicose veins.
On physical examination, pronounced varicose veins are visible in the legs. Patients complain of a feeling of fullness, paresthesia ("chills") in the shins, night cramps. There is a slight swelling of the feet, ankles and lower legs at night. In the morning, the swelling disappears.
Decompensation stage. Dermatitis, eczema join the listed signs. Patients are concerned about itching. The skin is dry, shiny, strongly adhered to the subcutaneous tissue. Small hemorrhages and the subsequent deposition of hemosiderin cause hyperpigmentation.
Classification by form
The following forms of varicose veins are differentiated:
- Segmental damage to subcutaneous and intradermal vessels without reflux.
- Segmental venous lesion with pathological secretion along superficial or communicative veins.
- Widespread lesion of veins with pathological secretion by superficial or communicative veins.
- Generalized venous involvement with abnormal deep venous discharge.
There is an internationally recognized classification of varicose veins used by doctors in many countries in the world:
Class 0. There are no signs of varicose veins. Patients complain of weight on their legs.
Class 1. Networks of veins and spider veins (telangiectasias) are determined visually. Some patients have muscle cramps at night.
Class 2. Upon examination of the patient, dilated veins are visible.
Class 3. Swelling of the feet, ankles and lower legs appears, which does not go away after a brief rest.
Class 4. Physical examination reveals signs of lipodermatosclerosis (dermatitis, hyperpigmentation of the legs).
Class 5. Previews are formed.
Class 6. Development of persistent trophic ulcers.
Symptoms and clinical manifestations
Varicose veins, which affect the veins of the lower limbs, are classified in international practice by stages, based on the neglect of the pathology and the severity of the manifestation. Each stage is diagnosed separately, all of them are characterized by different symptoms, from which the treatment method is selected.
Therefore, the symptoms that are a sign of varicose veins in different stages:
- In the first stage, the saphenous veins at the lower extremities present an almost imperceptible pattern and protrude slightly above the skin, with a slight redness. There are complaints to the doctor about weight on the legs, night swelling after a difficult day. Shoes that are too tight can cause swelling in the feet in the ankle area, and cramps are also possible. It should be noted that painful sensations can often appear long before the visible signs.
- In the second stage, a typical aspect of the diseased veins in the legs is already observed: they are significantly visible above the skin and palpable with the fingers, they look like knots or beads. With progression, the saphenous vein of the lower limb becomes visible and takes on a sinuous shape with a dark blue or even black hue.
- In the third stage, varicose veins are complicated, there are signs such as trophic changes in the leg veins, the skin is dry and pale, daily swelling, cramps. Often, the symptoms are manifested in the fact that the legs are covered by a rash, the skin itches and itches.
- The symptoms of the fourth stage, more severe, are inflammatory processes in the saphenous veins of the lower extremity, trophic ulcers that do not heal and are already difficult to treat. A fundamental characteristic of this stage of the disease is the addition of a secondary infection and thrombophlebitis. With these manifestations, there is an urgent need for hospitalization, the complex use of treatment methods for the whole organism.
Experts identify the main risk factors:
- hereditary diseases associated with varicose veins in different parts of the body;
- hormonal disorders can increase blood clotting, decrease the elasticity of the leg veins;
- obesity, ascites, which increases the load on the legs, accompanied by dilation of the vein walls;
- pregnancy or lifting heavy objects increases the pressure inside the abdominal cavity, which also contributes to the weakening of the vascular walls and varicose veins;
- without load on the legs, sedentary work is loaded with the expansion of the veins in the legs;
- tight underwear, smaller shoes that contract the vein; use of heels, which causes stagnation of blood circulation in the leg veins;
- Varicose veins are often caused by kidney or cardiovascular diseases, which cause edema, seen in the expansion of the veins of the lower extremities.
The main methods involving the diagnosis of varicose veins in the legs are:
- External examination of varicose veins in the legs, which must be performed by qualified doctors at the hospital.
- Doppler ultrasound, which allows the thickening of the wall in the veins of the lower extremities to be detected. These diagnostics make it possible to determine unequivocally the stage of the violation.
- The duplex scan of the veins in the legs, carried out by a specialist doctor, allows the varicose veins to be clearly identified. With this method, which combines ultrasound and Doppler, it is possible to verify what happens to the veins: the rate of blood circulation, the diameter of the vein in the legs, the functioning of the valves and the condition that characterizes the varicose veins.
- The phleboscintigraphic examination, which allows an analysis to be performed with great precision and, in an initial phase, to know the varicose veins of the legs and to take timely preventive measures. It is performed by injecting a special dye subcutaneously, such liquid in the vein is highlighted in the monitor in a contrasting color.
- Occlusal plethysmography.
- With the help of tomographic diagnostics of diseases (magnetic resonance, computed tomography), complications that accompany varicose veins can be identified.
- Bandage or tourniquet tests for the diagnosis of disease are used in combination as an addition to several methods to determine the stage of varicose veins.
Deciphering the results of the diagnosis of varicose veins, as a rule, does not take long. Most procedures take 10 to 40 minutes, after which the attending physician announces the diagnosis based on the information received. The diagnosis should be trusted only by an experienced clinical physician, who will be able to provide a clear and unambiguous diagnosis, because treatment at different stages involves different methods, treatment principles and medications.
In the treatment of patients with varicose veins, three main methods are used:
Conservative therapy includes general recommendations (normalization of physical activity, reduction of static load), physiotherapy exercises, use of elastic compression means (compression stockings, elastic bandages), phlebotonic treatment (diosmin + hesperidin, chestnut extract).
Conservative therapy cannot lead to complete healing and restore already dilated veins. It is used as a prophylactic agent during preparation for surgery and when surgical treatment of varicose veins is impossible.
With this treatment method, a special medication is injected into the dilated vein. The doctor, through a syringe, injects elastic foam into the vein, which fills the affected vessel and causes spasm. Then, the patient is placed in a compression stocking that keeps the vein in a collapsed state. After 3 days, the vein walls are bonded. The patient wears the sock for 1 to 1, 5 months until dense adhesions are formed.
The indications for compressive sclerotherapy are varicose veins that are not complicated by reflux from deep to superficial vessels through communicative veins. In the presence of such pathological discharge, the effectiveness of compression sclerotherapy decreases dramatically.
The main method of treatment complicated by reflux through the communicative veins of the varicose veins is surgery. For the treatment of varicose veins, several operative techniques are used, including the use of microsurgical techniques, radiofrequency and laser coagulation of the affected veins.
In the initial stage of varicose veins, photocoagulation or removal of the spider veins is performed with a laser. With severe varicose veins, phlebectomy is indicated - removal of the altered veins. Currently, this operation is increasingly performed with a less invasive technique - miniflebectomy.
Having found varicose veins in yourself, you need to take care of the cleanliness of the body and normalize blood circulation. For this, first, the diet is reviewed. The most useful for varicose veins are fresh products of plant origin:
- Vegetables - cabbage, tomatoes, peppers, herbs.
- Fruits - citrus fruits, apricots, apples, peaches, cherries, cherries, apples.
- Berries - strawberries, currants, currants.
- There are many recipes for traditional medicine, based on fresh herbal ingredients.
Unfortunately, varicose veins are a chronic disease and therefore "go toe-to-toe" with a person throughout their life. Without prevention, the disease can lead to the development of more serious complications.
- It is not recommended to take very hot baths, as well as to go to the sauna or to spend a lot of time in the sun in the heat. This leads to a decrease in venous tone, which will certainly lead to congestion in the legs.
- Lead an active lifestyle, that is, change a lot. Therefore, regular exercise will help not only strengthen blood vessels, but also improve the condition of the body as a whole. Moderate aerobics, swimming, cycling or running are great for preventing varicose veins. However, it is contraindicated to practice weight lifting, as well as lifting very heavy things.
- Weight loss. People with a lot of body fat are more susceptible to this disease, as more blood circulates in their body than a person of normal weight. That is why there is a large load on the vessels. In order for the pressure in the venous vessels to be less, obese people definitely need to get rid of the extra pounds, as well as adhere to the correct diet. As for the menu, it is advisable to minimize the consumption of very spicy foods. It is recommended to replace animal fats with vegetable oils.
- You should not wear tight clothes, or socks or stockings with tight elastics, as they can press on the veins with force, interfering with blood circulation.
- While sitting, you should not cross your legs, as normal blood flow is also disturbed during this position.
- Standing for a prolonged period also has an extremely negative effect on the condition of the veins. If you have a permanent job, try to move more often. Sitting constantly is no less harmful.
- Nutrition must be normalized. Therefore, regular constipation and intestinal dysbiosis can lead to the development of varicose veins. Foods rich in fiber should be included in your menu, which helps to improve intestinal motility, that is, digestion in general.
- Women should wear tight shoes as little as possible, as well as shoes with heels. If you cannot refuse these shoes, the heel should be no more than 3-4 feelings of height.
- After heavy work while standing or sitting, apply cold water to the legs to keep the veins in good condition. Baths with the addition of pine salt are also useful. You can wet your feet with cold water in the morning.
- The prevention of varicose veins includes the abandonment of bad habits, namely smoking, which has an extremely negative effect not only on the condition of the veins, but also on the entire human body.
- Light massage is considered an excellent preventive measure for this disease. This massage can be performed independently, caressing the skin of the lower extremities from bottom to top and then in the opposite direction, for 10 minutes. This self-massage is very useful in combination with spine massage procedures, which are performed by a professional chiropractor or massage therapist.
- The prevention of venous varicose veins also involves taking special medications to maintain venous tone.
- Try to get rid of chronic fatigue and frequent stress.
- Doctors advise to avoid overheating and colds.
- In the presence of varicose veins, a phlebologist should be consulted at least twice a year, who will monitor the condition of the veins and the stage of development of the disease.
To avoid diseases, walk further, take a contrast bath, visit the pool. Even if you don't know how to swim, it is useful to just stay in the water - the water column exerts a pressure of 60-70 mm Hg on your legs. Art. This is enough to pump stagnant blood into the veins. Gymnastics has the same effect at night - lift your legs while you lie down, do the "bicycle" exercise.
In case of venous insufficiency, preventive mesh should be used (special tight stockings and tights create a kind of frame around the veins, preventing them from expanding).
By the way, this type of nightgown is very useful during pregnancy. Even in the first three months, when the hormones are already having a negative effect. As the fetus grows, the mesh density needs to be increased. During childbirth, it is also necessary, because at the same time the blood pressure in the veins increases dramatically.