The word "varicose" comes from the Latin word varix, varicis - bloating. The first mention of varicose vein treatment is found in ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffers from chronic diseases of the veins of the lower extremities. Complications of dermatitis, cellulitis, bleeding, thrombosis, and trophic ulcers often lead to long-term disability, sometimes leading to disability.
Structure and function of the venous system
The operation of our veins is a complex process. To understand this, you need an initial knowledge of the structure of the veins. The venous wall consists of three layers. Internal - endothelium, which is represented by a cell layer on the connective tissue membrane. The middle layer is muscular. It consists primarily of circularly occurring smooth muscle cells that are approximately in the form of collagen fibers. Surface veins contain a thicker layer of muscle than deep veins. The outer venous sheath, called adventitia, is a dense tissue of collagen fibers. If we compare the structure of the veins and arteries, it must be said that the ratio of the thickness of the vessel lumen to the wall is much higher in the veins than in the arteries. Veins are much less flexible than arteries.
The main property of veins, thus influencing blood flow indicators, is the high extensibility of the wall. Especially as the pressure in the vessel increases, the vessels dilate and tend to form a slit-like round shape. The degree of extensibility of the venous wall is quite transient and depends on many others. This factor does not allow the use of strict mathematical formulas to calculate its movement along the blood. The thickness of the venous wall in the vessels of the legs is much greater than, for example, in the neck.
They come from the wall of venous valves. They usually consist of two valves that are oriented toward the heart. In the area of attaching the valve to the wall, the diameter of the vein is slightly larger. Normally, when the valve covers are closed, blood from the cover cannot penetrate the underlying one. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative, (some call it physiology) and absolute. The main difference is in the duration of reflux during functional tests. There is also an opinion that a normal valve should not flow back. The valves are unevenly distributed through the vessels. There are several of them where the work of the muscle pump is most pronounced - that is, on the lower leg.
The main venous system of the lower extremities is represented by the following groups:
- leg veins;
- deep veins of the legs and thighs (deep vein system);
- large and small saphenous veins (superficial venous system);
- communicating (perforating) veins - provide communication between superficial and deep veins.
The deep and superficial venous systems together form a "sponge" from which blood flows to the heart as you walk. The work of this system is supported by the work of a muscle pump located in the lower leg that creates intermittent pressure in the veins.
These systems move the blood column upward and the valves inside the veins prevent backflow.
Blood outflow from the lower extremities through the deep and superficial veins is uneven. About 85-90% of the blood flows through the deep veins and only 10-15% through the subcutaneous veins. Thus, in healthy people, blood flow is carried out by a system of deep, subcutaneous and communicating veins.
Varicose veins are a serious problem
To say that varicose veins are "a disease of the twentieth or 21st century" is to deviate from the truth. Varicose veins have long been a concern for people. Even in ancient dissertations on medicine, a description of varicose veins can be found, in ancient Rome, people bandaged their feet with leather “bandages” to get rid of venous insufficiency.
If your feet get tired often, this may be the first sign of an initial disease of the venous system. Evening discomfort, accompanied by swelling of the feet and ankles, especially after a long stay on the feet, is a clear indication of venous congestion. Soon, unfortunately, he discovers his first varicose veins. The altered blood vessels form a blue-blue or red "pattern" on your feet, "stars", capillary "cobwebs" (telangiectasias), and eventually dilated veins and varicose nodules.
Severity, burning sensation, tingling and itching, pain and swelling, "stars", swelling of the veins in the legs - an acute signal for urgent action to save the beauty and health of the legs.
Questions about the condition of veins should be asked immediately by a specialist - a phlebologist who studies and treats venous diseases.
Venous disease starts harmlessly, but if left untreated it can become a serious problem.
Causes of varicose veins
To date, a large number of theories have been proposed to explain the causes of varicose veins. The most common are hereditary, mechanical, hormonal, etc. However, they primarily reflect factors that contribute to the development of the disease or accelerate the onset of clinical symptoms of the disease.
Both lower limbs are more commonly affected. However, dilation of the veins first appears on one limb and after a while on the other. Varicose veins on the right foot are more common.
Varicose veins of the lower extremities occur only in humans. This is due to the vertical position of the body, the effect of hydrostatic and hydrodynamic venous pressure on the valve device and the venous wall of the limb. With the weakness of the venous wall and the impaired function of the valve device of the main veins, which occurs at their innate inferiority, abnormal reverse blood flow occurs. The most common causes of varicose veins are
- Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives, etc. ) - affect the structure and sound of the vessel wall by gradually weakening and damaging it.
- Pregnancy is one of the main risk factors for the development of varicose veins. In addition to hormonal changes, the enlarged uterus and fetus put pressure on the hip veins and significantly impede blood flow to the lower extremities.
- Obesity is a proven risk factor for varicose veins. This is due to the increasing load on the venous system of the lower extremities.
- Lifestyle: People with prolonged static loads (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wearing tight underwear that compresses the main blood vessels at the level of the lumbar folds. Women in high heels.
- Heavy physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the abuse of which can also cause varicose vein provocation.
The essence of varicose veins is that the above causes result in a gradual dilation of the lumen of the saphenous and perforating veins, resulting in insufficiency of the valve device (closure of the valve leaflets). Pathological reflux (return) of blood occurs both from top to bottom and horizontally through the destroyed perforating veins.
Diagnosis of varicose veins
For many years, the hand was the only medical device used to examine varicose veins. X-rays have helped the surgeon in the last century. However, X-ray contrast examination of veins is a rather complicated procedure, requires large and expensive equipment, and the X-ray contrast agents themselves are not safe for the body at all. With the development of microelectronics and computing, previously unavailable diagnostic methods have emerged: ultrasound Doppler, ultrasound angioscanning, plethysmography. The advent of ultrasound duplex scanning has provided new information that has allowed a new understanding of the issues surrounding the causes of varicose veins and an understanding of the intricacies of the pathological process.
Doppler ultrasound
This is an ultrasound diagnostic method that allows the speed and direction of movement of particles (in this case, blood cells) in the body. This way, the doctor can find out the direction and speed of blood flow in the vessels of the lower limbs. And when you do a number of physiological tests and the condition of the valve device in the veins of the lower limbs. The main requirement for the choice of treatment method is to know the structure of blood flow in the veins of the legs.
Ultrasound scanning
The essence of this method is that a real-time image of blood flowing from and through the vessel wall is formed on the ultrasound scanner monitor screen. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the condition and direction of the blood flow through this vessel. The method is extremely informative and much safer than X-ray examination, but it is quite expensive, so it is only used in difficult cases and in scientific research.
Plethysmography
This is a diagnostic method based on the determination of the electrical resistance of the tissues of the lower extremities. The point is that the total electrical resistance of the tissues of the human body depends directly on the amount of blood flowing into and out of them, and varies with each heartbeat over time. Plethysmography is used to diagnose the general functional status of blood flow in the lower extremities, to monitor drug therapy for venous or arterial insufficiency, to treat trophic disorders, and to assess the extent of venous insufficiency.
Of course, all of these techniques do not preclude direct examination of the patient by a physician, clarification of the history of the disease, and identification of complaints submitted by the patient. Based on the general picture of the disease, the doctor chooses the method of treatment.
Varicose veins management
Over the past 50 years, there has been a qualitative leap in the treatment of varicose veins as well as in other branches of medicine. In recent decades, various drugs have been developed and are being further developed to treat chronic venous insufficiency. The surgical technique for treating varicose veins has improved significantly. The technology of compression sclerotherapy has been developed and practically improved.
Currently, so-called sclerosurgery is gaining popularity around the world. Sclerosurgery is an intelligent combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can only be applied to initial and uncomplicated forms of varicose veins. Varicose veins are also not without problems, the operation of removing varicose veins is quite traumatic, requires hospitalization and a long rehabilitation period. A reasonable combination of these two methods makes it possible to minimize the trauma of the treatment process and to achieve an exceptionally high standard of treatment.
Varicose vein therapy
Quite often, there are cases where the patient has virtually no varicose veins or a very small number. However, the person suffers from leg difficulties, pain, swelling. All of these are signs of chronic venous insufficiency. In these cases, as well as if a significantly enlarged varicose vein is present, medications should be taken that improve blood circulation to the legs. There are currently dozens of drugs in the phlebologist’s arsenal to combat venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should only be selected by a physician. Despite the apparent simplicity of venotonic agent selection, only a physician can determine the full range of therapeutic measures and the appropriateness of a particular drug.
Compression therapy
Compression therapy has been considered an adjunct to drug therapy or surgery for many years. Compression treatment of varicose veins has been used since ancient times, and it is only in the last decade that flexible compression has been considered a separate and independent type of treatment - compression therapy. Compression therapy involves the use of various brands of medical elastic bandages and special medical compression stockings.
Global industry manufactures three types of elastic bandages: short, medium, and high stretch. High-elongation ligaments (elongation greater than 140%) are used in the postoperative period after surgery on abdominal and pelvic organs to prevent thrombotic complications and to fix joints and prevent sports injuries. Short stretch ligaments (elongation less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitic syndrome, and lymphatic insufficiency. Medium elongation dressings (70% to 140% elongation) are used to treat varicose veins, chronic venous insufficiency, and compression sclerotherapy.
Medical compression stockings include medical compression stockings, tights, and knee height. Many people are mistaken and see the various "anti-varicose" and "supportive" jerseys with increased density as therapeutic. It should first be noted that medical compression products are never labeled in DENs. DEN is a technical feature of a knitted fabric that is only indirectly related to the pressure created by the product.
Medical fields are classified into several functional compression classes. The class of the product is determined by the pressure exerted by the product on the ankle and lower third of the lower leg. For varicose veins, the use of compression class 2 knitwear is demonstrated. These stockings or knee heights cause a pressure of 23-32 mm Hg on the affected leg. Art. , That is, it completely equalizes the pressure in the varicose veins and eliminates venous insufficiency. Moreover, medical compression products create so-called distributed pressure. The pressure they create gradually decreases as the foot travels from the bottom up by 25-30%, which contributes to the efficient outflow of blood and lymph.
It should be noted at once that the medical jersey is never thin and transparent, a large amount of elastic fiber is required to create such high pressure, and the knitted fabric is accordingly thick. It should also be said that medical jerseys are never cheap. The technology of knitting special knitted fabric is much more complicated, and when knitting, the profile of the foot must also be modeled to create distributed pressure.
The ideal approach in compression therapy is the constant and widespread use of elastic bandages and / or compression stockings by the patient. For example, wearing elastic bandages for one month a day is almost entirely consistent with the effectiveness of monthly administration of an effective drug. The use of compression stockings is particularly effective in preventing varicose veins from forming and recurring. The main advantage of using compression products is that even compared to the best drugs, they are absolutely safe for their health and quite comparable in terms of cost.
Preventing varicose veins
If there are initial signs of varicose veins, adherence to fairly simple rules slows down and in some cases avoids further development. First of all, do not miss hot baths, saunas, prolonged sunshine. All of the above reduces venous tone, leading to stagnation of blood in the lower extremities. Do not wear tight clothing, stockings or socks with a tight elastic band as this will compress the blood vessels. Being overweight and sports that involve static load on the legs (tennis, weightlifting, bodybuilding) increase venous pressure. High heels (over 4 cm) - our veins don't like it. Be careful not to injure the veins.
If you feel heavy in the evening after a work day, keep your feet high while sleeping and resting. If your work is accompanied by a long sitting at the table, or if you are standing for a long time, you will need to change the position of your legs more often, move into place, and rotate your legs. There are special practices against venous diseases. After showering or bathing, rinse your feet with cold water. There are useful sports - mainly swimming, but also walking, cycling, skiing. Do not ignore folk remedies for prevention. Useful infusions of blueberry, St. John's wort, blueberry, rosehip leaves. Plant diet should be followed. Your doctor may also prescribe a medicine called phleboton to increase venous tone and improve microcirculation. Recently, methods of controlling and treating varicose veins have also become understandable successes due to the advent of high quality medical products.
Special word for the prevention of pregnant women. Varicose veins progress during pregnancy, especially if this is not the first and carrying a baby under 1 year of age does not contribute to good vascular function. Prevention is based on wearing special compression stockings, using phlebotonics both during pregnancy and after childbirth. Do not ignore the mention of veins to your gynecologist when prescribing hormonal medication to you, as these medications affect the function of the veins, reducing their voice.
Do not self-medicate. Talk to your doctor about what is best with your veins. This disease is treated by doctors - phlebologists.