Varicose veins

Varicose veins in the lower extremities are often asymptomatic in humans. Often the only problem with this pathology is the aesthetic defect of the legs caused by the protruding superficial veins. In this case, the disease may be accompanied by pain or increased sensitivity of the skin of the legs. Depending on the severity of the disease, the patient is advised not to be treated with medication, medication, or surgery. Read more about the first symptoms of varicose veins, the nature of its course and effective methods of treatment and prevention, read our material.

Which

Varicose veins are pathologies that only people suffer from. There is no such problem in animals, suggesting that the disease is associated with a straight posture. When the man stood up, most of the circulating blood began to settle below the level of the heart. In this case, all the conditions are created for the blood to circulate worse in the opposite direction, leading to stagnation.

According to statistics, certain disorders of the venous system are observed in 80% of people in developed countries. Moreover, similar problems are becoming more common at a young age. In all likelihood, one of the reasons for varicose veins to "get younger" is a sedentary lifestyle that only contributes to stagnation.

Interestingly, in the under-20 age group, varicose veins of the lower extremities occur with equal frequency in both men and women. However, after the age of 20, women begin to predominate in the morbidity structure. This is due to pregnancy and childbirth, which are serious factors in the development of venous diseases.

Characteristics, causes and mechanism of varicose veins formation

The exact causes of varicose veins in the lower extremities are still unknown. The disease is currently thought to be caused by congenital or acquired defects in the veins of the lower extremities.

Unobstructed ascending blood flow through the veins requires well-coordinated work of the venous valves. These valves only open for blood flowing upwards. However, a partial descending blood flow is also possible with a valve failure. This is how venous insufficiency develops, which manifests itself in edema, muscle cramps in the legs, and dilation of venous blood vessels.

Leukocytes may also be involved in the pathogenesis of varicose veins. This issue is currently being actively studied. Prolonged accumulation of leukocytes is thought to result in an inflammatory process in the tissues of the vessels (particularly in the area of the valve system) that spreads along the venous bed.

Because venous valves are subjected to constant mechanical stress, inflammation develops particularly rapidly in the region of the venous valve device.

Today, the vast majority of people in developed countries lead a sedentary lifestyle. But then why doesn't everyone have varicose veins? Consider the main risk factors that contribute to the development of the pathology:

• Hereditary factors. . . Although specific hereditary mechanisms associated with the formation of varicose veins have not yet been established, most experts agree on the presence of such a factor. However, there are serious counter-arguments for the development of varicose veins inheritance. For example, this is the incidence of varicose veins among African ethnic and African immigrants who have left for the United States. If the prevalence of varicose veins among sedentary Africans is about 0. 5%, then among emigrants this proportion reaches 20%. These numbers show that at least hereditary factors are not the only ones in the development of the disease and are unlikely to prevail.
• Obesity. . . Overweight and obese people are at risk. It is important to note that obesity contributes to varicose veins both due to the increasing stress on the blood vessels and the risk of other diseases affecting the blood vessels (diabetes mellitus, hypertension, and others).
• Pregnancy. . . This is one of the most obvious factors in the development of varicose veins in the lower extremities. In this case, the main risk factor is an increase in the volume of circulating blood and compression of the retroperitoneal veins by the fetus developing in the womb. Epidemiological studies have shown that second and subsequent pregnancies significantly increase the likelihood of developing varicose veins. After the first pregnancy, the likelihood of varicose veins in the legs remains low.
• Hormonal imbalance. . . Hormones are involved in the pathogenesis of most diseases. These pathologies include varicose veins. This problem is especially true for women who are taking hormonal contraceptives and who are taking hormone replacement therapy to treat certain conditions (such as osteoporosis) or during the premenopausal period. Female sex hormones (especially estrogens and progesterone) have been found to reduce vascular tone and destroy collagen fibers. Thus, the wall of the veins dilated pathologically.
• Lifestyle. . . The lifestyle of a person greatly influences the course of the disease. A sedentary lifestyle and work related to a long-term job or session (such as security guards, drivers, office workers, service workers, and others) contribute to the development of varicose veins. You also need to pay attention to nutrition. Lack of adequate amounts of vegetables and fruits in the diet worsens the condition of the walls of the blood vessels.

Stages of varicose veins in the lower extremities

Several classifications of varicose veins in the lower extremities are currently used. The international classification CEAP, adopted in 1994, is considered to be generally accepted. CEAP is an abbreviation where each letter corresponds to the name of a classification category:

• C (clinical)- the clinical class of the disease (type of veins involved, pigmentation, eczema, presence of trophic ulcers).
• E (Etiological)- etiology of the disease (congenital, primary, secondary).
• A (anatomical)- anatomical localization of the pathology (superficial or perforating veins).
• P (pathophysiology)- type of disorder (venous reflux, obstruction or a combination of the two).

The course of the disease takes place in six stages:

• Section zero. . . The earliest stage of varicose veins is when even doctors cannot reliably make a diagnosis. There are no external signs of the disease at this stage. Ultrasound diagnosis does not indicate the presence of pathology. However, the person in stage zero is worried about symptoms such as swelling, feeling of heaviness in the legs, and cramps, which indicate the presence of vascular problems.
• First phase. . . Already in the first stage of the disease, spider veins with a diameter of less than 1 millimeter can be seen on the surface of the skin of the foot. Medium-sized veins can increase in diameter by up to 3 mm. At this stage, physicians are not always able to make a correct diagnosis because the presence of such stars does not always indicate varicose veins.
• Second stage. . . At this stage, the veins may appear and disappear depending on the circumstances. For example, veins clearly appear after prolonged sitting, standing, or lifting heavy objects. The diameter of varicose veins at this stage is 3 mm or more. In the second stage, blood clots often form.
• Third stage. . . If the swelling of the legs appeared and disappeared in the earlier stages of the disease, the edema would become permanent in the third stage. Swelling of the legs is most severe in the evening.
• Fourth section. . . Significant trophic changes occur at this stage. In particular, the feeding of tissues is disturbed near the affected veins. The patient's skin develops lesions such as lipodermatosclerosis (inflammation of the fatty tissue under the skin), eczema and darkening or discolouration of the skin. The fourth stage of the disease is characterized by pigment changes. For example, the skin in the affected vessels may turn brown or even black, indicating the concentration of pigments in that area. The opposite situation is also possible when, as a result of an abnormal process, the pigment does not enter the affected area, leading to the appearance of pale skin tone. If varicose veins are not treated at this stage, the problem will only get worse with the further appearance of trophic ulcers.
• Fifth stage. . . In this stage of the disease, in addition to the above symptoms, trophic ulcers also appear, which heal quickly. If you do nothing to treat it, the ulcers will appear again and again.
• Section Six. . . Non-healing trophic ulcers appear. The temperature in the affected area rises significantly, pus can leak out of the wounds.

You should not wait for the last stages to develop - you should go to the doctor for a second to register and monitor the dynamics of the disease. Sometimes the symptoms improve on their own, and sometimes they progress quickly. That is why it is important to monitor the situation so that we can take timely action.

Symptoms

Consider the main symptoms of varicose veins in the lower extremities at different stages of the disease:

• Pain. . . This is the earliest sign of the disease. Because pain is not a specific symptom, it is impossible to make a diagnosis based on this symptom alone. In varicose veins of the lower extremities, pain is often localized along venous trunks.
• Feet in the legs. . . It also applies to early symptoms, while the blood vessels in the skin are not yet visible. The feeling of heat is often accompanied by throbbing pain.
• Cramps and itching in the muscles. . . They are most often disturbed at night.
• Swelling in the legs. . . In the early stages of the disease, the swelling is mild and transient. They usually show up in the evening and disappear in the morning. However, as the disease progresses, the severity increases and they become more permanent.
• Discoloration of the skin. . . In the case of varicose veins, the skin of the lower extremities darkens. The skin in the affected veins turns brown. In the advanced stages of the disease, eczema and dermatitis occur. The terminal sections of varicose veins are characterized by the appearance of trophic ulcers. Initially, these are ulcers that heal, but later they do not heal.
• Vascular spiders. . . In the medical literature, such stars are called telangiectasias. In some people, varicose veins may be limited to spider veins without developing into larger veins.
• Twisted dilated veins. . . The most common symptom of varicose veins is the twisted veins that form on the surface of the foot.

In summer, the symptoms of varicose veins become more pronounced. This is due to the high ambient temperature, which is already contributing to the dilation of the veins. Therefore, during the hottest hours, between 10 a. m. and 4 p. m. , it is best to stay in a well-ventilated area.

When to see a doctor

You should see a doctor as soon as the first symptoms of the disease appear - pain, swelling or spider veins. Because the early stages of varicose veins are difficult to diagnose, they may be misdiagnosed initially. The patient should closely monitor the condition of the legs and be monitored regularly by a phlebologist.

Diagnostics

Diagnosis of varicose veins in the lower extremities is limited to the following activities:

• External examination of the skin of the feet;
• Doppler ultrasound;
• Duplex vein scanning;
• Phlebography.

Characteristics of treatment

Varicose veins in the lower extremities are also treated conservatively and surgically. Conservative treatment is limited to the following activities:

• Drug therapy. . . This is the intake of medications that improve the tone of the venous walls. In addition, the patient is prescribed medications that reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, anticoagulants are also prescribed.
• Compression therapy. . . This is wearing a special compression stocking that reduces the load on the foot. The advantage is that the load can be evenly distributed even under heavy physical exertion. Congestion and swelling can be avoided when using a compression garment.
• Physiotherapy and lifestyle change. . . The patient is advised to exercise to relieve leg tension. It is important to avoid prolonged sitting or standing. If you need to stand or sit at work for long periods of time, you need to take more breaks.

If conservative therapy for varicose veins does not produce the expected results, a decision should be made on surgery. Most commonly, these are minimally invasive interventions, including:

• Sclerotherapy- the introduction into the vein of substances that adhere to the wall of the affected vessel. This treatment leads to the absorption of spider veins.
• Laser coagulation- the introduction of a laser light guide into a vein and the irradiation of the walls with a laser, which also leads to the gluing of the walls and the further resorption of the vessel.
• Radiofrequency ablation- gluing of vessels with high frequency current.
• Phlebectomy- Removal of affected veins in which blood circulation has deteriorated by 90%.

In some countries, surgery is free of charge under compulsory health insurance. But it is not a fact that all types of compulsory insurance operations are insured everywhere. In any case, they will give you help, but you need to find out if it is a traditional removal or a laser.

Contraindications for patients with varicose veins

• Sedentary lifestyle. . . It is important to avoid prolonged sitting or standing. Physical activity helps prevent vein congestion.
• Running and strenuous exercise. . . When exercising, it is important not to overdo it. If you have varicose veins, walking is definitely better than running.
• An unbalanced and unhealthy diet. . . You should give up fast food, even if your health seems to allow it. You should limit your consumption of sweets, semi-finished products, and rich broths and smoked meats. But it would be a good idea to eat more vegetables and fruits.
• Hot tubs and showers. . . For those with vascular problems in the extremities, too hot and prolonged aqueous procedures are contraindicated.

Complications of varicose veins

Varicose veins can be complicated by trophic ulcers, phlebitis, and deep vein thrombosis. The latter is the formation of blood clots in the deep veins that endanger human life.

Conclusion

Symptoms of varicose veins in the lower extremities usually do not appear immediately. Different people have different sets of manifestations. For example, sometimes with this pathology there is no edema or no local fever or pain. This does not mean that there is no disease at all. A timely visit to the doctor will significantly slow the progression of the disease or even stop it, preventing the development of trophic changes.