Varicose to find, or varicose veins of the lower limbs primary varicose transformation of superficial veins of the lower extremities, in which such "bumps" or "knots" on her legs.
Varicose disease is very prevalent all over the world. The frequency of reaching 60 % in adults, depending on the country. The interesting thing is that the people of the African continent, in the Asia-Pacific region, the varicose I found a lot less than people in the countries of Europe, in the united states.
In relation to the absence of a specific cause of varicose veins of the lower limbs is usually to talk about its risk factors, i.e., the probability of which is increased by pathology (a trait or characteristic of the human body, its effects on the body). The common risk factors into account-age, female sex, obesity in heredity. A typical "portrait" of the patient from the symptoms of varicose to find a female in a state of menopause, with an excessive body mass index, have more of the pregnancy to the birth of a baby in medical history.
The symptoms of varicose found on the legs
The majority of In a lot of cases, the varicose of the time, admitting it can be even without any specific medical education. Set a goal of signing the pathology — the appearance of the "bumps" or "nodes" of the lower extremities, while above them, on the skin are usually not distinguished by any particular color. The blue veins, and therefore is usually not a disease in its literal sense, although they often bring to the patient (most often female) features of an aesthetic nature.
However, in the more extreme cases of varicose found can be due to the accompanied by a discoloration of the skin, venous eczema, which is honored in a variety of different itchy skin rash (vesicles, nodules) on redness.
These symptoms, combined with swelling of the legs, which does not disappear on the night of the show by the time of the occurrence of chronic venous insufficiency.
As for the subjective symptoms of varicose found, it should be noted, however, that are quite specific. The complaint can be the show of the disease is in it you can log in to the overload of the venous system of the lower extremities. Most often, patients are suffering because of the weight, etc, in a mild non-localized aches of the pain in the calf. Sometimes, as with complaints of pain in the area of the varicose can be found in the fatigue of the feet.
A burning sensation, tingling sensation, muscle cramps night restless leg, or a syndrome, unpleasant sensations in the legs at rest, thus, when the movement to ease the discomfort) is the most frequently found in neurological diseases, such as radicular syndrome, in order to be considered carefully.
In the Pathogenesis of varicose found on the legs
In the Pathogenesis of varicose veins of the lower limbs is quite complex, the all-rounder. Play a major role in the mechanism of the disease, the development of the play to the damage of the walls of the valves can be found. As a result of their irregular business generated a reverse flow of blood (reflux), then there is a loss of the endothelium (the inner lining of the vessel), which is accompanied by inflammation of the joint.
Later in the pathological process involved in the medium in the inner layers of the vein wall, there is a proliferation of connective tissue into the muscle layer of the vein, and in nato, to its atrophy, which leads to the progressive destruction of the collagen of the vessel. These sessions will be to the elastic properties, in Vienna, austria, to contribute to the further expansion of its lumen in a spiral twisting along the length of the. At the same time, similar changes were observed in venous valves.
It should be Noted, however, that a vein visible "bumps" in the "knots", which is usually the result of the presence of the invisible, the source of the varicose found one of the large saphenous vein of the vein. In the vast majority of cases, it is a great, rare, small saphenous vein the vein. These changes in the pool of those to be found in the cause of varicose.
Complications of varicose found on the legs
Complications of varicose found the need to include trophic disorders (venous ulcers), thrombosis or changes in varicose veins (thrombophlebitis) or iz bleeding varicose "bumps in the node".
Trophic disturbances, as the consequence of the progression of the absence of the treatment of the diseases of the often the last year of the decade. You Start with the skin manifestations of hyperpigmentation (brown spots), venous eczema in lipodermatosclerosis (seal skin).
The main data of these changes, it is removed, though it can be venous eczema occur on any area of the varicose found, among other things, on the thigh. Depending on the source of the varicose found (big, small, or the saphenous vein is found) in the vein of the disease will be localized to either the inner or the outer surface of the lower thirds of the leg, and as a Result of malnutrition of the soft tissues of the formation of a venous ulcer at the site prior to the change. Ulcers as one, or more, with an irregular shape, sloping edges of a flat, smooth bottom. It should be Noted, however, scant discharge, often purulent in character. Of the wound, so that it will be accompanied by itching of the pain. Venous ulcers, For it is necessary to draw attention to the existence of a period of time (months) of the frequent recurrence of the.
Thrombophlebitis or superficial vein thrombosis is not for smes to be replaced by a deep vein thrombosis. In the second case, the situation is much more serious. However, in thrombotic lesions, varicose to find the symptoms very uncomfortable. In the region of the thrombosed vein painful threadlike form a seal, it is characterized by redness, local rise in temperature, increased sensitivity, and sometimes a seal to restrict movement of the limbs. In the clinical picture or, more resembling the ulcer of an abscess.
Thrombophlebitis is dangerous, you can, especially if they are taken up into the nature of the self he knows iz and moving the superficial system to the deep. In this case, it can be developed as a pulmonary embolism in deep vein thrombosis.
Bleeding from a varicose to find the look to be very frightening, due to the high pressure of the venous flow of blood strong enough. In some cases, it may result in no significant loss of blood.
The diagnosis of varicose found on the legs
The diagnosis of varicose veins of the lower extremities, usually does not cause any problems. A key feature of the disease is the presence of venous "strokes," and/or "node". Even though it is the development of excess subcutaneous fat in the lower limbs, so it may be difficult for you.
Further, For the confirmation of the diagnosis using various methods of instrumental diagnostics, the leader of which is ultrasonic duplex scanning (USDs). If it allows you to quickly, accurately worked to determine the source of the varicose identified, in order to estimate the size of the vessel, the structure, the function of vein valves, which involves the distribution of the return flow of the blood is detected to the presence of blood clots. At the same time look deep into the surface of the vein system. For the implementation of the survey is to be in a standing position, or, if the patient's condition does not allow to sit with the legs. The study in the supine position may result in no error in the determination of the reflux in the blood clotting.
To further assess the function of the valves, the length of the return flow of the blood, which is used for:
- the compression of the test pressure of the various segments of the lower limb;
- a sample of the straining (Valsalva test);
- a simulated walk;
- welcome to the paraná is easy to attempt to remove the patient from the equilibrium state, with the intention of calling the tension of the calf muscles.
Duplex ultrasonographic Summary of a study of lower limb veins is necessary to specify, in the form of an opinion, the graphics, the use of "vein map". The results of this study provide valuable assistance in the planning of further treatment. In spite of this, however, is that it should only be considered in conjunction with clinical information, such as a change in the pattern of the ultrasound of the absence of objective signs of disease (varicose find it), it should be taken into account, the functional (i.e., ki is not associated with the pathology of blood vessels). It should also be noted, however, that an ultrasound scan does not necessarily have to approach a diagnosis if it is not clear, the patient is not a plan for the surgical treatment of varicose veins.
There is a method to further diagnose:
- Doppler Ultrasound — Doppler ultrasound (not to be confused with the USDS);
- plethysmography;
- radiopaque venography;
- radiotelegraphy;
- computed tomography (CT);
- magnetic resonance imaging (MRI);
- thermography;
- intravascular ultrasound (IVUS) is a new method.
The treatment of varicose veins in the legs
The primary goal of the treatment of varicose veins of the lower extremities to eliminate the defect can be found. Yes, it is possible only by means of invasive surgery. There are three methods:
- Deleted — combined phlebectomy short vein Stripping, miniphlebectomy, dissection of the perforating veins;
- "Bonding" — sclerotherapy, mechanochemical ablation, cyanoacrylate obliteration;
- "Software" — endovenous laser or radiofrequency ablation.
In order to achieve the goal must be the treatment to do two tasks: in order to remove the source of the varicose found (the so-called vertical reflux) to remove the varicose can be found. For a long time The most widely applied method was the combination of phlebectomy. Its technical construction includes a two-phase process:
- Ligation anastomosis — the connection of the great saphenous vein of the vein of " the common femoral veins (crossectomy);
- Remove the trunk of the vein with the probe saphenous vein (Stripping).
This is an intervention radical in a number of the deficiencies as part of any performance: the frequent need for anesthesia, the presence of the incisions into the suture, in a significant rehabilitation period, in comparison with the other methods, the risk of complications.
However, about twenty years of age he was "the phlebology of the revolution." To become a result of the widespread adoption of ultrasound in scanning the appearance of fine techniques, endovenous thermal ablation. At its core, however, lies in the effects of a high-temperature veins in the walls from the inside out. That can be achieved with the laser radiation (EVLO) or an RFR (RFO), "safariways" the light into the vein.
Report it immediately to cease to act in and then gradually resolves. This Method allows you to cut quickly, efficiently, he was taken in by the aesthetic of a vertical the elimination of reflux, without the need for further rehabilitation. However, the bright representative of the "office surgery", endovenous thermal ablation, for ten years, is considered to be the most optimal method of treatment of varicose veins of the world.
Sclerotherapy (the sticking of the handicapped to find a injection of substances) has also found wide use in the remedy of varicose found. However, in order to achieve the desired result requires a careful selection of the patients because of an increased risk of recurrence of the disease.
Conservative treatment, including compression therapy, phlebotrophic drug use in the local medicinal forms (gels, ointments), that is, a purely auxiliary nature, which is mainly the impact of the symptoms of varicose veins elimination without its source.
Selection. The prevention of
Taking into account the modern methods of treatment, the prognosis is favourable, varicose can be found. The most advanced appears in cases in which the removal of varicose transformation of to find a the lead is not a rapid improvement in the health status of the patient.
However, the planning of the treatment, it is important to assess the risk, as with any intervention, still carries possible side effects. The duty of the physician is to minimize their likelihood of occurrence. Prior to any handling of it should be discussed with the patient all the aspects related to the intervention in to get his signature on the agreement.
[Spirits of the craft] - adverse events, which can be divided into the risks associated with surgery, including anesthesia, and the risk to the patient.
The risk of a small operation can, for example, inflammation of (phlebitis), against a "brewed" or sklerozirovanie of the time, a difference in its tracks the projections of the mild aches and pains. There may be areas of reduced sensitivity in the mouse skin in the hyperpigmentation of the skin. All of these effects, so that the side of the temporary, in the usually pass fairly quickly, and without consequences of any kind of.
No major complications, including deep vein thrombosis, allergic or toxic reactions to the anesthetic. They occur very rarely, but it has to be one of the patient who suffered this complication, and in the case of 100%, even if the stats of 1 of the operation in the case of the 10,000.
The prevention of venous thrombosis in the first instance, it is based on the calculation of the risk of the so-called scale-point scale, with the use of a table of the Caprini. Provides a variety of risk factors, such a gradation. Each Account is for the removal of a component in the overall score determines the level of risk involved in and, therefore, its prevention. Middle of the Main for the prevention of venous thromboembolism following:
- the reduction of the morbidity of the operation;
- the early activation of the patient;
- the compression of the sock;
- pharmacological prophylaxis, i.e. it functions according to the testimony of anticoagulants — drugs that thin the blood.
As for the prevention of varicose veins, it simply doesn't exist, because it is not yet clear, it is the main cause of the pathology, which is likely to have an impact, and to prevent its onset. Related to this, very often, the recurrence of varicose veins after any type of intervention. However, in the light of all the advantages of a minimally invasive treatment, it is not a significant problem. Keep your legs fairly easy, the main time refer to phlebologist