Varicose veins

Varicose veins in the legs (varicose veins) is a common disease characterized by the continuous and irreversible expansion and elongation of superficial veins and their functional impairment due to the development of pathological processes in the vein wall and congenital or acquired valve deficiency. apparatus.

According to the World Health Organization, varicose veins are found in every fifth adult on the planet. The first signs of varicose veins (venous reflux) are detected in 10-15% of children and adolescents aged 12-13 years.

Causes of varicose veins in the legs

• Hereditary tendency (congenital weakness of vascular valves). If your parents have signs of weakness of the vein walls in any vessel (legs, groin, esophagus, rectum), then with a high degree of probability symptoms of varicose veins may appear in you.
• Poor circulation in the lower legs during pregnancy and childbirth (compression of the abdominal veins by the developing fetus with increased pressure in the leg veins, hormonal changes cause a decrease in vein tone).
• Clogged blood flow during long standing (nodular veins on the lower leg more often among salesmen, teachers, waiters, surgeons) and in a sitting position (managers, accountants, office workers, drivers, etc. )
• Heavy physical work, sports training related to weight lifting (for athletes, loaders, builders, regular visitors to gyms and fitness clubs)
• Long-term use of contraceptive drugs with a high content of female sex hormones.
• Hormonal changes in the body, accompanied by a decrease in the tone of venous blood vessels (adolescence, pregnancy, menopausal disorders in old age).
• Factors such as being overweight, chronic cough, constipation, and the habit of wearing tight clothes and shoes interfere with venous outflow and often cause varicose veins.

Why do varicose veins occur during pregnancy?

In women, varicose veins on the lower legs are observed 3-5 times more often than in men and occur quite often for the first time during pregnancy. In 80% of cases, varicose veins first develop on the left leg, and only then on the right.

• The appearance of varicose veins is facilitated by hormonal changes in the female body during pregnancy, causing a decrease in the elasticity of the vein walls, stretching and transformation into varicose nodes.
• In the body of a pregnant woman, the amount of blood flow increases significantly. Increased venous pressure leads to thinning of the vein wall and local expansion (varicose veins).
• The growing fetus causes a corresponding enlargement of the uterus and difficulties in the outflow of blood from the lower legs through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
• Weight gain of pregnant women also has a negative effect on venous outflow.

Varicose veins on the lower legs: symptoms

Varicose veins develop relatively slowly, through several main stages in a row:

• In the first stage, the violation of venous circulation is accompanied by the appearance of individual "spider veins", thinning of the skin, where, during physical activity, the dilated veins in the form of twisted cords begin to appear through (usually in the popliteal fossa), there are no complaints.
• In the second stage of varicose veins, there is a feeling of heaviness, fatigue in the lower part of the legs, swelling of the legs in the evening and after a long walk, a feeling of "pins and needles" crawling along the legs, night cramps in the calf muscles, after careful examination, several veinsexpanded revealed on the lower part of the leg, and sometimes - on the leg and thigh.
• The third stage of varicose veins on the lower leg is characterized by significant swelling of the venous nodes especially on the inner surface of the leg, the appearance of brown or dark brown spots on the thin and easily injured skin of the legs, and the development of dermatitis with itching and rash. Swelling of the legs becomes more intense, making it difficult to walk.
• The fourth stage of varicose veins is the presence of varicose nodes on the legs, feet and thighs, the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose nodes, development of thrombophlebitis).
• Sometimes the fifth stage is also distinguished - there are all the characteristic symptoms of the fourth stage of varicose veins, with the spread of the process to the groin, buttocks, perineum, the presence of various trophic ulcers, the appearance of elephant legs, frequent. exacerbation of thrombophlebitis, and the onset of disability.

Complications of varicose veins

1. Superficial vein thrombophlebitis.
2. Bleeding when varicose veins rupture.
3. Dermatitis, eczema.
4. Trophic ulcer.
5. Deep vein thrombosis (phlebothrombosis) and postthrombophlebitic disease.
6. Pulmonary embolism (PE).
7. Lymphedema (elephantiasis).

Diagnosis of varicose veins

It is based on clinical examination, conducting functional tests, and conducting instrumental studies of veins.

• Clinical examination (clarification of complaints, history taking, examination, palpation).
• Doppler ultrasound.
• Ultrasound angioscanning.
• Plethysmography.
• Ascending and descending phlebography.
• Radionuclide phlebography (radiophlebography).
• Computed tomography and MRI (CT venography, MR venography).
• Intravascular ultrasound examination.
• Thermography.

Treatment of varicose veins on the lower leg

If varicose veins are detected at an early stage, you can overcome their manifestations using compression stockings, special therapeutic exercises and traditional treatment methods. But if you visit the doctor late, when varicose veins are visible to the naked eye, your legs hurt and swell, trophic ulcers appear, signs of thrombophlebitis, the only way out is surgical intervention.
At the same time, you don't need to be afraid of surgery, because modern technology makes it possible to remove varicose veins on the lower leg without wide incisions, without pain, and practically without interfering with a person's normal way of life.

The principle of surgical manipulation is similar for different techniques: pathologically altered superficial leg veins are ligated, cut and removed. In this case, the venous circulation in the lower part of the leg is not disturbed, because the operation does not affect the deep veins, where about 90% of venous blood flows.

The main types of operation for varicose veins

1. Sclerotherapy. In the initial stages of varicose veins, good cosmetic results are achieved by inserting special drugs into the problem veins, causing gradual sclerosis, "gluing" the pathologically expanded area of the vessel. A medicinal substance (usually a sclerosant) is injected through a special catheter or very thin needle into the varicose vein. To achieve a positive result, 3 to 10 injections are required.
2. Phlebectomy. The operation has been performed for almost a hundred years, but in modern conditions the wide incision has long been abandoned. Today's manipulation is carried out through a small incision of 3-5 millimeters. The pathologically dilated vein is first ligated and crossed at the point where it flows into the deep vein, and then removed using a special probe. The operation lasts about 1-2 hours, after which the patient remains in the hospital of the medical institution for 1-2 days.
3. Miniphlebectomy. The operation is performed under local anesthesia, without an incision, but with the help of a small puncture through which the varicose veins are removed. This achieves a good cosmetic effect (usually no stitches are needed) and significantly reduces the recovery period after surgery. In some cases, not the entire vein can be removed, but only its pathologically altered part. This intervention is called short stripping.
4. Endovenous laser coagulation of veins. Manipulation is carried out under ultrasound control. A special laser light guide is inserted into the pathologically dilated vein and the saphenous vein and its tributaries are burned. After a certain period of time, the destruction and sclerosis of the vein occurs, its complete closure. If necessary, laser coagulation is combined with miniphlebectomy. In this case, the effectiveness of the surgical treatment of varicose veins on the lower leg will be the highest.
5. Radio wave ablation of varicose veins. Destruction ("gluing") of the altered lumen of the vein is achieved through exposure to radio waves of a certain power supplied to the problem area of the vein through a special catheter. The duration of the procedure is about 20 minutes.

After the surgical treatment of varicose veins using one of the above methods, it is necessary to limit physical activity for a certain time, wear compression stockings and, if necessary, use drugs that have a venotonic effect. This will help restore normal blood circulation in the lower leg veins as soon as possible, prevent possible complications, and allow you to quickly return to work and a normal rhythm of life.

In what case is the surgical treatment of varicose veins of the legs undesirable?

• During pregnancy and in the first two months after birth.
• In the early stages of varicose veins, when there are no more complaints, and the existing cosmetic problem ("spider veins" on the legs), you can try to eliminate them with the help of exercise therapy, compression socks and traditional methods.
• In old age and in the presence of serious diseases of various organs and body systems with dysfunction, when the risk of possible complications increases significantly.
• In the presence of lymphatic drainage disorders, infectious lesions on the skin of the lower legs, thrombophlebitis, arteriovenous fistula.

With the correct choice of the most effective method of treatment for varicose veins of the lower extremities in this particular case, the absence of contraindications and following the doctor's recommendations in the postoperative period, a positive result of surgical intervention will be guaranteed.

Prevention of varicose veins on the lower leg

Regime and diet

Compliance with a certain work and rest regime, as well as nutrition, in most cases will prevent the appearance of varicose veins. To do this, you need to:

• Avoid clothing that restricts venous blood flow.
• Avoid prolonged periods of standing or sitting (take periodic breaks with rest and do simple gymnastic exercises).
• Avoid strenuous physical activity.
• Live an active lifestyle (moderate dynamic load - daily walking, swimming, cycling).
• Drink at least 1. 5-2 liters of fluid per day; Your daily diet should include vegetables and fruits, whole grain bread and cereals.
• Avoid visiting baths and saunas, and refuse to take hot showers.
• Contrast bath (warm - cold) every day.
• Use comfortable shoes with low heels.

Antiplatelet therapy

An important component of preventive measures for varicose veins on the lower leg is taking drugs that have an antiplatelet effect, that is, prevent the formation of blood clots. This includes:

• Acetylsalicylic acid and modern medicines containing it;
• Venotonics of plant origin - extracts from plants such as horse chestnut, hazelnut, mountain arnica are more often used;
• Synthetic venotonics. In this way, venotonic not only reduces the formation of thrombus, but also improves venous blood circulation, strengthens the vascular walls, prevents the appearance of expansion areas.

Compression jersey

For many years, bandages with elastic tube bandages have been successfully used in the early stages of varicose veins (when spider veins appear). Special clothes are now produced - compression knitwear, which allows you to choose the required size and choose the level of compression depending on the severity of the changes. Wearing tights and tights initially puts pressure on the top of the ankle, followed by a decrease in pressure and stimulation of blood flow up to the heart. Venous vessels work more efficiently, as a result of which venous congestion is eliminated, swelling disappears, and thrombus formation is prevented.

Gymnastics

Special exercises have been developed aimed at eliminating venous blood stagnation. The key to success here is the regularity of performing the complex. Let's consider some basic exercises recommended in the presence of risk factors for the development of varicose veins on the lower legs and in the early stages of the disease:

• Lie on your back, feet on a pillow on a raised platform. Relax and stay in this position for a few minutes.
• "Bicycle" - lie on your back, legs raised, knees bent. Perform movements that resemble pedaling while riding a bicycle;
• "Scissors" - lie on your back, lift your legs and cross them, change the position of your legs (up - down) for 1 minute;
• The leg is lifted and bent at the knee joint. Bend and straighten your legs, imitating walking;
• Lie on your back, bend your left leg, bring your knee to your chest. Wrap your hands around your legs at the ankle joint and gradually straighten your legs, making massaging movements on the calf muscles. Repeat the exercise with the right leg;
• Stand with feet together. Raise yourself on your toes and lower yourself (if there are no complications, the exercise can be performed abruptly - with your heels touching the floor).

Timely initiation and implementation of the correct preventive measures can prevent varicose veins on the lower legs or minimize their manifestations.