The word "varicose" comes from the Latin varix, varicis - bloating. The first mention of the treatment of varicose veins is found in the ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffer from chronic diseases of the veins of the lower extremities. Its complications in the form of dermatitis, cellulitis, bleeding, thrombosis, and trophic ulcers often lead to long-term disability, sometimes causing disability.
The structure and work of the vein system
How our veins work 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, represented by a layer of cells on the connective tissue membrane. The middle layer is muscular. It mainly consists of circularly located smooth muscle cells, which are, as it were, in a frame of collagen fibers. Superficial veins contain a thicker muscle layer than deep veins. The outer sheath of veins, the so-called adventitia, is a dense tissue of collagen fibers. If we compare the structure of veins and arteries, then it should be said that the ratio of the lumen of the vessel to the thickness of its wall in veins is much greater than in arteries. Veins have much less elastic fibers than arteries.
The main property of the veins, so influencing the blood flow indicators, is the great extensibility of its wall. In particular, when the pressure in the vessel rises, the veins expand and tend to acquire a round shape from a slit-like one. The degree of extensibility of the venous wall is quite ephemeral and depends on many other things. It is this factor that does not allow the use of rigorous mathematical formulas for calculating the movement of blood along them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, on the neck.
Venous valves originate from its wall. Normally they consist of two valves, which are oriented towards the heart. In the area of valve attachment to the wall, the vein diameter is slightly larger. Normally, when the valve leaflets close, blood from the overlying section cannot penetrate into the underlying one. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative, (some call it physiological) and absolute. The main difference is in the duration of reflux during functional tests. There is also an opinion that there should be no reflux with a normal valve. The valves are distributed unevenly through the veins. There are more 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:
- veins of the foot;
- deep veins of the leg and thigh (deep vein system);
- large and small saphenous veins (superficial vein system);
- communicating (perforating) veins - provide communication between superficial and deep veins.
The deep and superficial venous systems together form a "sponge", from which, when walking, blood rushes up to the heart. The work of this system is supported by the work of a muscle pump located in the lower leg and creating intermittent pressure in the veins.
These systems move the blood column upward, and valves inside the veins prevent backflow.
Outflow of blood from the lower extremities through 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, the outflow of blood is carried out by the system of deep, saphenous and communicating veins.
Varicose veins are a serious problem
To say that varicose veins are "a disease of the XX or XXI century" means to deviate from the truth. Varicose veins have been troubling people for a long time. Even in ancient treatises on medicine, there is a description of varicose veins, in ancient Rome people bandaged their legs with leather "bandages" to get rid of venous insufficiency.
If your legs often get tired, this may be the first sign of a beginning disease of the venous system. Evening discomfort, accompanied by swelling in the foot and ankle, especially after a long stay on the legs, are clear signs of congestion in the veins. Soon, unfortunately, you discover the first varicose vein. The altered vessels form a blue-blue or red "pattern" on your legs, "stars", capillary "cobwebs" (telangiectasias) and, finally, dilated veins and varicose nodes.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins on the legs - an acute signal for urgent action to save the beauty and health of your legs.
A question about the condition of your veins should be timely asked to a specialist - a phlebologist who studies and treats venous diseases.
Vein disease starts off harmlessly but can become a serious problem if left untreated.
The 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, and so on. However, they mainly reflect the factors that contribute to the development of the disease or accelerate the appearance of clinical signs of the disease.
Both lower extremities are more often affected. However, at first, the expansion of the veins appears on one limb, and after a while - on the other. Varicose veins are more common on the right leg.
Varicose veins of the lower extremities occur only in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the vein wall of the limb. With weakness of the venous wall and impaired function of the valve apparatus in the main veins, which occurs with their congenital inferiority, pathological reverse blood flow occurs. The most common causes of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, the use of hormonal contraceptives, and so on) - affect the structure and tone of the vascular wall with its gradual weakening and destruction.
- Pregnancy is one of the main risk factors for the development of varicose veins. In addition to hormonal changes, the enlarging uterus and fetus put pressure on the iliac veins and significantly impede blood flow from the lower extremities.
- Obesity is already 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 squeezes the main veins at the level of the groin folds. Women wearing high heels.
- Heavy physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the abuse of which can also provoke varicose veins.
The essence of varicose veins lies in the fact that as a result of the above reasons, a gradual expansion of the lumen of the saphenous and perforating veins occurs, as a result of which an insufficiency of the valve apparatus is formed (non-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, hands have been the only doctor's tool for examining a patient with varicose veins. X-rays have come to the aid of the surgeon for the past century. However, X-ray contrast examination of veins is a rather complicated procedure, requiring bulky and expensive equipment, and the X-ray contrast agents themselves are by no means safe for the body. With the development of microelectronics and computer technology, previously unavailable diagnostic methods appeared: ultrasound Doppler, ultrasound angioscanning, plethysmography. The advent of ultrasound duplex scanning has provided new information that has made it possible to take a fresh look at the issues of the causes of the development of varicose veins, and understand the intricacies of the pathological process.
Doppler ultrasound
This is an ultrasound diagnostic method that allows you to determine the speed and direction of movement of particles (in this case, blood cells) in the body. Thus, the doctor is able to find out the direction and speed of blood flow in the vessels of the lower extremities. And when performing a number of physiological tests and the state of the valve apparatus of the veins of the lower extremities. Knowledge of the structure of blood flow in the veins in the legs is the main requirement for choosing a treatment method.
Ultrasound angioscanning
The essence of this method is that an image of the walls of blood vessels and the blood flowing through them is formed on the screen of the monitor of an ultrasound scanner in real time. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the state and direction of blood flow through this vessel. The method is highly informative and much safer than X-ray examination, but it is quite expensive, therefore it is used only in difficult cases and during scientific research.
Plethysmography
This is a diagnostic method based on determining the electrical resistance of the tissues of the lower extremities. Its essence lies in the fact that the total electrical resistance of the tissues of the human body directly depends on the amount of blood flowing in and out of them and changes in time with each heartbeat. Plethysmography is used to diagnose the general functional state of blood flow in the lower extremities, is used to monitor drug therapy for venous or arterial insufficiency, in the treatment of trophic disorders and to assess the degree of venous insufficiency.
Of course, all these techniques do not exclude a direct examination of the patient by a doctor, clarifying the history of the disease and identifying complaints presented by the patient. Based on the overall picture of the disease, the doctor chooses a method of treatment.
Treatment of varicose veins
A qualitative leap in the treatment of varicose veins has occurred, as well as in other branches of medicine, over the past 50 years. Over the past decades, various drugs have been developed and continue to be improved for the treatment of chronic venous insufficiency. The surgical technique for treating varicose veins has been significantly improved. The technology of compression sclerotherapy has been developed and practically perfected.
At present, the so-called sclerosurgery is gaining popularity all over the world. Sclerosurgery is a smart combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can be used only for the initial and uncomplicated forms of varicose veins. Surgery of varicose veins is also not without problems, the operation to remove varicose veins is quite traumatic, requires hospitalization and a long rehabilitation period. A reasonable combination of these two methods allows you to minimize the trauma of the treatment process and obtain an exceptionally high quality of treatment.
Medicinal therapy of varicose veins
Quite often there are cases when a patient has practically no varicose veins or their number is very small. However, the person suffers from heaviness in the legs, pain, swelling. All these are signs of chronic venous insufficiency. In these cases, as well as when there are significantly enlarged varicose veins, it is necessary to take medications that improve blood circulation in the legs. Currently, in the arsenal of a phlebologist there are several dozen drugs aimed at combating venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should only be selected by a doctor. Despite the apparent simplicity of the selection of a venotonic agent, only a doctor can determine the whole range of therapeutic measures and the appropriateness of using a particular drug.
Compression therapy
Compression therapy has been seen for many years as an adjunct to drug therapy or surgery. Compression treatment of varicose veins has been used since ancient times, and only in the last decade, elastic compression began to be considered as a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of various brands and special medical compression hosiery.
The global industry produces three types of elastic bandages: short, medium and high stretch. High elongation bandages (elongation more than 140%) are used to prevent thrombotic complications in the postoperative period after operations on the abdominal and pelvic organs, as well as to fix joints after and to prevent sports injuries. Short stretch bandages (elongation less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitic syndrome and lymphatic insufficiency. Bandages of medium elasticity (elongation from 70% to 140%) are used in the treatment of varicose veins, chronic venous insufficiency and compression sclerotherapy.
Medical compression hosiery includes medical compression stockings, tights, knee-highs. Many people are mistaken, considering various "anti-varicose" and "support" jerseys of increased density to be therapeutic. To begin with, it is necessary to determine that medical compression products are never marked in DENs. DEN is a technical characteristic of a knitted fabric that is only indirectly related to the pressure that is created by the product.
Medical jerseys are classified into several functional compression classes. The class of the product is determined by the pressure that the product creates on the ankle and in the lower third of the lower leg. A person with varicose veins is shown the use of compression class 2 knitwear. These tights or knee-highs will create a pressure of 23-32 mm Hg on the sore leg. Art. , that is, completely equalize the pressure in the varicose veins and eliminate venous insufficiency. Moreover, medical compression products create a so-called distributed pressure. The pressure they create is gradually reduced as the leg moves from the bottom up by 25-30%, which contributes to the effective outflow of blood and lymph.
It should be noted right away that medical jersey is never thin and transparent, the creation of such a high pressure requires a large number of elastic fibers, and accordingly the knitted fabric is thick. It should also be said that medical jersey is never cheap. The technology of knitting a special knitted fabric is much more complicated; when knitting, it is also necessary to model the profile of the leg to create a distributed pressure.
The ideal approach in compression therapy is the constant and widespread use of elastic bandages and / or compression hosiery by the patient. For example, daily wearing of elastic bandages for a month almost completely corresponds to the effectiveness of a monthly intake of an effective drug. The use of compression hosiery is especially effective for the prevention of the development and recurrence of varicose veins. The main advantage of using compression products is their absolute safety for health, in comparison with even the best medicines, and in terms of cost they are quite comparable.
Prevention of varicose veins
If you have the initial signs of varicose veins, then following fairly simple rules will slow down, and in some cases even avoid its further development. First of all, do not get carried away by hot baths, saunas, prolonged sun exposure. All of the above reduces venous tone, leads to stagnation of blood in the lower extremities. Do not wear tight-fitting clothing, stockings and socks with tight elastic bands, as this will compress the veins. Excess body weight and sports associated with a large static load on the legs (tennis, weightlifting, bodybuilding) increase venous pressure. High heels (over 4 cm) - our veins don't like it. Take care of the veins, do not injure them.
If you feel heavy in your legs in the evening after a day at work, keep your legs elevated while sleeping and resting. If your work is accompanied by a long sitting at the table or you are standing for a long time, then you should change the position of your legs more often, step in place, and rotate your feet. There are special exercises for venous diseases. After showering or taking a bath, rinse your feet with cold water. There are sports that are useful - first of all, swimming, but also walking, cycling, skiing. Do not neglect folk remedies for prevention. Useful infusions of leaves of lingonberry, St. John's wort, cranberry, rose hips. A plant-based diet should be followed. Your doctor may also prescribe a drug called phlebotonic to increase venous tone and improve microcirculation. Recently, the methods of compression prevention and treatment of varicose veins have also become quite understandable success, due to the appearance of high-quality medical products on the market.
A special word about prevention for pregnant women. Varicose veins progresses during pregnancy, especially when it is not the first, and carrying a baby under 1 year old does not contribute to good vascular function. The basis for prevention is the wearing of special compression hosiery, the use of phlebotonics both during pregnancy and after childbirth. Do not neglect to mention your veins to the gynecologist when you are prescribed a hormonal drug, since these drugs affect the functioning of the veins, reduce their tone.
Don't self-medicate. Talk to your doctor about what to do with your veins. This disease is treated by doctors - phlebologists.