Varicose veins

Varicose veins of the lower extremities are often asymptomatic in humans. Often the only problem with this pathology is an aesthetic defect in the legs caused by 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 offered non-drug, drug or surgical treatment. Read more about the first symptoms of varicose veins, the nature of its course and effective methods of treatment and prevention in our material.

What it is

Varicose veins are a pathology that only people suffer from. Animals do not have this problem, which suggests that the disease is associated with upright posture. When a person got to his feet, the main part of the circulating blood began to be located below the level of the heart. In this case, all conditions are created for the blood to circulate worse in the opposite direction, which leads to stagnation.

According to statistics, some disorders of the venous system are observed in 80% of people in developed countries. Moreover, more and more often, similar problems are found in people at a young age. In all likelihood, one of the reasons why varicose veins "get younger" is a sedentary lifestyle, which only contributes to stagnation.

Interestingly, in the age group under 20, varicose veins of the lower extremities occur with the same 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 a serious factor in the development of venous diseases.

Features, causes and mechanism of development of varicose veins

The exact reasons for the development of varicose veins of the lower extremities are still unknown. Currently, it is believed that the disease is caused by congenital or acquired defects of the valve apparatus of the veins of the lower extremities.

For an unobstructed ascending blood flow through the veins, well-coordinated work of the venous valves is necessary. These valves only open for blood that flows upward. However, with a valve defect, a partial descending blood flow is also possible. This is how venous insufficiency develops, manifested by edema, cramps of the muscles of the legs and expansion of the venous vessels.

Leukocytes may also be involved in the pathogenesis of the development of varicose veins. This issue is now being actively studied. It is assumed that with prolonged accumulation of leukocytes in the tissues of the vessels (in particular, in the area of the valve apparatus), an inflammatory process develops, spreading along the venous bed.

Since the venous valves are subject to constant mechanical stress, inflammation develops especially quickly in the region of the vein valve apparatus.

Now the vast majority of people in developed countries lead a sedentary lifestyle. But why then does not everyone have varicose veins? Consider the main risk factors that contribute to the onset of this pathology:

• Hereditary factors. . . Despite the fact that the specific hereditary mechanisms that are associated with the development of varicose veins have not yet been established, most experts agree on the presence of such a factor. At the same time, there are weighty counterarguments regarding heredity in the development of varicose veins. For example, this is the prevalence of varicose veins in ethnic Africans and African immigrants who left to live in the United States. If the prevalence of varicose veins among sedentary Africans is about 0. 5%, then among emigrants this figure reaches 20%. These figures show that hereditary factors, at least, are not the only ones in the development of the disease, and, most likely, do not prevail.
• Obesity. . . Overweight and obese people are at risk. It is important to note that obesity contributes to varicose veins both due to an increase in the stress on the vessels, and in connection with the risk of other diseases affecting the vessels (diabetes mellitus, hypertension, and others).
• Pregnancy. . . This is one of the most obvious factors in the development of varicose veins of the lower extremities. In this case, the main risk factors are an increase in the volume of circulating blood, as well as compression of the retroperitoneal veins by the developing fetus in the uterus. According to epidemiological studies, the second and subsequent pregnancies lead to a significant increase in 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, as well as who are using hormone replacement therapy for the treatment of certain diseases (for example, osteoporosis) or during the premenopausal period. It has been established that female sex hormones (in particular, estrogens and progesterone) reduce vascular tone and destroy collagen fibers. Thus, the wall of the veins is pathologically dilated.
• Lifestyle. . . A person's lifestyle has a great influence on the course of the disease. A sedentary lifestyle, as well as work associated with prolonged standing or sitting (for example, security guards, drivers, office workers, service workers, and others) contribute to the development of varicose veins. You should also pay attention to nutrition. The lack of a sufficient amount of vegetables and fruits in the diet worsens the condition of the walls of blood vessels.

Stages of varicose veins of the lower extremities

Currently, several classifications of varicose veins of the lower extremities are used. The international classification CEAP, adopted back in 1994, is considered 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 (the type of affected veins, the presence of pigmentation, eczema, trophic ulcers).
• E (Etiological)- the etiology of the disease (congenital, primary, secondary).
• A (Anatomical)- anatomical localization of pathology (superficial or perforating veins).
• P (Pathophysiological)- the type of disorder (venous reflux, obstruction, or a combination of both).

The course of the disease takes place in six stages:

• Zero stage. . . The earliest stage of varicose veins, at which even doctors are not able to reliably establish a diagnosis. At this stage, there are no external signs of the disease. Ultrasound diagnostics does not show the presence of pathology. At the same time, a person at the zero stage is worried about such symptoms as swelling, a feeling of heaviness in the legs, as well as cramps, which indicates the presence of problems with blood vessels.
• First stage. . . Already at the first stage of the disease, spider veins are visible on the surface of the skin of the legs, the diameter of which is less than 1 millimeter. Veins of medium size can increase in diameter up to 3 mm. At this stage, doctors are not always able to establish the correct diagnosis, since the presence of such asterisks does not always indicate varicose veins.
• Second stage. . . At this stage, veins can appear and disappear depending on the conditions. For example, veins show up clearly after prolonged sitting, standing, or lifting heavy objects. The diameter of the varicose veins at this stage is 3 mm or more. Blood clots often form in the second stage.
• Third stage. . . If at the previous stages of the disease the swelling of the legs appeared and disappeared, then at the third stage the edema becomes permanent. The swelling of the legs is most severe in the evening.
• Fourth stage. . . At this stage, significant trophic changes occur. In particular, tissue nutrition is disrupted near the affected veins. The patient develops such changes on the skin as lipodermatosclerosis (inflammation of the subcutaneous fatty tissue), eczema, as well as darkening or discoloration of the skin. For the fourth stage of the disease, pigmentary changes are characteristic. For example, the skin in the area of the affected vessels may turn brown and even black, which indicates the concentration of pigments in this area. The opposite situation is also possible, when, due to a pathological process, pigment does not enter the affected area, which leads to the appearance of a pale skin tone. If at this stage varicose veins are not treated, then the problem will only worsen with the further appearance of trophic ulcers.
• Fifth stage. . . At this stage of the disease, in addition to the above symptoms, trophic ulcers also appear, which heal quickly. If you do not take any measures for treatment, then the ulcers will appear again and again.
• Sixth stage. . . Non-healing trophic ulcers appear. In the affected area, the temperature rises markedly, and pus may ooze from the wounds.

You should not wait for the development of the last stages - you should go to the doctor for the second one in order to register and track the dynamics of the disease. Sometimes the symptoms improve on their own, and sometimes they progress quickly. Therefore, it is important to monitor the situation in order to take action in time.

Symptoms

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

• Pain. . . This is the earliest sign of the disease. Since pain is a nonspecific symptom, it is impossible to establish a diagnosis based on this symptom alone. With varicose veins of the lower extremities, pain is often localized along the venous trunks.
• Feet in the legs. . . Also applies to early symptoms, while the veins in the skin are not yet visible. Often, the feeling of heat is accompanied by a throbbing pain.
• Cramps and itching in muscles. . . Most often disturbed at night.
• Swelling in the legs. . . In the early stages of the disease, swelling is minor and transient. As a rule, they appear in the evening and disappear in the morning. However, as the disease progresses, the severity increases and they become permanent.
• Discoloration of the skin. . . As a rule, with varicose veins, the skin of the lower extremities darkens. In the area of the affected veins, the skin turns brown. In the advanced stages of the disease, eczema and dermatitis appear. The terminal stages of varicose veins are characterized by the appearance of trophic ulcers. Initially, these are healing ulcers, but later non-healing wounds form.
• Vascular spiders. . . In the medical literature, such asterisks are called telangiectasias. In some people, varicose veins may be limited to spider veins, without progression to larger veins.
• Twisted dilated veins. . . The most characteristic sign of varicose veins is twisted dilated veins on the surface of the legs.

In the summer, the symptoms of varicose veins become more pronounced. This is due to the high ambient temperature, which already contributes to the expansion of the veins. Therefore, during the hottest hours, from 10 am to 4 pm, it is best to be in a well-ventilated area.

When to see a doctor

You should consult a doctor already at the first symptoms of the disease - pain, swelling, or the appearance of spider veins. Since the early stages of varicose veins are difficult to diagnose, it may initially be misdiagnosed. The patient should carefully monitor the condition of the legs and be regularly observed by a phlebologist.

Diagnostics

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

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

Treatment features

Varicose veins of the lower extremities are treated with both conservative and surgical methods. Conservative treatment is reduced to the following activities:

• Drug therapy. . . This is the use of drugs that improve the tone of the venous walls. Also, the patient is prescribed drugs that reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, then anticoagulants are also prescribed.
• Compression therapy. . . This is the wearing of special compression hosiery, which reduces the load on the leg. The benefit is that it is possible to evenly distribute the load, even with heavy physical exertion. When using compression garments, congestion and swelling can be avoided.
• Remedial gymnastics and lifestyle changes. . . The patient is advised to exercise to relieve tension in the legs. It is important to avoid prolonged sitting or standing. If you have to stand or sit for a long time at work, then you need to take breaks more often.

If conservative therapy of varicose veins does not bring the expected results, then a decision is made about surgical intervention. Most often these are minimally invasive interventions, including:

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

In some countries, you can get the operation free of charge, under the compulsory medical insurance. But it is not a fact that all types of compulsory insurance operations are provided everywhere. In any case, help will be provided, but it is necessary to find out whether it will be a conventional removal or laser.

Contraindications for people with varicose veins

• Sedentary lifestyle. . . It is important to avoid prolonged sitting or standing. Physical activity will help avoid congestion in the veins.
• Running and vigorous exercise. . . With physical activity, it is important not to overdo it. If you have varicose veins, walking is definitely better than running.
• Unbalanced and unhealthy diet. . . You need to give up junk food, even if it seems that health allows. You should limit the intake of sweets, semi-finished products, as well as rich meat broths and smoked meats. But eating more vegetables and fruits would be a good idea.
• Hot tubs and showers. . . For people with vascular problems in the extremities, excessively hot and prolonged water procedures are contraindicated.

Complications of varicose veins

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

Conclusion

The symptoms of varicose veins of the lower extremities, as a rule, do not appear immediately. Different people have a different set of manifestations. For example, sometimes with this pathology there is no edema or there is no local increase in temperature or pain. This does not mean at all that there is no illness. A timely visit to a doctor will significantly slow down the progression of the disease or even stop it, preventing the development of trophic changes.