Varicose veins of lower extremities - Causes, symptoms and treatment. MF.
Varicose veins or varicose veins are an enlargement of the superficial veins associated with the deficiency of venous valves and the violation of blood flow. This disease is the most common pathology of blood vessels among people of working age.
Causes of varicose disease
Traditionally, risk factors for the development and progression of the disease have been identified. Heredity and its contribution to the occurrence of varicose veins have not been unequivocally proven. It has been noticed that varicose veins are constantly found in some families, but now it is believed that the prevailing role in the appearance of the disease is played by nutritional factors, lifestyle characteristics, and also the conditions associated with changes in the hormonal cycle.
Obesity is one of the main risk factors for the development of the disease. And the frequency of development of varicose veins increases with increasing severity of obesity. Often obesity accompanies a motionless or inactive way of life and improper diet. In the diet of the population of industrially developed countries, at the present time products of a high degree of processing predominate, but at the same time there is insufficient consumption of vegetable fibers contained in raw vegetables and fruits. Plant fibers are necessary to strengthen the vascular wall, in addition, they prevent chronic constipation, which in turn leads to increased intra-abdominal pressure and the formation of varicose veins.
We should not forget about the wrong organization of the work process. Often, most of the time we spend sitting or standing, which is very bad for the valve veins. Also unfavorable is the hard work associated with a sharp( jerky) load on the lower limbs, for example, when lifting weights. In our dynamic time, long flights or crossings that are accompanied by the appearance of stagnation of blood in the veins of the legs and are also a risk factor for the development of venous diseases are not uncommon.
Adhering to fashion trends, many do not think that tight underwear leads to compression of veins at the level of inguinal folds, and corsets increase intra-abdominal pressure, so it is not recommended to wear them constantly. Also, do not forget about the dangers of wearing shoes with high heels, with uncomfortable insteps.
Repeated pregnancies are also a proven risk factor for the development of venous diseases. The enlarged uterus helps increase intra-abdominal pressure, and a hormone like progesterone has an adverse effect on the vein wall, destroying the collagen and elastic fibers contained therein. Some diseases, such as osteoporosis, rheumatoid arthritis, occur with a change in the hormonal status. At the same time, the risk of developing varicose veins increases dramatically.
Speaking about the causes leading to the expansion of veins, it is necessary to dwell on the structure of the veins of the lower extremities. Isolate the system of superficial veins( large and small hypodermic veins), a system of deep veins( deep veins of the lower leg and thighs) and communicative or perforating veins that connect the superficial and deep veins. Under normal conditions, outflow of blood in the leg area occurs through a system of deep( 90%) and superficial veins( 10%).In order for blood to move to the heart, and not in the opposite direction, there are valves in the walls of the veins that, when closed, do not allow blood to move from top to bottom under the influence of gravity. In addition, great importance is the contraction of muscles, which also contributes to the normal blood flow. The worst conditions for the movement of blood are provided standing in the absence of or insufficiently active muscle contractions. At the same time the blood stagnates, the pressure in the veins increases and they expand. Deficiency of the valve apparatus is formed, while the valve flaps do not completely close, and irregular movement of blood from the heart is formed.
Valvular failure in varicose veins.
The valves of the deep vein system are particularly affected, as they experience the maximum load. Due to abnormal blood flow, an overload of deep veins with an additional volume of blood develops. To reduce excess pressure through the system of communicating veins, blood is discharged into the superficial veins, which, in turn, are not designed to promote large amounts of blood. As a result, there is a hyperextension of their walls with the formation of characteristic varicose nodules. But the increased volume of blood continues to flow into deep veins, while the valves of communicating veins with an unobstructed horizontal blood flow are formed in the direction of both deep and surface vessels. In the final, chronic venous insufficiency is formed with edema, pain and trophic ulcers.
Symptoms of varicose veins of the lower extremities
As you can guess from the name, the main visible sign of varicose disease is the saccate or cylindrical widening of the superficial veins. Varicose veins on the legs.
They become crimped, protrude above the surface of the skin in the region of the shins and feet. The maximum varicose nodules are expressed after a heavy or prolonged physical exertion. Very often, enlarged veins appear at a young age, in women - during or after pregnancy.
In the early stage of varicose veins, the symptoms are few and nonspecific. All the signs of this stage are combined in the "heavy foot syndrome" .This worries increased fatigue, a feeling of heaviness in the legs, burning, raspiranie, the severity of which is maximal after physical exertion. There may also be transient edema, aching pain along the veins. This is characterized by a slight swelling of the ankles and the rear of the foot, which occurs in the evening, especially after a prolonged static load. A characteristic feature of edema is that in the morning they leave without a trace. For this stage, not necessarily the presence of visible enlarged veins. As a rule, most patients with varicose veins noted the presence of certain signs in the onset of the disease. Therefore, timely access to a specialist even at the initial stage of the disease will prevent further development of the disease.
Varicose veins develop slowly, sometimes for decades. In case of inadequate treatment, chronic venous insufficiency is formed during the progression of the disease.
Special attention should be given to considering the issue of "vascular asterisks" as an important symptom of venous insufficiency."Vascular asterisks" is a spiderweb of expanded more than 0.1 mm capillaries visible through the skin.
"Vascular Sprockets".
As a rule, women regard these "stars" as a cosmetic defect, men just do not notice. Indeed, in some cases, these are manifestations of dyshormonal disorders, abuse of the sauna, solarium, while avoiding high temperatures and eliminating hormonal imbalances( for example, the use of oral contraceptives) will completely cure the disease. But, in most cases, the appearance of "vascular asterisks" is the first and perhaps the only sign of overfilling of superficial veins and the development of varicose veins. Therefore, even in the presence of a small area of the expanded capillary network, specialist consultation is necessary.
Complications of varicose veins
Varicose veins are not only a cosmetic problem, but also a dangerous disease, primarily because of its complications. When improper or untimely treatment develops such formidable conditions as thrombosis and thrombophlebitis, as well as bleeding from the enlarged veins. Thrombosis( complete or partial closure of the vein thrombus) or thrombophlebitis( inflammatory disease of the venous wall in thrombosis) occurs suddenly, not associated with physical exertion. Edema swiftly spreads to the lower limb, which is accompanied by intolerable raspiruyuschimi pain. There may be redness or blueing, local soreness of the skin. In case of a thrombus rupture, it enters the vessels of the lung with the blood stream, and in case of complete or partial closure of the vessel it can lead to a severe disease - pulmonary embolism. This complication is often lethal. If you suspect that these complications of varicose disease should immediately take a horizontal position, raise your leg up, call the emergency medical service on the phone. You can not compress your leg muscles, use ointments, step on your leg.
A trauma to the area of dilated vessels is also considered dangerous, as it can cause severe bleeding. In this case, it is necessary to urgently apply a tourniquet above the place of bleeding, a tourniquet( medical or improvised), sufficiently strong, so that the bleeding stops. It is also necessary to urgently call an ambulance team.
If any of the above signs is detected, it is necessary to examine the phlebologist, a specialist in vein diseases and, if necessary, consult other specialists, such as a vascular surgeon, therapist, gynecologist.
Diagnosis of varicose veins
When referring to a doctor, you are likely to be offered the following examination:
- General blood test. The number of erythrocytes and the level of hemoglobin indicate the degree of blood clots, the level of platelets can be judged on the disease of the blood coagulation system( predisposition to thrombosis), the increase in the number of leukocytes characterizes inflammation( confirms thrombophlebitis).
- The "golden" standard for the diagnosis of varicose veins is the ultrasound of the veins of the lower limbs, in which the affected areas of the veins are determined. This principle builds an anatomical classification of varicose veins with an indication of the altered vessel. For example, the lesion of a large saphenous vein above or below the knee, a small saphenous vein. Ultrasound of the vessels of the lower extremities is recommended for detection of the above signs of varicose veins, even with the appearance of "vascular asterisks".
- Rheovasography is a method for determining the insufficiency of blood supply( nutrition) of tissues by calculating the rheographic index. On the basis of this indicator, the stage of the disease is identified: compensation, subcompensation or decompensation.
- In case of doubtful data of non-invasive methods, surgical methods of investigation, for example phlebography( intravenous administration of contrast medium for the evaluation of the venous system) are used.
Treatment of varicose veins
Treatment of varicose veins is a complex process, the duration of which directly depends on the stage of the disease. Medical activities are divided into surgical and conservative( not surgical).
Non-surgical treatment of varicose veins of the lower extremities gives good results only in the onset of the disease, when the skin manifestations are not very pronounced and only moderately reduce the ability to work. Also conservative therapy is indicated in the presence of contraindications to surgical treatment. In addition, these methods must necessarily be used in the postoperative period to prevent recurrence of the disease.
Conservative treatment of includes a reduction in the severity of risk factors, adequate physical activity, elastic compression, medications and physical therapy. Applying these measures together guarantees a good result. Together with a specialist, it is necessary to identify risk factors for varicose veins, for example, obesity, taking oral contraceptives, improper physical activity, and trying to work on them.
People who have risk factors for developing varicose disease, including hereditary predisposition, should consult at least twice a year with a phlebologist with mandatory ultrasound of the lower extremities veins, even if there are no symptoms of the disease.
In the absence of complications( thrombosis or thrombophlebitis), it is necessary to regularly train the veins of the lower extremities. It is recommended: as long as possible to keep your feet in an elevated position, use comfortable shoes. Walking, swimming, cycling, jogging are preferred. Physical loading( except for swimming) should be carried out under conditions of elastic compression. Contraindicated lessons are traumatic for the lower extremities sports, as well as in the case of the prevailing loads on the lower limbs: football, basketball, volleyball, tennis, mountain skiing, various types of martial arts, exercises related to lifting weights. At home, after consulting a specialist, several simple exercises are possible.
Before practicing, you need to lie down for a couple of minutes, keeping your feet in a raised position to prepare your body for exercise. The pace and speed of the exercises are individual, according to the physical possibilities. When conducting physical education the main thing is regularity.
In prone position.
1 "Bicycle".The back and waist are tightly pressed to the floor, we pedal.
2. "Vertical scissors".Hand along the trunk, we crossed our legs like scissors.
3.Work with the feet. In the prone position, bend and unbend, make circular movements in the ankles.
In standing position, as well as sitting at the desk, you can perform the following exercises. Each exercise is repeated 20 times
1. Lifting( socks - together).Socks are parallel, pressed against each other. We rise on socks, we freeze in this position for a few seconds, we fall to the floor.
2. Lifting( socks - apart).Heels together, socks apart. We rise on the toes, then sink to the floor.
3. Lifting( heels - apart).Socks together, heels apart. The movements are carried out as in the previous exercises.
A contrast shower is recommended several times a day. Massage the legs alternately with a cold and warm water jet for about 5 minutes each.
Elastic Compression is a method for treating varicose veins through elastic bandaging or the use of medical knitwear. In this case, a dose-controlled squeezing of the muscles is created. This promotes better blood flow through the veins, prevents stagnant phenomena. Due to the artificial maintenance of the "tone", the veins cease to expand, the prevention of thrombosis is created.
At all stages of development of varicose veins, the use of phlebotonic drugs is recommended. Their action is aimed at strengthening the vein wall. Today, drugs such as Detralex, Cyclo 3 Fort, Ginkor Fort, Troxevasin, Anvenol, Escuzan, Asklezan, Antistax, Flebodia 600 are used. The course is long, 6 months or more. Also shown are drugs that reduce blood viscosity - antiplatelet agents( aspirin, curantil), anti-inflammatory drugs( diclofenac).
No folk remedies, medicinal herbs are meant, will not equal the effectiveness with the listed drugs, so do not self-medicate. Drug therapy should be used only as directed by a physician. Local treatment, for example various ointments, gels are not recommended in the absence of thrombosis, thrombophlebitis.
Physiotherapy has no independent meaning. It is used only according to the doctor's prescription, depending on the main problem. The use of physical methods at home can lead to the development of a complication( attachment of inflammation, trombosis).In the case of proper assignment, the best effect is achieved by diadynamic currents, magnetic field, electrophoresis, and laser.
Varicose veins of the lower extremities are a surgical disease, a complete cure of which is possible only after surgical treatment of .Depending on the location of the lesion and the severity of the disease, the following methods of surgical treatment are used.
1. Phlebectomy - operative removal of the varicose-dilated vein. The aim of the operation is to eliminate the pathological discharge of blood by removing the main trunks of the large or small saphenous vein, as well as dressing the communicating veins. This operation is contraindicated when:
is a severe concomitant disease in which surgery can dramatically aggravate the condition;
late stage of varicose veins;
pregnancy;
presence in the body of any purulent process;
older age.
The use of endoscopic treatment methods makes this operation safer, more cosmetic. The package of measures for the best recovery after surgery( rehabilitation) depends on the complexity of the operation, but there are general principles. The final formation of joints takes 6 months, so to prevent their damage and avoid a cosmetic defect, it is recommended to exclude a gross mechanical impact on them( using a rigid sponge, squeezing clothes).Do not wash with hot water. After the operation, it is necessary to apply elastic compression, as a rule, within 6 months. In the future, compression knitwear is necessary in the event of a possible "harmful" load( lifts of gravity, long travel, flights).
2. Sclerozirovanie - the introduction of an enlarged vein of a special substance( sclerosant), which causes the walls to "stick together" with the cessation of blood flow along it. As a result, there is no pathological discharge of blood, a cosmetic defect is eliminated, since the vein recedes and becomes invisible. But sclerotherapy is effective only with the expansion of small branches of the main trunks, which limits its application with a high degree of process. The advantage of sclerotherapy is the absence of scars, the need for hospitalization. After sclerotherapy, specific rehabilitation is not required.
3. Laser coagulation is a method based on the destruction of the vein wall by means of a warm laser action, resulting in the "sealing" of the venous lumen. It is indicated only when the vein is enlarged no more than 10 mm. The method is associated with anesthesia. Cosmetically preferred in comparison with phlebectomy, but as after removal of the vein requires early activation of the patient, as well as prolonged elastic compression.
Prevention of varicose veins
In today's world, great importance is paid to the prevention of varicose veins. Regular implementation of simple measures will significantly reduce the risk of the onset and progression of the disease:
Moving lifestyle is the basis of prevention, it is also important to alternate the long-term static load with walking, running, cycling, swimming, performing simple exercises in the workplace.
Keep your feet as high as possible in an elevated position.
Avoid weight gain.
Wear comfortable shoes with a maximum heel size of up to 4 cm, if necessary use orthopedic insoles.
In the case of estrogen, for example, oral contraceptives, as well as during pregnancy, it is mandatory to undergo ultrasound of the veins of the lower extremities.
Physician therapist Sirotkina EV