Varicose veins

Varicose veins in the legs (varicose veins) is a common disease manifested by persistent and irreversible expansion and elongation of the superficial veins and disruption of their function due to the development of a pathological process in the venous wall and congenital or acquired insufficiency of the valve 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 of the legs

• Hereditary predisposition (congenital weakness of vascular valves). If your parents had signs of weakness of the venous wall in any vessels (legs, groin, esophagus, rectum), then with a high degree of probability symptoms of varicose veins may appear in you.
• Poor circulation in the lower extremities during pregnancy and childbirth (compression of the abdominal veins by the developing fetus with increased pressure in the veins of the legs, hormonal changes causing a decrease in the tone of the veins).
• Obstructed blood flow during prolonged standing (varicose veins of the lower extremities are more common among salespeople, teachers, waiters, surgeons) and in a sitting position (managers, accountants, office workers, drivers, etc. )
• Heavy physical work, sports training associated with lifting weights (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 the venous vessels (adolescence, pregnancy, menopausal disorders in old age).
• Factors such as excess weight, chronic cough, constipation, and the habit of wearing tight clothes and shoes disrupt venous outflow and often lead to varicose veins.

Why do varicose veins occur during pregnancy?

In women, varicose veins of the lower extremities 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 a woman’s body during pregnancy, causing a decrease in the elasticity of the venous wall, its stretching and transformation into a varicose node.
• In the body of a pregnant woman, the volume of blood flow increases significantly. Increased venous pressure leads to thinning of the venous wall and its local expansion (varicose veins).
• The growing fetus causes a corresponding enlargement of the uterus and difficulty in the outflow of blood from the lower extremities through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
• The increased body weight of a pregnant woman also negatively affects venous outflow.

Varicose veins of the lower extremities: symptoms

Varicose veins develop rather slowly, going through several main stages in succession:

• At the first stage, a violation of venous circulation is accompanied by the appearance of individual "spider veins", thinning of the skin, through which, during physical activity, dilated veins in the form of twisted cords begin to appear through (usually in the popliteal fossa), there are no complaints.
• At the second stage of varicose veins, there is a feeling of heaviness, fatigue in the lower extremities, swelling of the legs in the evenings and after a long walk, a feeling of "pins and needles" crawling along the legs, night cramps in the calf muscles, upon careful examination, several dilated veins are revealed on the lower legs, and sometimes -on the foot and thigh.
• The third stage of varicose veins of the lower extremities is characterized by pronounced bulging of venous nodes mainly on the inner surface of the leg, the appearance of dark brown or brown spots on the thin, easily wounded skin of the legs, and the development of dermatitis with itching and rashes. Swelling of the legs becomes more intense, making walking difficult.
• The fourth stage of varicose veins is the presence of varicose nodes on the foot, leg and thigh, the appearance of complications of the disease (chronic venous insufficiency with trophic ulcers, bleeding from damaged varicose nodes, the development of thrombophlebitis).
• Sometimes the fifth stage is also distinguished - there are all the symptoms characteristic of the fourth stage of varicose veins, with the process spreading to the groin areas, buttocks, perineum, the presence of multiple trophic ulcers, the appearance of elephantiasis, frequent exacerbations of thrombophlebitis, and the onset of disability.

Complications of varicose veins

1. Thrombophlebitis of superficial veins.
2. Bleeding when a varicose vein ruptures.
3. Dermatitis, eczema.
4. Trophic ulcers.
5. Deep vein thrombosis (phlebothrombosis) and postthrombophlebitic disease.
6. Pulmonary embolism (PE).
7. Lymphedema (elephantiasis).

Diagnosis of varicose veins

It is based on a clinical examination, performing functional tests, and conducting instrumental studies of the 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 of the lower extremities

If varicose veins are detected at an early stage, you can cope with its manifestations using compression hosiery, special therapeutic exercises and traditional methods of treatment. But if you visit a 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 should not be afraid of surgery, because modern technologies make it possible to get rid of varicose veins of the lower extremities without wide incisions, without pain, and practically without disturbing a person’s usual way of life.

The principle of surgical manipulation is similar for different techniques: pathologically altered superficial veins of the legs are ligated, excised and removed. In this case, venous circulation in the lower extremities is not disrupted, since the operation does not affect the deep veins, through which about 90% of venous blood flows.

Main types of operations for varicose veins

1. Sclerotherapy. In the initial stage of varicose veins, a good cosmetic result is achieved by introducing special drugs into the problem vein, causing gradual sclerosis, "gluing" of the pathologically dilated area of the vessel. A medicinal substance (usually a sclerosant) is injected through a special catheter or a very thin needle into a varicose vein. To achieve a positive result, 3 to 10 injections are required.
2. Phlebectomy. An operation that has been performed for almost a hundred years, but in modern conditions wide incisions have long been abandoned. Manipulation these days is carried out through miniature incisions of 3-5 millimeters. The pathologically dilated vein is first ligated and intersected at the point where it flows into the deep vein, and then removed using special probes. This operation lasts approximately 1-2 hours, after which the patient remains in the hospital of a medical institution for 1-2 days.
3. Miniphlebectomy. The operation is performed under local anesthesia, without incisions, but with the help of small punctures through which the varicose vein is removed. This achieves a good cosmetic effect (usually no stitches are required) and significantly reduces the recovery period after surgery. In some cases, not the entire vein may be removed, but only its pathologically altered section. This intervention is called short stripping.
4. Endovenous laser coagulation of veins. The 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 out. After a certain period of time, obliteration and sclerosis of the vein occurs, its complete closure. If necessary, laser coagulation is combined with miniphlebectomy. In this case, the effectiveness of surgical treatment of varicose veins of the lower extremities will be the highest.
5. Radio wave ablation of varicose veins. Obliteration ("gluing") of the lumen of the altered 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 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 medications that have a venotonic effect. This will help restore normal blood circulation in the veins of the lower extremities as soon as possible, prevent possible complications, and allow you to quickly return to work and the normal rhythm of life.

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

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

With the correct choice of the most effective treatment method 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 the surgical intervention will be guaranteed.

Prevention of varicose veins of the lower extremities

Regime and diet

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

• Avoid clothing that impedes the flow of venous blood.
• Avoid prolonged periods of standing or sitting (taking periodic breaks with rest and performing simple gymnastic exercises).
• Avoid strenuous physical activity.
• Lead an active lifestyle (moderate dynamic loads - daily walking, swimming, cycling).
• Drink at least 1. 5-2 liters of liquid 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 baths.
• Take a contrast shower (warm - cool) every day.
• Use comfortable shoes with low heels.

Antiplatelet therapy

An important component of preventive measures for varicose veins of the lower extremities is taking medications that have an antiplatelet effect, that is, preventing the formation of blood clots. These include:

• 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. By the way, venotonics not only reduce thrombus formation, but also improve venous blood circulation, strengthen the vascular wall, preventing the appearance of areas of expansion.

Compression jersey

For many years, bandaging with elastic tubular bandages has been successfully used in the initial stages of varicose veins (when spider veins appear). Special clothing is now being produced - compression knitwear, which allows you to select the required size and select the degree of compression depending on the severity of the changes. Wearing stockings and tights initially puts pressure on the upper part of the ankles, followed by a decrease in pressure and stimulation of blood flow upward 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 stagnation of venous blood. The key to success here is the regularity of performing the complex. Let's consider several basic exercises recommended in the presence of risk factors for the development of varicose veins of the lower extremities and in the initial stage of the disease:

• Lying on your back, legs on a pillow on a raised platform. Relax and remain in this position for several minutes.
• "Bicycle" - lying on your back, legs raised, knees bent. Perform movements that simulate pedaling when riding a bicycle;
• "Scissors" - lying on your back, raise your legs and cross them, changing the position of your legs (up - down) for 1 minute;
• The legs are raised and bent at the knee joints. Bend and straighten your feet, imitating walking;
• Lying on your back, bend your left leg, bring your knee to your chest. Wrap your hands around your leg at the ankle joint and gradually straighten your leg, performing massaging movements on the calf muscles. Repeat the exercise with the right leg;
• Standing with your feet together. Raise yourself on your toes and lower yourself down (if there are no complications, the exercise can be performed sharply - with your heels hitting the floor).

Timely initiation and proper implementation of preventive measures can prevent varicose veins of the lower extremities or minimize its manifestations.