Varicose veins are pathological expansion of the vein lumen caused by thinning of its walls and decreased tone. In advanced stages, venous nodes bulge under the skin and may become inflamed periodically. Varicose veins are not only an aesthetic defect. These symptoms indicate impaired blood circulation, which deteriorates the nutritional quality of tissues and organs and increases the risk of blood clots. Diagnosis and treatment at an early stage can delay the development of pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that includes any disturbance in the structure and function of the venous system. These can be congenital anomalies, genetically determined, as well as pathological changes that arise under the influence of external factors.
Varicose veins affect about 60% of adults worldwide, mostly Europeans. Most women suffer from varicose veins. This is due to the relationship between vascular wall tone and hormone levels.
Types of varicose veins
Varicose veins are usually understood as enlarged veins in the legs, but pathological changes can also affect other parts of the body. Depending on the location, there are:
- rectal varicose veins (hemorrhoids);
- dilation of the esophageal vein;
- varicose veins of the spermatic cord in men (varicocele);
- varicose veins on the lower leg.
Sometimes reticular varicose veins are isolated separately. It consists of a network of vessels and stars visible under the skin. It occurs mainly on the legs, but can appear under the breasts, on the stomach and other parts of the body. This disease is diagnosed when the saphenous vein of the reticular bed is dilated in the reticular layer of the dermis. Occurs in 50% of women. Nodule formation is uncommon.
Types of varicose veins on the legs according to the CEAP classification (stage of development):
- C0 – no sign;
- C1 – appearance of varicose veins and stars;
- C2 - varicose veins;
- C3 - leg swelling appears, indicating the development of venous insufficiency;
- C4 - trophic changes in the form of hyperpigmentation, lipodermatosclerosis (thickening of the skin of the lower third of the leg);
- C5 - heals venous ulcers;
- C6 – non-healing venous ulcers.
symptoms
The main symptoms of varicose veins on the lower legs include:
- heaviness in the legs (calves), swelling, worse in the evening;
- increased leg fatigue;
- aching pain in the calf that occurs after a long stay in a static position, standing or sitting.
As the pathology progresses, bluish, tortuous veins begin to bulge under the skin, sometimes swelling to the point of lumps. A sign of chronic venous insufficiency is a change in skin color associated with impaired tissue trophism (nutrition). Extensive eczema-type redness, itchy blisters, and nodules appear. The leg swelling does not go away even after resting overnight.
Signs of the reticular form of varicose veins are limited to the subcutaneous vascular pattern. Heaviness in the calf and mild itching in the area of dilated blood vessels may occur. Trophic disturbances are usually not observed.
Causes of varicose veins
Reticular varicose veins occur due to the replacement of collagen type 1 in the walls of blood vessels with collagen type 3. As a result, their contraction deteriorates - after expanding, the vessels no longer return to their original state. The cause of vascular wall thinning is excessive activity of enzymes that destroy extracellular matrix proteins and elastin.
In women, the hormone progesterone helps reduce the tone of the smooth muscle fibers of the vascular wall. Estrogen reduces the level of antithrombin, increases blood clotting and triggers the development of the stasis process.
The main cause of varicose veins on the legs, accompanied by the appearance of nodes and bumps, is damage to the valve mechanism. A valve is a fold formed by the inner lining of a vein. Normally, they work only in one direction: they open under the pressure of blood flow and do not let it back. If the valve mechanism is weak, blood flows back (reflux), causing the vein walls to expand and the lining to become inflamed. Next, the pathological process spreads into the deeper layers of the vein wall. His muscle fibers begin to be replaced by scar tissue, and atrophy occurs. The walls no longer shrink and the collagen structure is destroyed. The vein twists in a circle.
Increased pressure in the vessel causes damage to the muscular-venous pump. This is the system that controls the pumping of blood to the muscles during exercise and relaxation ("peripheral heart"). The result is congestion and venous insufficiency.
The provoking factors are:
- hereditary: in most cases, varicose veins are provoked by mutations in the genes responsible for the structure of valves and vein walls;
- overweight;
- sedentary lifestyle;
- increased load on the venous system of the legs due to standing work;
- pregnancy and childbirth, menopause, hormonal imbalance.
Varicose veins can be caused by poor leg movement due to uncomfortable shoes, as well as bad habits: smoking, alcohol abuse.
Diagnostics
The main method for diagnosing varicose veins includes a visual examination by a vascular surgeon, where he assesses the condition of the superficial and deep veins and identifies signs of malnutrition. The patient is then sent for additional diagnostics.
- Duplex ultrasound scanning. Allows you to assess the condition of the valves, the strength and direction of blood flow, the size of blood vessels, and identify the presence of blood clots.
- Valve function study: compression test, walking simulation, Parana maneuver.
- X-ray contrast venography is an X-ray with a contrast agent injected into the vein. Helps assess valve function, vein patency, and detect blood clotting.
To clarify the diagnosis, the doctor may prescribe CT, MRI, thermography, radiophlebography, intravascular ultrasound, blood tests for coagulation, etc.
Expert opinion
Varicose veins are more than just unsightly veins that protrude under the skin. Complications of varicose veins are very unpleasant.
- Trophic disorder. Large brown spots appear on the legs or thighs, and then large non-healing ulcers form that are itchy and painful.
- Thrombophlebitis is an inflammation of the vein walls, accompanied by the deposition of thrombotic masses on them. The thrombosed vein becomes red, thickened, painful, and the temperature around it rises. Externally it resembles an abscess. Threatening the spread of infection throughout the body.
- Bleeding. Bleeding from a ruptured varicose vein can occur both inside and outside the tissue. Bleeding is profuse and requires an ambulance call.
- Thromboembolism. Blood clots that form in dilated veins can break and block important arteries, such as the pulmonary artery. This condition often leads to immediate death.
Timely diagnosis will help prevent the serious consequences of varicose veins and identify the causes that cause them.
Treatment of varicose veins
Specific treatment of reticular varicose veins includes several areas.
- Compression therapy - wear supportive knitwear (stockings, tights) class A and I to prevent backflow of blood.
- Pharmacotherapy - taking phlebotonic drugs to increase vein tone. These drugs will not eliminate external signs, but they will eliminate subjective symptoms in the form of heaviness, swelling and painful pain.
- Phlebosclerosis is the adhesion of small vessels by inserting a sclerosant into them. Microsclerotherapy allows you to get rid of the vascular network.
- Laser therapy – allows you to eliminate the remaining small defects after microsclerotherapy. During the procedure, the doctor uses a beam of light to the affected area.
An important part of therapy is therapeutic exercise, weight loss, wearing comfortable shoes, and regular physical activity.
For the surgical treatment of varicose veins, accompanied by the appearance of nodes, two methods are used: classic phlebectomy and endovenous heat removal. The first method is considered obsolete. Includes ligation of the junction of the vein with the common femoral and removal of the affected part of the trunk. This method is characterized by increased trauma and a high risk of recurrence.
Heat removal is a gentle and minimally invasive treatment method. Through a small incision, the doctor inserts a catheter with a laser into the vein, turns on the radiation, and slowly withdraws it. As the laser moves, it closes the vein by increasing its temperature. After that, it gradually finished.
Prevention
To prevent the development or recurrence of varicose veins, people at risk should:
- minimize static load on the legs;
- eat rationally and, if necessary, take venotonics as prescribed by your doctor;
- wear compression stockings when standing in a static position for long periods of time.
It is useful to regularly give your body cardio exercises to train the heart and blood vessels.
Restoration
During the recovery period after surgery, patients should wear compression stockings, minimize load on the legs, avoid overheating, and take medications prescribed by the doctor. The amount of recovery time depends on the level of intervention and the presence of complications.