Varicose veins are a pathological expansion of the lumen of the veins caused by thinning of their walls and decreased tone. In an advanced stage, venous nodes protrude under the skin and may periodically become inflamed. Varicose veins are not just an aesthetic defect. The symptom indicates impaired blood circulation, which deteriorates the quality of nutrition of tissues and organs and increases the risk of blood clots. Diagnosis and treatment at an early stage can slow down the development of pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that includes alterations in the structure and functioning of the venous system. They can be genetically determined congenital anomalies, as well as pathological changes that arose under the influence of external factors.
Varicose veins affect approximately 60% of adults worldwide, mostly Europeans. Most women suffer from varicose veins. This is due to the presence of a connection between the tone of the vascular walls and hormonal levels.
Types of varicose veins
Varicose veins are generally understood as an enlargement of the veins in the legs, but pathological changes can also affect other parts of the body. Depending on the location, there are:
- varicose veins of the rectum (hemorrhoids);
- dilation of the veins of the esophagus;
- varicose veins of the spermatic cord in men (varicocele);
- Varicose veins of the lower extremities.
Sometimes reticular varicose veins are isolated separately. It is made up of vascular networks and stars that are visible under the skin. It occurs mainly in the legs, but can appear under the breasts, on the abdomen, and other parts of the body. The disease is diagnosed when the saphenous veins of the reticular bed are dilated in the reticular layer of the dermis. It occurs in 50% of women. Knot formation is not characteristic.
Types of varicose veins of the extremities according to the CEAP classification (stages of development):
- C0 – no signals;
- C1 – appearance of varicose veins and stars;
- C2 – varicose veins;
- C3 – swelling of the legs appears, which indicates 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 – healing of venous ulcers;
- C6 – non-healing venous ulcers.
Symptoms
The main symptoms of varicose veins of the lower extremities include:
- heaviness in the legs (calves), swelling, worse at night;
- increased fatigue in the legs;
- Aching pain in the calves that occurs after a long stay in a static position, standing or sitting.
As the pathology develops, bluish, tortuous veins begin to protrude under the skin, sometimes swollen to the point of forming lumps. A sign of chronic venous insufficiency is a change in skin color associated with impaired trophism (nutrition) of tissues. Extensive eczema-like redness, itchy blisters, and nodules appear. The swelling in the legs does not go away even after a night's rest.
Signs of the reticular form of varicose veins are limited to the subcutaneous vascular pattern. Heaviness in the calves and mild itching in the area of dilated blood vessels may occur. Trophic disorders are usually not observed.
Reasons for the development of varicose veins.
Reticular varicose veins occur due to the replacement of type 1 collagen in the walls of blood vessels with type 3 collagen. As a result, their contractility deteriorates: once expanded, the vessels no longer return to their original state. The cause of thinning of the vascular wall is the 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 walls. Estrogen reduces the level of antithrombin, increases blood clotting and provokes the development of stagnant processes.
The main cause of varicose veins of the extremities, accompanied by the appearance of nodes and bumps, is a malfunction of the valve mechanisms. Valves are folds formed by the inner lining of veins. They normally work in only one direction: they open under the pressure of blood flow and do not let it flow back. If the valve mechanism weakens, blood backs up (reflux), causing the walls of the veins to expand and their inner lining to become inflamed. In addition, the pathological process spreads to the deeper layers of the venous wall. Their muscle fibers begin to be replaced by scar fibers and atrophy occurs. The walls no longer contract and their collagen structures are destroyed. The vein spirals.
The increased pressure in the vessels causes the musculovenous pump to malfunction. This is a system that regulates the pumping of blood to the muscles during exercise and relaxation ("peripheral heart"). The result is congestion and venous insufficiency.
The provoking factors are:
- inheritance: in most cases, varicose veins are caused by mutations in the genes responsible for the structure of the valves and vein walls;
- overweight;
- sedentary lifestyle;
- increased load on the venous system of the extremities due to standing work;
- pregnancy and childbirth, menopause, hormonal imbalances.
Varicose veins can be caused by poor mobility of the foot due to uncomfortable shoes, as well as bad habits: smoking, alcohol abuse.
Diagnosis
The main methods of diagnosing varicose veins include a visual examination performed by a vascular surgeon, during which he evaluates the condition of the superficial and deep veins and identifies signs of tissue malnutrition. The patient is then sent for additional diagnostics.
- Duplex ultrasound scanning. It allows you to evaluate the condition of the valves, the strength and direction of blood flow, the size of blood vessels, and identify the presence of blood clots.
- Study of valve functions: compression tests, simulated walking, Paraná maneuver.
- X-ray contrast venography is an x-ray with a contrast agent injected into the veins. It helps evaluate valve function, vein patency, and detect blood clots.
To clarify the diagnosis, the doctor may prescribe computed tomography, magnetic resonance imaging, 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 from varicose veins are extremely unpleasant.
- Trophic disorders. 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 venous walls, accompanied by the deposition of thrombotic masses on them. The thrombosed vein becomes red, thick, painful, and the temperature around it increases. Outwardly it looks like an abscess. Threatens the spread of infections throughout the body.
- Bleeding. Hemorrhage from rupture of a dilated vein can occur both inside and outside the tissue. The bleeding is intense and requires calling an ambulance.
- Thromboembolism. A blood clot that forms inside a dilated vein can break loose and block vital arteries, such as the pulmonary artery. This condition often leads to instant death.
Timely diagnosis will help prevent the serious consequences of varicose veins and identify the causes that caused them.
Treatment of varicose veins
The specific treatment of reticular varicose veins includes several areas.
- Compression therapy: use of supportive knitwear (socks, tights) of class A and I to prevent blood reflux.
- Pharmacotherapy: taking phlebotonic medications to increase the tone of the veins. These remedies will not eliminate the external signs, but they will eliminate the subjective symptoms in the form of heaviness, swelling and pain.
- Phlebosclerosis is the sticking together of small vessels, introducing sclerosing substances into them. Microsclerotherapy allows you to get rid of vascular networks.
- Laser therapy - allows you to eliminate minor defects remaining after microsclerotherapy. During the procedure, the doctor applies a beam of light to the affected areas.
An important part of therapy is therapeutic exercises, weight loss, wearing comfortable shoes, and regular physical activity.
For the surgical treatment of varicose veins, accompanied by the appearance of lymph nodes, two methods are used: classic phlebectomy and intravenous thermal obliteration. The first method is considered obsolete. It includes ligation of the junction of the vein with the common femoral vein and removal of the affected part of the trunk. The method is characterized by greater trauma and a high risk of relapse.
Thermal obliteration 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 seals the vein by increasing its temperature. Later it is gradually solved.
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 a long time.
It is useful to periodically perform cardiovascular exercises to train the heart and blood vessels.
Rehabilitation
During the recovery period after surgery, the patient should wear compression stockings, minimize the load on the legs, avoid overheating, and take medications prescribed by the doctor. The total rehabilitation time depends on the extent of the intervention and the presence of complications.