Author Ольга Кияница
Varicose veins - is characterized by pathological changes in venous vessels, which can manifest in their elongation, thickening, deformation. Also, the venous mesh may be narrowed, and in severe cases, pathological nodes are formed.
Varicose disease affects about 25% of the population, among which are defined patients of different ages. More often, the disease is determined in women at an advanced age, whereas in the first-mothers the ratio between boys and girls is almost the same.
Varicose enlargement is often developed on the lower extremities, which is due to the increased load experienced by the vessels of the legs. Correct and timely diagnostics allows to prevent the development of serious complications. For this purpose, modern methods of treatment of varicose veins and prophylactic measures of progression of the disease are involved.
Video Varicose Veins: Causes, Symptoms, Treatment
What is varicose veins?
The definition of "varicose extension" is like lat. varix, which means "knot, bloat", and "expansion of the vein" on the other. Both characteristics accurately describe those pathological processes that develop during varicose veins, therefore this definition has taken root and is widely used by clinicians and patients.
During varices, the veins are affected - blood vessels that reach the heart. Due to the specific structure of the venous vessels, blood flow is carried out only in one direction - centrifugal.
In the bloodstream through the veins, a muscle-venous pump is directly involved, which includes:
- Venous mesh consisting of superficial and deep veins, venules and capillaries;
- Сalf muscles of the lower extremities.
In a normal state, the venous pressure (VD) should be 40-120 mm of the water column. In order to get the correct indicator, the patient should have about 10 minutes left alone before measuring. Increased vomiting leads to damage to the inner and middle layers of veins, which in turn provokes the development of varicose veins.
In varicoseas the surface veins are primarily affected, and only in very difficult cases, often in the absence of proper treatment, the pathological process goes to deep veins.
A bit of statistics on varicose veins:
- Over the past 20 years, about 57% of patients died within 3-4 years of the onset of the disease.
- Varicose veins are diagnosed in every fifth male and every third woman.
- Almost 80% of patients with varicose veins are diagnosed with another dangerous disease - thrombophlebitis.
- Effective treatment is in the hospital and for today it is provided in Ukraine only by some medical centers in the amount of 100-200 thousand UAH.
- If there is no treatment, then in 95% of cases severe complications develop.
The most common division of venous disease is by classification ICD-10, in which the disease is assigned code 183. Depending on the complications arising from the varicose veins (VRV), the following types are distinguished with the corresponding codes:
- Code 183.0 - varices of the lower extremities, which was complicated by trophic ulcers with any position on the legs.
- Code 183.1 - varicose veins on the legs, complicated by congestive dermatitis, eczema or other type of skin inflammation.
- The appearance of trophic ulcers and eczema.
- Code 183.9 - Varicose veins are not accompanied by accompanying processes of inflammation.
There is also a division of varicose veins, according to the ICD-10 norms, into two large groups:
The last group includes all cases of WBC in combination with pregnancy, lactation and thrombophlebitis.
When a patient loses his ability to work due to VRV, a special assessment scale proposed by WHO is used. It distinguishes the following gradations of loss of ability to perform labor duties:
0 - an asymptomatic course of the disease is observed.
1 - initial varices are determined, but the patient does not use special painkillers to perform work.
2 - work for 8 hours requires the use of painkillers.
3 - the patient can not perform work even with the help of medicines.
The main etiological factor of the development of varicose veins is complicated by the outflow of blood vessels. Under normal circumstances, she has to overcome the earth's attraction, and if there are additional obstacles in the form of thrombosis, the contraction of the veins of the pregnant uterus or tumor develops a health-threatening condition.
Sprained veins occur due to valve failure. If the venous vessel is stretched, then the operation of the valve becomes even more complicated. When moving blood, it can not close tightly and some of the biological fluid rushes back. This contributes to an increase in venous pressure, the vessel further expands further along a closed circle.
The exact cause of the illness is not fully understood today, but there are several theories that have been confirmed to a greater or lesser extent by various specialists.
Theories of varicose development:
- Hemodynamic causes - associated with a violation of the valve apparatus of the venous system, which contributes to the disorder of hemodynamics.
- Mechanical causes - are associated with various obstacles that arise in the path of blood flow.
- Congenital predisposition to varicose veins - adherents of this theory believe that the inherited weakness of the venous wall can be transmitted, due to which venous insufficiency develops.
- Neuroendocrine causes - the proof of the truth of this theory is the definition of vegeto-vascular disorders, which in some cases can really provoke the development of varicose veins.
- Allergic causes - lie in the wrong reaction of the immunological system, resulting in allergic reactions, and with them - varicose disease.
Conditions provoking the appearance of varices:
- Unfavorable working conditions - prolonged standing on the legs promotes an increase in venous pressure, and in the future - the development of VRV.
- Hormonal changes - with some physiological processes, such as pregnancy or menopause, the blood coagulability increases, the vascular wall tone is weakened. This in turn leads to varicose veins.
- Abuse of alcohol - under the influence of alcohol -containing substances, the blood in the vessels thickens, the risk of blood clots increases, which are most often localized in the venous system of the lower extremities, since here is the weakest current of blood.
- Heavy physical activity - varicose veins are often determined by loaders, heavyweights and athletes engaged in heavy sports. In such cases, increased intra-abdominal pressure, which does not allow the blood to circulate normally in the veins.
- Improper nutrition - there are products that provoke the development of SRV (animal fats, smoked foods, spicy and salty foods). The body should receive enough vitamins P, E, C, and with their lack of circulation blood circulation worsens.
- Frequent wearing of tight linen - promotes mechanical compression of venous vessels, as a result of which the outflow of venous blood from the lower extremities is disturbed.
In addition, the development of varicose veins may be associated with surgical interventions, concomitant cardiovascular disease, overdose of certain drugs and even being in a hot climate. That is why it is highly unlikely that a patient with varicose veins is in a sauna or bath.
Video Varicose disease of the lower extremities. Reasons
In the process of varicose development, complex mechanisms are involved, which are based on the formation of regurgitation (reflux) of the blood due to the unstable closure of venous valves.
At the cellular level, this process is associated with a violation of the physiological balance between muscle cells, collagen and elastic fibers of the venous wall.
The initial stage of the development of varicose veins is characterized by a slowing down of blood flow through the veins. In this case, the so-called shear-stress parameter (shear stress) is changed, which is a combination of indicators of blood flow through vessels. Changing the parameters triggers the reaction of the endothelium, which in turn provokes the development of the mechanism as a leukocyte roller.
Prolonged action of the provoking factor secures an inflammatory reaction, which gradually spreads through the venous vessels of the lower extremities.
At first, only the internal layer of the veins affects, further inflammation spreads deep into the walls of the vessel. Venous valves are most likely involved in such a pathological process, which is why very often their inadequacy is formed.
In the last stages of the development of the disease, dynamic venous hypertension occurs - this is when during rest, venous pressure does not decrease to the necessary figures, in which blood perfusion occurs through tissues. As a result, swelling appears, and lateral forms of blood penetrate into soft tissues, which leads to the appearance of lipodermatosclerosis and hyperpigmentation. Subsequently, microcirculation of tissues is disturbed so much that trophic ulcers are formed.
Clinical signs of varicose veins are directly related to the enlargement of the venous net. The most characteristic signs have entered the system of CEAR, where C is the signs of the disease, E is the etiological factors, A is the location of the pathological process, P is secondary manifestations of the disease (complications).
Clinical stages of varicose vein development through the CEAR system:
- Stage 0 - The patient complains of fatigue, although the examination does not reveal any visible lesions.
- 1 stage - on the lower extremities appear vascular mesh, thickness of which is not less than 1 mm. In addition, at night the patient may be disturbed by convulsions.
- Stage 2 - the thickness of the deformed vessels is 3 mm or more.
- Stage 3 - In the area of the ankle there is swelling, which after a long rest does not pass.
- Stage 4 - The skin in the area of lesions begins to change in its color. Pigment spots appear, often characterized by eczema and congestive dermatosis.
- Stage 5 - Trophic ulcers are determined, and after their healing, there are marked scars.
- Stage 6 - Trophic ulcers are formed on the legs from the bottom, which do not heal or do not heal at all.
The disease lasts for years, and in some cases decades. In the absence of adequate treatment, it can lead to thrombophlebitis, which in turn causes thromboembolism of the pulmonary artery. The latter pathology often ends lethally.
There are a number of instrumental studies that allow us to assess the degree of venous lesions, to determine the localization of the primary affected area. In particular, the following methods are used:
- Ultrasound scan - combined with dopplerometry, which allows you to see the structure of the vessel as much as possible, evaluate hemodynamics and determine the extent of its violation.
- Phlebography - a radiopaque substance is introduced into the circulatory system, which allows you to see a picture of the venous mesh of the lower extremities.
- Flose scintigraphy - by the method of conducting similar to the previous study, only the picture is observed on a special device.
If necessary, perform functional tests that help determine the rate of filling of venous vessels with the shins. If it is necessary to conduct a diagnosis of superficial veins, then inspect, palpinate the affected area.
There are several ways to treat varicose veins. First, conservative therapy is used, and in the case of ineffectiveness it is a surgical effect.
Drugs used to treat acute respiratory viral infections must meet the following requirements:
- Raise the tone of venous vessels.
- Reduce capillary permeability.
- Enhance lymph drainage.
- Improve microcirculation.
- Eliminate rheological disorders.
- Prevent the development of vascular inflammation.
- Well tolerated by the patient.
Conservative therapy is more commonly used in early stages of the disease, when signs just begin to appear. Includes various non-surgical methods of exposure to enlarged veins:
- Therapeutic physical training - used to improve blood circulation in the legs, helps to improve the tone of the vessels and thus remove some clinical manifestations. Is selected on an individual basis, taking into account the patient's specifics.
- Physiotherapy - is prescribed by a physician-physiotherapist, may be represented by massages, electrophoresis, hyperbaric oxygenation, lymphatic drainage. Also, depending on the readings, a dynamic and magnetic field can be used.
- Dietary nutrition - based on the exclusion from the diet of smoked meats, marinades, alcohol and coffee. The food is saturated with products rich in vitamins P, E, C, which help to strengthen the vascular walls. n particular, it is worthwhile to eat more seafood, citrus fruits, legumes, cherries and cherries, currants, nuts, spinach, grapefruit, etc.
- Organizing a healthy lifestyle - giving up smoking and other factors or substances that can contribute to blood congestion. It is necessary to use a moderate operating mode, without overwatching and stresses. It is also useful to wear medical stockings and bandage your legs.
- Medical correction is one of the most important ways of treating varicose veins. Today, many drugs and drugs are used, but the most effective ones have not yet been identified. More often, medicines are used from pharmacological groups such as venotonics (lyoton, detraplex), non-steroidal anti-inflammatory drugs (diclofenac, indomethacin). With the development of thrombophlebitis, anticoagulants (heparin) are used.
Patients with varicose veins can receive medical help in the form of surgical intervention. Previously, similar procedures were quite traumatic: most often carries the affected veins, which is called phlebectomy. This allowed for the treatment of a disease of an unfinished stage.
Indications for phlebectomy:
- Extensive varicose veins.
- Complication of VRV with thrombophlebitis.
- Complication of acne with unhealthy trophic ulcers.
- Bad health of the patient due to marked swelling, fatigue, etc.
Contraindications to phlebectomy:
- Old age
- Infectious diseases.
- Pregnancy in the second or third trimester.
Today, more attention is paid to the less traumatic types of surgery, which include:
- Laser coagulation is an endovascular intervention that is performed so quickly and atraumatically that it allows the patient to stay in the hospital.
- RF Frequency Coagulation - The method allows eliminating reflux in the large and small subcutaneous veins. Similar to the previous one, it is performed without cuts and without hospitalization.
- Sclerotherapy - this method of treating varicose veins has already been used for over a hundred years. Today, it differs in many respects from previously performed sclerotherapy. The method of execution allows the patient to keep up with the usual life and to conduct effective treatment sessions.
In cases of varicose veins, a relatively favorable prognosis is most often proposed, since the disease is rarely when threatened with fatal outcome. In severe cases, dangerous complications may develop:
- trophic ulcer;
- a tumor on the site of an unhealthy trophic ulcer.
In order to improve the prognosis, appropriate treatment should be performed, eliminating developmental factors, and performing preventive instructions from the physician.
There are several trends in the prevention of varicose veins:
- Application of compression methods.
- Support in the normal state of body weight.
- The exclusion of such bad habits as the use of alcohol and smoking.
The strengthening of the venous mesh is facilitated by foot massage, contrasting shower, the use of special creams and ointments. It is also useful to take the correct posture while sitting (do not cross legs, do not squeeze them under a chair, etc.). In addition, the underwear should be sufficiently free so as not to crush the vessels.
Answers to Frequently Asked Questions
How can cure varicose veins at home?
Homemade preparations are suitable for the treatment of primary hepatitis B virus or its prophylaxis. If a pronounced course of the disease is determined, then the following prescriptions are combined with medication therapy.
- Ointment from calendula - make a regular infusion of inflorescences of the plant, after which it is mixed with a glass of fat (maybe a rodochnoy, lanolin or petroleum jelly). Optional aroma oil (grapefruit, sage, eucalyptus, lavender, rose) is added. The ointment is rubbed on the legs in the area of unpleasant sensations until the mixture is absorbed. Depending on the indications, the calendula may be combined with hop cones, nettles or thyme.
- Chamomile oil - a simple recipe to remove unpleasant sensations in the onset of varicose veins. It is made from fresh inflorescences of medicinal chamomile and vegetable oil, better olive than 1: 1. Most often take a floor liters of one and the other component, after which everything is placed in a bottle of dark glass (best of all - brown). Insists medication a month. It is periodically shaken. If the time has come for its use, then the drug is filtered, if desired, an aromatic composition is added to it. To use, choose morning and evening time. Apply to the skin and rub massaging movements.
What cream can be used for varicose veins?
There are many creams that are recommended for use in varicose veins. All of them have a venotonizing effect, help to remove weight, fatigue, and eliminate pain. The following creams are most commonly used for VRVs:
- Venitane cream.
- Dr. Ven is a venotonizing agent.
- Cream based on horse chestnut.
How to treat varicose veins in pregnant women?
The period of bearing of the fetus is considered to be a provocative factor in the development of varicose veins in women. If the disease before or after the baby gave birth to itself, do not wait for long-term consequences. From pharmacological preparations prefer cream, which relieve the severity of the legs and edema. It can be a lyotone, an ascension, a skyscraper.
For compresses, use fresh leaves of cabbage and grated potatoes. If you put the remedy on the affected area, cover with parchment paper and wrap it with a cloth from above, then you can leave this compress for the night.
Should I wear compressive underwear for varicose veins?
Many patients are positive about compressive underwear, which helps to reduce fatigue and swelling, although the disease itself, of course, is not able to cure.To wear, tights, stockings, socks can be used. It is advisable to wear them every day.
Compression linen has its own marking, which is created from the calculation of the pressure exerted on the vessels.
- The greatest compression has linen with the mark IV ККл. It is intended for patients with congenital pathology of veins or elephants.
- The next degree is III KKL, such linen is designed for wearing trophic ulcers.
- II KKl - with threats of development of thrombophlebitis or after phlebectomy.
- I CCl - at the beginning of the development of varicose veins or during pregnancy.
Video Treatment of varicose veins in the home
In the early stages of the development of varicose veins, conservative treatment is most often used, which includes taking tablets of drugs and applying ointments to the affected areas of the body. In severe cases, resorted to the removal of veins. For this purpose, laser varicose vein treatment is widely used today. With its successful implementation, the general well-being of the patient improves markedly.
Leg varicose veins can have severe complications, even trophic ulcers, so appropriate measures should be taken when the slightest signs of illness appear. A phlebologist knows how to treat varicose veins. Each method of treatment has its own indications and contraindications.