Varicose veins of the legs are a common disease that is manifested by permanent and irreversible expansion and elongation of the superficial veins, as well as their dysfunction due to pathological processes in the vein wall and congenital or acquired insufficiency of the valve. equipment.
According to the World Health Organization, varicose veins occur in every fifth adult on the planet. The first signs of varicose veins (venous reflux) are seen in 10-15% of children and adolescents aged 12-13.
Causes of varicose veins of the legs
- Hereditary tendency (congenital weakness of vascular valves). If your parents had signs of weakness of the venous wall in any blood vessel (legs, groin, esophagus, rectum), then you may most likely have symptoms of varicose veins.
- Weak circulation in the lower limbs during pregnancy and childbirth (compression of abdominal veins by the developing fetus, increased pressure in the veins of the legs, hormonal changes causing a decrease in the tone of the veins).
- Obstruction of blood flow during prolonged standing (lower extremity varicose veins are more common among salespeople, teachers, waiters, surgeons) and sitting (managers, accountants, office workers, drivers, etc. )
- Heavy physical work, sports training related to weight lifting (for athletes, loaders, builders, regular visitors to gyms and fitness clubs)
- Long-term use of contraceptives with a high female sex hormone content.
- Hormonal changes in the body, accompanied by a decrease in the tone of venous vessels (adolescence, pregnancy, menopausal disorders in old age).
- Factors such as being overweight, chronic cough, constipation, and the habit of wearing tight clothes and shoes interfere with venous outflow and often lead to the development of varicose veins.
Why do varicose veins occur during pregnancy?
In women, varicose veins of the lower limbs are observed 3-5 times more often than in men, and they quite often occur for the first time during pregnancy. In 80% of cases, varicose veins first develop on the left leg, and only then on the right side.
- The appearance of varicose veins is facilitated by the hormonal changes that occur in the female body during pregnancy, which cause the venous wall to decrease in elasticity, stretch and turn into a varicose node.
- The amount of blood flow in a pregnant woman's body increases significantly. Increased venous pressure leads to thinning of the venous wall and local expansion (varicosis).
- The growing fetus causes a corresponding enlargement of the uterus and complicates the outflow of blood from the lower limbs through the pelvic veins due to increased intra-abdominal pressure and mechanical compression of the veins.
- The increased body weight of pregnant women also negatively affects venous outflow.
Varicose veins of lower limbs: symptoms
Varicose veins develop rather slowly and go through several main stages one after the other:
- In the first stage, the violation of venous circulation is accompanied by the appearance of individual "spider veins", thinning of the skin, through which dilated veins in the form of twisted cords begin to appear during physical activity (usually in the popliteal fossa), there are no complaints.
- In the second stage of varicose veins, a feeling of heaviness, fatigue in the lower limbs, swelling of the legs in the evening and after a long walk, a feeling of crawling on the legs, night cramps. after a careful examination of the calf muscles, several varicose veins are revealed on the lower legs, and sometimes - on the legs and thighs.
- The third stage of varicose veins of the lower limbs is characterized by the pronounced bulging of the venous nodes, primarily on the inner surface of the leg, the appearance of dark brown or brown spots on the skin of the thin, easily injured legs, as well as skin inflammation with itching and rashes. The swelling of the legs becomes more intense, which makes it difficult to walk.
- The fourth stage of varicose veins is the presence of varicose nodes on the leg, 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 - all the symptoms characteristic of the fourth stage of varicose veins are found, the process spreads to the lumbar areas, the buttocks, the perineum, the presence of multiple trophic ulcers, the appearance of elephantiasis, frequent exacerbations. thrombophlebitis and the development of disability.
Complications of varicose veins
- Thrombophlebitis of superficial veins.
- Bleeding when the vein bursts.
- Dermatitis, eczema.
- Trophic ulcers.
- Deep vein thrombosis (phlebothrombosis) and postthrombophlebitis disease.
- Pulmonary embolism (PE).
- Lymphedema (elephantiasis).
Diagnosis of varicose veins
It is based on clinical examination, performance of functional tests and instrumental examination 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 limbs
If varicose veins are detected at an early stage, you can cope with their manifestations with the help of compression stockings, special therapeutic exercises and traditional treatment methods. But if you consult 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, there is no need to be afraid of surgery, because modern technologies make it possible to get rid of varicose veins of the lower limbs without a wide incision, without pain and practically without disturbing a person's usual lifestyle.
The principle of surgical manipulation is similar for the various techniques: pathologically altered superficial veins of the leg are ligated, excised and removed. In this case, the venous circulation of the lower limbs is not disturbed, since the operation does not affect the deep veins, through which about 90% of the venous blood flows.
The main types of surgery for varicose veins
- Sclerotherapy. In the initial stages of varicose veins, a good cosmetic result can be achieved if special drugs are introduced into the problematic vein, gradually causing sclerosis, "gluing" the pathologically dilated area of the vessel. A medicinal substance (usually sclerosis) is injected through a special catheter or a very thin needle into the3-10 injections are required to achieve a positive result.
- Phlebectomy. It was an operation almost a hundred years ago, but in modern conditions wide incisions have long been abandoned. Today, the manipulation is performed with a miniature, 3-5 millimeter incision. The pathologically dilated vein is first ligated and cut at the point where it flows into the deep vein, and then removed with special probes. This surgery takes about 1-2 hours, after which the patient stays in the hospital of a medical facility for 1-2 days.
- Miniphlebectomy. The operation is performed under local anesthesia, without an incision, but with the help of small punctures through which the varicose veins are removed. This provides a good cosmetic effect (no stitches are usually required) and significantly reduces the recovery time after surgery. In some cases, it is not possible to remove the entire vein, but only its pathologically changed section. This intervention is called short stripping.
- Endovenous laser coagulation of veins. The manipulation is performed 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 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 limbs will be the highest.
- Radiowave ablation of varicose veins. Obliteration ("gluing") of the lumen of the altered vein is achieved by exposing the problem area of the vein to radio waves of a certain power through a special catheter. The duration of the procedure is approximately 20 minutes.
After the surgical treatment of varicose veins using one of the above methods, physical activity should be restricted for a certain period of time, compression stockings should be worn, and if necessary, drugs that have a venotonic effect should be used. This helps to restore normal blood circulation in the veins of the lower limbs as soon as possible, prevents possible complications and allows a quick return to work and a normal rhythm of life.
In which cases is it undesirable to treat leg varicose veins surgically?
- During pregnancy and in the first two months after birth.
- In the initial stage of varicose veins, when there are no complaints and there are cosmetic problems ("spider veins" on the legs), they can be eliminated first with exercise therapy, compression stockings and traditional methods.
- In old age and in the case of serious diseases of various organs and systems of the body, which are associated with functional disorders, when the risk of possible complications increases significantly.
- In the presence of lymphatic drainage disorders, infectious lesions of the skin of the lower limbs, thrombophlebitis, arteriovenous fistulas.
By correctly choosing the most effective treatment method for varicose veins of the lower limbs in this case, the absence of contraindications and following the doctor's recommendations in the postoperative period, a positive result of the surgical intervention is guaranteed.
Prevention of varicose veins of the lower limbs
Regime and diet
Adhering to a certain work and rest regime, as well as nutrition, prevents the development of varicose veins in most cases. For this you need:
- Avoid clothing that restricts venous blood flow.
- Avoid prolonged standing or sitting (taking occasional breaks with rest and performing simple gymnastic exercises).
- Avoid strenuous physical activity.
- Lead an active lifestyle (moderate dynamic load - daily walking, swimming, cycling).
- Drink at least 1. 5-2 liters of liquid per day, and our daily diet should include vegetables and fruits, whole grain bread and cereals.
- Avoid visiting baths and saunas and do not take hot baths.
- Take a contrast shower (hot-cold) every day.
- Wear comfortable, low-heeled shoes.
Platelet therapy
An important element of preventive measures for varicose veins of the lower limbs is the use of drugs that have an antiplatelet effect, that is, they prevent the formation of blood clots. These include:
- acetylsalicylic acid and modern drugs containing it;
- Venotonics of plant origin - extracts from plants such as horse chestnut, hazelnut, mountain arnica are more often used;
- Synthetic venotonic. By the way, venotonics not only reduce thrombus formation, but also improve venous blood circulation, strengthen the vessel wall, preventing the appearance of areas of expansion.
Compression shirt
Bandaging with flexible tubular bandages has been successfully used for many years in the initial stages of varicose veins (when spider veins appear). Currently, special clothing is produced - compression knitwear, which allows you to choose the required size and the degree of compression depending on the severity of the changes. Wearing stockings and tights initially puts pressure on the upper part of the ankle, then the pressure decreases and stimulates blood flow to the heart. Venous vessels work more efficiently, as a result of which venous congestion is eliminated, swelling is eliminated, and thrombus formation can be prevented.
Gymnastics
Special exercises have been developed to eliminate stagnation of venous blood. The key to success here is the regularity of the execution of the complex. Let's look at some basic exercises that we recommend in the presence of risk factors for the development of varicose veins of the lower limbs and in the initial stages of the disease:
- Lying on your back, feet on a pillow, on a raised platform. Relax and stay in this position for a few minutes.
- "Bicycle" - lying on your back, legs raised, knees bent. Perform movements that simulate pedaling while riding a bicycle;
- "Scissors" - lying on your back, raise your legs and cross them, changing the position of the legs (up and down) for 1 minute;
- The legs are raised and bent at the knee joints. Bend and straighten your legs, imitating walking;
- Lying on your back, bend your left leg and bring your knee to your chest. Wrap your hand around your leg at the ankle joint and gradually straighten your leg, massaging the calf muscles. Repeat the exercise with your right leg;
- To stand together. Raise yourself on your toes and lower yourself (if there are no complications, the exercise can be done sharply - with your heels touching the floor).
Timely initiation and proper implementation of preventive measures can prevent varicose veins of the lower limbs or minimize its manifestations.