Varicose veins are pathological enlargement of the vein lumen caused by thinning of their walls and reduced tone. In the advanced stage, the venous nodes protrude under the skin and may occasionally become inflamed. Varicose veins are not only an aesthetic defect. The symptom indicates impaired blood circulation, which impairs the quality of tissue and organ nutrition and increases the risk of blood clots. Diagnosis and treatment at an early stage can slow down the development of the pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that includes any disorders in the structure and functioning of the venous system. These can be congenital, genetically determined anomalies, as well as pathological changes that have arisen under the influence of external factors.
Varicose veins affect about 60% of adults worldwide, mostly Europeans. Mostly women suffer from varicose veins. This is due to the presence of a connection between the tone of the vascular walls and the hormonal level.
Types of varicose veins
Varicose veins usually mean the expansion of the veins in the legs, but pathological changes can also affect other parts of the body. Depending on the location, there are:
- dilated rectal veins (hemorrhoids);
- expansion of the veins of the esophagus;
- dilated veins of the spermatic cord in men (varicocele);
- varicose veins of the lower extremities.
Sometimes reticular varicose veins are isolated separately. It consists of vascular networks and stars that are visible under the skin. It occurs primarily on the legs, but it 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. Nodule formation is uncharacteristic.
Types of varicose veins of the extremities according to the CEAP classification (stages of development):
- C0 – no signs;
- 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 are:
- heaviness in the legs (bodies), swelling, worsening in the evening;
- increased leg fatigue;
- 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 lumps. A sign of chronic venous insufficiency is a change in skin color associated with tissue trophism (nutrition) damage. Extensive eczema-like redness, itchy blisters and nodules appear. Swelling of 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 enlarged blood vessels may occur. Trophic disorders are usually not observed.
Reasons for the development of varicose veins
Reticular varicose veins are caused by the replacement of collagen type 1 in the walls of blood vessels by collagen type 3. As a result, their contractility deteriorates - after dilation, the vessels no longer return to their original state. The cause of the thinning of the vascular wall is the excessive activity of enzymes that destroy proteins of the extracellular matrix and elastin.
In women, the hormone progesterone helps to reduce the tone of the smooth muscle fibers of the vascular walls. Estrogen reduces the level of antithrombin, increases blood clotting and causes the development of stagnant processes.
The main cause of varicose veins of the extremities, accompanied by the appearance of nodes and bumps, is the failure of the valve mechanisms. Valves are folds formed by the inner lining of veins. They usually work only in one direction: they open under the pressure of the blood flow and do not let it back. If the valve mechanism is weakened, blood flows backwards (reflux), causing the vein walls to expand and their inner lining to become inflamed. Then the pathological process spreads into the deeper layers of the vein wall. His muscle fibers begin to be replaced by scarred fibers and atrophy occurs. The walls no longer contract and their collagen structures are destroyed. The vein twists into a spiral.
Increased pressure in the vessels causes a malfunction of the muscular-venous pump. This is the system that regulates the pumping of blood to the muscles during exercise and relaxation (the "peripheral heart"). The result is congestion and venous insufficiency.
The provoking factors are:
- heredity: in most cases, varicose veins are caused by mutations in genes responsible for the structure of venous valves and walls;
- excess weight;
- sedentary lifestyle;
- increased load on the venous system of the extremities due to work in a standing position;
- pregnancy and childbirth, menopause, hormonal imbalance.
Varicose veins can be caused by poor mobility of the feet due to uncomfortable shoes, as well as bad habits: smoking, alcohol abuse.
Diagnostics
The main methods for diagnosing varicose veins include a visual examination by a vascular surgeon, during which he assesses the condition of superficial and deep veins and identifies signs of tissue malnutrition. The patient is then sent for additional diagnostics.
- Ultrasound duplex scan. It 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.
- Study of valve functions: compression tests, simulated walking, Parana maneuver.
- X-ray contrast venography is an X-ray image with a contrast agent that is injected into the veins. It helps to assess valve function, vein patency and detect blood clots.
To clarify the diagnosis, the doctor can prescribe CT, MRI, thermography, radiophlebography, intravascular ultrasound, blood tests for coagulation, etc.
Expert opinion
Varicose veins are more than just unsightly veins that stick out from under the skin. Complications of varicose veins are extremely unpleasant.
- Trophic disorders. Large brown spots appear on the legs or thighs, and later large, incurable, itchy and painful ulcers form.
- Thrombophlebitis is an inflammation of the vein walls, accompanied by the deposition of thrombotic masses on them. A thrombosed vein turns red, thickens, hurts, and the temperature around it rises. Externally it resembles an abscess. It threatens to spread the infection throughout the body.
- Bleeding. Bleeding from a ruptured varicose vein can occur inside or outside the tissue. Bleeding is heavy and requires an emergency call.
- Thromboembolism. A blood clot that forms inside a varicose vein can break off and block vital arteries, such as the pulmonary artery. This condition often leads to instant death.
Timely diagnosis will help prevent serious consequences of varicose veins and identify the causes that caused them.
Treatment of varicose veins
The specific treatment of reticular varicose veins involves several areas.
- Compression therapy - wearing supportive knitwear (socks, tights) of class A and I to prevent backflow of blood.
- Pharmacotherapy - taking phlebotonic drugs to increase vein tone. These drugs will not remove the external signs, but they will remove the subjective symptoms of heaviness, swelling and aching pain.
- Phlebosclerosis is the sticking of small blood vessels by introducing sclerosing substances into them. Microsclerotherapy allows you to get rid of vascular networks.
- Laser therapy – allows you to eliminate remaining minor defects after microsclerotherapy. During the procedure, the doctor applies a light beam to the affected areas.
An important part of therapy is therapeutic exercises, losing weight, wearing comfortable shoes and regular physical activity.
Two methods are used for the surgical treatment of varicose veins accompanied by the appearance of nodes: classic phlebectomy and endovenous thermal obliteration. The first method is considered outdated. It involves ligation of the junction of the vein with the common femoral bone and removal of the affected part of the trunk. The method is characterized by increased trauma and a high risk of recurrence.
Thermal obliteration is a gentle, 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, increasing its temperature. After that, it is gradually resolved.
Prevention
To prevent the development or recurrence of varicose veins, people at risk must:
- minimize the static load on the legs;
- eat rationally and, if necessary, take venotonics as recommended by the doctor;
- wear compression socks 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.
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.