Varicose disease of the lower extremities is very common, and if the past patients of the doctor, who was older, now it often affects people in the age 25-45. The symptoms, depending on the different statistics, which is taken into account in 66% of men and 90% of the women population in developed countries. The disease is progressive in nature and can be combined with the venous insufficiency.
Varicose disease of the lower extremities accompanied by an abnormal enlargement of the superficial veins, which is due to the failure of the venous valves, and accompanied by a significant violation of hemodynamics. In the future, this pathology may be impaired by thrombosis, which leads to an increased risk of phlebothrombosis and pulmonary embolism (PE).
The mechanism of the development of
The first starting mechanism in the development of this pathology of the lower limbs veins is a failure of the venous valves, leading to reflux of blood. As a result, slow down the blood flow to react with the endothelial cells and white blood cells that activate the inflammatory process in the vessel wall, which is spreading through the venous channel. In parallel with inflammation of the disordered functions of the endothelial layer of veins, and then all layers of the venous wall.
In the first place, and particularly acute from the above disease processes is the valve system of the veins. The first is usually on the affected area max load: at the mouth of the great and small saphenous veins or major perforating vessels. In the future, due to the overrun of the vein occurs hyperextension of venous wall, and the quantity of venous blood in the superficial venous vessels of the lower extremities increases. Further, this exceeded the range of flows through the particular system to the deep veins and stretches them. Later develops dilatation and insufficiency of venous valves.
These pathological changes lead to horizontal reflux (reflux of blood in the subcutaneous venous network) and the work of the venous pump completely loses its effectiveness. For the further development of venous hypertension that lead to venous insufficiency. Initially, the patient has edema, and then from the flow of blood in the soft tissue and penetrate blood cells, which are the result of hyperpigmentation and the skin. With the progression of the disease on the surface of the skin that occurs trophic ulcers, which may be complicated by secondary infection.
Doctors point to several reasons, which can lead to pathological disorders in the functioning of the venous system. They are divided into two main groups:
- I – genetic predisposition;
- II – a number of reasons, due to the impact of adverse factors or their combination.
Genetic predisposition to varicose veins can be determined for women and men, despite the fact that in most cases, this pathology is observed in women. The disease can be a long time does not manifest itself, but under certain conditions (for example, intensive physical exertion) failure of venous valves.
Doctors identify a number of adverse factors, which may cause varicose veins:
- hormonal imbalance;
- frequent constipation;
- surgical operation or injury;
- dependence on alcohol and Smoking;
- professional risk (high load, long forced-standing position);
- wearing a compression body linen;
- prolonged wearing of high heel shoes.
- pregnancy and childbirth;
- the constitutional features and congenital anomalies of the heart and the circulatory system;
- stay in adverse weather conditions.
Signs and symptoms
Varicose veins in most cases develops slowly and gradually. Early on it occurred in a few and nonspecific symptoms, which can be classified in the "syndrome of heavy legs":
- the feeling of weight in feet;
- fatigue of the legs;
- burning sensation and fullness in the region of the veins;
- pain the pain;
- occasionally swelling the back side of the foot and ankle, increasing in the evening and disappearing after a night's sleep.
The main and the first character of the start of the varicose veins become appear cylindrical parts of the enlarged surface veins. This symptom, accompanied by fatigue of the lower extremities, burning sensation and bloating in the region of the passage of vessels and the permanent feeling of weight in the legs. The dilated blood vessels become round and begin to protrude above the surface of the skin on the legs and the lower part of the leg, and after a long walk or intense exercise, they become more visible. Also, the person may be swelling, which is especially clearly manifested in the evening the ankles, lower Shin and the top of the foot. At night the patient may have cramping. And in the later stages of the disease due to insufficient blood circulation in the skin on the feet can aggravate.
In some cases, the first signs of varicose veins shows only the so-called "spider veins" (spider web varicose veins not thicker than 0.1 mm), and patients for a long time unaware of the beginning of the disease. Some women perceive this symptom, as it is only a cosmetic error, and men who simply do not notice it. Despite the absence of any other signs of varicose veins "spider veins," are the first and, in some cases, the only symptom of varicose veins and treatment to the doctor, in this stage of the disease can help the patient significantly slow down the progression of the disease vein.
Most often, doctors use a form of classification of varicose veins, proposed in the year 2000, which takes into account the shape of the disease and degree of chronic venous insufficiency:
- I – intradermal or segmental dilatation without the vein-venous reset;
- II – segmental varicose veins with reflux in the perforating and/or superficial veins;
- III – the common varicose veins with reflux in the perforating or superficial veins;
- IV – varicose veins with reflux in the deep veins.
Varicose veins you can:
- rise – the blood vessels begin to change the pathophysiology of the foot;
- negative – the development of varicose veins begins with the mouth of the great saphenous vein.
Also the detection of varicose veins on the legs to determine the tactics of treatment, it is important to take into account the degree of chronic venous insufficiency:
- 0 – CHANGING none;
- 1 – the patient is only the syndrome of "heavy legs";
- 2 – the patient, passing present swelling;
- 3 – the patient presented with persistent edema, eczema, Hypo - or hyperpigmentation;
- 4 – on the surface of the leg formed trophic ulcers.
At the first stages of development of varicose disease significantly impairs the quality of life for the patient and gives him some unpleasant moments in the form of a noticeable cosmetic problem. In the future, with the progression of the disease, the limbs may be formed ulcers, which are often complicated by secondary infection. For the first time, on the surface of the skin appear (usually in the lower third of the leg) of the area with thinning, dry, hard and shiny surfaces. Later appear the areas of hyperpigmentation and develops small ulcers, increasing in size and delivering pain. In the future, the edges become more dense, the bottom is covered with a touch of dirty colours and, occasionally, bleeding. With minimal damage to its borders has significantly increased, and the ulcer becomes infected.
Thrombophlebitis and thrombosis
The premature or improper treatment of varicose veins of the lower extremities may be complicated by thrombosis or thrombophlebitis. These diseases arise suddenly and are not associated with the influence of external adverse factors (e.g., intense physical activity). The patient has a significant and rapidly spreading to the entire leg edema, which is accompanied by severe pain expander nature. In some parts of the skin can appear local pain, redness or cyanosis. When you migrate a detached blood clot in the blood vessels of the lung may develop this serious complication of thrombosis of the lower limbs, pulmonary embolism.
Usually the diagnosis "varicose disease", it becomes clear that the phlebologist at the first hearing of the patient. After studying the patient's complaints, examination of the lower extremities and has a number of specific patterns, the doctor will prescribe a series of studies to confirm the diagnosis and determine the tactics of further treatment:
- clinical and biochemical blood analysis;
- ULTRASONIC dopplerography;
- duplex scan;
- occlusive plethysmography;
- venography (assigned only if a questionable indicator of non-intrusive methods).
The main objectives of the treatment of varicose veins of the lower extremities oriented in the stabilization and restoration of normal outflow of venous blood, improving the quality of life for the patient and prevention of complications caused by venous insufficiency. The therapeutic measures may include:
- conservative treatment can be used in the initial stages of the disease (when lesions of the skin on the legs is not yet featured and the ability to work the patient reduce moderate), in the postoperative period or with contraindications to surgical treatment;
- surgical treatment: prescribed for severe symptoms or in the advanced stages of the disease and can be done with minimally invasive methods or by radical surgery.
Conservative methods of treatment of varicose veins includes the following activities:
- Reducing risk factors for disease progression. Patients with varicose disease and persons at increased risk for the occurrence of varicose veins, it is recommended that continuous monitoring of the doctor.
- Fight against weaknesses. Patients who do not have signs of thrombophlebitis or thrombosis, have shown regular physical therapy sessions and some of the activities, which are aimed at strengthening and training on the veins of the lower extremities. The intensity of the exercise should be agreed with the doctor-physiotherapist. A beneficial effect on the situation in the veins of the legs: walking, Cycling, Running, swimming. So patients are advised to perform the exercises (except those who operate in the water), in the form of additional compression creates a special underwear or elastic bandages. Before training, the patient is recommended to lie down for a few minutes with raised legs. Patients with varicose veins is contraindicated classes traumatic foot sports: the different power of martial arts and sports associated with heavy lifting, skiing, tennis, basketball, volleyball, football.
- The compression therapy. For graduated compression of the muscles, which helps to eliminate stagnation of blood and normalize the venous circulation, apply elastic bandages and compression stockings of different compression classes. At 0 and 1 degree of chronic venous insufficiency recommended knit I-II class, 2 – class II, with 3 and 4 – II or III (and in severe cases, IV grade). Depending on the extent of the lesion of the veins, compression for the treatment of varicose veins of the lower extremities may be appointed as a limited or longer period of time.
- Treatment with medications. Patients with varicose veins of the lower limbs, along with a 1-4 degree of venous insufficiency, which shows the course of medication. We must not forget that the purpose of the drug therapy can be performed only doctor, because the mindless use of drugs can not relieve the patient of venous insufficiency and will only aggravate the disease. With appropriate and well-chosen treatment and counseling, medical compression treatments and physical therapy patient will be able to for 3-4 weeks, in order to achieve the elimination of clinical symptoms, complications and allowances of venous insufficiency. In the scheme of treatment can include such drugs: antiplatelet agents, anticoagulants, nonsteroidal anti-inflammatory drugs. In the complicated course of the disease and venous thrombosis regime may be supplemented by special funds for local use and the development of venous ulcers and their infection with antibiotics and wound healing agents.
- Physiotherapy. A complex of therapeutic procedures for varicose veins of the lower extremities can include a variety of treatments, which contribute to the normalization of tone of the walls of blood vessels, microcirculation, and lymph flow. If you want to do this, the patient can be administered: local darsonvalization, magnetotherapy, laser therapy, hyperbaric oxygenation and hydro - and balneotherapy (General and local baths of mineral water, in contrast with oxygen and pearl baths). In the absence of contraindications, the patient could be shown the courses easy massage that must be performed by a specialist or by yourself (after learning a simple technique from the experienced massage therapist). Many patients with varicose veins may be of such a sufficiently common treatments such as leech therapy.