Varicose disease of the lower limbs is extremely common, and if the past patients of the doctor was older, now it quite often affects people aged 25-45. Its symptoms, according to various statistics, observed in 66% of men and 90% women population in developed countries. The disease is progressive in nature and can be combined with venous insufficiency.
Varicose disease of the lower extremities is accompanied by abnormal enlargement of the superficial veins, which is caused by a failure of venous valves, and is accompanied by a significant violation of hemodynamics. In the future, this pathology may be exacerbated by thrombosis, leading to increased risk of phlebothrombosis and pulmonary embolism (PE).
The first starting mechanism in the development of this pathology of the lower limbs veins is a malfunction of the venous valves, which leads to reflux of blood. As a result, the slowing of blood flow react with endothelial cells and are white blood cells that activate the inflammatory process in the vessel wall, spreading through the venous channel. In parallel with inflammation of the disturbed functions of the endothelial layer of the veins, and then all layers of the venous wall.
In the first place and particularly acute from the above mentioned pathological processes is the valve system of the veins. First is usually affected area max load: at the mouth of the great and small saphenous veins or major perforating vessels. In the future, because of the overflow venous occurs hyperextension of venous wall, and the volume of venous blood in the superficial venous vessels of the lower extremities increases. Further, this exceeded the volume flows through the particular system to the deep veins and stretches them. They later develops dilatation and insufficiency of venous valves.
These pathological changes lead to horizontal reflux (reflux of blood into the subcutaneous venous network) and the work of the venous pump completely loses its effectiveness. To further develop venous hypertension leading to venous insufficiency. Initially, the patient edema, and then from the blood stream into soft tissue and penetrate blood cells, which result in hyperpigmentation and skin. With the progression of the disease on the surface of the skin appears trophic ulcer, which may be complicated by secondary infection.
Doctors point to several reasons that may lead to pathological disorders in the functioning of the venous system. They are divided into two main groups:
Genetic predisposition to varicose veins can be determined for both women and men, despite the fact that in most cases, this pathology is observed in women. The disease may for a long time does not manifest itself, but under certain circumstances (for example, intensive physical exertion) is the failure of the venous valves.
Doctors identify a number of adverse factors that may cause varicose veins:
Varicose veins in most cases develops slowly and gradually. Early on she manifested few and nonspecific symptoms that can be grouped into a "syndrome of heavy legs":
The main and the first sign of incipient varicose veins become appeared cylindrical sections of dilated superficial veins. This symptom is accompanied by fatigue of the lower extremities, burning and bloating in region of passage of the veins and the constant feeling of heaviness in the legs. The dilated vessels become round and begin to protrude above the surface of the skin in the feet and lower leg, and after a long walk or intense exercise, they become more visible. Also, a person may be swelling, which is especially clearly manifested in the evening of the ankles, lower Shin and top of the foot. At night the patient may have convulsions. And in the later stages of the disease due to insufficient blood circulation the skin on the feet may deteriorate.
In some cases, the first signs of varicose veins are manifested only so-called "spider veins" (spider web varicose veins not thicker than 0.1 mm), and the patient for a long time unaware of the beginning of the disease. Some women perceive this symptom as just a cosmetic defect, and men simply do not notice it. Despite the absence of any other signs of varicose veins is "spider veins" are the first and, in some cases, the only symptom of varicose veins and treatment to the doctor at this stage of the disease can help the patient significantly slow the progression of the pathological vein.
Most often, doctors use a form of classification of varicose veins, proposed in 2000, which takes into account the form of the disease and degree of chronic venous insufficiency:
Varicose veins can be:
Also the detection of varicose veins of the legs to determine the tactics of treatment it is important to consider the degree of chronic venous insufficiency:
On the first stages of development of varicose disease significantly impairs quality of life of 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. First, on the surface of the skin appear (usually in the lower third of the leg) areas with thinning, dry, hard and shiny surface. Later they appear areas of hyperpigmentation and develops small ulcers, increasing in size and delivering pain. In the future, its edges become more dense, and the bottom is covered with a touch of dirty color and occasionally bleeding. With minimal injuries its borders is significantly increased, and the ulcer becomes infected.
At untimely or incorrect 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 areas of the skin can appear local pain, redness or cyanosis. When you migrate a detached blood clot in the blood vessels of the lungs can develop this severe complication of thrombosis of the lower limbs, pulmonary embolism.
Usually the diagnosis is "varicose disease" becomes apparent to the phlebologist at the first examination of the patient. After studying the patient's complaints, examination of the lower limbs and holding a number of special samples, the doctor will prescribe a series of studies to confirm the diagnosis and determine the tactics of further treatment:
The main objectives of treatment of varicose veins of the lower limbs aimed at stabilizing and restoring the normal outflow of venous blood, improving the quality of life of the patient and prevention of complications caused by venous insufficiency. Therapeutic measures may include:
Conservative methods of treatment of varicose veins involve the following activities: