Varicose disease of the lower extremities

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 mechanism of development

varicose veins of the lower extremities

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.

Reasons

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:

  • I – genetic predisposition;
  • II – a number of reasons, due to the influence of adverse factors or their combination.

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:

  • hormonal imbalance;
  • age;
  • diabetes mellitus;
  • frequent constipation;
  • surgical surgery or injury;
  • hypercoagulability;
  • obesity;
  • addiction to alcohol and Smoking;
  • professional risks (high load, long forced standing position);
  • wearing compressing the body linen;
  • prolonged wearing of high heel shoes;
  • pregnancy and childbirth;
  • constitutional features and congenital anomalies of the circulatory system;
  • stay in adverse climatic conditions.

Signs and symptoms

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":

  • a feeling of heaviness in the legs;
  • fatigue of legs;
  • burning sensation and fullness in region of veins;
  • aching pain;
  • occasional swelling of the back side of the foot and ankle, increasing in the evening and disappearing after a night's sleep.

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.

Classification

signs of varicose veins

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:

  • I – intradermal or segmental dilatation without veno-venous reset;
  • II – segmental varicose veins with reflux in the perforating and/or superficial veins;
  • III – a common varicose veins with reflux in the perforating or superficial veins;
  • IV – varicose veins with reflux in the deep veins.

Varicose veins can be:

  • rising – the veins begin to change pathologically from the foot;
  • the downside – the development of varicose veins begins with the mouth of the great saphenous vein.

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:

  • 0 – CVI none;
  • 1 – the patient has only the syndrome of "heavy legs";
  • 2 – the patient passing present swelling;
  • 3 – the patient present with persistent edema, eczema, Hypo - or hyperpigmentation;
  • 4 – on the surface of the legs formed trophic ulcer.

Complications

Trophic ulcers

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.

Thrombophlebitis and thrombosis

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.

Diagnosis

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:

  • clinical and biochemical blood analysis;
  • ULTRASONIC dopplerography;
  • duplex scanning;
  • occlusive plethysmography;
  • rheovasography;
  • venography (assigned only when questionable indicator of non-invasive methods).

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 therapy can be used in the initial stages of the disease (when lesions of the skin of the feet has not yet pronounced and the ability to work the patient is reduced moderately), in the postoperative period or with contraindications to surgical treatment;
  • surgical treatment: prescribed for severe symptoms or in advanced stages of the disease and may be carried out using minimally invasive methods or by radical surgery.

Conservative therapy

treatment of varicose veins of the legs

Conservative methods of treatment of varicose veins involve the following activities:

  1. Reducing risk factors of disease progression. Patients with varicose disease and persons at increased risk of developing varicose veins, it is recommended that continuous follow-up at the doctor.
  2. Fighting weakness. Patients who have no signs of thrombophlebitis or thrombosis, are shown regular physical therapy sessions and some activities aimed at strengthening and training of the lower limb veins. Exercise intensity should be agreed with your doctor-physiotherapist. A beneficial effect on the condition of the vessels of the legs have: walking, Cycling, Jogging, swimming. Such patients are advised to perform the exercises (except those that run in the water) in terms of additional compression created 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: different power of martial arts and sports associated with heavy lifting, skiing, tennis, basketball, volleyball, football.
  3. Compression therapy. For the graduated compression of 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 veins, compression therapy for varicose veins of the lower extremities may be appointed as a limited or long period of time.
  4. Drug therapy. Patients with varicose veins of the lower extremities, accompanied by 1-4 degree of venous insufficiency, shown a course of medication. It should be remembered that the purpose of drug therapy can be performed only by a physician, because the mindless use of drugs can not relieve the patient of venous insufficiency and will only aggravate the disease. With adequate and well-chosen medical treatment and the advice of a medical compression therapy and physical therapy the patient will be able to for 3-4 weeks to achieve the elimination of clinical symptoms, complications and compensation of venous insufficiency. In the scheme of therapy can include such drugs: antiplatelet agents, anticoagulants, nonsteroidal anti-inflammatory drugs. In a complicated course of disease and venous thrombosis regimen may be supplemented by special funds for local use, and the development of venous ulcers and their infection with antibiotics and wound healing agents.
  5. Physiotherapy. The complex of therapeutic procedures for varicose veins of the lower extremities can include a variety of treatments that contribute to the normalization of tone of the walls of the veins, microcirculation, and lymph flow. 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 waters, in contrast, oxygen and pearl baths). In the absence of contraindications the patient can be shown the courses easy massage that must be performed by a specialist or by yourself (after learning a simple technique from an experienced massage therapist). Many patients with varicose veins may be of such insufficient common treatments like leech therapy.
30.04.2019