Varicose veins

Varicose veins are pathological dilation of the venous lumen due to thinning and reduced tone of the vein walls. In advanced stages, venous knots bulge under the skin and may become periodically inflamed. Varicose veins are more than just an aesthetic blemish. This symptom indicates impaired blood circulation, which reduces the nutritional quality of tissues and organs and increases the risk of blood clots. Early diagnosis and treatment can slow the progression of pathology and prevent complications.

About disease

Varicose veins are a chronic disease that includes any disorder of the structure and function of the venous system. These may be congenital, genetically determined abnormalities, or they may be pathological changes that occur under the influence of external factors.Varicose veins affect approximately 60% of adults worldwide, the majority of whom are Europeans. Most women suffer from varicose veins. This is due to a link between the tone of blood vessel walls and hormone levels.

Types of varicose veins

Varicose veins are usually understood as enlargements of the veins in the legs, but pathological changes can also affect other parts of the body. Depending on the location, there are:

• Rectal varicose veins (hemorrhoids);
• esophageal vein dilatation;
• Varicocele (varicocele) in men;
• Varicose veins of lower limbs.

Sometimes reticular varicose veins separate separately. It consists of a network of blood vessels and stars visible under the skin. It mainly occurs on the legs, but can also appear under the breasts, on the abdomen, and other parts of the body. The disease is diagnosed when the saphenous vein of the reticular bed of the reticular dermis is dilated. This happens to 50% of women. The formation of nodes is unusual.Types of varicose veins in the extremities according to CEAP classification (stage of development):

• C0 - no sign;
• C1 - the appearance of varicose veins and stellate veins;
• C2 - varicose veins;
• C3 – Swelling in the legs, indicating venous insufficiency;
• C4 – Nutritional changes in the form of hyperpigmentation, lipodermatosclerosis (thickening of the skin on the lower third of the legs);
• C5 – Heals venous ulcers;
• C6 – Non-healing venous ulcer.

symptom

The main symptoms of varicose veins in the lower limbs include:

• Heaviness and swelling in the legs (calves), worsening at night;
• increased leg fatigue;
• Soreness in the lower legs that occurs after remaining in a stationary position, standing, or sitting for an extended period of time.

As the pathology progresses, blue, tortuous veins begin to bulge under the skin, sometimes swelling to the point of a lump. One sign of chronic venous insufficiency is changes in skin color associated with impaired tissue nutrition (nutrition). Large areas of eczema-like red, itchy blisters and nodules appear. Leg swelling does not go away even after a night's rest.Signs of the reticular form of varicose veins are limited to subcutaneous vascular patterns. Calf heaviness and mild itching in areas of dilated blood vessels may occur. Nutritional disorders are usually not observed.

Causes of varicose veins

Reticular varicose veins occur when type 1 collagen is replaced by type 3 collagen in the blood vessel walls. As a result, their contractility worsens - after dilation, the blood vessels no longer return to their original state. Thinning of blood vessel walls is caused by excessive activity of enzymes that destroy extracellular matrix proteins and elastin.In women, the hormone progesterone helps reduce the tone of the smooth muscle fibers in blood vessel walls. Estrogen decreases antithrombin levels, increases blood clotting and triggers the development of stagnant processes.The main cause of varicose veins in the extremities with the appearance of nodules and masses is a malfunction of the valve mechanism. Valves are folds formed by the inner walls of veins. Usually, they only work in one direction: they open under the pressure of blood flow and prevent it from flowing back. If the valve mechanism weakens, blood can flow back (regurgitation), causing the vein walls to become dilated and the lining to become inflamed. Next, the pathological process spreads to deeper layers of the vein wall. Its muscle fibers begin to be replaced by scar fibers and atrophy occurs. The wall no longer shrinks and its collagen structure is destroyed. The veins are twisted in a spiral shape.Increased pressure in blood vessels can cause muscle venous pump failure. This is a system that regulates the pumping of blood to the muscles during exercise and relaxation (the "peripheral heart"). The result is congestion and venous insufficiency.Triggering factors include:

• Genetics: In most cases, varicose veins are caused by mutations in the genes responsible for the structure of the valves and walls of the veins;
• being overweight;
• sedentary lifestyle;
• Increased load on the venous system of the extremities due to standing work;
• Pregnancy and childbirth, menopause, hormonal imbalances.

Varicose veins can be caused by poor foot mobility due to uncomfortable shoes and bad habits (smoking, alcohol abuse).

diagnosis

The main method of diagnosing varicose veins involves a visual examination by a vascular surgeon, during which he evaluates the condition of the superficial and deep veins and identifies signs of tissue dystrophy. The patient is then sent for additional diagnostics.

• Ultrasound duplex scanning. Allows you to assess the condition of the valves, the strength and direction of blood flow, the size of the blood vessels, and determine whether blood clots are present.
• Valve function studies: compression testing, simulated walking, Paraná maneuver.
• X-ray contrast venography is an X-ray examination in which contrast material is injected into a vein. Helps assess valve function, venous patency and detect blood clots.

To confirm the diagnosis, the doctor may perform CT, MRI, thermal imaging, radiation venography, intravascular ultrasound, coagulation blood tests, etc.

Expert opinion

Varicose veins are more than just unsightly veins that protrude under the skin. The complications of varicose veins are very unpleasant.

• Nutritional disorders. The appearance of large, brown spots on the legs or thighs, followed by the formation of large, non-healing ulcers that are itchy and painful.
• Thrombophlebitis is an inflammation of the vein wall with the deposition of clots in the vein wall. Thrombus veins become red, thickened, painful, and the surrounding temperature increases. In appearance, it resembles an abscess. Threatens the spread of infection throughout the body.
• bleed. Bleeding from ruptured dilated veins can occur both inside and outside the tissue. The bleeding was severe and an ambulance needed to be called.
• Thromboembolism. Blood clots that form in dilated veins can rupture and block important arteries, such as the pulmonary artery. This condition usually results in immediate death.

Prompt diagnosis will help prevent the serious consequences of varicose veins and identify the cause of varicose veins.

Treatment of varicose veins

The specific treatment of reticular varicose veins includes several aspects.

• Compression therapy - Wearing Type A and Type I support knitwear (socks, tights) to prevent backflow of blood.
• Medication - Intravenous medications are given to increase venous tone. These treatments will not eliminate external symptoms, but they will eliminate subjective symptoms such as heaviness, swelling, and soreness.
• Phlebosclerosis occurs when a hardening substance is introduced into small blood vessels, gluing them together. Microsclerotherapy frees you from the network of blood vessels.
• Laser Therapy – can eliminate the tiny imperfections that remain after microsclerotherapy. During the procedure, the doctor shines a beam of light onto the affected area.

An important part of treatment is therapeutic exercises, weight loss, wearing comfortable shoes and regular physical activity.For the surgical treatment of varicose veins with the presence of lymph nodes, two methods are used: classic phlebectomy and endovenous thermal obliteration. The first method is considered obsolete. This involves ligation of the junction of the vein with the common femoral bone and removal of the affected portion of the trunk. This method is characterized by high trauma and high risk of recurrence.Thermal ablation 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 then slowly withdraws it. As the laser moves, it seals the vein by raising the temperature. Then, it gradually subsided.

prevention

To prevent the development or recurrence of varicose veins, people at high risk need to:

• Minimize static load on the legs;
• Eat properly and, if necessary, take intravenous supplements as prescribed by your doctor;
• Wear compression stockings when standing for long periods of time.

Regular aerobic exercise is useful for exercising your heart and blood vessels.

Rehabilitation

During the postoperative recovery period, patients need to wear compression stockings to minimize load on their legs, avoid overheating, and take medications prescribed by their doctor. The total recovery time depends on the extent of intervention and the presence of complications.