Varicose veins are a pathological expansion of the lumen of the veins caused by thinning of their walls and decreased tone. In an advanced stage, venous nodules bulge under the skin and may periodically become inflamed. Varicose veins are not just an aesthetic defect. The symptom indicates impaired blood circulation, which deteriorates the quality of nutrition of tissues and organs and increases the risk of blood clots. Early diagnosis and treatment can slow the development of the pathology and prevent its complications.
About the disease
Varicose veins are a chronic disease that includes any disturbances 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 approximately 60% of adults worldwide, mainly Europeans. Mostly women suffer from varicose veins. This is due to the presence of a link between the tone of the vascular walls and hormonal levels.
Types of varicose veins
Varicose veins are generally understood as the enlargement of the veins in the legs, but pathological changes can also affect other parts of the body. Depending on the location, there are:
- varicose veins of the rectum (hemorrhoids);
- dilation of the esophageal veins;
- varicose 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 visible under the skin. It occurs mainly on the legs, but can appear under the breasts, on the abdomen, and on 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. Node formation is uncharacteristic.
Types of varicose veins of the extremities according to the CEAP classification (development stages):
- C0 – no signals;
- C1 – appearance of varicose veins and stars;
- C2 – varicose veins;
- C3 – swelling appears in the legs, indicating the development of venous insufficiency;
- C4 – trophic changes in the form of hyperpigmentation, lipodermatosclerosis (thickening of the skin on the lower third of the leg);
- C5 – healing of venous ulcers;
- C6 – venous ulcers that do not heal.
Symptoms
The main symptoms of varicose veins of the lower extremities include:
- feeling of heaviness in the legs (calves), swelling, worse at night;
- increased leg fatigue;
- pain in the calves that occurs after a long stay in a static position, standing or sitting.
As the pathology develops, tortuous, bluish veins begin to swell under the skin, sometimes swollen to the point of forming lumps. A sign of chronic venous insufficiency is a change in skin color associated with impaired tissue trophism (nutrition). Extensive eczema-like redness, 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 the subcutaneous vascular pattern. There may be heaviness in the calves and slight itching in the area of dilated blood vessels. Trophic disturbances are usually not observed.
Reasons for developing varicose veins
Reticular varicose veins occur due to the replacement of type 1 collagen in the walls of blood vessels with type 3 collagen. As a result, their contractility deteriorates - after expanding, the vessels no longer return to their original state. The cause of thinning of the vascular wall is the excessive activity of enzymes that destroy extracellular matrix proteins and elastin.
In women, the hormone progesterone helps reduce the tone of smooth muscle fibers in the vascular walls. Estrogen reduces the level of antithrombin, increases blood clotting and provokes the development of stagnant processes.
The main cause of varicose veins in the extremities, accompanied by the appearance of nodules and swelling, is a malfunction of the valve mechanisms. Valves are folds formed by the inner lining of veins. Normally, they only work in one direction: they open under the pressure of blood flow and do not let it back. If the valve mechanism is weakened, blood flows back (reflux), causing the walls of the veins to expand and their inner lining to become inflamed. Furthermore, the pathological process spreads to the deeper layers of the venous wall. Your muscle fibers begin to be replaced by scar fibers and atrophy occurs. The walls no longer contract and their collagen structures are destroyed. The vein rotates in a spiral.
The increase in pressure in the vessels causes the musculovenous pump to malfunction. This is a system that regulates the pumping of blood to muscles during exercise and relaxation ("peripheral heart"). The result is congestion and venous insufficiency.
The provoking factors are:
- heredity: in most cases, varicose veins are caused by mutations in the genes responsible for the structure of the valves and venous walls;
- 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 difficulty in moving the feet due to uncomfortable shoes, as well as bad habits: smoking, alcohol abuse.
Diagnosis
The main methods of diagnosing varicose veins include a visual examination by a vascular surgeon, during which he assesses the condition of the superficial and deep veins and identifies signs of tissue malnutrition. The patient is then sent for further diagnostics.
- Ultrasound duplex scanning. 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, Paraná maneuver.
- X-ray contrast venography is an x-ray with a contrast agent injected into the veins. It helps assess valve function, vein patency and detect blood clots.
To clarify the diagnosis, the doctor may prescribe computed tomography, magnetic resonance imaging, thermography, radiophlebography, intravascular ultrasound, blood tests for coagulation, etc.
Expert opinion
Varicose veins are more than just unsightly veins that bulge under the skin. Complications from varicose veins are extremely unpleasant.
- Trophic disorders. Large brown spots appear on the legs or thighs and later large, non-healing ulcers that are itchy and painful form.
- Thrombophlebitis is an inflammation of the venous walls, accompanied by the deposition of thrombotic masses on them. The thrombosed vein turns red, thickens, hurts and the temperature around it increases. Externally, it looks like an abscess. It threatens the spread of infection throughout the body.
- Bleeding. Hemorrhage from a ruptured dilated vein can occur both inside and outside the tissue. The bleeding is severe and requires an ambulance to be called.
- Thromboembolism. A blood clot that forms inside a dilated 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 the serious consequences of varicose veins and identify the causes that provoked them.
Varicose veins treatment
The specific treatment of reticular varicose veins includes several areas.
- Compression therapy - use of support mesh (stockings, tights) of classes A and I to prevent blood backflow.
- Pharmacotherapy - use of phlebotonic medications to increase vein tone. These remedies will not remove the external signs, but they will eliminate the subjective symptoms in the form of heaviness, swelling and severe pain.
- Phlebosclerosis is the gluing of small vessels by introducing sclerosing substances into them. Microsclerotherapy allows you to get rid of vascular networks.
- Laser therapy – allows you to eliminate small defects remaining after microsclerotherapy. During the procedure, the doctor applies a beam of light to the affected areas.
An important part of therapy is therapeutic exercise, weight loss, wearing comfortable shoes, and regular physical activity.
For the surgical treatment of varicose veins, accompanied by the appearance of nodules, two methods are used: classic phlebectomy and intravenous thermal obliteration. The first method is considered obsolete. It includes ligation of the junction of the vein with the common femoral vein and removal of the affected part of the trunk. The method is characterized by increased trauma and a high risk of relapse.
Thermal obliteration is a gentle, minimally invasive treatment method. Through a small incision, the doctor inserts a laser catheter into the vein, turns on the radiation and slowly removes it. As the laser moves, it seals the vein by increasing its temperature. Thereafter, it gradually resolves.
Prevention
To prevent the development or recurrence of varicose veins, people at risk need to:
- minimize static load on the legs;
- eat rationally and, if necessary, take venotonics as prescribed by your doctor;
- wear compression socks when staying in a static position for a long time.
It is useful to regularly apply cardiovascular exercises to the body to train the heart and blood vessels.
Rehabilitation
During the recovery period after surgery, the patient needs to 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.