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 nodes swell under the skin and may periodically become inflamed. Varicose veins are not just a cosmetic defect. The symptom indicates impaired blood circulation, which deteriorates the quality of nutrition of tissues and organs and increases the risk of blood clots. Diagnosis and treatment at an early stage can slow the development of the disease and prevent complications.
About the disease
Varicose veins are a chronic disease that includes any disturbance in the structure and functioning of the venous system. These can be congenital, genetically determined anomalies, as well as pathological changes that have occurred under the influence of external factors.
Varicose veins affect approximately 60% of adults worldwide, especially Europeans. It is mainly women who suffer from varicose veins. This is due to the presence of a connection between the tone of the vascular walls and hormone levels.
Types of varicose veins
Varicose veins usually refer to 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 veins of the esophagus;
- varicose veins of the spermatic cord in men (varicocele);
- varicose veins of the lower limbs.
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 in 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. Knot formation is unusual.
Types of varicose veins of the extremities according to the CEAP classification (stages of development):
- C0 – no sign;
- C1 – appearance of varicose veins and stars;
- C2 – varicose veins;
- C3 – swelling of the legs appears, indicating the development of venous insufficiency;
- C4 – trophic changes in the form of hyperpigmentation, lipodermatosclerosis (thickening of the skin of 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:
- heaviness in the legs (calves), swelling, worse in the evening;
- increased leg fatigue;
- aching pain in the calves that occurs after a long stay in a static position, standing or sitting.
As the condition develops, bluish, twisting veins begin to swell under the skin, sometimes forming clots. A sign of chronic venous insufficiency is a change in skin color associated with impaired trophism (nutrition) of the tissues. Extensive eczema-like redness, itchy blisters, and nodules appear. The swelling in the legs does not disappear even after a night's rest.
Signs of the reticular form of varicose veins are limited to the subcutaneous vascular pattern. Heaviness in the calves and mild itching in the area of dilated blood vessels may occur. Trophic disorders are usually not observed.
Reasons for the development of 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: having expanded, 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 the smooth muscle fibers of the vascular walls. Estrogens reduce the level of antithrombin, increase blood clotting and provoke the development of stagnant processes.
The main cause of varicose veins of the extremities, accompanied by the appearance of knots and bumps, is a malfunction of the valve mechanisms. Valves are folds formed by the inner lining of the veins. Normally they work only in one direction: they open under the pressure of the blood flow and do not let it go 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. Subsequently, the pathological process spreads to the deeper layers of the venous wall. Its muscle fibers begin to be replaced by scarred fibers and atrophy occurs. The walls no longer contract and their collagen structures are destroyed. The vein twists in a spiral.
The increase in pressure in the vessels causes a malfunction of the musculovenous pump. This is a system that regulates the pumping of blood to the 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;
- excess weight;
- 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, as well as bad habits: smoking, alcohol abuse.
Diagnostics
The main methods of diagnosing varicose veins include a visual examination by a vascular surgeon, during which he evaluates the condition of the superficial and deep veins and identifies signs of tissue malnutrition. The patient is then sent for further diagnosis.
- Duplex ultrasound scanning. It allows you to evaluate 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, Parana maneuver.
- X-ray contrast venography is an x-ray with a contrast agent injected into the veins. It helps evaluate valve function, patency of veins, and detect blood clots.
To clarify the diagnosis, the doctor may prescribe CT, MRI, thermography, radiophlebography, intravascular ultrasound, blood tests for coagulation, etc.
Expert opinion
Varicose veins are much more than just unsightly veins that protrude under the skin. Complications of varicose veins are extremely unpleasant.
- Trophic disorders. Large brown spots appear on the legs or thighs, and large, itchy, painful, non-healing ulcers subsequently form.
- Thrombophlebitis is an inflammation of the venous walls, accompanied by the deposition of thrombotic masses on them. The thrombosed vein becomes red, thickens, hurts and the temperature around it increases. Externally it resembles an abscess. It threatens the spread of the infection throughout the body.
- Bleeding. Bleeding from a ruptured dilated vein can occur both inside and outside the tissue. The bleeding is intense and requires calling an ambulance.
- Thromboembolism. A blood clot that forms inside a dilated vein can rupture and block vital arteries, such as the pulmonary artery. This condition often leads to instant death.
A timely diagnosis will help prevent the serious consequences of varicose veins and identify the causes that provoked them.
Treatment of varicose veins
The specific treatment of reticular varicose veins includes several areas.
- Compression therapy: wear class A and I support hosiery (stockings, tights) to prevent blood backflow.
- Pharmacotherapy - taking phlebotonic drugs to increase the tone of the veins. These remedies will not remove external signs, but will eliminate subjective symptoms in the form of heaviness, swelling and aching pain.
- Phlebosclerosis is the gluing of small vessels by introducing sclerosing substances into them. Microsclerotherapy allows you to eliminate vascular networks.
- Laser therapy – allows you to eliminate minor defects remaining after microsclerotherapy. During the procedure, the doctor applies a light beam to the affected areas.
An important part of the therapy is therapeutic exercises, weight loss, wearing comfortable shoes and regular physical activity.
For the surgical treatment of varicose veins, accompanied by the appearance of nodes, 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 and removal of the affected part of the trunk. The method is characterized by increased trauma and a high risk of recurrence.
Thermal obliteration is a gentle and minimally invasive treatment method. Through a small incision, the doctor inserts a catheter with a laser into the vein, turns on the radiation and slowly withdraws it. As the laser moves, it seals the vein by increasing its temperature. It then gradually resolves.
Prevention
To prevent the development or recurrence of varicose veins, people at risk should:
- minimize the static load on the legs;
- eat rationally and, if necessary, take venotonics as prescribed by your doctor;
- wear compression stockings when standing in a static position for a long time.
It is useful to regularly subject your body to cardio exercises to train your heart and blood vessels.
Rehabilitation
During the recovery period after surgery, the patient should 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 operation and the presence of complications.