Varicose veins (varicose veins) is a disease in which superficial veins enlarge or swell. The disease in most cases occurs in persons over 30 years of age. In the vast majority of cases, it is observed in the lower extremities. Varicose veins are characterized by an enlargement of the lumen of the veins with a simultaneous change in their wall. The saphenous veins are well contoured, the direction of their flow becomes "snake". The large saphenous vein is usually affected, less frequently the small saphenous vein and even less often their saphenous anastomoses.
Causes of varicose veins
The proposed theories to explain the causes and mechanisms of disease onset can be reduced to three groups.
The theories of the first group explain the origin of varicose veins from the anatomical features of the location and structure of these vessels of the lower extremities. The veins have valves that block the centrifugal flow of blood and consequently its excessive flow from the subcutaneous to the deep veins of the leg. With the insufficiency of the valves in the saphenous veins, more blood is deposited, which leads to their expansion.
Theories of the second group in the development of varicose veins pay attention to the stagnation of blood in the pelvis during pregnancy, constipation, the consequences of inflammatory processes, as well as during prolonged standing.
The theories of the third group, which explain the origin of varicose veins with a constitutional predisposition, weakness of mesenchyme, are less proven.
With varicose veins, for various reasons, their walls change, they become thinner, so the increase in pressure leads to swelling of the walls. Initially it manifests itself in the form of nodules, and at the same time, compression zones are also observed that come from excessive growth of connective tissue. Mechanical factors contribute only to the development of the pathological process in the veins, but in no way are the main points of pathogenesis, etiology and causes of varicose veins of the lower extremities.
Symptoms of varicose veins
With varicose veins, patients usually experience a feeling of satiety and heaviness in the lower extremities. Sometimes it has a short, convulsive nature of pain. There is often swelling. The feeling of satiety and heaviness in the limbs increases in the evening, as the edema usually increases at this time. Itching occurs, there is often itching in the feet. In the later stages of the disease, ulcers form, usually located on the lower third of the lower leg on its inner side.
The main objective symptoms of the disease are veins with visible varicose veins. Examination of the patient to identify this symptom is performed in a standing position. At the same time, the dilated saphenous veins are clearly visible; on the lower leg they look more prominent, more intricate; in the thigh, the veins usually dilate only along the course of the main vascular trunk. Sometimes there is a varicose vein in the thigh almost at the junction of the largest saphenous vein in the femoral vein. Such a joint may be confused with a femoral hernia, but the softness of the joint, its rapid filling with blood after removal of the examiner's hand, and the presence of varicose veins in the lower leg provide a basis for diagnosis. exactly.
There are a number of symptoms that indicate the presence of venous trunk enlargement of the large saphenous vein. These include a symptom in which the patient is placed in a horizontal position, the foot is given an elevated position. By gently caressing the foot from the periphery to the center, the subcutaneous venous system empties, the site where the largest saphenous vein flows into the femoral vein is pressed firmly with the finger, and, holding the toe, the patient is transferred to the foot. position. If the filling of the veins occurs only after the removal of the finger, then this is a positive symptom. In such cases, anastomoses between the superficial and deep vein network are poorly expressed and surgery can have a positive effect. If, in a vertical position in a patient, the peripheral veins nevertheless begin to fill slowly, this indicates a significant development of anastomoses - a negative symptom. In this case, the vein ligation operation will be unsuccessful.
The Delbe-Perthes symptom shows how pronounced the emptying of the saphenous veins into the deep ones through the anastomoses is. The patient is placed an elastic bandage in a standing position at the border of the middle and lower third of the thigh, then offered to walk a little. If the tension of the varicose veins decreases significantly, this indicates the presence of anastomoses developed between the superficial and deep veins.
Other symptoms of varicose veins include swelling, eczematous skin changes, and ulcers. Swelling is different - from a slight adhesion to pronounced edema, when the skin loses its usual pattern and looks shiny, the perimeter of the lower leg increases significantly. From the eczematous manifestations there is dryness, peeling and finally eczematous redness. The skin on the bottom of the foot is usually affected. These changes occur as a result of trophic concerns.
Prevention and treatment of varicose veins
Prevention of varicose veins is reduced to a change of profession, if it is accompanied by prolonged standing, taking measures for regular bowel movements, bandaging the legs with an elastic bandage or wearing elastic socks. Bandaging the feet or wearing socks should be done during stretching. For a few minutes, the foot is held in an elevated position and, only after making sure the veins are empty, put on a bandage or put on a sock. The bandage starts to be applied from below and continues upwards, avoiding any stretching and squeezing that causes stagnation.
There are a number of methods for surgical treatment. The operation of ligation of the great saphenous vein in the Scarpov triangle at the place where it flows into the femoral vein is palliative. After this operation, recurrences are often observed. Therefore, it is used only in combination with other surgical interventions.
During Bebcock surgery, a skin incision is made at the lower end of the large dilated saphenous vein, it separates and binds. Above the dressing, it opens and a long abdominal probe is inserted into the lumen. A second small skin incision is made over the upper edge of the varicose vein. Its central end is connected and crossed, below the junction the vein is firmly connected above the probe, after which it is carefully removed through the lower incision. At the same time, the probe pulls out a vein that has been turned inward by the intima. The disadvantage of this method is that hematomas form at the site of torn anastomoses.
During Madelung surgery, varicose veins are removed everywhere. Of all the surgeries, this intervention is the most radical, giving the best long-term results.
Complications of varicose veins
The most common and difficult complications of varicose veins are varicose ulcers. These ulcers usually appear in the elderly. They are located on the inner surface, rarely on the outer, lower third of the lower leg. These ulcers are the result of chronic tissue malnutrition. They are usually deep, have a necrotic discharge end, foul-smelling, and high, calloused edges. Ulcers can reach large sizes, surrounding the entire lower leg. The skin around them is pigmented, sometimes inflamed, with eczematous irritation.
Varicose ulcers should be differentiated from syphilitic. Syphilitic ulcers are usually located in the upper third of the lower leg, most often on the anterior surface. In addition, with syphilitic ulcers, other signs of syphilis can be detected. Cutaneous tuberculosis (lupus) is more common on the face, much less common on the extremities. Lupus starts as isolated nodules that then ulcerate; in the future, a deeper tissue damage occurs, sometimes with the formation of smooth scars that tighten neighboring tissues.
Since varicose ulcers develop against the background of circulatory disorders and trophies, their treatment should be continuous and long. The constant position of the patient with the leg raised in most cases leads to rapid improvement. A bandage with 0. 5% solution of potassium permanganate, with penicillin ointment or balsamic liniment should be applied to the ulcer. When the wound is cleansed and the swelling around it disappears, removal of the veins is recommended. Only radical surgery to remove altered veins eliminates the risk of ulcer recurrence.
As the disease progresses and the varicose joints grow, their walls and the skin attached to them become thinner. As a result, usually during walking (when the joints are particularly tense), one of the joints may rupture and venous bleeding may occur. Although such bleeding may be significant, they do not pose a major risk, as they stop quickly if the patient lies down and the leg is raised. In this position negative pressure is created in the veins, they decrease and the bleeding stops. A light aseptic bandage is placed on the wound. Due to the fact that the bleeding may recur, surgery is recommended to remove the veins or connect them and remove the thinner joints. With bleeding from compensatory varicose veins, any surgery associated with ligation of the main vein trunk is categorically contraindicated.