Varicose veins of the lower extremities are a disease of the veins of the legs, characterized by the expansion and pathological deformation of the venous vessels, accompanied by the development of a number of complications.Varicose veins affect the superficial veins of the legs.
According to modern views, the main cause of the development of varicose veins is a defect (congenital or acquired) in the valve apparatus of the veins of the lower extremities, leading to the development of the reverse flow of venous blood (reflux).Reflux leads to venous leakage and pathological venous leakage (redirection of blood flow).
Which, in turn, leads to clinical manifestations of chronic venous insufficiency - such as swelling of the legs, pain along the varicose veins, itching of the skin, cramps in the calf muscles.
In advanced cases, the formation of skin pigmentation in the leg area, the formation of trophic ulcers, bleeding from varicose veins, as well as thrombophlebitis - inflammation of varicose veins with their thrombosis.Varicose veins develop gradually.
According to European statistics, chronic venous diseases are widespread throughout the world.It has been proven that in the adult population of different countries, the incidence of varicose veins varies from 2% to 60%.Surprisingly, in African countries, as well as in the Pacific region, despite multiple pregnancies, the incidence of varicose veins in women is no more than 6%.At the same time, in European countries the incidence of varicose veins in the adult population reaches tens of percent.It follows that the tendency to develop varicose veins depends on ethnicity.
There is also a clear trend towards increasing incidence.This may be due to the prevalence of a sedentary lifestyle, obesity and partly smoking.Patients in "public" hospitals are often deprived of the opportunity to receive modern diagnosis and modern treatment for varicose veins of the lower extremities.The lack of modern high-tech methods for the diagnosis and treatment of varicose veins in the public sector of medicine explains that combined phlebectomy remains the main method of treating varicose veins in public hospitals.That is, a very traumatic, inpatient operation with many incisions (and sutures) and mechanical removal of the trunk of the incompetent vein.
This operation is performed under general anesthesia or spinal anesthesia.World statistics claim that the vast majority of patients suffering from varicose veins can receive surgical treatment on an outpatient basis - without hospitalization, and also without spinal anesthesia and anesthesia.Conclusion - high-quality treatment of varicose veins is impossible without timely diagnosis and innovative technologies in treatment.
Symptoms of varicose veins of the lower extremities
Symptoms (manifestations) of varicose veins are signs that allow to suspect the disease with sufficient certainty.Symptoms can be subjective (it seems to me) and objective (I see).
Subjective symptoms of varicose veins include:
- Feeling of heaviness in the legs.As a rule - in the calf area.This symptom is more pronounced in the evening.
- Pain in calf muscles.Most often, it is pain, pain of low intensity, sometimes discomfort.
- Pain along varicose veins.As a rule, it is not intense, it appears more in the evening, after a working day.
- Leg fatigue.Fatigue is a decrease in tolerance (sensitivity) to physical activity - both static and dynamic.
- "Venous Claudius".Venous claudication is called increased pain in the calf muscles while walking.
- Swelling of the lower extremities in the area of the legs and feet.
- Skin hyperpigmentation.
- Burning, tingling, itching along the course of varicose veins.
- Trophic venous leg ulcer.
All symptoms of varicose veins, regardless of their heterogeneity, have common characteristics:
- symptoms intensify when the patient stays in a standing or sitting position for a long time.This happens because the muscular-venous pump does not work in a static position);
- symptoms decrease after walking, after resting in a horizontal position, as well as when using elastic compression;
- change the intensity of the manifestation depending on the season of the year.As a rule, the symptoms intensify in the summer;
- the manifestations of the disease may intensify before or during menstruation.
All the above symptoms are non-specific, that is, they can also appear in other diseases.Therefore, when diagnosing varicose veins, you should rely on objective signs:
- Dilated intradermal and saphenous veins (telangiectasia, reticular veins).Clearly visible to the naked eye.This is what patients often pay attention to.The presence of only telangiectasia (spider veins) without other signs of varicose veins is usually not dangerous.However, this is a clear reason for examination.
- Saphenous veins with varicose veins.Easily visible without equipment.The presence of varicose veins is a clear sign of varicose veins.However, ordinary people often confuse normal veins visible through the skin with varicose veins.In the first case, treatment is not required, in the second it is necessary.
- Swelling of the affected limb.This is also a non-specific symptom, but the presence of varicose veins can lead the doctor to believe that these facts are related.
- Changes in skin color and texture.With advanced forms of varicose veins, we often encounter hyperpigmentation (the skin turns brown or bluish).There may be areas of lipodermatosclerosis.The extreme manifestation is the appearance of a venous trophic ulcer.
Risk factors for varicose veins in the legs
- Non-specific: age, female gender, obesity, hereditary predisposition.
- Specific: pregnancy, taking hormonal drugs (estrogens, gestagens), menopause.
Stages of development of varicose veins
Like any chronic disease, varicose veins develop gradually.There is no clear stage, but we can talk about the initial stage (compensation) and the stage of development of chronic venous insufficiency.In the initial stage of the development of varicose veins, there are no subjective manifestations.The appearance of varicose veins, detected visually, is usually not accompanied by swelling, pain or cramping.
At this stage, the disease can remain unchanged for a long time.And maybe it will progress.In this case, the patient, accustomed to seeing varicose veins and accustomed to the idea that they do not cause him harm, may not associate the appearance of pain, swelling of the legs, itching and night cramps with the progression of varicose veins.This, in turn, can lead to the development of complications of varicose veins, such as inflammation of varicose veins (thrombophlebitis), the formation of venous trophic ulcers and bleeding from varicose veins.
To standardize the diagnosis of varicose veins and make it as accurate and understandable as possible for a doctor from anywhere in the world, phlebologists use the CEAP classification.The CEAP classification takes into account clinical manifestations (C – clinic), etiology (cause of the disease) (E – etiology), anatomical localization (A – anatomy) and pathogenesis (P – pathogenesis).
As a rule, the CEAP diagnosis is supplemented by a decoding (nosological formulation), which facilitates understanding for therapists, general practitioners and specialists.This approach allows the practitioner to navigate quickly when studying the patient's medical records.
Diagnosis of varicose veins
Modern diagnosis of varicose veins of the lower extremities presents the following tasks:
- Determination of the presence of chronic venous disease.Many patients who suspect they have varicose veins do not have them.And vice versa.The first task of a phlebologist is to determine whether the patient has this disease or not.
- Determination of the type of venous disease.Doctors say that it is of the "nosological" form.You need to know exactly which veins are affected, how bad it is and what it has led to or can lead to.
- Determination of treatment tactics - which specific technique (or combination of techniques) should be applied in this particular case.Treatment tactics should be discussed with the patient and reflected in treatment recommendations.
- The evaluation of the effectiveness of the treatment is carried out during the treatment and after its completion.
We prefer to carry out all stages of diagnosis and treatment in contact with the patient.
We believe that the patient has the right to accessible, understandable information about his disease and treatment methods.In response to a patient's question "why," we never say "because" or "because I always do it this way."We adhere to the principles of modern evidence-based medicine.
Methods for diagnosing varicose veins
- Clinical study.Includes clarification of patient complaints, examination and palpation (examination with hands).
- Ultrasound angioscan (vein ultrasound - duplex and triplex scan).
- Plethysmography.
- X-ray phlebography (ascending and descending).
- Radionuclide phlebography (radiophlebography).
- Computed tomography (CT venography).
- Magnetic resonance imaging (MR-venography).
- Intravascular ultrasound examination.
- Thermography.
In the vast majority of cases, to diagnose varicose veins and develop a correct treatment strategy, a clinical examination and ultrasound angiography is enough for a phlebologist.At the same time, the main instrumental study for diseases of the veins of the legs is ultrasound angiography - ultrasound of the veins.
During the study, it is clearly explained to the patient what exactly is "his" disease and how to fight it.
The study is carried out in a standing position (if necessary, even lying down), using simultaneously two or three scanning modes (B mode, color coding of blood flow and pulsed Doppler mode).The ultrasound angioscanning method allows you to visualize the vessel under study, determine the direction of blood flow and its parameters (speed, type of flow).
Both limbs are examined, not just the "diseased" one, and we always look at both the superficial and deep veins.If necessary, the patient may be prescribed additional research methods listed above.
Treatment of varicose veins
Specialists at the main phlebology center use only the most modern and best methods for treating varicose veins of the lower extremities.
Today, phlebologists use the following innovative treatment methods:
- Thermoabliteration (laser and radiofrequency).
- Non-thermal methods of treating varicose veins.
- Sclerotherapy.
- Miniphlebectomy.
- A combination of these techniques.
These methods meet European state standards.They allow you to treat varicose veins effectively, non-traumatically and on an outpatient basis - without hospitalization.No anesthesia or spinal anesthesia is required.It is this approach that provides the best treatment results.