Varicose veins (varicose veins) is a disease in which the superficial veins are varicose or swollen. The disease in most cases occurs in people over 30 years of age. In most cases it is observed in the lower extremities. Varicose veins are characterized by dilation of the lumen of the veins with a simultaneous change in their wall. The subcutaneous veins are well defined, the direction of their course becomes "serpentine". The great saphenous vein is usually affected, less often the small saphenous vein, and even less often their subcutaneous anastomoses.
Causes of varicose veins
The proposed theories to explain the causes and mechanisms of the disease can be reduced to three groups.
The theories of the first group explain the origin of varicose veins with the anatomical features of the location and structure of these vessels of the lower extremities. The veins have valves that prevent the centrifugal flow of blood and thus its excessive flow from the subcutaneous to the deep veins of the legs. In case of insufficiency of the valves, more blood is deposited in the subcutaneous veins, which leads to their dilation.
Theories from the second group on the development of varicose veins attach importance to the stagnation of blood in the pelvis during pregnancy, constipation, the consequences of inflammatory processes, as well as prolonged stay of the legs.
The theories from the third group are the least substantiated, which explain the origin of varicose veins with constitutional predisposition, weakness of the mesenchyme.
In varicose veins, for various reasons, their walls change, thin, so that increased pressure leads to protrusion of the walls. It first appears in the form of nodules, and at the same time areas of compaction as a result of excessive growth of connective tissue are noted. Mechanical factors only contribute to the development of the pathological process in the veins, but in no way are the main point 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 fullness and heaviness in the lower extremities. Sometimes there is a short-lived, convulsive nature of the pain. There is often swelling. The feeling of fullness and heaviness in the limbs intensifies in the evening, as the swelling usually increases by this time. Itching occurs, there are often scratches on the legs. In the later stages of the disease, ulcers form, usually located in the lower third of the lower leg on the inside.
The main objective symptom of the disease are visible varicose veins. Examination of the patient to identify this symptom is performed in an upright position. At the same time, varicose veins are clearly visible; on the lower leg they appear more convex, more curved; on the thigh the veins are usually dilated only along the course of the main vascular trunk. Sometimes there are varicose veins of the thigh almost at the infusion of the largest subcutaneous vein into the femoral vein. Such a node can be mistaken for a femoral hernia, but the softness of the node, its rapid filling with blood after removal of the researcher's arm, and the presence of varicose veins in the lower leg provide a basis for establishing the correct diagnosis.
There are a number of symptoms that indicate the presence of dilatation of the venous trunk of the great saphenous vein. These include a symptom in which the patient is placed in a horizontal position, his leg is given a raised position. By gently stroking the leg from the periphery to the center, the subcutaneous venous system is emptied, the site where the largest subcutaneous vein flows into the femoral vein is pressed firmly with a finger, and holding the finger, the patient is transferred to an upright position. position. If the filling of the veins occurs only after the removal of the finger, this is a positive symptom. In such cases, the anastomoses between the superficial and deep venous networks are weak and the operation may have a positive effect. If in a vertical position in a patient the veins in the periphery still begin to fill slowly, this indicates a significant development of anastomoses - a negative symptom. In this case, the vein ligation operation will fail.
The Delbe-Perthes symptom shows how pronounced the emptying of the subcutaneous veins in the deep through the anastomoses is. An elastic bandage is applied to the patient in an upright position on the border of the middle and lower thirds of the thigh, after which they are offered to walk a little. If the tension in the varicose veins decreases significantly, this indicates the presence of developed anastomoses between the superficial and deep veins.
Other symptoms of varicose veins include swelling, eczematous skin changes and ulcers. Puffiness is different - from mild pasty to pronounced swelling, when the skin loses its usual pattern and looks shiny, the circumference of the lower leg increases significantly. Eczematous manifestations include dryness, scaling, and finally eczematous rash. The skin of the lower leg is usually affected. These changes occur as a result of trophic disorders.
Prevention and treatment of varicose veins
Prevention of varicose veins is reduced to a change of profession, if it is associated with prolonged standing, taking measures for regular bowel movements, bandaging the legs with an elastic bandage or wearing an elastic sock. Bandaging the feet or putting on a sock should be done lying down. For a few minutes, the leg is kept in an elevated position, and only after making sure that the veins are empty, a bandage or sock is placed. The bandage is applied from below and continues upwards, avoiding any stretching and squeezing that causes stagnation.
There are a number of methods of surgical treatment. The operation to ligate the great saphenous vein in Skarpov's triangle at the point where it flows into the femoral vein is palliative. Relapses are common after this operation. Therefore, it is used only in combination with other surgical procedures.
During Bebcock surgery, a skin incision is made in the lower end of the dilated great saphenous vein, detached and bandaged. A long abdominal tube is opened above the bandage and inserted into the lumen. A second small skin incision is made over the upper end of the varicose vein. Its central end is tied and crossed, below the point of intersection the vein is tied tightly on the probe, then carefully removed through the lower incision. At the same time, the probe pulls out a vein that has been turned from the inside out by the intima. The disadvantage of this method is that hematomas form at the site of torn anastomoses.
During the Madelung operation, varicose veins are cut everywhere. Of all the operations, this intervention is the most radical, giving the best long-term results.
Complications of varicose veins
The most common and difficult to treat complications of varicose veins are varicose ulcers. These ulcers usually occur in the elderly. They are located on the inner, less often on the outer surface of the lower third of the lower leg. These ulcers are the result of chronic tissue malnutrition. They are usually deep, have a necrotic discharge bottom with an unpleasant odor and high, callused edges. Ulcers can reach large sizes, surrounding the entire lower leg. The skin around them is pigmented, sometimes inflamed, with eczematous irritation.
Varicose ulcers must be distinguished from syphilitic ones. Syphilitic ulcers are usually located in the upper third of the lower leg, more often on the front surface. In addition, other signs of syphilis can be found in syphilitic ulcers. Tuberculosis of the skin (lupus) is more common on the face, much less common on the limbs. Lupus begins as isolated nodules that then ulcerate; in the future there is a deeper damage to the tissues, sometimes with the formation of smooth scars that tighten the adjacent tissues.
Given that varicose ulcers develop on the background of circulatory and trophic disorders, their treatment should be persistent and long. The constant position of the patient with a raised leg in most cases leads to rapid improvement. The ulcer should be bandaged with 0, 5% solution of potassium permanganate, with penicillin ointment or balsamic liniment. When the wound is cleared and the swelling around it disappears, it is recommended to cut the veins. Only radical surgery to remove altered veins eliminates the risk of recurrence of ulcers.
As the disease progresses and the enlarged nodules enlarge, their walls and the skin soldered to them become thinner. As a result, usually during walking (when the nodes are particularly tense), one of the nodes may rupture and venous bleeding may occur. Although such bleeding can be significant, they do not pose a great danger, as they stop quickly if the patient is placed and the leg is raised. In this position, negative pressure is created in the veins, they subside and the bleeding stops. A light aseptic dressing is applied to the wound. Due to the fact that bleeding may recur, surgery to excise the veins or ligate them and remove the thinnest nodules is recommended. In case of bleeding from compensatory varicose veins, any operation related to ligation of the main trunk of the vein is strictly contraindicated.