Varicose veins of the lower extremities is a disease of the veins of the legs, characterized by pathological expansion and 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 reason for the development of varicose veins is a defect (congenital or acquired) in the valvular apparatus of the veins of the lower extremities, leading to the development of a reverse flow of venous blood (reflux).Reflux leads to venous transfusion and pathological venous outflow (diversion 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 area of the shin, the formation of trophic ulcers, bleeding from enlarged nodes, 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 among the elderly population of different countries, the frequency 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 frequency of varicose veins among the elderly population reaches tens of percent.It follows that the tendency to develop varicose veins depends on ethnicity.
There is also a clear trend towards an increase in morbidity.This may be due to the predominance of a sedentary lifestyle, obesity and partly smoking.Patients in "state" hospitals are often deprived of the opportunity to receive modern diagnostics and modern treatment of 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 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 - quality treatment of varicose veins is impossible without timely diagnosis and innovative technologies in treatment.
Symptoms of varicose veins of the lower extremities
The symptoms (manifestations) of varicose veins are signs that allow one 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:
- A feeling of heaviness in the legs.As a rule - in the area of the calf.This symptom is more pronounced in the evening.
- Calf muscle pain.Most often it is pain of low intensity, sometimes discomfort.
- Pain along the varicose veins.As a rule, it is not intense, it manifests itself more in the evening, after a working day.
- Tired legs.Fatigue is a decrease in tolerance (susceptibility) to physical exertion - both static and dynamic.
- "Venous claudication".Venous claudication is called increased pain in the calf muscles when walking.
- Swelling of the lower limbs in the area of the legs and feet.
- Hyperpigmentation of the skin.
- Burning, tingling, itching along the course of varicose veins.
- Trophic venous leg ulcer.
All symptoms of varicose veins, despite their heterogeneity, have common characteristics:
- symptoms are aggravated when the patient remains in a standing or sitting position for a long time.This happens because the musculo-venous pump does not work in a static position);
- symptoms decrease after walking, after resting in a horizontal position, and also when using elastic compression;
- changing the intensity of manifestation depending on the season of the year.As a rule, the symptoms intensify in the summer;
- the manifestations of the disease may increase before or during menstruation.
All the above symptoms are non-specific, i.e.can also occur in other diseases.Therefore, when diagnosing varicose veins, you should rely on objective signs:
- Dilated intradermal and saphenous veins (telangiectasia, reticular veins).It is clearly visible to the naked eye.This is what patients often pay attention to.Having only telangiectasias (spider veins) without other signs of varicose veins is usually not dangerous.However, this is a clear reason for review.
- Varicose saphenous veins.Easily visible without equipment.The presence of varicose veins is a clear sign of varicose veins.However, ordinary people often confuse ordinary veins visible through the skin with varicose veins.In the first case no treatment is required, in the second it is necessary.
- Swelling of the affected limb.This is also a non-specific symptom, but in the presence of varicose veins, it can lead the doctor to believe that these facts are interconnected.
- Changes in skin color and texture.In advanced forms of varicose veins, we often find hyperpigmentation (the skin turns brownish or bluish).There may be areas of lipodermatosclerosis.The final 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, progestogens), menopause.
Stages of development of varicose veins
Like any chronic disease, varicose veins develop gradually.There is no clear staging, but one can speak of an initial stage (compensation) and a stage of development of chronic venous insufficiency.In the initial stage of 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 the appearance of varicose veins and accustomed to the thought 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), formation of trophic venous ulcers and bleeding from varicose veins.
In order 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 the clinical manifestations (C – clinic), the etiology (the cause of the disease) (E – etiology), the anatomical localization (A – anatomy) and the pathogenesis (P – pathogenesis).
As a rule, the CEAP diagnosis is supplemented by decoding (nosological formulation), which facilitates understanding for therapists, general practitioners and specialists.This approach allows the practitioner to quickly navigate when studying the patient's medical records.
Diagnosis of varicose veins
Modern diagnostics of varicose veins of the lower extremities sets the following tasks:
- Establishing the presence of chronic venous disease.Many patients who suspect they have varicose veins do not.And vice versa.The first task of the phlebologist is to determine whether the patient has this disease or not.
- Determination of the type of venous disease.Doctors say 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 may lead to.
- Determination of treatment tactics - which particular technique (or combination of techniques) should be applied in the 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 conduct 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 illness and treatment methods.In response to the 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 research.It includes clarification of the patient's complaints, examination and palpation (examination with hands).
- Ultrasound angioscanning (ultrasound of veins - duplex and triplex scanning).
- 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 majority of cases, a clinical examination and ultrasound angiography for a phlebologist are sufficient to diagnose varicose veins and develop the correct treatment tactics.At the same time, the main instrumental examination for diseases of the veins of the legs is ultrasound angiography - ultrasound of the veins.
During the examination, the patient is clearly explained what exactly is "his" disease and how to fight it.
The examination is carried out in the upright position (if necessary, in the supine position) using two or three scanning modes (B-mode, color coding of blood flow and pulsed Doppler mode) at the same time.The ultrasound angioscanning method allows you to visualize the studied vessel, determine the direction of blood flow and its parameters (speed, type of flow).
Both limbs are examined, not only the "sick" one, always looking at both superficial and deep venous vessels.If necessary, the patient may be prescribed additional research methods listed above.
Treatment of varicose veins
Specialists at the leading 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:
- Thermal obliteration (laser and radio frequency).
- Non-thermal methods for the treatment of varicose veins.
- Sclerotherapy.
- Miniphlebectomy.
- A combination of these techniques.
These methods meet the state European 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.