Varicose veins (varices).

10 August 2018

Varicose veins (varices) is one of the most common and oldest diseases of the circulatory system, which has opened since the time of ancient Egypt. With the help of the Egyptian papyri and raw materials, it was found a mummy with signs of varicose veins. The disease interested in the famous and ancient doctors: Hippocrates, Galen, and Avicenna, and later Troyanova, Trendelenburg. IDO still the disease has not lost its importance in modern medicine. Definition of "Varicose" comes from the Latin word "varix", which means "extension", so the disease, which is called "Varicose veins." This disease is characterized by the enlargement and increase of the length of the peripheral veins in serpentines tortuosity (deformation), as well as a violation of the outflow of blood on them, the resulting valve insufficiency and the weakening of their walls. The disease most often affects veins of the lower extremities, as the main burden of the outflow of blood (large volume), which falls on them, so prefer this section. Varicose veins occurs in about 17 - 25% of the population. At a young age, the disease occurs equally in boys and girls. In the mature age for women will be sick 2 - 3 times more often than men, due to hormonal changes of the female body (menstruation, pregnancy, menopause).

Causes and risk factors in the development of varicose veins

The exact cause of the disease is not known, we only know that it is under the influence of certain factors is the development of a weakening of the valves, the pressure increase and loss of elasticity of the walls of the superficial and connecting veins. Risk factors:

Genetic predisposition: the transfer of varicose veins by inheritance, is caused by mutations of the gene responsible for the structure of the vascular walls, which are the result of mutation, children are born with congenital weakness of the connective or muscular tissue of the vascular walls, or not for this, the valve (negative number), and as a result of this is the weakness of the vascular walls, and increased pressure in the veins.
Hormonal changes (pregnancy, menopause): pregnancy, hormonal changes the makeup of the organism (increasing the level of progesterone and decrease of estrogen) that affect the formation of clotting factors (increase) decrease in tone of the venous walls (as a result of destruction of collagen and elastic fibers in the vascular walls) all of this leads to the formation of blood clots, blockage of blood vessels and their deformation.
Obesity : excess weight leads to a sedentary lifestyle, which is a slowdown in circulation, plus excess fat increases the intra-abdominal pressure, which violates the outflow of blood through the veins, resulting in the development of stagnation in the veins and the possible development of the disease.
Diabetes :chronic elevated level of sugar in the blood at the time of injury blood vessels, which is a favourable environment for the development of blood clots.
Alcohol abuse : excessive alcohol consumption leads to dehydration and thickening of blood caused by blood clots that clog the arteries and compromises blood flow.
Lifting weights (movers),long walking or long standing work (vendors, guides): associated with the reduction of muscle tone, increased intra-abdominal pressure and, consequently, slowing down and obstruction of blood flow to the heart and the development of stagnation in the lower extremities.
Congenital coagulation defects: congenital hypercoagulation (excessive production of clotting factors in the blood) leads to the formation of blood clots and disruption of the blood through the veins.
Poor diet: a lack of certain vitamins in the diet (Vit.C, E, R, plant fibers role in strengthening vascular walls and improve blood circulation).
Wearing tight underwear: wearing continuously lead to mechanical compression of the veins, causing obstruction of the venous outflow from the lower extremities.
Chronic constipation : frequent increase in abdominal pressure (during exertion) leads to the problems in the outflow of blood from the lower extremities.
Frequent walking high heel: the lack of movement of leg muscles and the development of stagnation.
Hot season: frequent thirst leads to dehydration of the body occurs blood clots and blood clots.
Concomitant diseases of the cardiovascular system or diseases of the kidney: impaired outflow of venous blood (heart valve insufficiency, congenital defects).
Overdose of the drugs increasing blood coagulation: risk for blood clots and blockage of blood vessels.
Surgery the loss of some blood volume is not a comfortable position on the operating table (compression of certain blood vessels), making the risk for blood clots.

Complications of varicose veins

The formation of blood clots, as a result of the stagnation of the blood in the veins;
detachment of a thrombus and occlusion of the vessel, which coincides with its diameter;
thrombophlebitis (clots in the lumen in the vein is the inflammation of its walls);
pulmonary embolism (detached blood clot blood occurs in the pulmonary artery, which participates in blood circulation in a small circle. If the clot diameter coincides with the diameter of the trunk of this artery, which can cause sudden death. If the clot is smaller in diameter, passes on the branches of the pulmonary arteries, causing pulmonary infarction or edema).
sores or eczema legs cause eating disorders (poor blood circulation leads to lack of oxygen in the tissue, which is the main food of the tissues in the body);
swelling of the different parts of the body, as a result of stagnation in the veins (they are soft, elastic, bluish color, their education does not depend on time, often in the form of the affected area);
dermatitis (inflammation of the skin in the affected area) because of the malnutrition of the city;
change the color of the skin of the affected area;
the tightness of the subcutaneous adipose tissue in the affected area due to swelling.

The diagnosis of varicose veins

In the flagellum (functional) tests (determination of the patency of the veins and their valves): Troyanova - Trendelenburg,Pratt, Chania, Delbe-pertes and others. One of the most common test Troyanova - Trendelenburg, with which the patient is in a horizontal position, lift the legs to 45 ⁰, the doctor makes a stroking from the foot up (as a result, the superficial veins are emptied), then establishes a tourniquet to the upper part of the thighs and ask the patient to stand normally, the filling of the veins of the lower leg should happen more than 15 seconds;
Duplex ultrasound scan of the veins (ultrasound angioscanning) the most informative method for the assessment of blood flow in the tank and see the vessel;
Dopplerhophy - the method by which to assess the blood flow in the vessel;
Venography is the injection of a contrast agent intravenously and the study of x-ray images;
Phleboscintigraphy - intravenous administration of the radiopharmaceutical and the observation on a special device.

Treatment of varicose veins

Non-surgical treatment

Traditional methods of treatment (as a complement to the treatment: wearing compression hosiery (socks); special exercises (swimming, bike, skis, feet above his head about 20 ⁰ towards the bed, special exercises ("Bike", who is lying on his back and breathing in, imagine that you are pedal Cycles; alternately bend and unbend the foot at the ankle joint forward and backward) are used to improve the outflow of blood, but only in complex cases); contrast shower (under running water, that the leg gradually reduces the temperature of the water reaches the cold); foot bath (not hot) decoction of oak bark, chestnut, chamomile, st. john's wort; rubbing alcohol tincture of flowers of acacia, the leaves of Kalanchoe, Apple cider vinegar; thrombophlebitis treatment with leeches.
Day: in the morning, slow getting out of bed (about 5-10 minutes), during sleep puts the cushion under the heel so as to lift the leg approximately 15-20 ⁰ according to bed, the walk must be calm, you cannot sit crossed leg on the leg, bandaging the legs with elastic bandages from the foot to upper thigh, dressed in medical socks, a good diet to avoid any boring movement and any substances or factors that contribute to thickening of the blood, with the exception of Smoking, the prevention of constipation.
Diet : the body needs food that contains vitamins to strengthen blood vessels and improves blood flow: vitamin C (made with citrus fruits, tomatoes, rose hips, etc..), vitamin E (legumes, liver, egg yolk, green onion), vitamin R (grapefruit, walnut, black currant), bioflavonoids (dark sweet cherries, sour cherries), copper (fruit). Adequate daily fluid intake-at least 1.5 litres. Limited to the use of alcoholic drinks, coffee, marinades, smoked products.

Surgical treatment

Phlebectomy:Indications for the removal of veins: extensive varicose veins, saphenous vein pathologically expanded, trophic disorders of the skin, which are not amenable to conservative treatment of acute thrombophlebitis, varicose saphenous veins accompanied by a violation of the General condition (severe fatigue, swelling of the legs) of the patient. Contra-indications for the removal of veins: coronary heart disease, severe infectious processes, age of the patient, pregnancy in 2. and 3. trimesters, inflammation on the legs (erysipelas, pyoderma, eczema). The advantages of the surgical treatment: the only treatment in severe cases, the only radical method of correction of the valves of the deep veins. Disadvantages of surgical treatment: traumatic (cosmetic errors), which requires anesthesia, you need is a few days in the hospital, under the supervision of a physician. Laser therapy (endovascular microtermocoagulation) :Indications: the Combination of varicose veins with the following diseases: cardiovascular disease (coronary heart disease, high blood pressure), peripheral vascular disease (phlebitis, thrombophlebitis), respiratory diseases (asthma, bronchitis, pneumonia), diseases of the digestive system (cholecystitis, peptic ulcer and duodenal ulcers), diseases of the nervous system (craniocerebral traumas, neuroinfections), diseases of the genitourinary system (pyelonephritis, endometritis, salpingitis), with skin diseases (dermatitis, Neurodermatitis), peritonitis, boils. Contra-indications: people suffering from oncological diseases, diseases of the liver, kidney and heart in the stage of decompensation, cerebral sclerosis, pregnancy. Advantages: eliminates unpleasant vascular pattern, fast (15-20 min), requires no hospitalization, safe and painless, does not damage the vessel tissue and surrounding tissue. Cons: not available everywhere method expensive method, removing the larger vessels can be thermal damage to the tissue, the possible formation of scars and depigmentation (whitening) of the skin in the treated area. Radiofrequency coagulation (ablation) of varicose veins: Indications: varicose veins with a lesion of the trunk of the great or small saphenous veins, trophic ulcers due to the varicose veins. Contra-indications: acute thrombophlebitis of the subcutaneous veins, the inability of active walking, pregnancy, mental disorder. Advantages: no cosmetic defects, painless, requires no hospitalization, does not violate the capacity. Weaknesses: the only weakness is the price. Sclerotherapy: Indications: the small, varicose veins, large varicose veins, when you use the duplex dopplerography, varicose veins in the early stages (if the damage is only surface veins. Contra-indications: pregnancy and breast-feeding, allergic to sclerosus, deep vein thrombosis, purulent-inflammatory diseases of the feet. Advantages: lower cost in comparison with surgery, quickly the period of reconstruction, does not require a stay in hospital (home), the best cosmetic result. Weaknesses:possible use in deep vein sclerosus, decreased efficiency due to mixing sclerosus with blood, are ineffective in advanced cases.