Varicose veins of the lower extremities is a chronic venous disease, which is characterized by the thinning of their walls, the extension of the lumen and formation of aneurysm-sicut nodes. Most often varicose disease affects the lower extremities; this is one of the most common disease – affects around 40% of women and 20% men.
Causes and risk factors
Through the veins of the lower extremities the blood up, that is, she has to overcome the force of gravity. This flow is by pressure, which is located in the vicinity of the veins and tendons of the residual arterial pressure. The flow of blood through the veins in the lower limbs and promotes a "muscle pump": when moving, the leg muscles contract and compress the veins, placebat ei pulsare thereby are in their blood up, since the reverse-current prevention of venous valves.
Weakness of the muscular layer of the venous wall and valvular incompetence can be a reason to influence the actions of the "muscle pump" blood to flow in the opposite direction, i.e. down. This leads to increased pressure on the walls of blood vessels, further progression of the valve disease, enlargement of the lumen of the veins and tubers. The muscle fibers of vein walls atrophy, disrupted nerve receptors, which regulate venous tone, which further increases the manifestations of venous insufficiency.
Risk factors for development of varicose disease of lower limbs:
- genetic predisposition;
- pregnancy;
- obesity;
- daily prolonged sitting or standing;
- activities associated with the lifting of heavy loads;
- systematically wearing tight clothing, corsets;
- incorrect diet with insufficient intake of dietary fiber and vitamins;
- a violation of hormonal status.
In the prevention of varicose veins play an important role in the active entertainment: sports (swimming, Cycling, fitness), dancing, Hiking, etc ..
Forms of the disease
On the basis of the characteristics of clinical manifestations, there are the following forms of varicose veins of the lower extremities:
- segmental damage to the intradermal and subdermal veins without return flow;
- segmental injury of blood vessels of the lower limbs, together with the abnormal flow of blood;
- common in vessels with reversed blood flow in the superficial veins;
- common vascular injury, coupled with an abnormal outflow of blood from the deep venous system.
The stage of the disease
In 2000, the Russian phlebologists was adopted in the classification of varicose veins of the lower extremities, taking into account the form of the disease, the degree of venous insufficiency, presence or absence of complications. According to him, there are three stages of varicose disease of lower limbs:
- The compensation stage. Patients do not show any complaints. During the inspection on one or both legs they discovered superficial dilated veins.
- In the stage of subcompensation. Patients complain of night cramps, a disorder of the skin, sensation (paresthesias) in the legs, bloating. In the evening there is often swelling of the legs, ankles and feet, disappearing after a night's sleep. During the inspection of the feet are clearly visible dilated varicose veins.
- Phase of decompensation. The above characters are joined by eczema and dermatitis. Skin with pigment spots, dry, shiny, closely associated with the subcutaneous fat.
Symptoms
The clinical picture is varicose veins of the lower extremities is determined by the stage of the disease. So, when the paid stage only symptom of venous insufficiency is the appearance on the legs spider veins (telangiectasias).
The transition of the disease in subcompensated stage, accompanied by pain in the legs, swelling of feet and ankles, cramps in calf muscles. After resting in the horizontal position, these symptoms cease.
The most clear clinical picture is varicose veins of the lower extremities is reflected in the decompensated stage of the disease. Foot pain to become permanent. Patients complain of itching of the skin, which intensifies in the evening and night hours. Over time, dermatitis, eczema, difficult healing of the sores. On the stage are frequent common symptoms: dizziness, low blood pressure. They are associated with deposition in the enlarged venous network of the leg, large amounts of blood.
Complication of varicose veins is phlebitis, thrombophlebitis, bleeding from varices, ulcers, pulmonary embolism.
Diagnosis
The diagnosis of varicose veins of the lower extremities is not difficult. This is on the basis of characteristic clinical symptoms and data of objective inspection.
To assess the severity of hemodynamic disorders of the use of instrumental methods of diagnostics:
- Doppler ultrasound of lower limb veins;
- duplex angioscanning;
- rheovasography on the veins of the lower extremities.
Treatment
In the treatment of varicose disease of the lower extremities according to the testimony of the following methods or a combination of them:
- conservative treatment;
- sclerosing therapy;
- surgery.
Conservative treatment of varicose disease of the lower extremities may be recommended in patients in the early stages of the disease, its aim – prevention of progression of chronic venous insufficiency. It is also used in subcompensated and decompensated stages of the disease in the period of preparation of the patient on the surgical intervention or in cases when other methods are contraindicated. Conservative treatment of varicose veins, based on the use of phlebotonics, wearing compression hosiery. In addition, patients are encouraged to regularly participate in physical therapy to avoid long-term static loads.
Varicose veins of the lower extremities is not complicated by significant hemodynamic disturbances, can be used for compression sclerotherapy. The method consists in conducting into the affected vein drug, causing its spasm. After that leg wear compression stockings or bandaging, exercise the legs with an elastic bandage to maintain the wall of the veins in the dormientes condition. After a few days it begins the process of gluing the vein walls. A compression garment must be worn after sclerotherapy for at least six weeks, until the formation between the walls of the veins rather dense adhesions.
In the advanced stage of varicose disease of the lower extremities, is the most effective method – surgery. Techniques, business techniques, which are selected on the basis of the stage of the disease, its forms, characteristics of hemodynamic disorders:
- laser coagulation;
- radiofrequency coagulation;
- miniphlebectomy;
- phlebectomy.
Possible complications and consequences
Complications of varicose veins develop mainly in the stage of decompensation. These include:
- phlebitis (inflammation of veins enlarged);
- thrombophlebitis (inflammation of a vein with formation in the lumen of blood clots);
- bleeding from varices;
- sores;
- pulmonary embolism (PE).
Most often varicose disease affects the lower extremities; this is one of the most common disease – affects around 40% of women and 20% men.
Forecast
The prognosis of varicose veins of the lower extremities with timely treatment favorable.
Prevention
For the prevention of varicose veins of the lower limbs is necessary to prevent long-term static loads. If the work requires a longer stay in a standing position or sitting, you must make periodic breaks for small exercises or at least walking. After the working day is recommended to lie down, gives the feet a horizontal or elevated position.
In the prevention of varicose veins play an important role in the active entertainment: sports (swimming, Cycling, fitness), dancing, Hiking, etc ..