Varicose veins of the lower extremities is a disease of the veins of the legs, which is characterized by the 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 cause of the development of varicose veins is a defect (congenital or acquired) in the valve apparatus of the veins of the lower extremities, which leads to the development of reverse venous blood flow (reflux).Reflux leads to venous overflow and pathological venous emptying (redirection of blood flow).
Which, in turn, leads to clinical manifestations of chronic venous insufficiency - such as swelling of the legs, pain along the enlarged veins, itching of the skin, cramps in the lower leg muscles.
In advanced cases, pigmentation of the skin in the lower leg area, trophic ulcers, bleeding from enlarged nodes, as well as thrombophlebitis - inflammation of enlarged veins with their thrombosis, occur.Varicose veins develop gradually.
According to European statistics, chronic venous diseases are widespread throughout the world.It has been proven that among 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 does not exceed 6%.At the same time, in European countries, the incidence of varicose veins among 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 modern diagnostics and modern treatment of varicose veins of the lower extremities.The lack of modern high-tech methods for diagnosing and treating varicose veins in the public medical sector explains why combined phlebectomy remains the main method of treating varicose veins in public hospitals.That is, a very traumatic, inpatient operation with many incisions (and stitches) and mechanical removal of the body 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 undergo surgical treatment on an outpatient basis - without hospitalization, but also without spinal anesthesia and anesthesia.Conclusion - high-quality treatment of varicose veins is impossible without timely diagnosis and innovative treatment technologies.
Symptoms of varicose veins of the lower extremities
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 lower leg area.This symptom is more pronounced in the evening hours.
- Calf muscle pain.Most often it is pain, of low intensity, sometimes discomfort.
- Pain along varicose veins.As a rule, it is not intense, it manifests itself more in the evening, after a working day.
- Leg fatigue.Fatigue is a decrease in tolerance (susceptibility) to physical activity - static and dynamic.
- "Venous claudication."Venous claudication is called increased pain in the calf muscles when walking.
- Swelling of the lower extremities in the area of the legs and feet.
- Hyperpigmentation of the skin.
- Stinging, tingling, itching along the course of varicose veins.
- Trophic venous leg ulcer.
All symptoms of varicose veins, despite their heterogeneity, have common features:
- symptoms intensify 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, as well as when using elastic compression;
- change the intensity of the manifestation depending on the season.As a rule, the symptoms intensify in the summer;
- manifestations of the disease may intensify before or during menstruation.
All the above-mentioned symptoms are non-specific, i.e. 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 inquiry.
- Saphenous varicose 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, treatment is not necessary, in the second case, 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 related to each other.
- Changes in skin color and texture.In advanced forms of varicose veins, we often encounter hyperpigmentation (the skin turns brown or bluish).There may be areas of lipodermatosclerosis.An extreme manifestation is the appearance of a venous trophic ulcer.
Risk factors for varicose veins in the legs
- Non-specific: age, female sex, 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 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, observed visually, is usually not accompanied by swelling, pain or cramps.
At this stage, the disease can remain unchanged for a long time.And maybe it will improve.In this case, the patient, accustomed to the sight of varicose veins and accustomed to the idea that they do not harm him, 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 trophic venous ulcers and bleeding from enlarged nodes.
In order to standardize the diagnosis of varicose veins and make it as precise 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 decoding (nosological formulation), which facilitates understanding by 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 diagnosis of varicose veins of the lower extremities sets the following tasks:
- Determining 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 a "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.
- Determining treatment tactics - which specific technique (or combination of techniques) should be applied in this particular case.Treatment tactics must be discussed with the patient and reflected in treatment recommendations.
- The evaluation of the effectiveness of the treatment is performed 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, comprehensible information about his illness 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
- A clinical study.It includes clarifying the patient's complaints, examination and palpation (hand examination).
- Ultrasound angioscanning (vein ultrasound - duplex and triplex scanning).
- Plethysmography.
- X-ray phlebography (ascending and descending).
- Radionuclide phlebography (radiophlebography).
- Computed tomography (CT venography).
- Magnetic resonance (MR-venography).
- Intravascular ultrasound examination.
- Thermography.
In the vast majority of cases, a clinical examination and ultrasound angiography are sufficient for the phlebologist to diagnose varicose veins and develop the correct treatment strategy.At the same time, the main instrumental study for leg vein diseases is ultrasound angiography - ultrasound of the veins.
During the study, the patient is clearly explained what exactly is "his" disease and how to fight it.
The study is performed in a standing position (if necessary, 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 being studied, determine the direction of blood flow and its parameters (speed, type of flow).
Both limbs are examined, not just the "sick" ones, and we always look at the superficial and deep veins as well.If necessary, the patient can be prescribed additional research methods listed above.
Treatment of varicose veins
Specialists of the leading phlebology center use only the most modern and best methods for the treatment of varicose veins of the lower extremities.
Today, phlebologists use the following innovative treatment methods:
- Thermoobliteration (laser and radiofrequency).
- Non-thermal methods of treatment of varicose veins.
- Sclerotherapy.
- Miniphlebectomy.
- A combination of these techniques.
These methods meet national European standards.They provide you with effective, non-traumatic and outpatient treatment of varicose veins - without hospitalization.No anesthesia or spinal anesthesia is required.This approach gives the best treatment results.