The word "varicose" comes from the Latin variz, varicis - swelling. The first mention of the treatment of varicose veins is found in ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffers from chronic diseases of the veins of the lower extremities. Its complications in the form of dermatitis, cellulite, bleeding, thrombosis and trophic ulcers usually lead to long-term disability, sometimes causing disability.
The structure and functioning of the venous system
The functioning of our veins is a complex process. To understand this, you need an initial understanding of the structure of the veins. The venous wall consists of three layers. Internal - endothelium, represented by a layer of cells in the connective tissue membrane. The middle layer is muscular. It consists mainly of smooth muscle cells located circularly, which are, as it were, in a structure of collagen fibers. The superficial veins contain a thicker muscle layer than the deep veins. The outer sheath of the veins, called adventitia, is a dense tissue of collagen fibers. If we compare the structure of the veins and arteries, it must be said that the relationship between the lumen of the vessel and the thickness of its wall in the veins is much greater than in the arteries. Veins have much less elastic fibers than arteries.
The main property of the veins, influencing blood flow indicators, is the great extensibility of its wall. In particular, when the pressure in the vessel increases, the veins expand and tend to take on a round shape from a crack. The degree of extensibility of the venous wall is quite ephemeral and depends on many other things. It is this factor that does not allow the use of rigorous mathematical formulas to calculate the movement of blood along them. The thickness of the venous wall in the vessels of the legs is much greater than, for example, in the neck.
Venous valves originate from your wall. They are usually composed of two valves, which are oriented towards the heart. In the area of attachment of the valve to the wall, the diameter of the vein is slightly larger. Normally, when the valve flaps are closed, blood from the underlying section cannot penetrate the underlying section. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative (some call it physiological) and absolute. The main difference is in the duration of reflux during functional tests. There is also the opinion that there should be no backflow with a normal valve. The valves are distributed unevenly through the veins. There are more of them where the work of the muscle pump is more pronounced - that is, in the lower leg.
The main venous system of the lower extremities is represented by the following groups:
- veins of the foot;
- deep veins in the leg and thigh (deep vein system);
- large and small saphenous veins (superficial vein system);
- communicating veins (perforating) - provide communication between superficial and deep veins.
The deep and superficial venous systems together form a "sponge", from which, when walking, blood rises to the heart. The work of this system is supported by the work of a muscle pump located in the lower leg, which creates intermittent pressure in the veins.
These systems move the blood column upwards and the valves inside the veins prevent reflux.
The blood flow from the lower extremities to the deep and superficial veins is irregular. About 85-90% of the blood flows through the deep veins and only 10-15% through the subcutaneous veins. Thus, in healthy people, blood flow is carried out through the deep and communicating saphenous vein system.
Varicose veins are a serious problem
To say that varicose veins are "a disease of the 20th or 21st century" means to deviate from the truth. Varicose veins have been bothering people for a long time. Even in ancient medical treaties there is a description of varicose veins: in ancient Rome, people bandaged their legs with leather "bandages" to get rid of venous insufficiency.
If your legs are frequently tired, this may be the first sign of the onset of a disease of the venous system. Nighttime discomfort, accompanied by swelling in the foot and ankle, especially after a long stay in the legs, are clear signs of congestion in the veins. Soon, unfortunately, you discover the first varicose vein. The altered vessels form a blue-blue or red "pattern" on the legs, "stars", "spider webs" capillaries (telangiectasias) and, finally, dilated veins and varicose nodules.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins in the legs - an acute sign of urgent action to save the beauty and health of your legs.
A question about the state of your veins should be asked immediately to a specialist - a phlebologist who studies and treats venous diseases.
Venous disease starts harmlessly, but it can become a serious problem if left untreated.
The causes of varicose veins
So far, a large number of theories have been proposed to explain the causes of varicose veins. The most common are hereditary, mechanical, hormonal and so on. However, they mainly reflect the factors that contribute to the development of the disease or accelerate the onset of clinical signs of the disease.
Both lower extremities are most frequently affected. However, at first, the expansion of the veins appears in one limb, and after a while - in the other. Varicose veins are more common in the right leg.
Varicose veins in the lower extremities occur only in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and on the limb vein wall. With weakness of the venous wall and impaired function of the valve apparatus in the main veins, which occurs with its congenital inferiority, the pathological reverse blood flow occurs. The most common causes of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives and so on) - affect the structure and tone of the vascular wall with its gradual weakening and destruction.
- Pregnancy is one of the main risk factors for the development of varicose veins. In addition to hormonal changes, the enlarged uterus and fetus put pressure on the iliac veins and significantly impede blood flow to the lower extremities.
- Obesity is a proven risk factor for varicose veins. This is due to the increased load on the venous system of the lower extremities.
- Lifestyle: People with prolonged static charges (hairdressers, teachers, cooks, surgeons) suffer more frequently.
- Wear tight underwear that compresses the main veins at the level of the groin folds. Women in high heels.
- Intense physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the abuse of which can also cause varicose veins.
The essence of varicose veins lies in the fact that, due to the reasons above, there is a gradual expansion of the light of the saphenous and perforating veins, resulting in insufficiency of the valve apparatus (not closing the valve leaflets). Pathological reflux (return) of blood occurs both from top to bottom and horizontally through the destroyed perforating veins.
Diagnosis of varicose veins
For many years, the hands have been the doctor's only tool for examining a patient with varicose veins. X-rays helped the surgeon in the past century. However, examining X-ray contrast in the veins is a very complicated procedure, requiring bulky and expensive equipment, and the X-ray contrast agents themselves are not safe for the body. With the development of microelectronics and information technology, diagnostic methods that were previously unavailable have emerged: Doppler ultrasound, ultrasound angioscanning, plethysmography. The advent of duplex ultrasound scanning has provided new information that has enabled a new look at the issues of the causes of the development of varicose veins and to understand the intricacies of the pathological process.
Ultrasound Doppler
This is an ultrasound diagnostic method that allows you to determine the speed and direction of movement of particles (in this case, blood cells) in the body. Thus, the doctor is able to discover the direction and speed of blood flow in the vessels of the lower extremities. And when performing a series of physiological tests and the state of the valve apparatus of the veins of the lower extremities. Knowledge of the structure of blood flow in the leg veins is the main requirement for choosing a treatment method.
Ultrasound angioscanning
The essence of this method is that an image of the blood vessel walls and the blood that flows through them is formed on the monitor screen of a real-time ultrasound scanner. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the state and direction of blood flow through that vessel. The method is highly informative and much safer than X-ray examination, but it is quite expensive, so it is used only in difficult cases and during scientific research.
Plethysmography
This is a diagnostic method based on determining the electrical resistance of the lower extremity tissues. Its essence lies in the fact that the total electrical resistance of the tissues of the human body depends directly on the amount of blood that flows in and out of them and changes with time with each heartbeat. Plethysmography is used to diagnose the general functional state of blood flow in the lower extremities, it is used to monitor drug therapy for venous or arterial insufficiency, to treat trophic disorders and to assess the degree of venous insufficiency.
Of course, all of these techniques do not exclude a direct examination of the patient by a doctor, clarifying the history of the disease and identifying the complaints presented by the patient. Based on the general picture of the disease, the doctor chooses a treatment method.
Treatment of varicose veins
In the last 50 years, there has been a qualitative leap in the treatment of varicose veins, as well as in other branches of medicine. In the past decades, several drugs have been developed and continue to be improved for the treatment of chronic venous insufficiency. The surgical technique for treating varicose veins has improved significantly. The technology of compressive sclerotherapy has been developed and practically improved.
Currently, so-called sclerosurgery is gaining popularity around the world. Sclerosurgery is an intelligent combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can be used only with the initial and uncomplicated forms of varicose veins. Varicose vein surgery is also not without problems, the operation to remove the varicose veins is quite traumatic, requires hospitalization and a long period of rehabilitation. A reasonable combination of these two methods allows you to minimize the trauma of the treatment process and obtain exceptionally high quality of treatment.
Medical therapy for varicose veins
Often, there are cases when a patient has practically no varicose veins or their number is very small. However, the person suffers from heaviness in the legs, pain, swelling. All of these are signs of chronic venous insufficiency. In these cases, as well as when there are significantly increased varicose veins, it is necessary to take medications that improve blood circulation in the legs. Currently, in the arsenal of a phlebologist, there are several dozen drugs that aim to combat venous insufficiency.
The treatment of varicose veins and chronic venous insufficiency should be selected only by a physician. Despite the apparent simplicity of selecting a venotonic agent, only a doctor can determine the full range of therapeutic measures and the appropriateness of using a particular medication.
Compression therapy
Compression therapy has been seen for many years as a complement to drug therapy or surgery. The treatment of varicose vein compression has been used since antiquity and, only in the last decade, elastic compression has come to be considered a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of various brands and special medical compression stockings.
The global industry produces three types of elastic bandages: short, medium and high elasticity. High elongation bandages (elongation greater than 140%) are used to prevent thrombotic complications in the postoperative period after operations on Organs abdominal and pelvic organs, as well as to fix joints after and prevent sports injuries. Short dressings (stretching less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep venous thrombosis, post-thrombophlebitic syndrome and lymphatic insufficiency. Medium elongation bandages (stretching from 70% to 140%) are used to treat varicose veins, chronic venous insufficiency and compressive sclerotherapy.
Medical compression stockings include medical compression stockings, tights and high tops. Many people are mistaken, considering various therapeutic "anti-varicose" and "support" meshes of increased density. To begin, it is necessary to determine that medical compression products are never marked on DENs. DEN is a technical characteristic of a knitted fabric that is only indirectly related to the pressure that is generated by the product.
Medical T-shirts are classified into several classes of functional compression. The class of the product is determined by the pressure the product creates on the ankle and the lower third of the leg. A person with varicose veins can use a class 2 compression mesh. These socks or tights will create a pressure of 23-32 mm Hg on the sore leg. Art. , That is, completely equalize the pressure in the varicose veins and eliminate venous insufficiency. In addition, medical compression products create so-called distributed pressure. The pressure they create is gradually reduced as the leg moves upwards by 25-30%, which contributes to the effective flow of blood and lymph.
It should be noted at the outset that the medical mesh is never thin and transparent, creating such a high pressure requires a large amount of elastic fibers and, therefore, the mesh fabric is thick. It must also be said that the medical shirt is never cheap. The technology of knitting a special knit fabric is much more complicated; when knitting, it is also necessary to model the profile of the leg to create a distributed pressure.
The ideal approach in compression therapy is the constant and widespread use of elastic bandages and / or compression stockings by the patient. For example, the daily use of elastic bandages for a month corresponds almost completely to the effectiveness of a monthly intake of an effective medication. The use of compression stockings is especially effective for preventing the development and recurrence of varicose veins. The main advantage of using compression products is their absolute safety for health, even compared to the best medicines, and in terms of cost they are quite comparable.
Prevention of varicose veins
If you have the initial signs of varicose veins, following very simple rules will slow down and, in some cases, even prevent further development. First of all, don't get carried away by hot baths, saunas, prolonged exposure to the sun. All of the above reduce venous tone, leading to blood stagnation in the lower extremities. Do not wear tight clothes, socks and stockings with tight rubber bands, as this will compress the veins. Excess body weight and sports associated with a large static load on the legs (running shoes, weightlifting, weight training) increase venous pressure. High heels (more than 4 cm) - our veins don't like it. Take care of the veins, don't hurt them.
If you feel heavy on your legs at night after a day at work, keep your legs elevated while you sleep and rest. If your work is accompanied by a long session at the table or if you stand for a long time, then you should change the position of your legs more often, stay in place and rotate your feet. There are special exercises for venous diseases. After bathing or showering, wash your feet with cold water. There are sports that are useful - first of all, swimming, but also walking, cycling, skiing. Do not neglect folk remedies for prevention. Useful infusions of blueberry leaves, St. John's wort, blueberry, rosehips. A plant-based diet should be followed. Your doctor may also prescribe a medication called phlebotonic to increase venous tone and improve microcirculation. Recently, methods of preventing compression and treating varicose veins have also become a very understandable success, due to the emergence of high quality medical products on the market.
A special word on prevention for pregnant women. Varicose veins progress during pregnancy, especially when it is not the first, and carrying a baby under 1 year does not contribute to good vascular function. The basis of prevention is the use of special compression stockings, the use of phlebotonics both during pregnancy and after delivery. Be sure to mention your veins to the gynecologist when you are prescribed a hormonal medication, as these drugs affect the functioning of the veins, decrease their tone.
Don't self-medicate. Talk to your doctor about what is best to do with your veins. This disease is treated by physicians - phlebologists.