The disease caused by a violation of the structure of the vascular walls, their thinning, with accentuated processes of stagnation of blood flow, is called varicose veins. The disease usually affects the lower extremities, although it can be located in the rest of the body. According to the International Classification of Diseases of the tenth revision of the ICD 10, varicose veins are coded 183, which includes four titles that describe various manifestations of the disease.
How did varicose veins appear?
The first mentions of varicose veins were found in ancient Greek papyrus. History and confirmed scientific facts say that varicose veins of the lower extremities were found in the Egyptian mummy found - it could be argued that the disease has followed mankind throughout its existence.
Excellent Doctors - Avicenna, Hippocrates, Galen tried to treat varicose veins in the lower extremities. In the 19th century, painful and traumatic treatment methods were used, which consisted of dissecting the tissues of the thigh and leg to damage the saphenous veins, followed by bandaging. It was understood that this way it is possible to prevent the stagnation of blood flow and the varicose veins will be eliminated. However, the methods left terrible and extensive scars on the patients' bodies and contributed to damage to nerves, arteries and disruption of lymphatic flow.
A little later, the history of the treatment of varicose veins had a positive advance - in 1908, for the first time, a metal probe was used as a means of minimally invasive effect on the walls of blood vessels. The discovery of radiography made it possible to carry out more precise and efficient surgical operations to eliminate varicose veins. Now, when correct diagnosis and treatment of the disease is needed, duplex and triplex scanning, powerful medications, laser therapy and sclerotherapy are used. Surgical intervention is used only in cases where varicose veins cannot be removed in moderation.
The main causes of the disease
Varicose veins are a great danger, the pathology has become "younger" - before, they mainly suffered from the elderly, now varicose veins are diagnosed in young patients, extremely rarely in children.
Causes of disease:
- Genetic predisposition.
- Overweight, overweight, obesity.
- Sedentary and inactive lifestyle.
- Inadequate diet, poor blood quality.
- Concomitant disease of the cardiovascular system.
- Professional activity.
- Extended standing, heavy physical exertion.
- Pregnancy and hormonal changes.
- Individual characteristics of the structure of the vascular system.
- Pathological congenital diseases.
- Wear high-heeled shoes, tight clothes.
- Thermal treatments.
Any of the above reasons can cause the development of varicose veins, the consequences are dangerous, including death.
The structure of venous vessels
To understand what causes varicose veins in the lower extremities, you need to have an idea of the structure of the vascular system and how it works. It represents the totality of the main (deep and superficial) and perforating (communicating) connecting veins.
The small superficial vein starts in the foot region, runs along the back of the leg, branches under the knee into two branches, connects with the popliteal vein and the deep femoral vein.
A large superficial saphenous vein forms in the ankle region, runs along the surface of the leg and knee joint, and connects to the femoral vein. The deep veins are located along the branches of the arteries, and the entire venous system is connected by perforating vessels.
With normal blood flow, oxygenated blood flows directly to the heart and special venous valves prevent backflow. Varicose veins of the lower extremities imply strong pressure, the diameter of the venous lumen increases significantly, the valves do not support the task, there is reflux - reverse blood flow. Inadequate blood circulation causes excessive expansion (stretching) of vascular walls, their thinning, venous obstruction, and blood stasis. As a result - swelling, swelling of the veins, the formation of nodules.
Symptoms and clinical presentation
Varicose veins are able to progress latently for a long time, so the signs appear:
- The formation of spider veins is an accumulation of small dilated veins.
- Well-defined pattern of congested veins protruding under the skin.
- The formation of sites of compaction of blood vessels - varicose veins in the shape of well-distinguished tubercles in the legs.
- Change in normal skin color, cyanosis, darkening appears, the upper layer (dermis) acquires a loose structure.
- Feeling of pain, heaviness, distension and fatigue in the legs, decreased mobility, difficulty walking.
- With varicose veins in the lower extremities, swelling of the soft tissue is possible.
Ignoring timely treatment leads to serious and dangerous consequences, when a person can only be cured by immediate surgical intervention.
Disease classification
Varicose veins, according to ICD 10, are classified as ulcer disease, with inflammation, with ulcer and inflammation, when these signs are absent. According to the international classification of chronic venous diseases, created in 1994, varicose veins are classified into:
- Intradermal, segmental. No pathological venous discharge is observed.
- Segmental with reverse blood flow, occurs through superficial and perforating veins.
- Distributed with reverse blood flow through superficial and perforating veins.
- Varicose veins with reverse blood flow in the deep veins.
It is common to divide the disease according to the additional signs of the clinical picture:
- On examination or palpation, there are no symptoms.
- Reticular veins are expressed.
- There are varicose veins.
- There is swelling of the soft tissue.
- Violation of normal skin color.
- Revealed lipodermatosclerosis.
- There is a healed ulcer.
- An active ulcer was revealed.
Symptoms are absent or subjective (feelings of the patient). In addition, varicose veins are classified by reasons: congenital, primary, secondary, with an unknown factor that caused the development of the disease.
Diagnosis of varicose veins
The predominant way to identify varicose veins is by visual examination and palpation of the patient. To carefully determine the severity of the disease and choose the correct treatment, when analyzing the clinical history and applying palpation, the phlebologist prescribes:
- A complete blood count is the main standard for determining the number of red blood cells and the hemoglobin level. According to blood clotting, conclusions are drawn about the degree of development of the disease and predisposition to thrombosis.
- Doppler ultrasound. The method consists of ultrasound diagnosis of the velocity and direction of blood particles. This allows you to establish in which direction the blood flow is carried out, if it is fast enough.
- Ultrasonic agioscanning. It is used for visual examination of the vascular walls, their structure, direction and velocity of blood flow in real time on the monitor of the ultrasound machine.
- Plethysmography. Diagnosis is based on detecting the electrical resistance of the leg tissues. With proper circulation, the parameter should indicate the normal pattern.
- Rheovasographic diagnostics. Based on the determination of the tissue's blood filling index. The rheographic index helps determine the stage of varicose veins - compensation, undercompensation or decompensation.
The history of the disease and its study, obtaining comprehensive diagnostic data, allow the physician to choose the method of treatment.
conservative drug therapy
This method of treatment involves the indication of special medications that have a positive effect on the course of the disease. Conservative treatment of varicose veins is effective in the early stages, it is used as an additional method of treatment in the formation of nodules, ulcers, eczema.
The main groups of prescription drugs are:
- Phlebotonics and phleboprotectors. Venotonic drugs are the standard, implying conservative treatment. Promotes the restoration of the structure of vascular walls, strengthens and tones blood vessels.
- Means to effectively dilute blood. They contribute to improved quality makeup, blood flows faster in the veins, reduce the risk of blood clots, restore normal blood circulation and relieve pain.
- NSAIDs (anti-inflammatory drugs). Eliminate pain, prevent cramps and effectively relieve inflammation and swelling.
Conservative treatment helps in timely referral to a phlebologist, in the early stage it is possible to influence the composition of the blood and the condition of the vascular walls. With complex forms of the disease, drastic measures are needed.
laser therapy
Laser therapy is recognized as a mild and less traumatic method when varicose veins in the legs require treatment classified according to ICD 10 code 183. The idea of the method is to use a laser beam that actively affects the vascular walls and promotes your membership. An LED connected to a laser device is inserted into a vein through a puncture in the skin. The beam is selective and has no effect on adjacent healthy tissue. Significant advantages of laser therapy in the treatment of varicose veins:
- Fast positive effect.
- Absence of pain and injury.
- Stable result, long term remission.
- Restoration of normal blood circulation.
Contraindications for use will be thick or very thin vessel walls, large venous lumens, pregnancy, oncology and other serious concomitant diseases.
Sclerotherapy for varicose veins
The method is based on the introduction into vessels affected by varicose veins of special liquids or foam preparations - sclerosing agents. They replace endothelial cells with fibrous tissue. To perform sclerotherapy, needles, syringes and sclerosing agents are used.
The treatment technique consists of the following steps:
- perforation of a pathological vein;
- pump (remove) all blood from the vessel;
- administration of a sclerosing preparation;
- the imposition of an appropriate bandage or mesh compression.
This method gives a lasting result. The procedure is painless, the fusion of vascular tissues with varicose veins is an alternative to surgery.
performing an operation
The most painful and traumatic way to treat varicose veins is surgery. Indications for carrying out this will be extensive vascular lesions, presence of varicose veins, dangerous consequences of the disease, for example, acute thrombophlebitis.
Phlebectomy is performed under local anesthesia, the pathological vein is ligated, the necessary number of incisions are made to remove it and removed. The operation is recognized as an effective method of treatment, showing the result in eighty percent of cases. But phlebectomy has several side effects: wound complications, trauma to the lymph nodes, in extreme cases with deep nerve damage, immobilization and disability can occur.
To prevent dangerous complications of varicose veins, which are manifested by: nodules, ulcers, bleeding, phlebothrombosis, pulmonary embolism and other serious consequences, you should consult a doctor in the initial stage of varicose veins!