Varicose veins or varicose veins of the lower limbs is of primary varicose transformation of superficial veins of the lower extremities, in which the phenomena appear "bumps" or "knots" on his feet.
Varicose disease is very widespread around the world. Its frequency reaches 60 % among adult partisans on the hell of the country. Interestingly, the inhabitants of the African continent and the Asia-Pacific region suffer from varicose veins much less frequently than people in European countries and the USA.
In connection with the absence of definite causes of varicose veins of the lower extremities is customary to talk about the risk factors, t.. Zn. that increases the likelihood of developing this pathology (property or characteristic of the human body, any impact on the body). Common risk factors consider age, female gender, obesity and heredity. Typical "portrait" of a patient with symptoms of varicose veins — a woman in a state of menopause, excess weight index a, which may multiple pregnancies and childbirth in anamnesis.
Symptoms of varicose veins in the legs
In overwhelming majority of cases, varicose veins can be recognized, even without special medical education. A definite objective sign of pathology — the phenomenon of the appearance of "bumps" or "nodes" on the lower limbs, while the skin over them is usually not distinguished by any special color. Blue veins usually are not phenomena of disease in its literal sense, although they often bring patients (most often women) inconvenience of an aesthetic nature.
However, in advanced cases, varicose veins may be accompanied by skin discoloration due to venous eczema, which is manifested in a variety itchy skin rash (vesicles, nodules) and redness.
These signs, along with swelling of the legs, which does not disappear for an hour a night of rest, indicated the formation of chronic venous insufficiency.
As for the sub subjective symptoms of varicose veins, it should be noted their non-specificity. Complaints can indicate the disease, and can be a sign of overload of the venous system of the lower extremities. Most often patients suffer from heaviness, bloating and weak non-localized aching pain in the calf. Hourly phenomena there are complaints of pain in the area of varicose veins and fatigue legs.
Burning, tingling, muscle cramps at night or restless leg syndrome (unpleasant sensations in the legs at rest, if you want their movement to alleviate this discomfort) was most commonly found in neurological disease, for example, radicular syndrome, and should be taken into consideration with caution.
Pathogenesis of varicose veins in the legs
Pathogenesis of varicose veins of the lower limbs is quite complicated and versatile. The main role in the mechanism of disease development plays damage the walls and valves of veins. As a result of their irregular work formed a reverse flow of blood (reflux), then there is a loss of the endothelium (the inner lining of the vessel), which is accompanied by inflammation.
Distances in the pathological process involved the middle and inner layers of the venous wall, there is a proliferation of connective tissue in the muscular layer of the vein, and then its atrophy, which leads to the gradual destruction of the collagen of the vessel. These phenomena violate the Java elastic properties of Vienna, contribute to the further expansion of its lumen and the helical twist along the length. At the same time similar changes were observed in venous valves.
It should be noted that venous visible "bumps" and "knots" are usually phenomena are caused by the presence of an invisible source of varicose veins — saphenous vein violent. In the vast majority of cases this is a large, rarely small saphenous vein. The above changes in the pool of these veins and lead to varicose disease.
Complications of varicose veins in the legs
Yes, complications of varicose veins should include trophic disorders (venous ulcers), thrombosis or varicose changed veins (thrombophlebitis) or bleeding from varicose "bumps" and "nodes".
Trophic disorders phenomena are the result of disease progression in the absence of treatment, it often takes years and decades. They start with cutaneous manifestations of hyperpigmentation (brown spots), venous eczema and lipodermatosclerosis (seal skin).
The main localization of these changes is the tibia, although venous eczema may occur in any region of varicose veins, including on the thigh. According to the hell of source of varicose veins (great or small saphenous veins) of venous disorders will be localized or on the inner or outer surface of the lower third of the leg, respectively. The result of malnutrition of the soft tissues is the formation of venous ulcers at the site of the previous changes. Ulcers are single or multiple, with irregular shape, sloping edges and a flat, smooth bottom. It is noted scant discharge, often purulent character. Phenomenon, the appearance of ulcers accompanied by itching and pain. For venous ulcers characterized by a long survival (months) and frequent recurrence.
Thrombophlebitis or superficial vein thrombosis should not be confused with deep vein thrombosis. In the second case the situation is much more serious Esna. However, in thrombotic lesions varicose veins symptoms are very unpleasant. In the region of the thrombosed vein painful threadlike forms a seal, it is characterized by redness, local fever, hypersensitivity, hours the seal restricts movement of the limb. The clinical picture more reminiscent of ulcer or abscess.
Thrombophlebitis can be especially dangerous if you take upward character and move from the superficial system into the deep. In this case, it may develop as pulmonary embolism and deep vein thrombosis.
Bleeding from varicose veins look very scary, because due to the high venous pressure stream of blood strong enough. In some cases this can result in significant blood loss.
Diagnosis of varicose veins in the legs
Diagnosis of varicose veins of the lower extremities do not usually cause any problems. A key feature of the disease is the presence of venous "bumps" and/or "nodes". Although excessive development of the subcutaneous fat of the lower limbs, to see them in google + difficult.
To further confirm the diagnosis using various methods of instrumental diagnostics, the leading of which phenomenon is ultrasonic duplex scanning (USDs). It allows you to quickly, accurately and safely determine the source of varicose veins, to assess the size and structure of the vessel, the function of venous valves, the scale distribution of the return current of blood and to detect the presence of blood clots. At the same time look deep and superficial venous system. To conduct the research should be in the standing position or, if the patient's condition does not allow sitting down with their feet. The study in the prone position can also lead to errors in the determination of the reflux and blood clots.
To further evaluate the function of the valves and the duration of the reverse current of blood used:
- compression test with pressure on different segments of the lower extremities;
- the sample with straining (Valsalva test);
- a simulated walk;
- welcome paraná is easy to attempt the removal of the patient from the equilibrium state with the purpose of calling the tension of calf muscles.
The result of ultrasonographic duplex study of lower limb veins is necessary to fix in the form of an opinion, and graphics, by drawing a "vein map". The results of the study provide an invaluable aid in planning further treatment. However, they need to be taken into account only in conjunction with clinical data, as changes in the ultrasound pattern in the absence of objective signs of disease (varicose veins) should be considered functional (t.. Zn. not related to pathology of the veins). It should also be noted that ultrasound scanning is not necessarily undertaken if the diagnosis is clear and if the patient does not plan surgical treatment of varicose veins.
There are additional methods of diagnosis:
- Doppler ultrasound — Doppler ultrasound (not to be confused with USDS);
- plethysmography;
- radiopaque venography;
- radiotelegraphy;
- computed tomography (CT);
- magnetic resonance imaging (MRI);
- thermography
- intravascular ultrasound (IVUS) is a new method.
Treatment of varicose veins in the legs
The primary goal of treatment of varicose veins of the lower extremities phenomenon is the removal of all veins not working correctly. This is only possible by means of invasive intervention. There are three methods:
- Deleted — combined phlebectomy short vein Stripping, miniphlebectomy, dissection of perforating veins;
- "Bonding" — sclerotherapy, mechanical washing, cyanoacrylate obliteration;
- "Brewing" — endovenous laser or radiofrequency ablation.
To achieve the goal of treatment must perform two tasks: to remove the source of varicose veins (so-called vertical reflux) and remove varicose veins. For a long time the most commonly used method was combined phlebectomy. Its technical construction includes two stages:
- Ligation anastomosis — the connection of the great saphenous vein with the common femoral vein (crossectomy);
- Remove trunk of the saphenous vein with the probe (Stripping).
This intervention is radical and may a number of disadvantages inherent in any operation: frequent need for anesthesia, the presence of incisions and sutures, sensitive rehabilitation period and increased in comparison with other methods the risk of complications.
However, about twenty years ago there was a "phlebology revolution." It became possible thanks to the widespread adoption of ultrasound scanning and phenomena phenomena gourmet techniques — endovenous thermal ablation. Its essence lies in the effects of high temperatures on the scene the vein from the inside. This is achieved by laser radiation (EVLO) or RFR (RFO), "safariways" the lumen of the vein.
Vienna this immediately ceases functioning, and then gradually resolves. This app allows without incisions, fast, efficient, safe and aesthetically pleasing vertical to eliminate reflux without the need for further rehabilitation. Ate aleutica bright representative of "office surgery", endovenous thermal ablation for ten years is considered the most optimal method of treatment of varicose veins worldwide.
Sclerotherapy (bonding affected veins by injecting a substance) also found wide use in the elimination of varicose veins. However, to achieve the desired result requires careful selection of patients due to the increased risk of disease recurrence.
Conservative treatment methods, which include compression therapy, phlebotrophic drugs and local medicinal forms (gels, ointments), are purely auxiliary in nature, affecting mostly the symptoms of varicose veins without eliminating its sources.
Forecast. Prevention
Taking into account modern methods of treatment, the prognosis of varicose veins is favorable. Even in the most seemingly advanced cases to remove the varicose transformed veins leads to rapid improvement of the patient's condition.
However, when planning treatment it is important to assess its risks, as any intervention still carries potential adverse effects waking. A duty of the physician is to minimize their likelihood. Before any manipulation should be discussed with the patient all aspects regarding the intervention and to obtain his signature on informed consent.
All adverse events of Java can be divided into risks associated with surgery, including anaesthesia and the risks to the patient.
The risks of surgery can be small, for example, inflammation (phlebitis) in the "brewed" or sklerozirovanie veins, which is accompanied by a seal in their projections and moderate pain. Can phenomena are areas of skin with reduced sensitivity, and hyperpigmentation of the skin. All these effects of Java temporary and usually pass fairly quickly without any consequences.
Yes serious complications include deep vein thrombosis, allergic and toxic reactions to anesthetics. They occur very rarely, but for a single patient, who suffered such a complication, the case of the phenomena is 100 percent, and even with the statistics of 1 case per 10,000 operations.
Prevention of venous thrombosis, primarily based on the calculation of its risks in the so-called scale-point system using the table Caprini. It contains various risk factors, which have a gradation. Account of each factor and the total elimination of the ball determines the degree of risk and therefore its prevention. The main means of prevention of venous thromboembolism following:
- minimizing the morbidity of the operation;
- early activation of the patient;
- compression stockings;
- pharmacological prophylaxis, i.e. assignment according to the testimony of anticoagulants — drugs that thin the blood.
As for the prevention of varicose veins, it is simple-simple does not exist, because it is still not clear the main cause of the pathology, which could have an impact and thus to prevent the phenomena of the appearance of the disease. Linked to this is the rather frequent recurrence of varicose veins after any type of intervention. However, given all the advantages of minimally invasive treatment, this phenomenon is not a significant problem. To maintain the legs quite simple, the main time to apply and phlebologist