The word "varicose" comes from the Latin varix "varicis - flatulence". The first mention of the treatment of varicose veins is found in the ancient Greek papyri.
Varicose veins are the most common disease. Up to 40% of the adult population suffer from chronic diseases of the veins of the lower extremities. The complications in the form of dermatitis, cellulitis, bleeding, thrombosis, and trophic ulcer often result in long-term disability, sometimes resulting in disability.
The structure and work of the venous system
How our veins work 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 on the connective tissue membrane. The middle layer is muscular. It consists mainly of smooth muscle cells arranged in a circle, which are, so to speak, located in a frame made of collagen fibers. Superficial veins contain a thicker layer of muscle than deep veins. The outer vein sheath, the so-called adventitia, is a dense tissue made of collagen fibers. If we compare the structure of veins and arteries, it should be said that the ratio of the lumen of the vessel to the thickness of its wall is much larger in veins than in arteries. Veins have much less elastic fibers than arteries.
The main property of the veins that affects the blood flow indicators is the great extensibility of their wall. In particular, with increasing pressure in the vessel, the veins expand and tend to take on a round shape from a slit-like one. The degree of extensibility of the vein wall is quite short-lived and depends on many other things. It is this factor that does not allow the use of strict mathematical formulas to calculate the movement of blood along it. The thickness of the venous wall in the vessels of the legs is much greater than, for example, on the neck.
Venous valves arise on the wall. Usually they consist of two valves that face the heart. In the area where the valve is attached to the wall, the diameter of the vein is slightly larger. Normally, when the valve leaves are closed, no blood can penetrate from the section above into the section below. In this case, the condition is called reflux. Reflux is also controversial. It can be relative (some call it physiological) and absolute. The main difference is the duration of reflux during functional tests. There is also an opinion that there should be no backflow in a normal valve. The valves are unevenly distributed through the veins. There are more of them where the work of the muscle pump is most pronounced - that is, on the lower leg.
The main venous system of the lower extremities is represented by the following groups:
- foot veins;
- deep veins of the leg and thigh (deep venous system);
- large and small saphenous veins (superficial venous system);
- communicating (perforating) veins - communication between superficial and deep veins.
The deep and superficial venous systems together form a "sponge" from which blood flows to the heart when walking. The work of this system is supported by the work of a muscle pump in the lower leg, which creates intermittent pressure in the veins.
These systems move the column of blood upwards and valves in the veins prevent backflow.
The flow of blood from the lower extremities through deep and superficial veins is uneven. About 85-90% of the blood flows through the deep veins and only 10-15% through the subcutaneous veins. Thus, in healthy people, the outflow of blood is carried out through the system of deep, saphenous and communicating veins.
Varicose veins are a serious problem
To say that varicose veins are "a disease of the 20th or 21st century" is to deviate from the truth. Varicose veins have long worried people. Even in ancient treatises on medicine there is a description of varicose veins, in ancient Rome people tied their legs with leather bandages to get rid of venous insufficiency.
If your legs get tired frequently, this can be the first sign of the onset of a disease of the venous system. Evening discomfort, accompanied by swelling of the foot and ankle, especially after a long stay on the legs, are clear signs of a blockage of the veins. Unfortunately, you will soon discover the first varicose vein. The altered vessels form a blue-blue or red "pattern" on your legs, "stars", capillary "cobwebs" (telangiectasias) and finally dilated veins and varicose veins.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins on the legs - an acute signal for urgent action to save the beauty and health of your legs.
A question about the condition of your veins should be immediately asked to a specialist - a phlebologist who examines and treats venous diseases.
The venous disease starts out harmlessly, but 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. But they mainly reflect the factors that contribute to the development of the disease or accelerate the appearance of clinical signs of the disease.
Both lower extremities are more frequently affected. However, the expansion of the veins occurs first on one limb and after a while on the other. Varicose veins are more common on the right leg.
Varicose veins of the lower extremities only occur 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 the vein wall of the extremity. With a weakness of the vein wall and a dysfunction of the valve apparatus in the main veins, which occurs with their congenital inferiority, a pathological reverse blood flow occurs. The most common causes of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, use of hormonal contraceptives, etc. ) - 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 from the lower extremities.
- Obesity is already a proven risk factor for varicose veins. This is due to the increasing load on the venous system of the lower extremities.
- Lifestyle: People with prolonged static exposure (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wear tight underwear that compresses the main veins at the level of the groin folds. Women wear high heels.
- Heavy physical activity (carrying loads, lifting weights).
- Thermal procedures (saunas and baths), the misuse of which can also cause varicose veins.
The essence of varicose veins lies in the fact that, for the reasons given above, there is a gradual expansion of the lumen of the saphenous vein and perforation veins, as a result of which there is an inadequacy of the valve apparatus (non-closure of the valve leaves). Pathological backflow (reflux) of blood occurs both from top to bottom and horizontally through the destroyed perforation veins.
Diagnosis of varicose veins
For many years, hands have been the only medical instrument used to examine a patient with varicose veins. X-rays have been helping the surgeon for a century. However, X-ray contrast examination of veins is a rather complicated procedure that requires bulky and expensive equipment, and the X-ray contrast media themselves are by no means safe for the body. With the development of microelectronics and computer technology, previously unavailable diagnostic methods have appeared: ultrasonic Doppler, ultrasonic angioscanning, plethysmography. The advent of ultrasonic duplex scanning has provided new information that has made it possible to re-examine the problems of the formation of varicose veins and understand the intricacies of the pathological process.
Doppler ultrasound
This is an ultrasound diagnostic technique that allows you to determine the speed and direction of movement of particles (in this case, blood cells) in the body. In this way, the doctor can determine the direction and speed of blood flow in the vessels of the lower extremities. And when conducting a number of physiological tests and the condition of the valve apparatus of the veins of the lower extremities. Knowing the structure of blood flow in the veins in the legs is the main requirement for choosing a treatment method.
Ultrasonic angioscanning
The essence of this method is that an image of the walls of the blood vessels and the blood flowing through them is created in real time on the screen of the monitor of an ultrasound scanner. The doctor has the opportunity to observe the shape of the vessel, the structure of the wall, the condition and direction of blood flow through this vessel. The method is very 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 tissues of the lower extremities. Its essence lies in the fact that the total electrical resistance of the tissues of the human body is directly dependent on the amount of blood flowing in and out of them and changes over 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 diseases and to assess the degree of venous insufficiency.
Of course, none of these techniques exclude a direct examination of the patient by a doctor, clarification of the medical history and identification of the patient's complaints. Based on the overall picture of the disease, the doctor will choose a method of treatment.
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 areas of medicine. In the last few decades, various drugs for the treatment of chronic venous insufficiency have been developed and are still being improved. The surgical technique for treating varicose veins has been significantly improved. Compression sclerotherapy technology was developed and practically perfected.
So-called sclerosurgery is currently gaining popularity worldwide. Sclerosurgery is a smart combination of surgical treatment and sclerotherapy. It is known that sclerotherapy can only be used for the initial and uncomplicated forms of varicose veins. The operation of varicose veins is also not without problems. Surgery to remove varicose veins is quite traumatic, requires hospitalization and a long period of rehabilitation. A sensible combination of these two methods will allow you to reduce the trauma of the treatment process to a minimum and achieve an exceptionally high quality of treatment.
Medical therapy for varicose veins
Very often there are cases in which a patient has practically no varicose veins or their number is very small. However, the person suffers from heaviness in the legs, pain and swelling. These are all signs of chronic venous insufficiency. In these cases, as well as with significantly enlarged varicose veins, drugs must be taken that improve the blood circulation in the legs. Currently, in a phlebologist's arsenal, there are several dozen drugs to combat venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should only be selected by a doctor. Despite the obvious simplicity of choosing a venotonic agent, only a doctor can determine the full spectrum of therapeutic measures and the appropriateness of using a particular drug.
Compression therapy
Compression therapy has been viewed for many years as a supplement to drug therapy or surgery. Compression treatment for varicose veins has been used since ancient times, and only in the last decade has elastic compression been 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 makes three types of elastic bandages: short, medium and high stretch. High stretch bandages (stretch more than 140%) are used to prevent thrombotic complications in the postoperative period after operations on the abdominal and pelvic organs, as well as to fix the joints after and for the prevention of sports injuries. Short-range bandages (stretching less than 70%) are used to treat complicated forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitic syndrome and lymphatic insufficiency. Medium stretch bandages (stretch from 70% to 140%) are used to treat varicose veins, chronic venous insufficiency, and compression sclerotherapy.
Medical compression stockings include medical compression stockings, tights and knee socks. Many people are mistaken when considering different "anti-varicose" and "support" jerseys with increased density as therapeutic. First of all, it must be stated that medical compression products are never labeled in DENs. DEN is a technical feature of a knitted fabric that is only indirectly related to the pressure generated by the product.
Medical jerseys are divided into several functional compression classes. The class of the product is determined by the pressure that the product exerts on the ankle and the lower third of the lower leg. A person suffering from varicose veins is shown how to use 2nd grade compression knitwear. These tights or knee socks create a pressure of 23-32 mm Hg on the painful leg. Art. , That is, completely equalize the pressure in the varicose veins and eliminate venous insufficiency. Medical compression products also generate what is known as distributed pressure. The pressure they create is gradually reduced as the leg moves 25-30% from the bottom up, which contributes to the effective outflow of blood and lymph.
It should be noted immediately that medical jerseys are never thin and transparent, that creating such a high pressure requires a large number of elastic fibers, and accordingly the knitted fabric is thick. It should also be said that medical jersey is never cheap. The technology of knitting a special knitted 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, wearing elastic bandages every day for a month corresponds almost entirely to the effectiveness of taking an effective drug every month. The use of compression stockings is particularly effective in preventing the development and recurrence of varicose veins. The main advantage of using compression products is their absolute health safety compared to the best medicines, and their costs are comparable.
Prevention of varicose veins
When you have the first signs of varicose veins, following relatively simple rules slows down and, in some cases, prevents their further development. Above all, don't get carried away by hot baths, saunas and prolonged exposure to the sun. All of this reduces venous tone and leads to stagnation of blood in the lower extremities. Avoid wearing tight-fitting clothing, stockings, and socks with tight elastic bands, as this will compress the veins. Obesity and sports associated with a large static load on the legs (tennis, weight lifting, bodybuilding) increase venous pressure. High heels (over 4 cm) - our veins don't like it. Take care of the veins, do not injure them.
If you feel heavy in your legs at night after a day of work, keep your legs up while you sleep and rest. If your work is accompanied by long periods of sitting at the table or standing for a long time, you should change the position of your legs, step into position and rotate your feet more often. There are special exercises for venous diseases. Rinse your feet with cold water after showering or bathing. There are sports that are useful - especially swimming, but also hiking, cycling, skiing. Do not neglect the folk remedies for prevention. Useful infusions of lingonberry leaves, St. John's wort, cranberries and rose hips. A plant-based diet should be followed. Your doctor may also prescribe a medication called phlebotonic to increase venous tone and improve microcirculation. Recently, the methods of preventing compression and treating varicose veins have also become understandable successes due to the advent of high quality medical products in the marketplace.
A special prevention word for pregnant women. Varicose veins progress during pregnancy, especially if it is not the first, and carrying a baby under 1 year of age does not contribute to good vascular function. The basis for prevention is the wearing of special compression stockings and the use of phlebotonics both during pregnancy and after childbirth. If you are prescribed a hormonal drug, don't forget to tell the gynecologist about your veins, as these drugs affect the veins' function and 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 doctors - phlebologists.