Varicose veins of the lower extremities are often asymptomatic in humans. Often the only problem with this pathology is an aesthetic defect in the legs caused by protruding superficial veins. In this case, the disease may be accompanied by pain or increased sensitivity of the skin of the legs. Depending on the severity of the disease, the patient is offered non-drug, drug, or surgical treatment. Read more about the first symptoms of varicose veins, the nature of their course and effective methods of treatment and prevention, read our material.
Varicose veins are a disease that only humans suffer from. Animals do not have this problem, suggesting that the disease is associated with upright posture. When a person stood up, most of the circulating blood began to be below the heart. In this case, all the conditions are created for the blood to circulate worse in the opposite direction, which leads to stagnation.
According to statistics, some diseases of the venous system are observed in 80% of people in developed countries. In addition, similar problems are increasingly found in people at a young age. One of the reasons varicose veins "get younger" is, in all likelihood, a sedentary lifestyle, which only contributes to stagnation.
Interestingly, in the age group under 20, varicose veins of the lower extremities are equally common in men and women. From the age of 20, however, women begin to dominate the morbidity structure. This is due to pregnancy and childbirth, which are a serious factor in the development of venous diseases.
Features, causes and mechanism of the development of varicose veins
The exact reasons for the development of varicose veins of the lower extremities are still unknown. It is currently believed that the disease is caused by congenital or acquired defects in the valve apparatus of the veins of the lower extremities.
A well coordinated work of the venous valves is necessary for an unhindered ascending blood flow through the veins. These valves only open to blood flowing upward. In the case of a valve defect, however, a partially descending blood flow is also possible. This creates venous insufficiency, which manifests itself in edema, spasms of the leg muscles and expansion of the venous vessels.
Leukocytes can also be involved in the pathogenesis of the development of varicose veins. This topic is currently being actively researched. It is believed that with prolonged accumulation of leukocytes in the tissues of the vessels (especially in the area of the valve apparatus), an inflammatory process develops, which spreads along the venous bed.
Since the venous valves are exposed to constant mechanical stress, inflammation occurs particularly quickly in the area of the venous valve apparatus.
Today, the vast majority of people in developed countries lead a sedentary lifestyle. Then why doesn't everyone have varicose veins? Consider the main risk factors that contribute to the onset of this pathology:
- Hereditary factors. . . Despite the fact that the specific hereditary mechanisms associated with the development of varicose veins have not yet been clarified, most experts agree on the presence of such a factor. At the same time, there are weighty arguments against heredity in the development of varicose veins. For example, this is the prevalence of varicose veins among ethnic Africans and African immigrants who emigrated to the United States. If the prevalence of varicose veins in sedentary Africans is around 0. 5%, then that figure reaches 20% in emigrants. These figures show that hereditary factors, at least, aren't the only ones in the development of the disease, and most likely do not predominate.
- obesity. . . Overweight and obese people are at risk. It is important to note that obesity contributes to varicose veins, both due to increased stress on the blood vessels and in connection with the risk of other diseases of the blood vessels (diabetes mellitus, high blood pressure, etc. ).
- pregnancy. . . This is one of the most obvious factors in the development of lower extremity varicose veins. In this case, the main risk factors are an increase in the volume of circulating blood, as well as compression of the retroperitoneal veins by the developing fetus in the uterus. According to epidemiological studies, the second and subsequent pregnancies lead to a significant increase in the likelihood of developing varicose veins. After the first pregnancy, the likelihood of varicose veins in the legs remains low.
- Hormonal imbalance. . . Hormones are involved in the pathogenesis of most diseases. These pathologies include varicose veins. This problem is particularly true for women taking hormonal contraceptives, hormone replacement therapy to treat certain diseases (e. g. osteoporosis) or during the premenopausal period. It has been found that female sex hormones (especially estrogens and progesterone) reduce vascular tone and destroy collagen fibers. This pathologically dilates the wall of the veins.
- way of life. . . A person's lifestyle has a major influence on the course of the disease. A sedentary lifestyle, as well as work that involves standing or sitting for long periods of time (e. g. , security guards, drivers, office workers, service workers, and others) contribute to the development of varicose veins. You should also pay attention to your diet. The lack of a sufficient amount of vegetables and fruits in the diet worsens the condition of the walls of blood vessels.
Stages of varicose veins of the lower extremities
Several classifications of varicose veins of the lower extremities are currently in use. The international CEAP classification, which was adopted in 1994, is generally recognized. CEAP is an abbreviation, with each letter corresponding to the name of a classification category:
- C (clinical)- the clinical class of the disease (type of affected veins, pigment spots, eczema, trophic ulcers).
- E (etiological)- the etiology of the disease (congenital, primary, secondary).
- A (anatomical)- anatomical localization of the pathology (superficial or perforating veins).
- P (pathophysiological)- the nature of the disease (venous reflux, obstruction, or a combination of both).
The disease progresses in six stages:
- Zero level. . . The earliest stage of varicose veins that even doctors cannot make a reliable diagnosis. At this stage there are no external signs of the disease. Ultrasound diagnosis does not reveal any pathology. At the same time, a person at zero stage is concerned about symptoms such as swelling, heaviness in the legs, as well as cramps, which indicate problems with blood vessels.
- First stage. . . Even in the first stage of the disease, spider veins with a diameter of less than 1 millimeter are visible on the skin surface of the legs. Medium-sized veins can increase in diameter by up to 3 mm. At this stage, doctors cannot always make the correct diagnosis, since the presence of such asterisks does not always indicate varicose veins.
- Second floor. . . At this stage, veins can appear and disappear depending on the conditions. For example, veins show up clearly after long periods of sitting, standing, or lifting heavy objects. The diameter of the varicose veins at this stage is 3 mm or more. In the second stage, blood clots often form.
- Third section. . . If in the previous stages of the disease the swelling of the legs appeared and disappeared, then in the third stage the edema becomes permanent. The swelling of the legs is greatest in the evening.
- Fourth stage. . . At this stage, significant trophic changes occur. Tissue nutrition is disturbed, particularly in the vicinity of the affected veins. The patient develops such skin changes as lipodermatosclerosis (inflammation of the subcutaneous fat), eczema, and darkening or discoloration of the skin. For the fourth stage of the disease, pigment changes are characteristic. For example, the skin in the area of the affected vessels may turn brown and even black, which indicates the concentration of pigments in this area. The reverse situation is also possible if, due to a pathological process, pigment does not penetrate the affected area, which leads to the appearance of a pale skin tone. If varicose veins are not treated at this stage, the problem will only worsen as trophic ulcers continue to appear.
- Fifth stage. . . At this stage of the disease, in addition to the above symptoms, trophic ulcers appear, which heal quickly. If you don't take any treatment, the ulcers will keep coming back.
- Sixth stage. . . Non-healing trophic ulcers appear. The temperature rises significantly in the affected area and pus can seep out of the wounds.
You should not wait for the development of the last stages - you should go to the doctor for the second in order to register and track the dynamics of the disease. Sometimes symptoms improve on their own, sometimes they progress quickly. Therefore, it is important to monitor the situation in order to take timely action.
Consider the main symptoms of varicose veins of the lower extremities at different stages of the disease:
- pains. . . This is the earliest sign of the disease. Since pain is a nonspecific symptom, it is impossible to make a diagnosis based on that symptom alone. With varicose veins of the lower extremities, the pain is often localized along the venous trunks.
- Feet in the legs. . . Also applies to early symptoms while the veins in the skin are not yet visible. Often the feeling of heat is accompanied by a throbbing pain.
- Cramps and itching in the muscles. . . Most often disturbed at night.
- Swelling in the legs. . . In the early stages of the disease, the swelling is minor and temporary. Usually they appear in the evening and go away in the morning. However, as the disease progresses, the severity increases and they become permanent.
- Discoloration of the skin. . . As a rule, with varicose veins, the skin of the lower extremities darkens. In the area of the affected veins, the skin turns brown. In the more advanced stages of the disease, eczema and dermatitis appear. The final stages of varicose veins are characterized by the appearance of trophic ulcers. These are initially healing ulcers, but later non-healing wounds form.
- Vascular spiders. . . In the medical literature, such asterisks are called telangiectasias. In some people, varicose veins can be limited to spider veins without progressing to larger veins.
- Twisted dilated veins. . . The most characteristic sign of varicose veins is twisted dilated veins on the surface of the legs.
In the summer, the symptoms of varicose veins become more severe. This is due to the high ambient temperature, which already contributes to the expansion of the veins. Therefore, during the hottest hours, between 10am and 4pm, it is best to be in a well-ventilated area.
When to see a doctor
You should consult a doctor at the first symptoms of the disease - pain, swelling or the appearance of spider veins. Since varicose veins are difficult to diagnose in their early stages, they may initially be misdiagnosed. The patient should carefully monitor the condition of the legs and be regularly observed by a phlebologist.
The diagnosis of varicose veins of the lower extremities is reduced to the following activities:
- External examination of the skin of the legs;
- Doppler ultrasound;
- Duplex vein scanning;
Varicose veins of the lower extremities are treated both conservatively and surgically. Conservative treatment is reduced to the following activities:
- Drug therapy. . . This is the use of drugs that improve the tone of the walls of the veins. In addition, the patient is prescribed drugs that reduce capillary permeability and improve blood microcirculation. If there is a risk of blood clots, anticoagulants are also prescribed.
- Compression therapy. . . This involves wearing special compression stockings that relieve the leg. The advantage is that the load can be evenly distributed even with vigorous physical exertion. By using compression clothing, congestion and swelling can be avoided.
- Remedial gymnastics and lifestyle changes. . . The patient is advised to take part in sports to relieve tension in the legs. It is important to avoid sitting or standing for long periods of time. If you have to stand or sit for long periods of time at work, you need to take more frequent breaks.
If conservative therapy for varicose veins does not bring the expected results, a decision is made about surgical intervention. In most cases, these will be minimally invasive procedures, including:
- Sclerotherapy- the introduction into the vein of substances that glue the walls of the affected vessel. This treatment leads to the resorption of the spider veins.
- Laser coagulation- Insertion of a laser light guide into a vein and irradiation of the walls with a laser, which also leads to the walls sticking together and further resorption of the vessel.
- Radio frequency ablation- Gluing veins with high frequency current.
- Phlebectomy- Removal of the affected veins where blood flow has deteriorated by 90%.
In some countries you can have the operation carried out free of charge as part of the statutory health insurance. But it is not a fact that all types of compulsory insurance are offered everywhere. In either case, help will be provided, but it is important to find out whether it is a conventional removal or a laser.
Contraindications for people with varicose veins
- Sedentary lifestyle. . . It is important to avoid sitting or standing for long periods of time. Physical activity helps prevent congestion in the veins.
- Running and vigorous exercise. . . When doing physical activity, it is important not to overdo it. If you have varicose veins, walking is definitely better than running.
- Imbalanced and unhealthy diet. . . You have to avoid junk food, even if your health allows it. You should limit your intake of sweets, semi-finished products, as well as rich meat broths and smoked meat. But eating more vegetables and fruits would be a good idea.
- Jacuzzis and showers. . . In people with vascular problems in the extremities, excessively hot and prolonged water treatments are contraindicated.
Complications from varicose veins
Varicose veins can be complicated by trophic ulcers, phlebitis (inflammation of the veins), and deep vein thrombosis. The latter is the formation of blood clots in deep veins that threaten human life.
Symptoms of lower extremity varicose veins usually do not appear immediately. Different people have different manifestations. For example, sometimes with this pathology there is no edema, or there is no local increase in temperature or pain. This in no way means that there is no disease. A timely visit to the doctor will significantly slow or even stop the progression of the disease and prevent the development of trophic changes.