Varicose veins of the lower limbs

Characteristic structure of veins help to redistribute blood during exercise and not to do the reverse movement of blood.

The loss of elasticity in the wall of the venous vessel type, with the extension of its level, with the development of insufficiency of the cardiac valves, linked to the violation of the normal blood flow - has received a nosological unit in the form of a disease called varicose veins or varices, from the Latin varix .

 

In the walls of affected blood vessels develop sclerotic-degeneration) changes, which are determined by their elongation, thinning, resulting in the formation of a spherical head extensions (nodes) on her course. The flaps of the valves in the initial stages of the disease is still saved, but the full closure of the lumen of the vessel, with their help, is not the case. Later, during the connection of a local inflammation, and thrombosis, the valves disappear, exacerbating the clinical picture of venous insufficiency.

The disease is quite common: the average "coverage" of the population - 10-18%, with a prevalence in subjects of the female sex (2-3 times).

Most of all varices changes are the veins of the lower limbs. However, the varicose veins, it is possible to observe and in the blood vessels of the wall of the large and small basin. Virtually no disease occurs in the blood vessels of the upper limbs.

The extension of the lumen of the veins, as a manifestation and a complication of other diseases of internal organs, it is possible to observe in the submucosal veins of the esophagus diseases of the liver, the mucosa of the rectum with hemorrhoids in the veins in the cord connecting tubule and eggs with varicocele. The overlap of important level of the ship growing tumor to adjacent organs, can cause varicose veins, with unusual for this disease localization.

Reasons for development of varicose veins and risk factors

1. The legacy.

Occurs when genetically influenced, is usually transmitted, the functional immaturity of the valve unit of the veins and of underdevelopment in the connective tissue of a component of the blood vessel wall. This leads to an increase of the pressure within the blood vessels and the development of varicose veins already in early childhood, with the emergence of the first physical.

2. Disorders of blood coagulation.

To this group belong the defects in factors linked to hypercoagulation. Formed in these cases, blood clots, create obstacles to the normal flow of blood, resulting in enlargement of the lumen of the vessel.

3. Changes in hormone levels.

This factor is more obvious in women because of a change of level of sex hormones during pregnancy and menopause. The reduction of estrogen by increasing progesterone, when physiological and dysfunctional states, increase the production of blood clotting factors. Moreover, this balance of hormones leads to changes in protein and lipid metabolism with a reduction of the synthesis of elastic fibers and collagen with a consequent decrease of the tone of the venous wall of the vessel. Total general becomes a reduction in the flow of blood with the formation of blood clots and valvular insufficiency of the machine.

4. The increased weight of the body.

General obesity has a mechanical effect on the wall of the veins, in particular, this occurs when the abdominal type, causing increased venous pressure below the zone of crushing. Also, occur dysmetabolic and dishormonal changes in extreme degrees of obesity, distort the normal rheological properties of blood. This also leads to a mechanical occlusion of blood vessels within (thrombosis). The life of sedentary obesity the same way, contributes to slowing down the circulation of the blood.

5. Diabetes mellitus.

As A result of complex disorders of the metabolism due to hyperglycemia, with relative insufficiency of insulin – occurs a reduction of the elasticity of the venous wall resulting in the extension of its level.

6. Alcoholism. Constant dehydration, observed in alcoholism, increases the coagulation of blood, resulting in the interruption of blood flow. 7. Professional factors associated with increased physical activity, and long-term vertical position. This as far as motors, conductors, salesmen, surgeons, barbers, labourers, for the maintenance of the production lines, etc the Risk of the development of varicose veins, these people, led by a stagnation of blood in the lower limbs for a reason permanent high intra-abdominal pressure, which prevents the delivery of blood into the heart. 8. Mechanical compression of the veins narrow bed. It is observed with a constant wear this type of clothing. 9. Constipation frequent. Lead to an increase in intra-abdominal pressure when straining, with the consequent logic of the chain of the development of varicose veins level veins. 10. Wear shoes with a high heel. Dangerous, first of all, limitation of the movements of the ankle and, therefore, reduction of the muscles of the tibia, which help to promote the blood up. 11. The climate factors. Stay in conditions of high ambient temperature without a corresponding compensate for the loss of liquid - becomes a cause of thrombosis, with consequent interruption of the venous outflow. 12. Unjustified the appointment and the uncontrolled intake of medicines of the base or a side effect in the form of accelerating the clotting of the blood. 13. Transferred previously cavitali operational. Dangerous increase of the risk of formation of small and large thrombi, venous, consequent interruption of the outflow of blood from the ends. 14. Heavy cardiovascular diseases with phenomena of circulatory failure, as a result of reduction of the contractile function of the myocardium. 15. Transferred earlier injury to the limbs, and surgical interventions on them. Here have a value cicatricial processes that prevent the outflow of blood. 16. Constitutional features. Marked by a predisposition to varicose veins people more high, especially in combination with excess body weight. 17. The race. The development of varicose veins predominantly observed in caucasians. 18. The chronic inflammatory processes organs of the pelvic cavity.

Usually, with regard to the diseases of the inner genitals (prostatitis) in men, and inflammation of the adnexa in women). The mechanism is due to involvement in the inflammatory process of small venules. Occurs when swelling within the flooring, and hinders the outflow of the blood, forcing the dissemination and communication of the blood vessels, which brings together the arterial and venous mainstream. The blood in the veins arrive with a significant increase of blood pressure and intravascular volume. After this, it repeats the mechanism described above: the extension of the lumen of the veins and insufficiency of the venous valves.

Varicose veins of the lower extremities: the symptoms

1. External changes of the subcutaneous veins. The most clear manifestation of varicose veins is a change in the shape and contour of the intradermal and subcutaneous blood vessels of the lower limbs.

Vienna buy patches uniform or saccular thickening of the diameter, with the formation of special knots and tangles of blood vessels. Modified blood vessels are colored dark purple or blue. Small, previously not decernit of vienna, emerge the contours in the form of intradermal venous "lattices".

Often these changes are to the vienna stop and the tibia. The progress of the process, a similar pattern detected in the venous vessels of the thighs.

2. The pain. The pain</2_img>

The patients indicate early fatigue, heaviness in the legs. Appears a dull pain arching nature of the calf muscles. With time the pain becomes more intense with the possible onset of muscle cramps of the calf. Found that, after to have found some legs in a horizontal position, the described symptoms for a while disappears, which would then, when you pass in a vertical status, the new resume . The pain intensifies with palpation of the tibia. In the absence of changes of the superficial veins, in this situation, you should suspect the presence of varicose veins of changes in the deep veins of the limb.

3. Edema of the subcutaneous tissue. Appears swelling stop (spongy nature) with the spread on the lower third of the tibia, accompanied by itching of the skin in the projection of defeat. If at night, spongy nature of the subcutaneous tissue at the level of the ankles of the ankle is not coming out, you should think that the phenomena of venous insufficiency passed in a phase of decompensation. In these situations, you must also exclude the accession secondary infection, and the debut of trophic ulcers. 4. Itching of the skin. May appear before the bright manifestation symptoms of varicose veins of the veins, but most often occurs already at the phenomena expressed violations of the outflow of venous blood. 5. Hyperpigmentation. Occurs already once you have deployed the clinical picture of the disease. The skin becomes darker, and in movement, modified the veins, and perifocal from them, in places of mechanical damage to the bruises. Later, all the skin in the distal parts of the limbs become cyanotic color (indurate). The epithelium of the coating thins, the subcutaneous structure is degenerate. 6. Hypothermia the end sections of the limbs. On palpation the skin of the limbs cold. The sick too, feel a permanent "freezing" of the arts. 7. Sores. Part of clinicians consider this to be a sign of a complication varicose veins of the veins. The other part considers the appearance of defects in the skin in the form of ulcers on the background induratsionno sections changed – the last stage of the disease.

Complications of varicose veins:

  1. Thrombophlebitis.
  2. The accession secondary infection (often erysipelas) available to trophic ulcers and with the development of wet gangrene on the limbs.
  3. Deep venous thrombosis with subsequent fatal thromboembolism of the pulmonary veins.
  4. Eczema (dermatitis).
  5. Bleeding of the damaged varicose veins are the varicose veins.

Classification of varicose veins

1. Primary. The changes relate primarily to the superficial veins. The structure of the venous and the change in the exercise of their functions initially absent. 2. Secondary.

Develops as a complication of primary disease, deep vein, after which changes occur in the superficial veins of the lower limbs. This occurs in the presence of developmental defects of the venous system (vascular dysplasia, fistulas), and also as a result of having previously been phlebothrombosis deep veins. The causes of the formation of blood clots in the veins have been considered above.

In addition, the division of varicose veins clinical forms.
  1. Varicose veins lateral (side) veins of the thigh and calf.
  2. Varicose veins reticular.
  3. Varicose telangiectasia.

Varicose veins on the side, you are of the veins of the lower limb comes alone and in combination with other clinical species. Reverse reset of venous blood occurs in a deep vein in the thigh through the subcutaneous and surrounding veins.

Reticular (net), and in the form telangiectasia (nodules intradermal blood capillaries) varicose veins, isolated its variants to the development of venous insufficiency, not the door. These forms of varicose veins expresses only a cosmetic discomfort.

Recently, surgeons have begun to highlight yet, and venous insufficiency idiopathic ( IVN). The veins in this disease, unlike other forms of the disease, have initially high, the venous tone, without particular reasons. The symptoms when IVN is not different from the classical manifestations of varicose disease.

The phase of payment.

The pain is minimal or non-existent. Given the discomfort in the foot with a long sitting or standing. The surface areas of the skin are detected in small capillaries. Periodically you experience slight swelling stop, and ankles. Pass quickly after the adoption of a limb to the horizontal.

The Stage subcompensation. Already when casting a gaze out on a limb, the presence of varicose veins with the advanced options of the game worthy of note.

The complaints of the patients with the most specific: sore legs arching character, the greater the fatigue. Night you experience cramps of the muscles of the tibia suddenly or in the background, the feeling of "tingling" (paresthesia). Swelling in the lower third of the tibia and the feet are more pronounced, however, after a night of sleep disappear.

Phase of decompensation.

The clinical picture worsened the local changes on the part of the skin, which assumes the aspect of cleaning and a smooth surface, occurs the loss of hair, hyperpigmentation of the skin .

Swelling persisted, rise above.

Frequent small intradermal hemorrhage make the pigmentation more intense due to the loss of emosederina (blood pigment). Small wounds and abrasions heal very long, passing gradually into the azwenne defects.

In 2000, the Russian Phlebology has been proposed the classification pathogenetic of varicose vein disease. And has achieved wide recognition.

Form:
  1. Partial (segmental) changes the subcutaneous and intradermal injection of the veins of the limb without a bank account (reflux).
  2. Segmental varicose veins with reflux for communicative and/or surface blood.
  3. Total varicose veins with reflux of blood in the surface and communication to vienna.
  4. Varicose veins with reflux of blood through the deep veins of the limbs.