Varicose veins of the lower limbs is a chronic disease of the superficial veins of the legs, which is characterized by an elongation and a degree of deformation of the blood vessels and causes chronic venous insufficiency, is in constant progression. This is a very common illness – she suffers from every fourth resident. According to the statistics, surgical hospitals, women get sick 6-7 times more often than men. However, some authors believe this information is incorrect, and suggest that men suffer from varicose veins in equal with women can, however, of a cosmetic problem them less, so they turn to the doctors rarely – only when they are expressed manifestations of chronic venous insufficiency.
In our article will focus on the causes, mechanism of development of this pathology, the symptoms, principles of diagnosis and treatment, including physiotherapy techniques.
The causes and the mechanism of the development of the disease
Varicose veins of the lower limbs is the primary (occurs due to any congenital disorders of the structure of the venous wall or the insufficiency of the valve unit, is a disease-independent) and secondary (develops as a complication of diseases, deep vein, for example, when the PTS).
Known for a series of factors that increase pressure on the veins, reduce the tone of the venous wall, which increase the likelihood of developing varicose veins. This:
- heavy physical work;
- hormonal adjustment in the body (puberty, menopause);
- taking a combined oral contraceptive;
- long stay in the standing position;
- a period of gestation of a child.
Under the influence of the causal factors in venous vessels increases the hydrostatic pressure, which results in an increase in the diameter and the progression of the dysfunction group tube. As A result of the outflow of the blood to the surface treatment of the veins and harder, the blood of the deep veins thrown on the surface – they are full, too stretched, twist, and form a different extension – a cylindrical, bag-like, mixed – form. With the progression of the disease of stasis of blood leads to disorders of nutrition (trophic) tissue of the lower divisions of the limbs – the skin reddens, dries, occur dermatitis, eczema, and in an advanced stage – sores.
Scientists believe that varicose veins – a sort of "showdown" person to walk upright.
3 of the 4 patients is determined by the extension of the main subcutaneous venous vessels (the trunk), the rest has placed widespread varicose (all, including intradermal). In 8 of the 10 cases of the disease the defeat, determined in the pool, great saphenous vein, the remaining 20 % comes defeat the small saphenous vein and mixed-defeat – equally.
The clinical manifestations
Depending on the severity the chronic insufficiency of the veins during the varicose veins, we distinguish 3 phases:
- The phase compensation;
- II – stage of subcompensation;
- III – stage of decompensation.
In the first stage of the disease the patients have complaint solely for cosmetic defects – telangiectasia, serpentine deformation in the subcutaneous trunks the venous, which is in a vertical position the patient, most often after physical or static load, and even in the evening. Subjective feelings during this stage, the injured patients.
In the second stage of the complaints in patients moreover, all of these are symptoms of disorders of regional circulation. The patients say:
- the heaviness of the lower limbs, especially after the load over them or in the evening;
- tingling sensation, pins and needles in the lower regions of the legs;
- swelling of the feet and lower third of the legs;
- the pain in these departments legs of medium intensity, arching nature;
- spasms of the muscles of the foot and leg, especially at night.
After that, as a little down time with high the affected limb, it is observed a relief of state – complaint "to go" or become less pronounced.
Visually in the second stage of varicose vein disease is determined to a considerable extension, ornatezza of the subcutaneous veins, more marked in the condition of a patient, in feet, that is when the largest load on the venous machine.
In the third phase, visual varicose determined constantly, have a stable place swelling of the lower extremities localization of the pathology. To these symptoms are added, and trophic disturbances (power supply) of the skin is dry, thin, and very red; it is possible the appearance of ulcers and defects, especially in the antero-medial (internal) surface of the lower third of the leg (often on the inside ankle).
Patients worried fatigue, expressed heaviness in the limbs, particularly evident in the standing position and during walking, and also the swelling.
Doctors use in their practice of the international classification of chronic venous insufficiency, fully reflecting the symptomatology of the disease:
- class 0 – signs of chronic insufficiency of the veins is damaged.
- class 1 – on the skin, visible capillaries (spider veins) and reticular veins;
- class 2 – defined twisted of vienna with a deformation in the shape of a bag;
- class 3 – have place varicose veins and swelling of the limbs;
- class 4 – certain trophic disturbances of the skin – increased pigmentation, signs of dermatitis, eczema;
- class 5 – average changes for class 4, the more trophic ulcer, which is healed;
- class 6 – average changes for class 4, open trophic ulcer.
The complications of the varicose disease of the veins
A result of damage to the thinning, with the affected veins varicose vein that is welded, the skin can open the bleeding. In this case the outbreak of a knot of blood pours in the castings, which can lead to a significant loss of blood.
The feared complication is thrombophlebitis of acute. It manifests with redness of the skin over the affected vienna, painful seal in the form of a string for its movement. It is a dangerous condition because a blood clot or part of it can detach from the vessel wall, and with a current of blood in the blood vessels of the lungs or the brain, closing them.
To establish the diagnosis of varicose disease of the veins to the specialist in the vast majority of cases is not difficult. To do this, you can already on the basis of complaints of the patient, data of the history of his life and of the disease, as well as the results of the objective assessment of the state. It is important to not only accept the fact of having this disease, and to determine in what state are the valves of the veins, what is the permeability of the blood vessels – this completely depends on the tactic the next treatment.
Assess the state of the valves will help made sick functional tests:
- test Troyanova-Trendelenburg;
- the test, Pratt-2;
- the test Shania.
Assess the patency of the deep veins help you test the Pratt-1 and be-Bonne.
Describe the technique of execution and the principle of evaluation of the results of these tests we will not be, because this is to divert the reader from the theme of the article.
Of great importance in the diagnosis of varicose vein disease has ultrasound. It allows you to characterize the context of the circulation of the blood. Used:
- ultrasonic Doppler (using his judge the patency of the vein and the presence/absence of the launch of the blood of the deep veins in the surface);
- duplex scanning in colour to determine the order of thread (this is the "gold standard" for the diagnosis, with which it is easy to assess the state of the superficial veins and the deep, see the valves, determine the diameter of the vessel and verify the presence or absence of vienna of blood clots).
In cases of varicose veins apply a special procedure, which assess the state of the muscle-venous pump of the calf.
The tactic of treatment
There are 2 main types of treatment: conservative and surgical. Conservative includes the normalization of life style, the rate of therapy, pharmacological treatment and sclerotherapy. Conservative treatment will not help you to get rid of the disease, and aims to slow down the process of further progression.
And conservative treatment, and rehabilitation phase after the operation are widely used in therapy physical factors.
The patient is required in all senses of the word, love the veins:
- avoid prolonged contact of the static condition;
- avoid heavy physical workloads;
- to wear the shoes, not the foot, comfortable, with a rigid sole, a small, stable heel;
- if the forecasts of activity of the patient includes a long stay in a sitting position, it is necessary to use a support under the feet, to give the legs a sublime location, and also each 1-1.5 hours to take a break from work, during which walk, or hop on the socks 10-20 times.
Also, if the weight of the patient above the norm, should be reduced. In the diet, we recommend limiting the consumption of salt and fluid intake.
Elastic compression improves the flow of blood in the deep veins and reduces the number of its in the subcutaneous veins, does not allow onset of edema, activates microcirculation and metabolism in tissues.
Apply elastic bandages and stockings. It is important to choose the tool essential with a specific patient, the degree of compression. Not less important for the patient to know the technique of bandaging the limb. Begin to bandage the morning, not getting up from the bed, in the direction of the fingers of the foot to the thigh, grabbing the heel and the ankle. The band should be so for each of the next wrapping cycle to half overlaps the previous one.
The doctor can prescribe the patient, of course, the use of such drugs:
- funds to improve the tone of veins;
- improve the microcirculation;
- prevent the formation of blood clots;
- non-steroidal anti-inflammatory drugs.
Indications for the performance sclerosing therapy are:
- the categorical rejection of the patient by the operation;
- the relapse after the intervention – the individual varicose veins;
- the first phase of varicose veins;
- contraindications to the performance of the operation.
The essence of the method is to introduce in the affected by a vein-a substance that damages the inner lining of the vessel and leads to the development of inflammation of the vein, with subsequent obliteration (occlusion) his level. That is, after the treatment vienna stops working.
The surgical treatment
The operation is the main method of treatment of varicose veins of the lower limbs. Can be done at any phase in the absence of contraindications. The essence of the intervention is to remove modified of the subcutaneous veins through specially made individual cuts. In the last few years apply endoscopic procedure removal of the affected vein with the help of an endoscope – a flexible tube with an optical device and tools in the end.
The rehabilitation after the surgery
To minimize the risk of developing the syndrome, all patients in the postoperative period should be carried out the rehabilitation activities. The main one is the overlap on the tibia and the foot, the zinc-gelatine bands. Do it immediately after the surgery or if the patient is set of the drainage, after 24 hours, after she, for a period of 7-9 days, then take off and remove the stitches. The patient is prescribed a healing massage physical education.
The methods of this treatment for varicose veins focus on the strengthening of the venous wall, raising his tone, the improvement of the rheological properties of blood and the outflow of the veins.
Increase the tone of the venous wall of blood:
- electrophoresis within the tissue special medications the patient is taking the form of a tablet, the medication or get it by injection, then in a distressed area the ship to position the electrodes in the transverse and methodology, the spend procedure, the duration of which is 1 hour frequency of sessions – for each day or 1 time every 2 days; treatment of the exchange – up to 10 influences;
- therapy segmental (patient places the limb in hyperbaric chambers, which pressure acts up to 113 Kpa; the procedure takes up to half an hour; lead sessions every day or 1 time every 2 days a course of 20-25 influences).
Improve the outflow of blood and lymph of the arts:
- magnetotherapy low-frequency (arto put in a block of solenoids and affect the magnetic field; the duration of a session of 20 minutes, frequency of 1 time per day, the course of treatment – 13-15 impacts);
- electrophoresis of proteolytic enzymes – a procedure lasting 15 to 20 minutes pass cross-methodology each day of the course 12-15 impacts;
- therapeutic massage (perform according to the method of aspiration with a delicate techniques in the field of pathology; pass 1 time per day in the course of 12-15 influences).