Varicose veins - disease, accompanied by a thinning of the venous wall, the increase in the level of the veins, and the formation of aneurysm-like knotty extensions. Usually, talking about varicose veins, involving independent disease - varicose disease of the lower limbs. Varicose veins disease is manifested by a feeling of heaviness in the legs and their fatigue, swelling in the feet and legs, night cramps in the legs, visual, subcutaneous varicose veins with the formation of venous thrombosis nodes. For varicose veins can be complicated, phlebitis, tromboflebita, the development of chronic venous insufficiency and the formation of venous ulcers. The main way in which the diagnosis of varicose veins and its complications is UZDG.
Varicose veins (varicose veins)
Varicose veins (varicose veins) - pathology of the veins, which is manifested in their expansion, izvitiya, the destruction of the valve unit. The events are the formation of varicose veins, swelling of the subcutaneous veins, the formation of knots, pain, varicose veins, heaviness in the legs. With the progression of the disease is join the signs of chronic insufficiency of venous circulation: swelling stop and the legs, cramps in the calf muscles, wounds, thrombophlebitis, interruptions of modified veins.
In certain conditions (some disease, or a congenital disorder) may expand not only the veins of the lower limbs. Thus, portal hypertension may be the cause of varicose veins of the esophagus. When varicocele registered varicose veins of the spermatic cord, hemorrhoids - varicose veins in the anal area and lower rectum. Regardless of the localization of the process, there is a hereditary predisposition to the development of varicose veins, related to the congenital weakness of the vascular wall and insufficiency of the venous valves.
Diseases, accompanied by varicose veins in different areas of the human body, with the exception of the lower limbs, are dedicated to the individual articles. In this article we are going to talk about car-disease - varicose veins of the lower limbs.
Varicose veins - the disease, with extension of the superficial veins, failure of the venous valves, training, subcutaneous nodes, and a violation of the flow of blood in the lower limbs. According to various studies in the field of phlebology-varicose veins affection from 30 to 40% of women and 10% to 20% of men over the age of 18 years.
The mechanism of development of varicose veins
The veins of the lower limbs form a vast network, which consists of subcutaneous injections and venous, connected perforating (communication) veins. Through the superficial veins occurs outflow of blood from the subcutaneous tissue and the skin, through the deep - from the rest of the tissues. Communicating blood serve for pressure compensation between the deep and superficial veins. The blood for him is normal, which flows in only one direction: from a superficial vein to the deep.
The muscle layer of the vein wall is weak and can not force the blood to move upward. The flow of blood from the periphery to the centre, to the detriment of the residue of arterial pressure and the pressure in the tendons, near the blood vessels. A key role plays the so-called muscle pump. During exercise the muscles contract, and blood is squeezed upwards, because the downward movement to prevent venous valves. For the maintenance of the normal circulation of the blood and the continuous venous pressure affects the venous tone. The pressure in the veins adjustable vasomotor center, located in the brain.
Insufficiency of the valves, and the weakness of the vascular wall lead to the fact that the blood under the action of the muscle pump begins to flow not only upward, but downward, exerting pressure on the walls of the blood vessels, resulting in varicose veins, the formation of tangles and the progression of the valvular insufficiency. Interrupted blood flow to the communication in the veins. The reflux of the blood vessels deep in the surface leads to a further increasing pressure of the superficial veins. Nerves located in the walls of the veins, suggests the signals in сосудодвигательный center, which gives the command to increase the venous tone. Vienna can not cope with the increased load, gradually dilate, lengthen, become tortuous. The increasing pressure causes atrophy of the muscle fibers of the vein wall and the death of the nerves involved in the regulation of venous tone.
The risk factors for varicose veins
Varicose veins - polyethical disease. Highlight a number of factors that increase the risk of developing varicose veins:
- Genetic predisposition, because of a weakness of the vascular wall due to rupture of the connective tissue.
- Pregnancy. Considered to be that of varicose veins during pregnancy develops because of an increase in the volume of circulating blood and constriction retroperitoneal varicose veins in pregnancy the uterus.
- Obesity proven to be a risk factor for the onset of varicose veins. If the body mass index increases up to 27 kg/m2, the risk of developing the disease increases by 33%.
- The style of life. The risk of developing varicose veins increases in the case of extended stays in a sitting position or standing, permanent static loads, in particular connected with the lifting of heavy loads. The negative impact on the course of the disease have corsets, help to increase the intra-abdominal pressure and tight clothing, crushing the trunk of vienna in the field of the inguinal folds.
- Power supply characteristics. The likelihood of developing varicose veins increases low diet of raw fruits and vegetables. The lack of crude fiber leads to chronic constipation and lack of some nutrients - to the violation of the recovery of the structure of the venous wall.
- Hormonal imbalance. A certain impact on the prevalence of the disease is having a wide spread of means of hormonal contraceptives and hormonal drugs, which apply when the therapy of osteoporosis and menopause syndrome.
Classification of varicose veins
There are different classifications of varicose veins. This diversity is due polyethiologic disease and a plethora of options to the flow of varicose veins.
The russians called phlebologists widely used gradual classification of varicose veins, the option of which is the classification of Vs Savelyeva:
- The phase of the transfer (Saveliev And payment). Complaints are not present. During the inspection were observed varicose veins on one or two feet.
- The Stage subcompensation (Saveliev - compensation (B). During the inspection of the feet are visible, expressed varicose veins. Patients present with complaint of a feeling of fullness, paresthesia ("goose bumps") in the area of the legs, nocturnal cramps. There is a slight swelling of the feet, ankles and legs in the evening. In the morning swelling to disappear.
- Phase of decompensation. These features combine dermatitis, eczema. Patients worried about itching. The skin becomes dry, bright, well-knit with of the subcutaneous tissue. Small hemorrhages and the subsequent deposition of hemosiderin cause hyperpigmentation.
Contemporary Russian classification proposed in 2000, reflects the degree of chronic venous insufficiency, in the form of varicose veins caused varicose veins complications.
Classification of forms of
Distinguish the following forms of varicose veins:
- Segmental defeat, subcutaneous, and intracutaneous blood without reflux.
- Segmental defeat the veins with a pathological rejection of the surface, or communication in the veins.
- The common defeat of the veins with a pathological rejection of the surface, or communication in the veins.
- The common defeat of the veins with a pathological rejection of the deep veins.
The international classification
There is recognized in the international classification of varicose veins, used by doctors in many countries of the world:
- Class 0. Signs of varicose veins are not present. The patients have complaints about the heaviness in the legs.
- Class 1. Visually defined network of veins and capillaries (telangiectasia). In some patients the night appear muscle cramps.
- Class 2. During the examination the patient visible advanced of vienna.
- Class 3. Appear swelling of the feet, ankles and legs, do not disappear after a short rest.
- Class 4. During the inspection revealed signs of lipodermatosclerosis (dermatitis, hyperpigmentation legs).
- Class 5. Form prejudiced.
- Class 6. Develop trophic ulcers and persistent.
The symptoms of varicose veins
The clinical manifestations of the disease depend on the stage of varicose veins. Some patients even before the appearance of visual signs of the disease have complaints of heaviness in the legs, increased fatigue, local pain in the area of the legs. It is possible the appearance of spider veins. Signs of disorders of the venous outflow damaged. Often the disease is in the payment phase, asymptomatic, and patients do not turn to a doctor. When physical examination you can detect a local of varicose veins, often in the upper third of the tibia. Advanced vein soft, well back, the skin over them is not changed.
Patients with varicose veins in the stage of subcompensation complain of transient pain, swelling, arising in the case of stay in the upright position and disappears in supine position. Physically (especially in the afternoon) you can detect pastosity, or slight swelling in the area of the ankles.
Patients with varicose veins in the phase of decompensation, requiring the complaint to the permanent of heaviness in the legs, dull pain, increased fatigue, nocturnal leg cramps. Itching of the skin, more pronounced in the evening is an omen of disorder trophic. During the external inspection registered expressed varicose and global violation of venous hemodynamics. The storage of large amount of blood in the affected limbs, in some cases, can lead to dizziness and fainting due to a drop in blood pressure.
Palpatory defined the advanced, thesis, vienna tautoelastic consistency. The walls of the affected veins braised with the skin. Local investigation in the matter of adhesions say they experience periphlebit. Visually recorded hyperpigmentation of the skin, pockets cyanosis. The subcutaneous tissues in areas of hyperpigmentation sealed. The skin rough, dry, not to take into the fold. Are marked dyshidrosis (more often than not, anhidrosis, at least - hyperhidrosis). Trophic disturbances often appear on the front-internal surface of the tibia in the lower third. Areas develops eczema on a background of which later form the wounds.
The diagnosis of varicose veins
The diagnosis presents no difficulties. To assess the severity of the violations of hemodynamics applies duplex angioscanning, UZDG veins of the lower limbs. Can be used in radiological, sources of radionuclides in research methods and rheovasography of the lower extremities.
Treatment of varicose veins
In the treatment of patients with varicose veins are used three main techniques:
- Conservative therapy of varicose veins
The conservative therapy includes general recommendations (normalization of motor activity, reduction of static load), curative physical education, the use of instruments of elastic compression (compression hosiery, elastic bandages), the treatment phlebotonic (diosmin + hesperidin and horse-chestnut extract). The conservative treatment can not lead to the complete healing and recover already advanced to vienna. Apply as a preventive measure, in the period of preparation for surgery and in case of impossibility of surgical treatment of varicose veins.
- Compression sclerotherapy of varicose veins
With this technique the treatment is carried out for the introduction of changes in the portal vein a special drug. The doctor, through a syringe injects into the vein elastic foam that fills hit a vase, causing it to spasm. Then the patient to wear a compression stocking, which holds vienna in collided can. After 3 days, the wall of vienna are glued together. The patient wears a sock for 1-1,5 months, until they form points dense. Indications for compression sclerotherapy - varicose veins, not complicated reflux of the vessels deep to the surface through the communication of vienna. If you have similar pathological rejection efficiency of compression sclerotherapy is drastically reduced.
- The surgical treatment of varicose veins
The main method of treatment of complicated reflux through communication veins varicose veins is surgery. For the treatment of varicose veins applied a lot of technical operational, including - with the use of microsurgical technique, radio-frequency and laser coagulation of the affected veins.
In the initial stage of varicose veins produce photocoagulation or eliminate varicose veins with the laser. When expressed varicose expansion shown phlebectomy - removal of changed veins. Currently this operation, more and more often, is made using the less invasive technique - miniblectomy. In cases, when varicose veins complicated thrombosis of vienna in all its course, and the addition of a infection, illustrates the operation Troyanova-Trendelenburg.
The prevention of varicose veins
An important preventive role it plays in the formation of correct stereotypes behavioral (be better than to sit and walk better, than sitting). If you need to stay a long time standing or sitting, it is necessary to periodically straining the muscles of the legs, to give the legs sublime or horizontal position. Useful to practice sport activities (swimming, cycling). During pregnancy and the hard work it is advised to apply the tools elastic compression. When the first signs of varicose veins is necessary to consult a phlebologist.