Varicose veins most often affect the venous system of the legs. External manifestations (protruding nodular blue veins, swelling) are not just a cosmetic problem, but signs of a serious disease that worsens over time.
What are varicose veins: definition of the disease
The word "varicose veins" comes from the Latin varix - "swelling". The name fully reflects the pathological process: the wall of the veins thins, in some areas expansions (sac-like swellings) - nodes - develop.
The first case of varicose veins was reported in a B. C. It was recorded by a document from 86. BC: Roman general Gaius Marius complained of leg pain due to "blue swollen veins".
The main reason for the development of varicose veins (varicose veins) is an increase in pressure in the system of surface vessels. This is facilitated by certain diseases, hormonal changes and a sedentary lifestyle.
At first, even under the influence of these factors, the blood vessels function normally, but gradually they become deformed, their structure changes, and they can no longer fully transport blood.
Varicose veins can develop in almost any part of the body, but most often in the lower limbs. Therefore, when it comes to varicose veins, by default they are a problem of the legs.
Varicose veins code in ICD-10
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.
I83 - varicose veins of the lower limbs:
- I83. 0 - varicose veins of the lower limbs with ulcers;
- I83. 1 - varicose veins of the lower limbs with inflammation;
- I83. 2 - varicose veins of the lower limbs with ulcers and inflammation.
85 - esophageal varices:
- I85. 0 - varicose veins of the esophagus with bleeding;
- I85. 9 - esophageal varices without bleeding.
I86 - varicose veins of other localization:
- I86. 0 - varicose veins of the sublingual veins;
- I86. 1 - the scrotal varicose vein (anatomical formation in men - the container of the testicles and their appendages);
- I86. 2 - varicose veins of the pelvis;
- I86. 3 - varicose veins of the pubic body (female external genitalia);
- I86. 4 - varicose veins of the stomach.
O22. 0 - varicose veins of the lower limbs during pregnancy.
In our country, 30 million people suffer from various forms of varicose veins. Complications of a third - trophic ulcers. An open defect of the skin or mucous membrane that occurs due to damage to blood circulation and tissue innervation.
The mechanism of the formation of varicose veins
The body's pathological reactions are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels helps us understand how and why the disease develops.
How blood moves in the body
There are two types of blood vessels in the human body - veins and arteries. Blood flows from the heart to all the organs and tissues through the arteries. This happens at high pressure (70-120 mmHg) and at high speed.
Blood flows from the organs and tissues through the veins and is directed towards the heart at low pressure (0-20 mmHg).
The walls of veins are less thick and flexible than the walls of arteries, and unlike arteries, they do not contain such a developed layer of muscle. Therefore, varicose veins are only possible in veins, but not in arteries.
The human arterial and venous circulatory system. Veins are marked in blue, arteries in red.
Low pressure in the veins is necessary to transport blood from the periphery to the center. At the same time, on the way to the heart, the blood flow encounters an obstacle - the force of gravity. This force forces the blood to return through the veins.
We often hear that varicose veins are humanity's revenge for walking straight. After all, the longest distance that blood has to travel in the body, overcoming gravity, is the journey from the legs to the heart. The movement of blood through the veins is ensured by the contractions of the heart, the muscle pump of the surrounding muscles, and the negative pressure that develops in the chest during inhalation.
In healthy blood vessels, the valves on the inner wall of the veins prevent the reverse flow of blood. The valves act like a one-way swinging door—they open to allow blood to flow into the heart and close immediately when gravity tries to push the blood back.
Not only the valves help the veins supply blood to the heart, but also the muscles surrounding the vessels. Through their contraction and relaxation, the muscles promote the flow of blood through the veins. This mechanism only works when a person is moving. If you stand or sit for a long time, the muscle pump is practically inactive.
The tips of the venous valves always face the direction of blood flow - towards the heart
How failure and disease happen
An increase in pressure in the venous system disrupts the function of the valves and leads to the reverse flow of blood through the veins. Because of this, as well as the stagnation of excess blood and the weakness of the valve apparatus (for example, in the case of connective tissue diseases), the lumen of the veins expands, the walls are deformed, thinned and become local sac-like. protrusions - junctions - are formed.
The process is similar to inflating a balloon: if you don't let the air out, the balloon inflates more and more.
On the left is normal blood flow; on the right side - multidirectional blood flow due to impaired functioning of the venous valves and vascular deformation
There are superficial and deep veins on the legs. 85-90% of the total blood volume passes through the deep, and only 10-15% through the superficial. The walls of the deep veins are thicker and better adapted to the increased blood volume. And the superficial veins of the legs are thinner and more sensitive to varicose veins.
There are large venous plexuses in the pelvis and lower parts of the esophagus, which can also undergo varicose transformation. The mechanism of the disease in the veins of the small pelvis is the same as in the lower limbs. But varicose veins of the esophagus also arise for another reason: due to portal hypertension - increased pressure in the portal venous system, which is associated with liver cirrhosis, hepatitis, parasitic liver changes, fatty hepatosis, etc.
Causes of varicose veins
Many factors contribute to the formation of varicose veins on the legs. Those are the main oneskeyboard failureAndheredity. It is known that close relatives of a quarter of patients suffered from some form of varicose veins.
Overweight. The more extra pounds a person has, the greater the load on the venous system. Over time, the veins cannot cope with such pressure: the lumen of the vessels increases, and the valves on the walls cease to close completely. As a result, blood stagnates and varicose veins develop.
Pregnancy. Hormonal changes occur in the woman's body, body weight, intra-abdominal pressure and the volume of circulating blood increase - this leads to disruption of outflow, stretching of the walls of the veins and changes in the functioning of the valve apparatus.
After childbirth, the diameter of dilated veins decreases, but does not always return to its original value. The risk of developing varicose veins increases with subsequent pregnancies.
Circle. Varicose veins often affect people after the age of 50. The older a person is, the more worn out the venous valves are, while the recovery processes slow down, and the mechanism of pathological expansion of the veins - the formation of varicose veins - begins.
Venous refluxVenous reflux Backflow of blood through the veins due to resistance to blood flow, lat. refluo - "to flow backwards". It is found in 10-15% of 12-13-year-old schoolchildren. The disease is "rejuvenating" due to a sedentary lifestyle and excess weight.
Varicose veins of the lower limbs develop faster if there are additional risk factors.
Risk factors that contribute to the development of varicose veins in the legs:
- lack of physical activity - during movement, the muscles stimulate blood flow through the veins, and without movement, blood circulation in the veins can be difficult;
- smoking - the chemicals in tobacco smoke damage the walls of blood vessels, as a result of which their lumen narrows, blood flow becomes difficult and stagnation occurs, which leads to the formation of varicose veins;
- professions in which you have to stand or sit for a long time - hairdressers, surgeons, cooks, waiters, drivers, office workers are at risk;
- menopause - in women aged 40-50, the production of sex hormones (estrogen and progesterone) decreases and, at the same time, the tone of the venous wall decreases. This increases the likelihood of varicose veins.
Women suffer from varicose veins 3-4 times more often than men. This occurs due to hormonal variability (menstrual cycle, pregnancy, menopause).
During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva
Varicose veins can occur not only in the lower limbs, but also in other parts of the body.
The main causes of varicose veins in different places
Esophageal varicose veins
Changes in the veins of the esophagus with uneven growth of the lumen, wall protrusion and the formation of knotty tortuosity of the vessels. It often leads to a life-threatening complication - bleeding.
Reasons:
- cirrhosis
- liver cancer
- other diseases that cause increased pressure in the system of the portal vein - it collects blood from the abdominal organs
Varicose veins of the scrotum (varicocele)Abnormal expansion of the veins of the pampiniform plexus of the testicle. It manifests itself in varicose veins of the scrotum and blood flow disorders
Reasons:
- congenital incompetence of the valves of the testicular veins (usually the left side).
- mechanical compression of the testicular vein (inguinal hernia)
Varicose veins of the pelvis
It is characterized by dilation of ovarian veins and intrapelvic venous plexuses of different diameters. The condition is also known as pelvic congestion syndrome
Reasons:
- polycystic ovary syndrome
- two or more pregnancies
- hormonal dysfunction
Varicose veins of the vulva
Varicose veins in the pelvis, which affect the veins of the labia and perineum
Reasons:
- compression of the retroperitoneal vessels by the uterus during pregnancy
- significant physical activity
- tumors of the uterus and ovaries
Varicose veins of the sublingual veins (sublingual varicose veins)
Asymptomatic damage to the veins under the tongue. It manifests itself in a slight protrusion of the blood vessels and a change in color from deep blue to purple
Reasons:
- hypertension
- smoking
- old age
Varicose veins of the stomach
Isolated changes in the veins of the stomach or in combination with varices of the esophagus
Reasons:
- cirrhosis
- portal hypertension syndrome - increased pressure in the portal venous system in other gastrointestinal diseases (neoplastic tumors, thrombosis, venous malformations)
Symptoms of varicose veins
In rare cases, only the aesthetic side of the disease appears - bluish veins. Most patients with varicose veins of the legs report at least one or more unpleasant symptoms.
Symptoms of varicose veins of the lower extremities:
- feeling of fatigue, pain or heaviness in the legs - this is caused by stagnation of blood and pressure on the surrounding tissues;
- burning sensation, tingling or throbbing in the legs - a reaction to the slowing down of blood flow and the overflow of the venous system of the lower extremities;
- nocturnal muscle spasms in the legs - painful spasms occur due to blood stagnation and the accumulation of metabolic products in the tissues;
- swelling of the leg and ankle - due to the stagnation of the veins, the liquid part of the blood seeps into the subcutaneous tissue through the changed vessel wall;
- skin itching around the damaged veins - dilated and altered blood vessels do not ensure normal blood circulation and nutrition of the skin, so it becomes dry and rough.
Unpleasant sensations in the legs of patients with varicose veins intensify in the evening, especially after sitting or standing for a long time.
The appearance of altered veins is not always proportional to the severity of the symptoms. Thus, veins affected by varicose veins that are barely noticeable to the eye can cause serious discomfort, while lumpy and thickened veins are a minimal cause for concern.
Varicose veins affect different veins: from the small vessels of the skin to the large saphenous veins
The symptoms of other types of varicose veins depend largely on the underlying cause of the disease. Patients often do not complain about anything, and the doctor identifies the problem only during the examination. This happens, for example, with the varicose veins of the sublingual veins.
In some cases, as with varicosities of the esophagus or stomach, the pathology immediately manifests itself as a life-threatening complication - bleeding.
Classification of venous diseases
In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation formed by the initial letters of the main sections of the classification:
- C — clinic (clinical changes);
- E - etiology (origin of the disease);
- A - anatomy (anatomical localization of varicose veins);
- P - pathogenesis (mechanism of venous blood flow disorders).
Complications of varicose veins on the legs
Varicose veins are usually not life-threatening by themselves. But sometimes the disease can cause complications.
Thrombophlebitis- inflammation of the vein wall, which is associated with the formation of a thrombus (blood clot) that closes the lumen of the vessel. It manifests itself as swelling and redness along the affected vein. The patient feels pain, the skin in the affected area becomes red and hot to the touch.
Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue along the thrombosed vein.
Venous trophic ulcer- an open defect of the skin and soft tissues due to blood stagnation, edema and impaired cell nutrition. Ulcers appear on the legs and ankles near varicose veins. In the lower parts of the legs, the swelling is more pronounced, which means that the tissues are compressed more than in other areas. Ulcers take a long time to heal and often contain bacteria that increase inflammation.
Trophic ulcers heal very poorly due to impaired blood circulation and tissue nutrition
Bleeding- occurs when a vein dilated due to varicose veins ruptures. In the later stages of the disease, the skin over such veins is very thin and dry - a minor injury is enough to damage the integrity of the vessel and cause bleeding. Sometimes spontaneous rupture of a vein occurs in the area of varicose nodes.
Diagnosing varicose veins of the legs
A phlebologist deals with the diagnosis, treatment and prevention of venous diseases. The doctor makes a diagnosis based on the patient's complaints, examination and instrumental tests. If the symptoms of varicose veins are pronounced, tests are not usually prescribed: a medical examination is sufficient.
The doctor may prescribe laboratory tests during the preparation of the operation or to rule out simultaneous diseases affecting the condition of the blood vessels.
One such disease is diabetes mellitus. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).
For an accurate diagnosis and determination of treatment tactics, you will need a duplex ultrasound scan - the gold standard for diagnosing vascular conditions. The method enables the evaluation of the structure, function, patency of the superficial and deep veins, the consistency of the valves, and the determination of the direction of the blood flow.
If the secondary nature of varicose veins is suspected (it can occur after deep vein thrombosis), the doctor prescribes venography, CT or MRI venography.
Phlebography is an X-ray test used to determine deep vein patency and valve function.
Computerized or magnetic resonance venography is used to visualize the venous system in three-dimensional projection and with very high spatial resolution.
Treatment of varicose veins on the legs
The goal of treating varicose veins is to reduce or eliminate symptoms, improve the appearance of the veins, and prevent complications.
The doctor selects the treatment method depending on which vessels are affected and how severe the patient's varicose veins are.
Non-invasive treatments
Noninvasive treatments for varicose veins include compression therapy, drug therapy, and lifestyle changes.
Compression therapy involves wearing special socks, stockings, and tights. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the right knitwear.
A compression garment in the lower legs compresses more than in the upper legs - pushing blood towards the heart and eliminating congestion
Effects of compression therapy on varicose veins:
- the manifestation of symptoms decreases - heaviness, fatigue in the legs, night cramps, burning sensation or pain;
- the severity of edema decreases due to better blood circulation;
- The healing of trophic ulcers is accelerated because elastic compression improves blood circulation and tissue nutrition.
Drug therapy - the doctor can prescribe phlebotropic drugs (phleboprotectors, venotonics) Biologically active substances that increase venous tone and reduce the severity of venospecific symptoms. (venotropic) drugs.
The main groups of phlebotropic drugs used to treat varicose veins are:
- angioprotectors: improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the likelihood of blood clots;
- antithrombotic agents: they reduce the risk of the formation of dangerous blood clots (thrombus) in the lumen of blood vessels and promote the dissolution of existing ones;
- bioflavonoids: natural plant compounds that improve venous tone and reduce venous congestion.
Lifestyle changes for varicose veins significantly slow down the development of the disease, and in combination with other recommendations of the attending physician, help to stop the pathological process.
Important guidelines for changing the lifestyle of varicose veins patients:
- moderate intensity exercises: walking, swimming, water aerobics, leg exercises, yoga. Strengthening the muscles helps normalize blood circulation in the vessels, relieves venous stagnation and edema;
- weight control: thanks to the normalization of body weight, the load on the blood vessels is reduced and it facilitates the return of blood to the heart through the veins;
- giving up bad habits: nicotine and alcohol damage the inner walls of blood vessels and disrupt the regulation of blood vessel tone. Stopping smoking and drinking alcohol improves the condition of the veins and the functioning of the valves.
Invasive methods for the treatment of varicose veins
Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure performed with a special sclerosing solution (sclerosing agent). The solution is injected through a thin needle into the problematic vein, which causes sclerosis - "sticking". The vein is disconnected from the blood stream, and the neighboring veins become invisible over time. Sclerotherapy is performed without hospitalization - after the procedure, the patient can go home.
The sclerotherapy procedure takes 5-30 minutes, depending on how many varicose veins need to be filled with sclerosing agent and how big they are.
Endovenous laser thermoobliteration (EVLO). A catheter with a laser light guide is inserted into the blood vessel through a small incision. The laser's heat energy heats the vein and it disappears—it "closes. " After a few months, the vessel is replaced by connective tissue and disappears. The procedure is performed on an outpatient basis.
Radiofrequency vein obliteration (RFO) is the effect of high-frequency current on the inner surface of blood vessels. Through micropuncture, a catheter is inserted into the vein, which is connected to a device that generates radio frequency pulses. In the vessel, the radio wave is converted into heat energy, which "seals" the vein.
With EVLO, the vein is exposed to a high temperature for a short time, with RFO, the temperature is lower, but the session is longer. Both procedures are effective and safe.
NTNT deletion, or non-thermal, non-tumescent methods:
- venous obliteration with cyanoacrylate glue;
- mechanochemical obliteration, in which the vessel is simultaneously affected by mechanical and chemical effects.
NTNT obliteration is the most modern, least traumatic method in the treatment of varicose veins, with a short rehabilitation period.
Phlebectomy is the removal of saphenous veins in varicose veins. It can be performed as a stand-alone operation or in combination with other techniques. Varicose veins are removed under local anesthesia with small punctures.
Prevention of varicose veins of the legs
You can prevent the development of varicose veins if you follow simple rules of prevention in your everyday life.
A combination of provoking factors - prolonged sitting with crossed legs, wearing uncomfortable shoes - increases the risk of developing varicose veins on the legs.
Varicose veins prevention - what you need to know:
- moderate physical activity (walking, swimming, leg exercises) and resting with raised legs improve the free movement of blood in the blood vessels and help to avoid stagnation in the veins;
- rational nutrition and weight normalization lead to strengthening of blood vessels;
- wearing loose clothing that does not restrict movement improves blood circulation;
- a cold shower in the warm season helps to keep the tone of the veins;
- comfortable shoes with a low heel (no more than 3 cm) allow you to avoid improper loading of the foot and disruption of blood flow;
- a reasonable approach to visiting saunas and steam baths allows you to maintain normal blood flow (long-term thermal procedures greatly expand the veins, so blood flow slows down).