Varicose veins (varicose veins) is a disease in which the superficial veins are enlarged or swollen. The disease in most cases occurs in people over 30 years of age. In the vast majority of cases, it is observed in the lower extremities. Varicose veins are characterized by an expansion of the lumen of the veins with a simultaneous change in their wall. Saphenous veins are well contoured, the direction of their course becomes "serpentine". The great saphenous vein is usually affected, less often the small saphenous vein, and even less often its saphenous anastomoses.
Causes of varicose veins
The theories proposed to explain the causes and mechanisms of disease onset can be reduced to three groups.
Theories of the first group explain the origin of varicose veins by the anatomical characteristics of the location and structure of these vessels of the lower extremities. Veins have valves that prevent the centrifugal flow of blood and therefore its excessive flow from the subcutaneous tissue to the deep veins of the leg. With valve failure in the saphenous veins, more blood is deposited, which leads to their expansion.
Theories of the second group on the development of varicose veins attach importance to the stagnation of blood in the pelvis during pregnancy, constipation, consequences of inflammatory processes, and also during prolonged stay in the legs.
The theories of the third group, which explain the origin of varicose veins by a constitutional predisposition, weakness of the mesenchyme, are the least supported.
With varicose veins, due to various reasons, their walls change, they become thinner, so increased pressure leads to bulging of the walls. It first manifests itself in the form of knots, and at the same time, areas of compaction resulting from overgrowth of connective tissue are also observed. Mechanical factors only contribute to the development of the pathological process in the veins, but by no means are the main point of the pathogenesis, etiology and causes of varicose veins of the lower extremities.
varicose veins symptoms
With the expansion of the veins, patients often experience a feeling of fullness and heaviness in the lower extremities. Sometimes there is short-term convulsive nature of the pain. There is often swelling. The feeling of fullness and heaviness in the limbs increases at night, as the swelling usually increases at this time. Itching appears, often there are scratches on the legs. In the later stages of the disease, ulcers form, usually located in the lower third of the leg on its inner side.
The main objective symptom of the disease is visible varicose veins. Examination of the patient to identify this symptom is performed while standing. At the same time, the dilated saphenous veins are clearly visible; on the lower part of the leg they appear more prominent, more curled; in the thigh, the veins are usually dilated only along the course of the main vascular trunk. Sometimes there is a varicose vein in the thigh almost at the confluence of the greater saphenous vein in the femoral vein. Such a nodule can be mistaken for a femoral hernia, but the softness of the nodule, its rapid filling with blood after withdrawal of the examiner's hand, and the presence of dilated veins in the lower leg provide the basis for establishing the correct diagnosis.
There are a number of symptoms that indicate the presence of expansion of the venous trunk of the great saphenous vein. These include a symptom where the patient is placed in a horizontal position, the leg is placed in an elevated position. By carefully stroking the leg from the periphery to the center, the subcutaneous venous system is emptied, the place where the greater saphenous vein flows into the femoral vein is firmly pressed with a finger, and, holding the finger, the patient is transferred to a position of standing position. If the filling of the veins occurs only after the finger is removed, then this is a positive symptom. In these cases, the anastomoses between the superficial and deep venous network are poorly expressed and the operation can have a positive effect. If, in an upright position in a patient, the veins of the periphery begin to slowly fill, then this indicates a significant development of anastomoses - a negative symptom. In this case, the vein ligation operation will not be successful.
The Delbe-Perthes symptom indicates how accentuated the emptying of the deep saphenous veins through the anastomoses is. An elastic bandage is applied to the patient standing on the edge of the middle and lower third of the thigh, then they are offered to walk around a bit. If the tension of the dilated veins decreases significantly, this indicates the presence of anastomoses developed between the superficial and deep veins.
Other symptoms of varicose veins include swelling, eczematous skin changes, and ulcers. Swelling is different - from a slight grazing to pronounced edema, when the skin loses its usual pattern and looks shiny, the circumference of the leg increases sharply. Of the eczematous manifestations, dryness, desquamation and, finally, eczematous eruptions are observed. The skin on the lower leg is usually affected. These changes occur as a result of trophic disturbances.
Prevention and treatment of varicose veins
The prevention of varicose veins is reduced to a change of profession, if it is associated with a prolonged position, taking measures for regular bowel movements, wrapping the legs with an elastic bandage or wearing an elastic stocking. Bandaging the legs or putting on a sock should be done lying down. For several minutes, the leg is held in an elevated position, and only after making sure that the veins are empty, they put on a bandage or a sock. The dressing starts from below and continues upwards, preventing any stretching and squeezing that causes stagnation.
There are several methods of surgical treatment. The operation to ligate the great saphenous vein in Scarpov's triangle at the place where it empties into the femoral vein is palliative. After this operation, relapses are often observed. Therefore, it is only used in combination with other surgical interventions.
During the Bebcock operation, a skin incision is made at the lower end of the dilated great saphenous vein, which is separated and tied off. Above the dressing, it is opened and a long belly tube is inserted into the lumen. A second small skin incision is made above the upper end of the dilated vein. Its central end is tied and crossed, below the intersection the vein is firmly tied over the probe, after which it is carefully removed through the lower incision. At the same time, the probe pulls a vein that has been turned inside out by the intima. The disadvantage of this method is that hematomas are formed at the site of ruptured anastomoses.
During Madelung's operation, dilated veins are excised throughout. Of all the operations, this intervention is the most radical, giving the best long-term results.
Varicose Veins Complications
The most common and most difficult-to-treat complications of varicose veins are varicose ulcers. These ulcers usually occur in the elderly. They are located on the inner, less often the outer, surface of the lower third of the leg. These ulcers are the result of chronic tissue malnutrition. They are usually deep, with a necrotic and foul-smelling background and high, calloused margins. Ulcers can reach large sizes, encircling the entire lower leg. The skin around them is pigmented, sometimes inflamed, with eczematous irritation.
Varicose ulcers must be distinguished from syphilitic ulcers. Syphilitic ulcers are usually located on the upper third of the leg, most often on the anterior surface. Also, with syphilitic ulcers, other signs of syphilis can be detected. Tuberculosis of the skin (lupus) is most common on the face, much less often on the extremities. Lupus starts as isolated nodules that later ulcerate; in the future, deeper tissue damage occurs, sometimes with the formation of smooth scars that pinch neighboring tissues.
Given that varicose ulcers develop against the background of circulatory and trophic disorders, their treatment must be persistent and time-consuming. The constant position of the patient with the leg raised in most cases leads to rapid improvement. A dressing with a 0. 5% potassium permanganate solution with penicillin ointment or balsamic liniment should be placed on the ulcer. When the wound is clean and the swelling around it has disappeared, excision of the veins is recommended. Only a radical operation to remove the altered veins eliminates the risk of ulcer recurrence.
As the disease progresses and the varicose nodules enlarge, their walls and the skin welded to them become thinner. As a result of this, usually while walking (when the nodes are especially tense), one of the nodes may rupture and venous bleeding may occur. While this bleeding can be significant, they do not pose a great danger as they stop quickly if the patient is lying down and the leg is raised. In this position, negative pressure is created in the veins, they narrow and bleeding stops. A light aseptic dressing is placed on the wound. Due to the fact that bleeding can be repeated, surgery is recommended for excision of the veins or their ligation and removal of the thinnest nodules. With bleeding from compensatory dilated veins, any operation associated with ligation of the main trunk of the vein is categorically contraindicated.