Varicose veins of the lower extremities are a disease of the leg veins, characterized by pathological expansion and deformation of venous vessels, accompanied by the development of a number of complications.Varicose veins affect the superficial veins in the legs.
According to modern views, the main cause of the development of varicose veins is a defect (congenital or acquired) in the valve apparatus of the veins of the lower extremities, leading to the development of reverse flow of venous blood (reflux).Reflux leads to venous overflow and pathological venous discharge (redirection of blood flow).
Which, in turn, leads to clinical manifestations of chronic venous insufficiency - such as swelling in the legs, pain in varicose veins, itchy skin, cramps in the calf muscles.
In advanced cases, the formation of skin pigmentation in the shin region, the formation of trophic ulcers, bleeding from varicose nodules, as well as thrombophlebitis - inflammation of varicose veins with their thrombosis.Varicose veins develop gradually.
According to European statistics, chronic venous diseases are widespread throughout the world.It has been proven that among the adult population of different countries the incidence of varicose veins varies from 2% to 60%.Surprisingly, in African countries, as well as in the Pacific region, despite multiple pregnancies, the incidence of varicose veins in women is no more than 6%.At the same time, in European countries, the incidence of varicose veins in the adult population reaches tens of percent.It is concluded that the tendency to develop varicose veins depends on ethnicity.
There is also a clear trend of increasing incidence.This may be due to the prevalence of a sedentary lifestyle, obesity and, in part, smoking.Patients in “public” hospitals are often deprived of the opportunity to receive modern diagnosis and treatment for varicose veins of the lower extremities.The lack of modern high-tech methods for diagnosing and treating varicose veins in the public sector of medicine explains that combined phlebectomy remains the main method of treating varicose veins in public hospitals.In other words, a very traumatic stationary operation, with many incisions (and sutures) and mechanical removal of the incompetent vein trunk.
This operation is performed under general anesthesia or spinal anesthesia.World statistics state that the vast majority of patients suffering from varicose veins can receive surgical treatment on an outpatient basis - without hospitalization and also without spinal anesthesia and anesthesia.Conclusion - high-quality treatment of varicose veins is impossible without timely diagnosis and innovative treatment technologies.
Symptoms of varicose veins of the lower extremities
The symptoms (manifestations) of varicose veins are signs that make it possible to suspect the disease with sufficient certainty.Symptoms can be subjective (it seems to me) and objective (I understand).
Subjective symptoms of varicose veins include:
- Feeling of heaviness in the legs.As a rule - in the calf area.This symptom is more pronounced at night.
- Pain in the calf muscles.Most of the time, it is a painful, low-intensity pain, sometimes discomfort.
- Pain along varicose veins.As a rule, it is not intense, it appears more at night, after a day of work.
- Fatigue in the legs.Fatigue is a decrease in tolerance (susceptibility) to physical activity - both static and dynamic.
- "Venous claudication."Venous claudication is called increased pain in the calf muscles when walking.
- Swelling of the lower extremities in the legs and feet region.
- Skin hyperpigmentation.
- Burning, tingling and itching along varicose veins.
- Trophic venous ulcer of the leg.
All symptoms of varicose veins, despite their heterogeneity, have common characteristics:
- Symptoms intensify when the patient remains standing or sitting for a long time.This happens because the musculovenous pump does not work in a static position);
- symptoms decrease after walking, after resting in a horizontal position and also when using elastic compression;
- change the intensity of the manifestation depending on the season.As a rule, symptoms intensify in summer;
- manifestations of the disease may intensify before or during menstruation.
All of the above symptoms are nonspecific, that is, they can also appear in other diseases.Therefore, when diagnosing varicose veins, one should rely on objective signs:
- Dilated intradermal and saphenous veins (telangiectasia, reticular veins).Clearly visible to the naked eye.This is what patients usually pay attention to.The presence of just telangiectasia (vein veins) without other signs of varicose veins is generally not dangerous.However, this is a clear reason for examination.
- Varicose saphenous veins.Easily visible without equipment.The presence of varicose veins is a clear sign of varicose veins.However, common people often confuse common veins visible through the skin with varicose veins.In the first case, treatment is not necessary, in the second it is necessary.
- Swelling of the affected limb.This is also a non-specific symptom, but in the presence of varicose veins it can lead the doctor to believe that these facts are interconnected.
- Changes in skin color and texture.In advanced forms of varicose veins, we often find hyperpigmentation (the skin turns brownish or bluish).There may be areas of lipodermatosclerosis.The extreme manifestation is the appearance of venous trophic ulcers.
Risk factors for varicose veins in the legs
- Nonspecific: age, female sex, obesity, hereditary predisposition.
- Specific: pregnancy, use of hormonal medications (estrogens, gestagens), menopause.
Stages of development of varicose veins
Like any chronic disease, varicose veins develop gradually.There is no clear staging, but we can talk about the initial stage (compensation) and the development stage of chronic venous insufficiency.At the initial stage of development of varicose veins there are no subjective manifestations.The appearance of varicose veins, detected visually, is generally not accompanied by swelling, pain or cramps.
At this stage, the disease can remain unchanged for a long time.And maybe that will progress.In this case, the patient, accustomed to the sight of varicose veins and accustomed to the idea that they do not cause harm, may not associate the appearance of pain, swelling in the legs, itching and nocturnal cramps with the progression of varicose veins.This, in turn, can lead to the development of complications of varicose veins, such as inflammation of varicose veins (thrombophlebitis), formation of trophic venous ulcers, and bleeding from varicose nodules.
To standardize the diagnosis of varicose veins and make it as accurate and understandable as possible for a doctor anywhere in the world, phlebologists use the CEAP classification.The CEAP classification takes into account clinical manifestations (C – clinical), etiology (cause of the disease) (E – etiology), anatomical location (A – anatomy) and pathogenesis (P – pathogenesis).
As a rule, the CEAP diagnosis is complemented by a decoding (nosological formulation), which makes it easier for therapists, general practitioners and specialists to understand.This approach allows the doctor to quickly navigate when studying the patient's medical documents.
Diagnosis of varicose veins
Modern diagnosis of varicose veins of the lower extremities presents the following tasks:
- Determine the presence of chronic venous disease.Many patients who suspect they have varicose veins do not have them.And vice versa.The phlebologist's first task is to determine whether the patient has this disease or not.
- Determine the type of venous disease.Doctors say it is “nosological”.You need to know exactly which venous vessels are affected, how bad it is, and what has caused it or could lead to it.
- Determine treatment tactics – which specific technique (or combination of techniques) should be applied in this specific case.Treatment tactics should be discussed with the patient and reflected in treatment recommendations.
- Assessment of treatment effectiveness is carried out during treatment and after its end.
We prefer to carry out all stages of diagnosis and treatment in contact with the patient.
We believe that patients have the right to accessible and understandable information about their illness and treatment methods.In response to a patient’s “why” question, we never say “because” or “because I always do it this way.”We adhere to the principles of modern evidence-based medicine.
Methods for diagnosing varicose veins
- Clinical study.It includes clarification of the patient's complaints, examination and palpation (examination with the hands).
- Ultrasonographic angioscanning (vein ultrasound - duplex and triplex scanning).
- Plethysmography.
- X-ray phlebography (ascending and descending).
- Radionuclide phlebography (radiophlebography).
- Computed tomography (CT venography).
- Magnetic resonance imaging (MR venography).
- Intravascular ultrasound examination.
- Thermography.
In the vast majority of cases, to diagnose varicose veins and develop a correct treatment strategy, a clinical examination and ultrasound angiography are sufficient for a phlebologist.At the same time, the main instrumental study for diseases of the leg veins is ultrasound angiography - ultrasound of the veins.
During the study, the patient is clearly explained what exactly “his” disease is and how to combat it.
The study is carried out while standing (if necessary, also lying down), simultaneously using two or three scanning modes (B-mode, color coding of blood flow and pulsed Doppler mode).The ultrasonic angioscanning method allows you to visualize the vessel under study, determine the direction of blood flow and its parameters (speed, type of flow).
Both limbs are examined, not just the “sick” one, and we always look at the superficial and deep venous vessels.If necessary, the patient may be offered additional research methods listed above.
Varicose veins treatment
Specialists of the leading phlebology center use only the best and most modern methods for treating varicose veins of the lower extremities.
Today, phlebologists use the following innovative treatment methods:
- Thermobliteration (laser and radiofrequency).
- Non-thermal methods of treating varicose veins.
- Sclerotherapy.
- Miniphlebectomy.
- A combination of these techniques.
These methods meet state European standards.They allow you to treat varicose veins effectively, non-traumatically and on an outpatient basis - without hospitalization.No anesthesia or spinal anesthesia is required.It is this approach that provides the best treatment results.