Varicose veins (varicose veins) is a disease in which the superficial veins dilate or swell. The disease most often occurs in people over 30 years of age. It is most often observed in the lower extremities. Varicose veins are characterized by changes in the walls of the vessels at the same time as the expansion of the lumen of the vessels. Safen veins are well contoured, the direction of their course is "serpentine". Usually the large sapen vein, less often the small sapen vein, and even less often their saphenous anastomoses are affected.
Causes of varicose veins
The proposed theories to explain the causes and mechanisms of the onset of the disease can be divided into three groups.
The theories of the first group explain the origin of varicose veins by the anatomical features of the location and structure of these vessels of the lower extremities. The arteries have valves that block the centrifugal flow of blood, thus preventing it from flowing subcutaneously to the deep veins of the foot. Safen veins collect more blood due to a lack of valves, which causes them to dilate.
Theories of the second group in the development of varicose veins focus on pelvic blood stasis during pregnancy, constipation, the consequences of inflammatory processes, as well as prolonged stay in the legs.
Theories of the third group, which explain the origin of varicose veins by the constitutional tendency, the weakness of the mesenchyme, are the least substantiated.
With varicose veins, for various reasons, their walls change and become thinner, so the increased pressure causes the walls to swell. Initially, it manifests itself in the form of nodules, and at the same time there are areas of compression caused by excessive growth of connective tissue. Mechanical factors only contribute to the development of the pathological process in the vessels, but in no way are the main points in the pathogenesis, etiology and causes of varicose veins of the lower extremities.
Symptoms of varicose veins
With varicose veins, patients usually experience a feeling of fullness and heaviness in the lower extremities. Sometimes the pain is short-lived, convulsive. Often there is swelling. The feeling of fullness and heaviness in the limbs increases in the evening, as edema usually increases by this time. Itching is visible, often there are scratches on the feet. In the later stages of the disease, ulcers form, usually on the inside of the lower third of the lower leg.
The main objective symptom of the disease are visible varicose veins. The patient is examined on a regular basis to determine this symptom. At the same time, the dilated saphenous veins are clearly visible; the lower leg appears more convex, more curved; The femoral veins usually dilate only along the main vascular trunk. Sometimes there is almost a bud varicose vein at the junction of the largest saphenous vein with the femoral vein. Such a nodule can be mistaken for a femoral hernia, but the softness of the nodule, the fact that it quickly fills with blood after the examiner's hand is removed, and the presence of dilated veins in the lower part of the foot make a correct diagnosis.
There are a number of symptoms that indicate the presence of dilatation of the venous trunk of the great saphenous vein. These include a symptom in which the patient is placed in a horizontal position, given a high position of the foot. The subcutaneous venous system is emptied by carefully stroking the foot from the periphery to the center, the area where the largest saphenous vein flows into the femoral vein is firmly pressed with the toe, and the patient is transferred to the ground by holding the toe. position. If the filling of the veins occurs only after the removal of the finger, this is a positive sign. In such cases, the anastomoses between the superficial and deep vein networks are poorly expressed, and the operation may yield a positive result. In a patient in a vertical position, if the vessels in the periphery begin to fill slowly, it indicates a significant development of anastomoses - a negative symptom. In this case, the operation to close the vessels will fail.
The Delbe-Perthes symptom indicates how open the safen veins are to the deep veins through anastomoses. The patient is applied an elastic bandage in a stable position on the border of the middle and lower third of the thigh, then they are offered a short walk. If the tension of the dilated vessels is significantly reduced, this indicates the presence of advanced anastomoses between the superficial and deep veins.
Other symptoms of varicose veins include swelling, eczematous skin changes, and ulcers. The swelling is different - from a light paste to a clear maturation, when the skin loses its normal pattern and looks radiant, the area around the lower leg increases significantly. Eczematous manifestations include dryness, peeling and, finally, eczematous rash. Usually the skin of the lower leg is affected. These changes occur as a result of trophic disorders.
Prevention and treatment of varicose veins
Prevention of varicose veins is reduced to a change of occupation if it is associated with standing for a long time, taking measures for regular bowel movements, tying the legs with an elastic bandage or wearing elastic socks. Wrap your legs or wear socks while lying down. The foot is kept in a high position for a few minutes, and only after making sure that the veins are empty do they apply a bandage or socks. The bandage begins to be applied from the bottom and continues upwards, avoiding any stretching and compression that causes stagnation.
There are a number of methods for surgical treatment. In the Scarpov triangle, the operation to close a large saphenous vein where it flows into the femoral vein is palliative. Recurrences are often observed after this operation. Therefore, it is used only in combination with other surgical interventions.
During Bebcock's operation, skin incisions are made, separated, and closed at the lower end of the large saphenous vein. It is opened above the bandage and a long abdominal probe is inserted into the lumen. A second small skin incision is made over the upper end of the dilated vein. Its central end is closed and cut, the vein under the intersection is tightly closed on the probe, and then carefully removed from the lower incision. At the same time, the probe draws a vein turned inwards by the intima. The disadvantage of this method is the formation of hematomas at the site of torn anastomoses.
During Madelung's operation, the dilated veins are cut. Of all the operations, this intervention is the most radical and gives the best long-term results.
Complications of varicose veins
The most common and difficult to treat complications of varicose veins are varicose ulcers. These ulcers usually occur in the elderly. They are located on the inner, less outer, surface of the lower third of the lower leg. These ulcers are the result of chronic tissue malnutrition. They are usually deep, necrotic, have a foul-smelling discharge bottom and tall, calloused edges. Ulcers can reach large sizes, covering the entire lower leg. The skin around them is pigmented, sometimes inflamed, with eczematous irritation.
Varicose ulcers should be distinguished from syphilis. Syphilitic ulcers are usually located in the upper third of the lower leg, more often on the anterior surface. In addition, other signs of syphilis can be detected with syphilitic ulcers. Tuberculosis of the skin (lupus) occurs more often on the face, less often around. Lupus begins as isolated nodules and then ulcers; in the future, deeper tissue damage sometimes occurs with the formation of smooth wounds that compress adjacent tissues.
Given that varicose ulcers develop against the background of circulatory and trophic disorders, their treatment should be continuous and long-lasting. The constant position of the patient with the raised leg often leads to rapid improvement. The wound should be bandaged with 0. 5% potassium permanganate solution, penicillin ointment or balsamic liniment. When the wound is cleansed and the swelling around it is gone, excision of the vessels is recommended. Only a radical operation to remove the altered vessels eliminates the risk of recurrence of ulcers.
As the disease progresses and the varicose veins increase, their walls and the skin soldered to them become thinner. As a result, venous hemorrhage may occur during walking (especially when the nodes are particularly tense). Although such bleeding may be significant, it does not pose a great danger, because they stop quickly when the patient is lying down and lifting his leg. In this case, the negative pressure in the arteries, they decrease and the bleeding stops. A light aseptic dressing is applied to the wound. Because bleeding can recur, surgery is recommended to cut or close the arteries and remove the thinnest nodules. Any operation involving the closure of the main trunk of the vessel, with bleeding from the compensating dilated vessels, is strictly contraindicated.