Varicose veins of the lower extremities is a disease of the leg veins characterized by the pathological expansion and deformation of the venous vessels, accompanied by the development of a number of complications.Varicose veins affect the superficial veins of the legs.
According to modern views, the main reason for the development of varicose veins is a defect (congenital or acquired) in the valvular apparatus of the veins of the lower extremities, which leads to the development of the reverse flow of venous blood (reflux).Reflux leads to venous flooding and pathological venous emptying (redirection of blood flow).
This, in turn, leads to clinical manifestations of chronic venous insufficiency - for example, swelling of the legs, pain along the varicose veins, itching of the skin, cramps in the calf muscles.
In advanced cases, the formation of skin pigmentation in the calf area, the formation of trophic ulcers, bleeding from varicose nodes, 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 the frequency of varicose veins varies from 2% to 60% among the adult population of different countries.Surprisingly, in African countries, as well as in the Pacific region, despite the high number of pregnancies, the prevalence of varicose veins in women does not exceed 6%.At the same time, the frequency of varicose veins among the adult population in European countries reaches tens of percent.It follows that the tendency to develop varicose veins depends on ethnicity.
There is also a clear trend towards the increase of the disease.This may be due to the prevalence of sedentary lifestyle, obesity and partly smoking.Patients in "State" hospitals are often deprived of the opportunity to receive modern diagnostics and modern treatment for varicose veins of the lower limbs.The lack of modern high-tech methods for diagnosing and treating varicose veins in the public sector of medicine explains why combined phlebectomy remains the main method of treating varicose veins in public hospitals.That is, a very traumatic, inpatient operation with many incisions (and stitches) and mechanical removal of the incompetent vessel body.
This operation is performed under general anesthesia or spinal anesthesia.World statistics claim that the vast majority of patients suffering from varicose veins can receive surgical treatment on an outpatient basis - without hospitalization, as well as without spinal anesthesia and anesthesia.Conclusion - high-quality treatment of varicose veins is impossible without innovative technologies in timely diagnosis and treatment.
Symptoms of varicose veins of the lower extremities
Symptoms (manifestations) of varicose veins are signs that allow you to suspect the disease with sufficient certainty.Symptoms can be subjective (it seems to me) and objective (I see).
Subjective symptoms of varicose veins include:
- Heaviness in the legs.As a rule - in the calf area.This symptom is more pronounced in the evening.
- Pain in calf muscles.Often this is a dull, low-intensity pain, sometimes discomfort.
- Pain along varicose veins.As a rule, it is not intense, it manifests itself more often in the evening, after a working day.
- Leg fatigue.Fatigue is a decrease in tolerance (sensitivity) 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 area of the legs and feet.
- Skin hyperpigmentation.
- Burning, tingling, itching along the course of varicose veins.
- Trophic venous leg ulcer.
All symptoms of varicose veins, despite their heterogeneity, have common features:
- Symptoms worsen when the patient is standing or sitting for a long time.This happens because the musculo-venous pump does not work in a static state);
- symptoms decrease after walking, after resting in a horizontal position, as well as when using elastic compression;
- change the intensity of the manifestation depending on the season of the year.As a rule, symptoms intensify in the summer;
- symptoms of the disease may intensify before or during menstruation.
All of the above symptoms are non-specific, that is, they can be seen in other diseases.Therefore, objective signs should be relied upon when diagnosing varicose veins:
- Dilated intradermal and saphenous vessels (telangiectasia, reticular vessels).It is clearly visible to the naked eye.Patients often pay attention to this.The presence of only telangiectasia (spider veins) without other symptoms of varicose veins is often not dangerous.But this is a clear reason for examination.
- Varicose veins of the saphenous veins.Easily seen without equipment.The presence of varicose veins is a clear sign of varicose veins.However, ordinary people often confuse ordinary veins visible through the skin with varicose veins.In the first case, treatment is not required, in the second case, it is necessary.
- Swelling of the affected limb.This is also a non-specific symptom, but the presence of varicose veins can convince the doctor that these facts are related to each other.
- Changes in skin color and texture.With advanced forms of varicose veins, we often experience hyperpigmentation (the skin turns brown or blue).There may be areas of lipodermatosclerosis.An extreme manifestation is the appearance of a venous trophic ulcer.
Risk factors for varicose veins in the legs
- Non-specific: age, female gender, obesity, hereditary predisposition.
- Special: pregnancy, taking hormonal drugs (estrogens, progestogens), menopause.
Stages of development of varicose veins
Like any chronic disease, varicose veins develop gradually.There is no clear stage, but we can talk about the initial stage (compensation) and the stage of development of chronic venous insufficiency.There are no subjective manifestations in the initial stage of the development of varicose veins.The appearance of visually detected varicose veins is usually not accompanied by swelling, pain or cramps.
At this stage, the disease may remain unchanged for a long time.And maybe there will be progress.In this case, the patient, accustomed to the appearance of varicose veins and accustomed to the idea that they do not harm him, cannot associate the appearance of pain, swelling of the legs, itching and night 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), the formation of trophic venous ulcers and bleeding from varicose nodes.
Phlebologists use the CEAP classification to standardize the diagnosis of varicose veins and make it as accurate and understandable as possible for a doctor from anywhere in the world.CEAP classification takes into account clinical manifestations (C – clinic), etiology (cause of the disease) (E – etiology), anatomical localization (A – anatomy) and pathogenesis (P – pathogenesis).
As a rule, the diagnosis of CEAP is completed with a decoding (nosological formula) that facilitates understanding for therapists, general practitioners and specialists.This approach allows the physician to quickly navigate through the patient's medical records.
Diagnosis of varicose veins
Modern diagnosis of varicose veins of the lower extremities performs the following tasks:
- Determination of the presence of chronic venous disease.Many patients with suspected varicose veins do not have varicose veins.And vice versa.The first task of the phlebologist is to determine whether the patient has this disease.
- Determination of the type of venous disease.Doctors say that it is a "nosological" form.You need to know exactly which veins are affected, how bad they are, and what they lead to or can lead to.
- Determination of treatment tactics - what specific technique (or combination of techniques) should be applied in this particular case.Treatment tactics should be discussed with the patient and reflected in treatment recommendations.
- Evaluation of the effectiveness of treatment is carried out during treatment and after its completion.
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, understandable information about their disease and treatment methods.In response to a patient's question "why," we never say "because" or "because that's how I always do it."We are committed to the principles of modern evidence-based medicine.
Methods of diagnosis of varicose veins
- Clinical research.Clarification of the patient's complaints, examination and palpation (manual examination) are included.
- Ultrasound angioscanning (ultrasound of vessels - 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 most cases, clinical examination and ultrasound angiography are sufficient for a phlebologist to diagnose varicose veins and develop the correct treatment strategy.At the same time, the main instrumental research for diseases of leg vessels is ultrasound angiography - ultrasound of the vessels.
During the examination, the patient is clearly explained exactly what "his" disease is and how to deal with it.
The study is carried out in a standing position (if necessary, also lying down) using two or three scanning modes (B-mode, color coding of blood flow and pulsed Doppler mode) at the same time.The ultrasound angioscanning method allows to visualize the studied vessel, determine the direction of blood flow and its parameters (speed, type of flow).
Both limbs are checked, not just the "patient", and we always look at both the superficial and deep veins.If necessary, the patient may be prescribed additional research methods listed above.
Treatment of varicose veins
Specialists of the leading phlebology center use only the most modern and best methods for the treatment of varicose veins of the lower extremities.
Today, phlebologists use the following innovative treatment methods:
- Thermoablation (laser and radio frequency).
- Non-thermal methods of treating varicose veins.
- Sclerotherapy.
- Miniphlebectomy.
- A combination of these techniques.
These methods meet the state European standards.They allow 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.