The word "varicose" comes from the Latin word, varicis - bloating. The first mention of the treatment of varicose veins is found in ancient Greek papyrus.
Varicose veins are the most common disease. Up to 40% of the adult population suffers from chronic vascular disease in the lower extremities. Complications in the form of dermatitis, cellulitis, bleeding, thrombosis, and trophic ulcers often lead to long-term disability, sometimes leading to disability.
Structure and function of venous systems
The way our veins work is a complex process. To understand this, you need initial knowledge of vein structure. The vein wall consists of three layers. Internal - endothelial, represented by a layer of cells on the membrane of connective tissue. The middle layer is muscular. Mainly composed of roundly located plain muscle cells, which are within the framework of collagen fibers. The superficial veins contain a thicker layer of muscle than the deep veins. The outer vein sheath, called Adventitia, is a dense collagen fiber tissue. If we compare the structure of veins and arteries, then it must be said that the ratio of the lumen of a vessel to its wall thickness in a vein is much greater than that of an artery. Veins have much less elastic fibers than arteries.
The main characteristic of a vein, which affects the direction of blood flow, is the length of its walls. In particular, as the pressure inside the vessel increases, the veins expand and tend to acquire a round shape from a slit-like shape. The extent to which the venous wall is stretched is relatively short and depends on many other things. It is this factor that does not allow the use of strict mathematical formulas to calculate the movement of blood along them. The thickness of the venous wall in the leg canal is much larger than, for example, in the neck.
The venous valve comes from the wall. They are usually composed of two valves, which are oriented towards the heart. In the area of installation of the valve to the wall, the diameter of the vein is slightly larger. Usually, when the valve leaflet is closed, blood from the top cannot penetrate into the underlying one. When this happens, the condition is called reflux. Reflux is also controversial. It can be relative, (some call it physiological) and absolute. The main difference is in the period of reflux during the functional test. There is also the opinion that there should be no reflux with normal valves. Valves are distributed unevenly through veins. There are many of them where the work of the muscle pumps is most noticeable - i. e. on the lower part of the foot.
The main venous system in the lower leg is indicated by the following groups:
- leg veins;
- deep leg and thigh veins (deep vein system);
- large and small saphenous veins (superficial vein system);
- communicate (perforated) veins - provide communication between superficial and deep veins.
The deep and superficial venous system together forms a "sponge", from which, while walking, blood flows to the heart. The work of this system is supported by the work of the muscle pump located at the bottom of the leg, which causes intermittent pressure on the veins.
This system moves the blood column upwards, and the valves in the veins block the flow back.
Blood flow from the lower part of the foot through the deep and superficial veins is uneven. As much as 85-90% of the blood flows through the deep veins and only 10-15% through the subcutaneous veins. Thus, in healthy people, the outflow of blood is done by the deep, subcutaneous and communicating vascular system.
Varicose veins are a serious problem
To say that varicose veins are a "XX or XXI century disease" means to deviate from the truth. Varicose veins have long bothered people. Even in ancient pamphlets on medicine, there is a description of varicose veins, in ancient Rome people bandaged their feet with "bandages" of skin to eliminate venous insufficiency.
If your legs are often tired, this may be the first sign of a disease beginning with the venous system. Discomfort at night, accompanied by swelling in the legs and ankles, especially after a long stay in the legs, are clear signs of congestion in the veins. Soon, unfortunately, you find the first varicose veins. Transformed vessels form a blue or red "pattern" on your feet, "stars", capillaries "spider webs" (telangiectasias) and, finally, dilated veins and knots.
Severity, burning, tingling and itching, pain and swelling, "stars", swelling of the veins in the legs - acute signals for immediate action to save the beauty and health of your feet.
Questions about the condition of your veins should be directed to a specialist - a phlebologist who studies and treats venous diseases.
Venous disease starts harmlessly but can be a serious problem if left untreated.
Causes of varicose veins
To date, a large number of theories have been proposed to explain the causes of varicose veins. The most common are heredity, mechanical, hormonal, and so on. However, it mainly reflects the factors that contribute to the development of the disease or accelerate the appearance of clinical signs of the disease.
Both lower extremities are more often affected. However, at first, varicose veins appear on one limb, and after a few seconds - on the other. Varicose veins are more common in the right leg.
Varicose veins on the lower part of the foot only occur in humans. This is due to the vertical position of the body, the influence of hydrostatic and hydrodynamic venous pressure on the valve apparatus and the venous wall of the limb. With venous wall weakness and dysfunction of the valve apparatus in the main vein, which occurs with their congenital inferiority, pathological reverse blood flow occurs. The most common cause of varicose veins:
- Hormonal changes (pregnancy, menopause, puberty, hormonal contraceptive use, etc. ) - affect the structure and tone of the vascular wall with its gradual weakness and destruction.
- Pregnancy is one of the major risk factors for the development of varicose veins. In addition to hormonal changes, the growing uterus and fetus press on the iliac veins and significantly block blood flow from the lower legs.
- Obesity is a proven risk factor for varicose veins. This is due to the increased load on the venous system at the bottom of the foot.
- Lifestyle: people with prolonged static load (hairdressers, teachers, cooks, surgeons) suffer more often.
- Wear tight panties that squeeze the major veins at the level of the groin folds. Women wearing high heels.
- Heavy physical activity (carrying loads, lifting weights).
- Thermal procedures (sauna and bath), its abuse can also trigger varicose veins.
Diagnosis of varicose veins
For many years, the hand was the only doctor's tool for examining patients with varicose veins. X-rays have helped surgeons for over a century. However, X-ray contrast examination of the vein is a rather complicated procedure, requiring large and expensive equipment, and the X-ray contrast agent itself is not safe for the body. With the development of microelectronic and computer technology, previously unavailable diagnostic methods emerged: Doppler ultrasound, angioscanning ultrasound, plethysmography. The emergence of duplex ultrasound scans has provided new information that makes it possible to look back at the issues causing the development of varicose veins, and understand the intricacies of pathological processes.
Ultrasound Doppler
This is an ultrasound diagnostic method that allows you to determine the speed and direction of movement of particles (in this case, blood cells) in the body. Thus, the doctor can know the direction and speed of blood flow in the vessels at the bottom of the foot. And while performing a number of physiological tests and the condition of the vein valve device on the lower part of the foot. Knowledge of the structure of blood flow in the veins in the legs is a key condition for choosing a method of treatment.
Ultrasound Scanning
The essence of this method is that a picture of a wall of blood vessels and blood flowing through it is formed on the screen of the ultrasound scanner monitor in real time. The doctor has the opportunity to observe the shape of the vessel, the wall structure, the condition and the direction of blood flow through this vessel. The method is very informative and much safer than X-ray examination, but it is quite expensive, so it is only used in difficult cases and during scientific research.
Plethysmography
This is a diagnostic method based on determining the electrical resistance of the tissues in the lower leg. The point lies in the fact that the electrical resistance of the entire tissue of the human body directly depends on the amount of blood flowing in and out of them and the change of time with each heartbeat. Plethysmography is used to diagnose the general functional state of blood flow in the lower extremities, used to monitor drug therapy for venous or arterial insufficiency, in the treatment of trophic disorders and to assess the degree of venous insufficiency.
Of course, all of these techniques do not include direct examination of the patient by a physician, explaining the history of the disease and identifying complaints submitted by the patient. Based on the overview of the disease, the doctor chooses the method of treatment.
Treatment of varicose veins
Qualitative leaps in the treatment of varicose veins have occurred, as have other branches of medicine, over the past 50 years. Over the past few decades, various drugs have been developed and further improved for the treatment of chronic venous insufficiency. Surgical techniques to treat varicose veins have been significantly improved. Compression sclerotherapy technology has been developed and perfected practically.
Currently, sclerosurgery operations are becoming increasingly popular around the world. Sclerosurgery is a smart combination of surgical treatment and sclerotherapy. It is well known that sclerotherapy can only be used for early and uncomplicated forms of varicose veins. Varicose vein surgery is also not without problems, varicose vein removal surgery is quite traumatic, requires hospital treatment and a long recovery period. The proper combination of these two methods allows you to reduce the trauma of the treatment process to a minimum and obtain a very high quality of treatment.
Varicose vein medical therapy
There are often cases when the patient practically does not have varicose veins or the number is very small. However, the person experiences heaviness in the legs, pain, swelling. All of these are signs of chronic venous insufficiency. In these cases, as well as when the varicose veins grow significantly, it is necessary to take medications that increase blood circulation in the legs. Currently, in the warehouse of phlebologists, there are dozens of medicines aimed at combating venous insufficiency.
Treatment of varicose veins and chronic venous insufficiency should only be chosen by a doctor. Although there is simplicity in the selection of venotonic agents, only a physician can determine the overall therapeutic measures and appropriateness of the use of a particular drug.
Compression therapy
Compression therapy has been considered for many years in addition to drug therapy or surgery. Varicose vein compression treatment has been used since ancient times, and only in the last decade, elastic compression began to be considered as a separate and independent type of treatment - compression therapy. Compression therapy includes the use of medical elastic bandages of various brands and special medical socks.
The global industry produces three types of elastic bandages: short, medium and high stretch. High elongated bandages (elongation of more than 140%) are used to prevent thrombotic complications in the postoperative period in the abdominal and pelvic organs, as well as to improve post-operative joints and to prevent sports injuries. Short stretching bandages (elongation of less than 70%) are used to treat complex forms of chronic venous insufficiency, deep vein thrombosis, post-thrombophlebitis syndrome and lymphatic insufficiency. Moderate elongated bandages (elongation from 70% to 140%) are used in the treatment of varicose veins, chronic venous insufficiency and compression sclerotherapy.
Medical compression stockings include medical compression stockings, tights, knees. Many people are confused, considering various jerseys "anti-varicose" and "support" with increasing density into therapy. For starters, it is necessary to determine that medical compression products are never marked in the DEN. DEN is a technical feature of knitted fabrics that is indirectly only related to the pressure generated by the product.
Medical jerseys are classified into several functional compression classes. The product class is determined by the pressure produced by the product on the ankle and in the lower third of the lower leg. A person with varicose veins is shown the use of compression class 2 knitwear. This tension or knee height will cause a pressure of 23-32 mm Hg on the sore leg. Art. , That is, equally equates pressure on varicose veins and eliminates venous insufficiency. Moreover, medical compression products cause distributed stress. The pressure they create gradually decreases as the foot moves from bottom to top by 25-30%, which contributes to the effective outflow of blood and lymph.
It should be immediately noted that medical jerseys are never thin and transparent, the creation of high pressure requires a large number of elastic fibers, and thus a thick knitted fabric. It should also be said that medical jerseys are not necessarily cheap. The technology of knitting special knitted fabrics is much more complicated; when knitting, it is also necessary to model the foot profile to create diffuse pressure.
The ideal approach in compression therapy is the continuous and widespread use of elastic bandages and / or compression socks by patients. For example, the use of elastic bandages every day for almost the same as the effectiveness of taking effective medicine every month. The use of compression gloves is very effective in preventing the development and recurrence of varicose veins. The main advantage of using compression products is absolute safety for health, compared to the best drugs, and the price is quite comparable.
Prevention of varicose veins
If you have early signs of varicose veins, then the relatively simple rules will slow down, and in some cases prevent further development. First of all, do not get carried away with hot showers, saunas, prolonged exposure to sunlight. All of the above reduces venous tone, causing blood stagnation in the lower leg. Do not wear tight clothing, stockings or stockings with tight elastic straps, as this will squeeze the veins. Excess weight and sports associated with large static loads on the legs (tennis, weightlifting, bodybuilding) increase venous pressure. High heels (more than 4 cm) - our veins do not like it. Take care of the veins, do not injure them.
If your feet feel heavy in the evening after a day of work, you should make sure your feet stay high during sleep and rest. If your work is accompanied by sitting for a long time at a table or you are standing for a long time, then you should change the position of your legs more often, step into place, and rotate your legs. There is special training for venous diseases. After bathing or showering, rinse your feet with cold water. There are useful sports - first of all, swimming, but also walking, cycling, skiing. Do not neglect folk remedies for prevention. Preparation of useful lingonberry leaves, St. John's wort. John, cranberry, rose hips. A plant-based diet should be followed. Your doctor may also prescribe a medication called phlebotonic to improve venous tone and improve microcirculation. Recently, methods of compression prevention and treatment of varicose veins have also become understandable success, due to the emergence in the market of high quality medical products.
Special words about prevention for pregnant women. Varicose veins develop during pregnancy, especially when not the first, and carrying a baby under 1 year does not contribute to good vascular function. The basis of prevention is to wear special compression socks, the use of phlebotonics both during pregnancy and after childbirth. Do not neglect to mention your veins to the gynecologist when you are given hormone medication, as these drugs affect venous function, reducing their tone.
Do not treat yourself. Talk to your doctor about what to do with your veins. The disease is treated by doctors - phlebologists.