Varicose veins most often affect the venous system of the legs. External manifestations (protruding nodular blue veins, swelling) are not only a cosmetic problem, but signs of a serious disease that worsens over time.
What are varicose veins: definition of the disease
The word "varicose veins" comes from the Latin varix - "swell". The name fully reflects the pathological process: the walls of the veins become thinner, and in some areas, expansions (swellings like bags) - nodes are formed.
The first case of varicose veins was recorded in a document from 86 BC. BC: Roman general Gaius Marius complained of leg pain due to "blue swollen veins".
The main reason for the appearance of varicose veins (varicose veins, varicose veins) is an increase in pressure in the system of superficial vessels. Certain diseases, hormonal changes and a sedentary lifestyle contribute to this.
At first, even under the influence of these factors, the vessels function normally, but they gradually deform, change their structure and can no longer fully transport blood.
Varicose veins can develop on almost any part of the body, but most commonly occur in the lower extremities. So, when it comes to varicose veins, by default they imply a problem with the legs.
Code for varicose veins in ICD-10
The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.
I83 - varicose veins of the lower extremities:
- I83. 0 - dilated veins of the lower extremities with ulcers;
- I83. 1 - enlarged veins of the lower extremities with inflammation;
- I83. 2 - dilated veins of the lower extremities with ulcers and inflammation.
85 - varicose veins of the esophagus:
- I85. 0 - dilated esophageal veins with bleeding;
- I85. 9 - varicose veins of the esophagus without bleeding.
I86 - varicose veins of other locations:
- I86. 0 - varicose veins of the sublingual veins;
- I86. 1 - dilated veins of the scrotum (anatomical formation in men - vessel for testicles and their appendages);
- I86. 2 - enlarged pelvic veins;
- I86. 3 - dilated veins of the vulva (female external genitalia);
- I86. 4 - varicose veins of the stomach.
O22. 0 - varicose veins of the lower extremities during pregnancy.
In our country, 30 million people suffer from various forms of varicose veins. A third of them have complications - trophic ulcers. An open defect on the skin or mucous membrane caused by disturbed blood circulation and tissue innervation.
Mechanism of development of varicose veins
The pathological reactions of the body are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels will help to understand how and why the disease develops.
How blood moves through the body
There are two types of blood vessels in the human body - veins and arteries. Blood flows through arteries from the heart to all organs and tissues. This happens under high pressure (70-120 mm Hg) and at high speed.
Blood flows through veins from organs and tissues, under low pressure (0-20 mm Hg) it is directed to the heart.
The walls of veins are less thick and elastic than the walls of arteries and, unlike arteries, do not have such a developed muscle layer. Therefore, varicose veins are possible only in veins, but not in arteries.
Arterial and venous system of human blood flow. Veins are marked in blue, arteries in red.
Low pressure in the veins is necessary for the transport of blood from the periphery to the center. But at the same time, on the way to the heart, blood flow encounters an obstacle - the force of gravity. This force forces the blood back through the veins.
You often hear that varicose veins are mankind's revenge for walking upright. After all, the longest distance that blood has to travel in the body, overcoming gravity, is the journey from the feet to the heart. The movement of blood through the veins is ensured by the contractions of the heart, the muscular pump of the surrounding muscles and the negative pressure in the chest during inhalation.
In healthy vessels, reverse blood flow is prevented by valves on the inner walls of the veins. The valves act like a one-way revolving door – they open and allow blood to flow to the heart and immediately close if gravity tries to push the blood back.
It's not just the valves that help the veins deliver blood to the heart, but also the muscles that surround the blood vessels. By contracting and relaxing, the muscles help the blood move through the veins. This mechanism works only when the person is moving. When you stand or sit for a long time, the muscle pump is practically inactive.
The cusps of the venous valves always face the direction of blood flow - towards the heart
How failure arises and disease arises
The increase in pressure in the venous system disrupts the functioning of their valve apparatus and leads to the reverse flow of blood through the vessels. Because of this, as well as due to stagnation of excess blood, weakness of the valve apparatus (for example, in connective tissue diseases), the lumen of the veins expands, the walls are deformed, condition and locally resemble bags. protrusions - nodes are formed.
The process is similar to inflating a balloon: if you don't let the air escape, the balloon inflates more and more.
On the left side there is normal blood flow; on the right - multidirectional blood flow due to impaired work of venous valves, vascular deformation
There are superficial and deep veins on the legs. 85-90% of the total volume of blood passes through the deep, only 10-15% through the superficial. The walls of the deep veins are thicker and more adapted to the increased volume of blood. And the superficial veins of the legs are thinner and more susceptible to varicose veins.
In the pelvis and lower parts of the esophagus there are large venous plexuses, which can also undergo varicose transformation. In the veins of the small pelvis, the mechanism of disease development is the same as in the lower extremities. But varicose veins of the esophagus arise for another reason: due to portal hypertension - increased pressure in the portal vein system, which develops with cirrhosis of the liver, hepatitis, parasitic lesions of the liver, fatty hepatosis, etc.
Causes of varicose veins
A number of factors contribute to the appearance of varicose veins on the legs. They are the main onesvalvular insufficiencyIheredity. It is known that a quarter of patients had close relatives suffering from one of the forms of varicose veins.
Excessive weight. The more a person weighs, the greater the load on the venous system. Over time, the veins stop coping with such pressure: the lumen of the blood vessels increases, and the valves on their walls stop closing completely. As a result, there is stagnation of blood and the development of varicose veins.
Pregnancy. Hormonal changes occur in a woman's body, body weight, intra-abdominal pressure and volume of circulating blood increase - this leads to outflow disorders, causes stretching of the vein walls and changes in the functioning of the valvular apparatus.
After childbirth, the diameter of varicose veins decreases, but does not always return to its original value. With subsequent pregnancies, the risk of developing varicose veins increases.
Old age. Varicose veins often affect people after 50 years. The older a person is, the more worn out the venous valves are, and the recovery processes slow down, and the mechanism of pathological expansion of veins is triggered - the development of varicose veins.
Venous refluxVenous reflux Return of blood through the veins due to resistance to blood flow, from lat. refluo - "to flow backwards". It is found in 10-15% of school children aged 12-13. The disease is "rejuvenating" due to a sedentary lifestyle and excess weight.
Varicose veins of the lower extremities develop more quickly if there are additional risk factors.
Risk factors that contribute to the appearance of varicose veins on the legs:
- lack of physical activity - when moving, the muscles stimulate blood flow through the veins, and without movement, blood circulation in the veins can be difficult;
- smoking - chemicals contained in tobacco smoke damage the walls of blood vessels, which narrows their lumen, hinders blood flow and stagnates, which leads to varicose veins;
- professions that involve standing or sitting for a long time - hairdressers, surgeons, cooks, waiters, drivers, office workers are at risk;
- menopause - in women aged 40-50, the production of sex hormones (estrogen and progesterone) decreases, and at the same time the tone of the vein wall decreases. This increases the likelihood of varicose veins.
Women suffer from varicose veins 3-4 times more often than men. This happens due to hormonal variability (menstrual cycle, pregnancy, menopause).
During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva
Varicose veins can appear not only on the lower extremities, but also on other parts of the body.
The main causes of varicose veins in different locations
Dilated veins of the esophagus
Changes in the veins of the esophagus with an uneven increase in their lumen, bulging of the wall and the development of nodular curvature of blood vessels. It often leads to a life-threatening complication - bleeding.
Reasons:
- cirrhosis
- liver cancer
- other diseases that cause increased pressure in the portal vein system - it collects blood from the abdominal organs
Dilated veins of the scrotum (varicocele)Pathological dilation of the veins of the pampiniform plexus of the testis. It is manifested by dilated veins in the scrotum and disturbed blood flow
Reasons:
- congenital incompetence of the valves of the testicular veins (usually the left)
- mechanical compression of the testicular vein (inguinal hernia)
Dilated pelvic veins
It is characterized by enlargement of ovarian veins and intrapelvic venous plexuses of different diameters. The condition is also known as pelvic congestion syndrome
Reasons:
- polycystic ovary syndrome
- two or more pregnancies
- hormonal dysfunction
Varicose veins of the vulva
Dilated veins of the pelvis, affecting the veins of the lips and perineum
Reasons:
- compression of the retroperitoneal vessels by the uterus during pregnancy
- significant physical activity
- uterine and ovarian tumors
Varicose veins of the sublingual veins (sublingual varicose veins)
Asymptomatic damage to the veins under the tongue. It manifests as a slight bulging of blood vessels and a change in color from dark blue to purple
Reasons:
- hypertension
- smoking
- old age
Varicose veins of the stomach
An isolated change in the veins of the stomach or in combination with dilated veins of the esophagus
Reasons:
- cirrhosis
- portal hypertension syndrome - increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thrombosis, abnormalities of vein development)
Symptoms of varicose veins
In rare cases, only the aesthetic side of the disease appears - bluish veins. Most patients who suffer from varicose veins report at least one or more unpleasant symptoms.
Symptoms of varicose veins of the lower extremities:
- fatigue, pain or a feeling of heaviness in the legs - this is caused by blood stagnation and its pressure on the surrounding tissues;
- burning, tingling or throbbing in the legs - a reaction to the slowing down of blood flow and overflowing of the venous system of the lower extremities;
- night muscle cramps in the legs - painful cramps are caused by blood stagnation and the accumulation of metabolic products in the tissues;
- swelling of the feet and ankles - due to stagnation in the veins, the liquid part of the blood penetrates into the subcutaneous tissue through the altered vascular wall;
- itching of the skin around damaged veins – enlarged and altered blood vessels do not provide normal circulation and nutrition to the skin, so it dries out and becomes rough.
Unpleasant sensations in the legs in patients with varicose veins intensify in the evening, especially after sitting or standing for a long time.
The appearance of altered veins is not always proportional to the severity of the symptoms. Thus, veins that are barely noticeable to the eye and affected by varicose veins can cause severe discomfort, while nodular and thickened veins can cause minimal concern.
Varicose veins affect different veins: from the small blood vessels of the skin to the large veins of the skin
The symptoms of other types of varicose veins largely depend on the underlying cause of the disease. Often, patients do not complain about anything, and the doctor identifies the problem only during the examination. This happens, for example, with varicose veins of the sublingual veins.
In some cases, as with varicose veins of the esophagus or stomach, the pathology immediately manifests itself as a life-threatening complication - bleeding.
Classification of vein diseases
In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation made up of the initial letters of the main sections of the classification:
- C — clinic (clinical changes);
- E — etiology (origin of the disease);
- A - anatomy (anatomical localization of varicose veins);
- P - pathogenesis (mechanism of venous blood flow disorders).
Complications of varicose veins on the legs
Typically, varicose veins themselves are not life-threatening. But sometimes the disease can cause complications.
Thrombophlebitis- inflammation of the vein walls, which is accompanied by the formation of a thrombus (blood clot) that closes the lumen of the vessel. It manifests as swelling and redness along the affected vein. The patient feels pain, the skin in the affected area becomes red and hot to the touch.
Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue along a thrombosed vein.
Venous trophic ulcer- open skin and soft tissue defect due to blood stagnation, edema and disturbed cell nutrition. Ulcers occur on the legs and ankles near the area of varicose veins. In the lower parts of the legs, the swelling is more pronounced, which means that the tissues are more compressed than in other areas. Ulcers take a long time to heal, and often contain bacteria that increase inflammation.
Trophic ulcers heal very poorly due to disturbed circulation and tissue nutrition
Bleeding- occurs when a vein bursts, dilated due to varicose veins. In the later stages of the disease, the skin over such veins is very thin and dry - a minor injury is enough to damage the integrity of the vessels and cause bleeding. Spontaneous vein rupture sometimes occurs in the area of enlarged nodes.
Diagnosis of varicose veins of the legs
A phlebologist deals with the diagnosis, treatment and prevention of vein diseases. The doctor makes a diagnosis based on the patient's complaints, examination and instrumental studies. If the symptoms of varicose veins are pronounced, tests are usually not prescribed: a doctor's examination is sufficient.
The doctor can prescribe laboratory tests in preparation for the operation or to rule out accompanying diseases that affect the condition of the blood vessels.
One of these diseases is diabetes mellitus. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).
For an accurate diagnosis and determination of treatment tactics, you will need a duplex ultrasound scan - the gold standard for diagnosing vascular conditions. The method allows you to assess the structure, function, patency of superficial and deep veins, valve consistency, and also determine the direction of blood flow.
If the secondary nature of varicose veins is suspected (it can appear after deep vein thrombosis), the doctor prescribes venography, CT or MRI venography.
Phlebography is an X-ray examination used to determine the patency of deep veins and valve function.
Computer or magnetic resonance venography is used to visualize the venous system in a three-dimensional projection and in a very high spatial resolution.
Treatment of varicose veins on the legs
The goal of treating varicose veins is to reduce or eliminate symptoms, improve the appearance of veins, and prevent complications.
The doctor chooses the treatment method depending on which blood vessels are affected and how serious the condition of the patient with varicose veins is.
Non-invasive treatments
Noninvasive treatments for varicose veins include compression therapy, drug therapy, and lifestyle changes.
Compression therapy involves wearing special socks, stockings and tights. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the appropriate hosiery.
The compression jersey compresses more in the lower legs than in the upper legs - thus pushing blood towards the heart and eliminating stagnation
Effects of compression therapy for varicose veins:
- manifestations of symptoms decrease - heaviness, fatigue in the legs, night cramps, burning or pain;
- the severity of edema decreases due to improved blood circulation;
- The healing of trophic ulcers is accelerated, because elastic compression improves blood circulation and tissue nutrition.
Drug therapy - the doctor can prescribe phlebotropic drugs. (venotropic) drugs.
The main groups of phlebotropic drugs used for varicose veins:
- angioprotectors: improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the likelihood of blood clots;
- antithrombotic agents: reduce the risk of the formation of dangerous blood clots (thrombi) in the lumen of blood vessels and accelerate the dissolution of existing ones;
- bioflavonoids: natural plant compounds that improve venous tone and reduce venous congestion.
Lifestyle changes for varicose veins significantly slow down the development of the disease, and in combination with other recommendations of the doctor, it helps to stop the pathological process.
Important directions in changing the lifestyle of patients with varicose veins:
- moderate intensity exercises: walking, swimming, water aerobics, leg exercises, yoga. Strengthening the muscles will help normalize blood circulation in the vessels, relieve venous stagnation and edema;
- weight control: thanks to the normalization of body weight, the load on the blood vessels is reduced and the return of blood through the veins to the heart is facilitated;
- giving up bad habits: nicotine and alcohol damage the inner walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of the veins and the function of the valves.
Invasive methods for the treatment of varicose veins
Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure using a special sclerosing solution (sclerosant). The solution is injected into the problem vein through a thin needle, which causes its sclerosis - "sticking". The vein is disconnected from the blood stream and over time becomes invisible, its function is taken over by neighboring veins. Sclerotherapy is performed without hospitalization - after the procedure the patient can go home.
The sclerotherapy procedure lasts from 5 to 30 minutes, depending on how many varicose veins need to be filled with sclerosant and how big they are.
Endovenous laser thermoobliteration (EVLO). A catheter with a laser light guide is inserted into the vessel through a small incision. The thermal energy of the laser heats up the vein and it becomes obliterated - "sealed". After a few months, the vessel is replaced by connective tissue and disappears. The procedure is performed on an outpatient basis.
Radiofrequency vein obliteration (RFO) is the effect of high-frequency current on the inner surface of blood vessels. By micropuncture, a catheter is inserted into the vein, which is connected to a device that generates radiofrequency pulses. Inside the vessel, the radio wave is converted into heat energy, which "seals" the vein.
With EVLO, the vein is briefly exposed to high temperature, with RFO, the temperature is lower, but the session is longer. Both procedures are effective and safe.
NTNT obliteration, or non-thermal non-tumescent methods:
- vein obliteration using cyanoacrylate glue;
- mechanochemical obliteration, in which mechanical and chemical effects occur simultaneously on the vessel.
NTNT obliteration is the most modern, low-traumatic method of treating varicose veins with a short rehabilitation period.
Phlebectomy is the removal of saphenous veins that are affected by varicose veins. It can be performed as a stand-alone operation or in combination with other techniques. Varicose veins are removed under local anesthesia through small punctures.
Prevention of varicose veins on the legs
You can prevent the development of varicose veins if you follow simple prevention rules in your daily life.
A combination of provoking factors - sitting for a long time with crossed legs, wearing uncomfortable shoes - increases the risk of varicose veins on the legs.
Prevention of varicose veins - what you need to know:
- moderate physical activity (walking, swimming, leg exercises) and resting with the legs raised improves the free movement of blood through the blood vessels and helps to avoid stagnation in the veins;
- rational nutrition and weight normalization lead to strengthening of blood vessels;
- wearing loose clothing that does not restrict movement helps improve blood circulation;
- a cold shower in the warm season helps keep the veins in tone;
- comfortable shoes with a low heel (no more than 3 cm) make it possible to avoid improper foot loading and blood flow disorders;
- A reasonable approach to visits to saunas and steam baths allows you to maintain normal blood flow (long-term thermal procedures greatly expand the veins, so blood flow slows down).