Varicose veins of the lower limbs are a disease of the veins in the legs, characterized by pathological dilation and deformation of the veins, and are accompanied by the occurrence of various complications.Varicose veins affect the superficial veins in the legs.
According to modern opinion, the main cause of varicose veins is a defect (congenital or acquired) in the venous valve apparatus of the lower extremities, resulting in reverse flow (reflux) of venous blood.Reflux causes venous overflow and pathological venous drainage (redirection of blood flow).
This in turn leads to clinical manifestations of chronic venous insufficiency such as leg swelling, varicose vein pain, itchy skin, and calf muscle spasms.
In advanced cases, skin pigmentation forms in the tibial area, trophic ulcers form, varicose nodules bleed, and thrombophlebitis - inflammation of varicose veins and their thrombosis.Varicose veins develop gradually.
According to European statistics, chronic venous disease is prevalent worldwide.The prevalence of varicose veins has been confirmed to vary from 2% to 60% in the adult population in different countries.Surprisingly, in African countries and the Pacific, the incidence of varicose veins in women does not exceed 6% despite multiple pregnancies.At the same time, in European countries, the incidence of varicose veins among adults reaches several dozen percent.It follows that the tendency to develop varicose veins depends on race.
The incidence rate also has a significant increasing trend.This may be due to a sedentary lifestyle, obesity and partly the prevalence of smoking.Patients in "public" hospitals are often deprived of the opportunity to receive modern diagnosis and modern treatment of varicose veins of the lower limbs.The lack of modern high-tech methods for diagnosing and treating varicose veins in the public health sector means that combined phlebectomy remains the main method of treating varicose veins in public hospitals.That said, it is a very invasive, fixed procedure that requires many incisions (and sutures) and mechanical removal of the incompetent venous trunk.
The surgery is performed under general or spinal anesthesia.World statistics show that the vast majority of patients with varicose veins can be treated surgically on an outpatient basis – without hospitalization and without spinal anesthesia and anesthesia.Conclusion - High-quality varicose vein treatment is impossible without timely diagnosis and innovative treatment techniques.
Symptoms of varicose veins in lower limbs
Symptoms (manifestations) of varicose veins are a sign that can make one suspect the disease with enough certainty.Symptoms can be subjective (in my opinion) and objective (I get it).
Subjective symptoms of varicose veins include:
- Legs feel heavy.Usually - in the calf area.This symptom is more noticeable at night.
- Calf muscle pain.The most common are aches, low-intensity pain, and sometimes discomfort.
- Pain along varicose veins.Generally speaking, it is not intense, it manifests itself more in the evening after working days.
- Leg fatigue.Fatigue is a decreased tolerance (sensitivity) to physical activity (static and dynamic).
- "Venous claudication." Venous claudication is pain in the calf muscles that worsens when walking.
- Swelling of the lower limbs in the leg and foot areas.
- Hyperpigmentation of the skin.
- There is a burning, stinging, or itching sensation along the path of the varicose vein.
- Nutritional venous ulcer of the legs.
All symptoms of varicose veins, although heterogeneous, share common characteristics:
- Symptoms may worsen when patients remain standing or sitting for long periods of time.This happens because the muscle venous pump does not work in a static position);
- Symptoms are reduced after walking, after horizontal rest, and when using elastic compression;
- Vary the intensity of the performance depending on the season of the year.Generally, symptoms worsen in the summer.
- Manifestations of the disease may intensify before or during menstruation.
All the above-mentioned symptoms are non-specific, that is, they can appear in other diseases as well.Therefore, when diagnosing varicose veins, one should rely on objective signs:
- Dilatation of intradermal and saphenous veins (telangiectasia, reticular veins).Clearly visible to the naked eye.This is a common concern for patients.The mere presence of telangiectasia (spider veins) without other signs of varicose veins is usually not dangerous.However, this is a clear reason to check.
- Saphenous varicose veins.No equipment required for easy viewing.The presence of varicose veins is a telltale 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 needed, in the second case, it is.
- Swelling of the affected limb.This is also a non-specific symptom, but in the presence of varicose veins, may lead doctors to believe that these facts are related.
- Changes in skin color and texture.With advanced varicose veins, we often encounter hyperpigmentation (the skin turns brown or blue).There may be areas of fatty skin hardening.An extreme manifestation is the appearance of venous trophic ulcers.
Risk factors for varicose veins in the legs
- Non-specific: age, female gender, obesity, genetic predisposition.
- Specific: pregnancy, taking hormonal drugs (estrogen, progesterone), menopause.
Stages of development of varicose veins
Like any chronic disease, varicose veins develop gradually.There are no clear stages yet, but we can talk about the initial (compensatory) and developmental stages of chronic venous insufficiency.There are no subjective symptoms in the early stages of varicose vein development.Varicose veins detected by visual inspection are usually not accompanied by swelling, pain, or cramping.
At this stage, the condition may remain unchanged for a long time.Maybe it will progress.In this case, the patient, accustomed to the sight of varicose veins and to the idea that varicose veins do not harm him, may not associate the appearance of pain, leg swelling, itching and night cramps with the progression of varicose veins.This, in turn, can lead to the development of varicose vein complications such as varicose inflammation (thrombophlebitis), formation of trophic venous ulcers, and varicose nodule bleeding.
In an effort to standardize the diagnosis of varicose veins and make it as accurate and understandable to doctors around the world, phlebologists use the CEAP classification.The CEAP classification takes into account clinical manifestations (C – clinical), etiology (cause of disease) (E – etiology), anatomic localization (A – anatomy), and pathogenesis (P – pathogenesis).
Often, CEAP diagnosis is supplemented by decoding (disease classification), which aids understanding by therapists, general practitioners and specialists.This approach allows physicians to quickly navigate when researching a patient's medical files.
Diagnosis of varicose veins
Modern diagnosis of varicose veins of the lower limbs poses the following tasks:
- Determine if chronic venous disease is present.Many patients who suspect they have varicose veins do not actually have varicose veins.vice versa.The phlebologist's first task is to determine whether the patient has this disease.
- Determine the type of venous disease.Doctors say it's a form of "nosology."You need to know exactly which veins are affected, how severe it is, and what it has caused or could cause.
- Determine the treatment strategy - which specific technique (or combination of techniques) should be used in this particular situation.Treatment strategies must be discussed with the patient and reflected in treatment recommendations.
- Treatment effectiveness is assessed during and after treatment is completed.
We prefer to conduct all stages of diagnosis and treatment in close contact with the patient.
We believe patients have the right to understandable information about their disease and treatments.When answering 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.
How to diagnose varicose veins
- clinical research.Includes clarification of patient's complaints, examination, and palpation (manual examination).
- Ultrasound vascular scan (venous ultrasound - dual and triple scan).
- Plethysmography.
- X-ray venography (ascending and descending).
- Radionuclide venography (radiovenography).
- Computed tomography (CT venography).
- Magnetic resonance imaging (MR-venography).
- Intravascular ultrasonography.
- Thermal imaging.
In the vast majority of cases, in order to diagnose varicose veins and develop the correct treatment strategy, clinical examination and ultrasound angiography are sufficient for the phlebologist.Meanwhile, the main instrument for the study of venous disease in the legs is ultrasound angiography - venous ultrasound.
During the study, the patient is clearly explained to the patient what exactly "his" disease is and how to combat it.
The study was performed in a standing position (or lying down if necessary) using two or three scanning modes simultaneously (B-mode, blood flow color-coding and pulsed Doppler mode).The ultrasound vascular scanning method allows you to observe the blood vessel under study and determine the direction of blood flow and its parameters (speed, type of blood flow).
Both limbs are examined, not just the "diseased" limb, and we always examine the superficial and deep veins.If necessary, patients may be prescribed other studies listed above.
Treatment of varicose veins
Specialists at leading phlebology centers use only the most modern and best methods to treat varicose veins of the lower limbs.
Today, phlebologists use the following innovative treatments:
- Thermal ablation (laser and radiofrequency).
- Non-thermal ways to treat varicose veins.
- Sclerotherapy.
- Venectomy.
- A combination of these technologies.
These methods comply with European national standards.They allow you to treat varicose veins effectively and non-invasively on an outpatient basis, without the need for hospitalization.No anesthesia or spinal anesthesia is required.It is this method that provides the best therapeutic results.