Varicose veins are persistent and irreversible dilation and elongation of veins, resulting from gross changes in their walls, as well as insufficiency of their valve apparatus due to a genetic defect.
The predisposition of women is explained by a cyclical increase in the distensibility of the vein walls and loosening of the valves with increases in the concentration of the hormone progesterone.
The primary factors for the occurrence of varicose veins are hereditary weakness of the vascular wall.
Most often, with varicose veins, patients are bothered by a feeling of heaviness, fullness, heat and pain in the calf muscles. A characteristic feature of these signs is their appearance after prolonged standing. As a rule, the unpleasant sensations disappear completely or their intensity decreases significantly when walking and after a night's rest. An important sign of the disease is cramps in the calf muscles, usually occurring at night.
The saphenous veins expand in the form of bizarre convoluted bluish conglomerates along the lower leg and thigh.
As varicose veins develop, nutritional disorders of the skin of the lower leg develop. Initially, areas of excessive staining appear, somewhat later the subcutaneous tissue and skin thicken, the latter acquiring a characteristic “varnished” appearance. In the center of the colored area of skin, in response to minimal trauma, a small whitish area appears, reminiscent of stearin. This is the so-called white skin atrophy, followed by a trophic ulcer.
Radionuclide and radiopaque venography were previously considered the main methods of instrumental diagnosis of varicose veins, but currently they are used only when ultrasound angioscanning is unavailable.
Modern treatment for varicose veins includes surgery, sclerotherapy, compression treatment and the use of various medications.
Surgical intervention involves excision of varicose saphenous veins. Currently, the technique of such interventions has been sufficiently developed and allows one to obtain good functional and cosmetic results.
Sclerotherapy successfully complements, and in some cases (initial stages of varicose veins) replaces surgery. The procedure involves injecting a special drug into a varicose vein.
Compression treatment of varicose veins
Compression therapy is a mandatory component of any treatment for varicose veins and the most effective method of its prevention.
To carry out compression treatment, elastic bandages are most often used, which, depending on the degree of stretching, are divided into 3 classes: short (bandage elongation is no more than 70% of the original size), medium (range of increase in the original length with stretching within 70–140%) and long (140% and above) elongation. It must be indicated on the packaging of the bandage, and it is a necessary characteristic for the correct selection of the product.
It is advisable to use long-extensibility bandages in the immediate postoperative period for the purpose of hemostasis and reliable fixation of the bandage. To ensure optimal therapeutic compression, bandages of short and medium elongation are most suitable.
When using elastic leg bandaging, you should adhere to the following rules:
Most patients with varicose veins should wear an elastic band throughout the day, applying it in the morning before getting out of bed and removing it in the evening before resting at night. To treat trophic ulcers, multilayer compression bandages can be used, which are not removed for a long period of time, while bandages impregnated with medicinal substances (zinc-gelatin, zinc-oxide, etc.) are in direct contact with the affected area of the skin of the leg. Additional fixation of compression bandages is carried out using special adhesive bandages, which is especially necessary when bandaging the thigh.
Despite its high effectiveness, compression treatment with elastic bandages has obvious disadvantages - causing physical and aesthetic discomfort. Therefore, special medical socks, stockings and tights are becoming very popular. They are represented by knee socks, stockings up to the lower, middle and upper thirds of the thigh, as well as tights (including special tights for pregnant women) of four compression classes. They are made from cotton, natural rubber - elastane and synthetic rubber - elastoden. Products made from natural fibers are optimal for sensitive and damaged skin (varicose eczema, dermatitis, trophic disorders). As for synthetic fibers, their advantages are their small diameter and variety of colors, which make it possible to produce medical knitwear with high aesthetic properties.
Means for the treatment of varicose veins
Detralex is prescribed in a daily dose of 1 tablet (500 mg) 2 times a day, and after the first week of treatment a single dose of two tablets is possible. Usually during this period positive dynamics appear: night cramps, pain, a feeling of heaviness disappear, swelling decreases. It is believed that the minimum duration of the course should be at least 2 months. In severe forms of varicose veins, taking the drug can be continued for up to six months or more. An important advantage of Detralex is the possibility of its use in pregnant women.
Ginkor-Fort is taken in a daily dose of 1 capsule 2 times after meals. The course of treatment varies from 1.5–2 months or more, depending on the severity of the disease. In the vast majority of cases, the drug was well tolerated. Contraindications to its use are hyperthyroidism and therapy with MAO inhibitors.
Cyclo 3 Fort is taken for varicose veins after meals in a daily dose of 2-3 capsules. The only contraindication is intolerance to certain components of the drug.
The ease of use and relative cheapness of ointments and gels make them very popular among patients and doctors. A serious disadvantage of the uncontrolled use of topical medications is the high incidence of skin complications in the form of peeling, dermatitis and eczema caused by increased sensitivity with prolonged use of the same product.
We recommend using Cyclo 3 cream in combination with its tablet analogue, as a result of which the therapeutic effect is enhanced. The cream is applied 2-3 times a day to the calf muscles and along the varicose veins.
Essaven-gel is applied 3-4 times a day along the course of the altered veins. It is easily rubbed into the skin, and due to the evaporation of the alcohol base, an additional analgesic effect is noted.
Lyoton 1000 gel is used 3-4 times a day. When starting to use, slight skin irritation and peeling may occur in the areas where the drug is used.
Physiotherapy is widely used in the complex treatment of varicose veins. Preference is given to alternating and eddy magnetic fields, Bernard currents, and laser therapy. A good therapeutic effect can be obtained by using special devices (“Lymph-press”, “Veno-press”, etc.).
Rational organization of work and rest is necessary for all patients with varicose veins. This category of patients is not recommended for work involving prolonged standing or sitting, heavy lifting, or exposure to high temperatures. At work and at home, they need periodic rest with their legs raised at an angle of 15–20 degrees (during sleep, it is recommended to raise the foot end of the bed above the level of the heart), a balanced diet that excludes the consumption of spicy and salty foods, as well as alcohol. Body weight should be strictly controlled, since obesity leads to progression of the disease.
In conditions of elastic compression, it is allowed to engage in active sports (skiing, cycling), but optimal conditions for venous outflow and training the muscles of the lower extremities are provided by swimming.
Varicose veins are a disease characterized by abnormal functioning of the vascular valves in the legs and feet. Diagnosis of varicose veins allows you to determine the stage of the disease and select a treatment method.
Varicose veins are a disease characterized by enlarged blood vessels. At the same time, the venous walls become thinner, nodes form, and blood vessels change their shape.
Varicose veins appear as a consequence of the inability of blood vessels to cope with blood flow in the lower extremities. At the same time, the vessels become thinner, and the valves that regulate blood flow work less and less well. Thus, the disease progresses.
Varicose veins are dangerous due to complications.
The disease in the later stages can provoke the development of thrombophlebitis (inflammatory processes in the veins, the formation of blood clots), so it is important to know how to recognize the disease.
Chronic venous insufficiency (CVI) can appear with a long-term disease of varicose veins, as a consequence of thrombophlebitis, as a result of the presence of congenital anomalies in the structure of the blood vessel system. CVI has the same symptoms as varicose veins, but these are different diseases, so the pathology can only be determined by examination by a specialist. CVI can develop in the absence of visible signs and is characterized by disturbances in the functioning of the veins of the lower extremities.
Varicose veins can be identified at an early stage with constant monitoring of the body’s condition. Symptoms of the disease are:
With varicose veins, “vascular patterns” of dark red and purple colors and protruding veins appear on the skin. The skin changes its color to brown and pigmentation is observed. In the later stages of venous disease, poorly healing wounds (eczema and ulcers) may be found on the legs and feet.
If you have a genetic predisposition to this disease, it is important to know how to identify the first symptoms of the pathology in order to prevent the development of possible complications. When the first signs appear in the early stages of varicose veins, you should seek help from a specialist to undergo all the necessary diagnostic procedures. Varicose veins are treated by a phlebologist.
Both men and women are susceptible to varicose veins. There are several reasons for the development of this disease:
Varicose veins can often be observed in pregnant women. It appears due to increased load on the legs (change in body weight) and compression of the pelvic veins.
Varicose veins are a serious disease that requires immediate treatment. With varicose veins, diagnosis helps determine the extent of the spread of the pathology. Treatment is selected individually for each patient depending on the test data obtained. If a disease is suspected, the doctor may require you to undergo the following types of procedures, which include the diagnosis of varicose veins:
These diagnostic methods and tests for varicose veins allow the doctor to better understand the patient’s disease and make the correct diagnosis. The doctor will definitely prescribe a blood clotting test. This is important because the disease causes venous thrombosis.
There are various methods of treating varicose veins: surgical, sclerotherapeutic and conservative. In the latter case, doctors suggest wearing special underwear - compression hosiery (therapeutic golf and tights) as a preventive measure. This provides external support for weakened blood vessels, which, in turn, helps normalize blood flow in the legs. Thus, excess pressure on the veins of the lower extremities is eliminated, and varicose veins in the legs do not progress. Compression hosiery is selected by the doctor in each individual case, depending on the stage of varicose veins and the individual characteristics of the patient.
Drug therapy is used to control symptoms of the disease in certain conditions. In this case, the emphasis is on relieving pain, swelling, reducing the number of cramps at night, etc. However, this method of treatment is not able to prevent the progression of varicose veins. As a rule, the use of medications is included in the complex of basic treatment. Your doctor may prescribe medications as a preventive measure. At an early stage of disease of the veins of the lower extremities, it is possible to treat with medications without surgery.
Sclerotherapy for varicose veins is one of the main non-surgical treatment methods. It is characterized by the removal of dilated vessels using intravenous administration of special drugs. The treated vein “stops” working, blood moves only through healthy areas. This procedure is considered safe. Treatment depends on the stage of the disease and the individual characteristics of the patient. After a course of procedures, there is an improvement in blood flow to the lower extremities, and the symptoms of varicose veins practically disappear. IN
During therapy, it is necessary to wear compression stockings so that the treatment is more effective and the disease goes away easier.
Sclerotherapy for varicose veins is highly effective and there is no risk of severe complications. However, the treatment does not ensure complete recovery after the first therapy (like other types of procedures for problems with the veins of the legs and feet), therefore, repeated consultation and constant monitoring with a doctor may be required, a secondary use of diagnosing varicose veins in the legs.
Varicose veins require constant monitoring by specialists to avoid progression of the disease. During a long trip/air flight, people suffering from this disease must do the following:
Preventive measures for varicose veins include long walks in the fresh air, performing simple physical exercises, and reducing the load on the legs during the day. These measures are designed to improve blood circulation in the lower extremities and increase blood flow in the legs. If you have varicose veins, it is undesirable to sunbathe for a long time, visit a bathhouse, sauna, or take a hot bath.
Varicose veins are a visible, superficial reflection of deep problems that involve disruption of the direction of blood flow through the veins. The basis for the disruption of blood flow through the veins is a change in the normal direction of blood flow to the opposite, which leads to congestion of the veins. Mild forms of varicose veins are only cosmetic in nature, contributing to the appearance of a subcutaneous network of dilated and tortuous venous vessels. More serious forms of varicose veins can lead to numerous systemic disorders and even loss of life or limb.
Most patients with varicose veins experience limb pain, cramps, fatigue, heaviness, throbbing and burning. If varicose veins exist for a long time, they can damage the skin and soft tissue, causing discoloration, skin diseases, non-healing ulcers and even the development of cancerous tumors.
The trigger point for the development of vein dilation is an increase in pressure inside their lumen. The veins in the legs are most often affected. This is because these veins are subject to strong hydrostatic pressure when a person is in an upright position. There are also other reasons associated with impaired outflow through the veins, for example, when a blood clot forms in the deep veins or when a vein is compressed from the outside.
Consider the development of varicose veins on the legs. Veins in the legs are divided into three types: deep, superficial and connecting. The deep veins of the legs are located inside the muscle sheath and can withstand pressure of up to 5 atmospheres. Superficial veins are located subcutaneously and are easily stretched. The connecting veins run from the superficial to the deep veins. All leg veins have valves. The valves consist of two leaflets that close and prevent blood from passing through when the pressure in the veins increases. Thanks to the valves, blood moves only in one direction - from the periphery to the center, from the bottom up in the legs and from the surface to the depths. When the pressure inside the superficial vein increases, it stretches. The increase in pressure may be quite insignificant if a person has a predisposition to varicose veins. When the pressure in the veins of the legs increases, the internal lumen expands, the valve flaps do not reach each other and cannot ensure a tight closure, and the blood begins to flow in the opposite direction. This phenomenon is called reflux. The occurrence of reflux leads to dilation of the veins in adjacent segments and to the capture of another valve. The reaction then develops along the chain. Dilated superficial veins can store large amounts of blood. This increases the load on the connecting veins. Due to the increased load, the connecting veins dilate and valve insufficiency develops in them too. As a result, the blood, which should be pushed upward when the leg muscles contract, begins to flow through the incompetent valves of the connecting veins into the system of superficial veins, leading to their even greater expansion. A visible manifestation is the appearance of varicose veins on the legs. The development of reverse blood flow leads to a slowdown in the movement of blood through the veins and can cause thrombosis and thrombophlebitis of the superficial and deep veins.
The cause of the development of varicose veins can be any factor leading to an increase in pressure in the veins and/or to a weakening of the strength of the venous wall. Such factors may be deep vein thrombosis, pregnancy, compression of the inferior vena cava by tumors, harmful occupational factors such as prolonged standing or physical activity associated with lifting weights.
The main factors leading to the development of varicose veins are also known: female gender, excess weight, tall height, genetic predisposition.
Long-term dilated veins in the legs can cause disturbances in the blood supply to the skin and soft tissues. Poor blood supply manifests itself in tissue swelling and insufficient supply of oxygen and nutrients. Because of this, so-called trophic changes develop. The skin in the area of dilated veins becomes thicker, peels, and becomes inflamed. Often it changes color and ulcers may appear on it, which do not heal for a long time.
The most dangerous complication of varicose veins is deep vein thrombosis. Thrombosis occurs due to disruption of blood flow through the veins. The formation of a blood clot can affect a small segment, or it can affect the entire leg, exiting through the deep veins into the inferior vena cava. The most dangerous is the appearance of floating blood clots. These blood clots have a movable tip that can break off, causing pieces of the blood clot to travel to the lungs and even to the brain (if the foramen ovale is open in the heart). A blood clot entering the lungs is called pulmonary embolism, and a blood clot entering the brain is called a stroke. These are very dangerous conditions that can potentially lead to death.
Dilated veins in the legs are usually clearly visible and are easily noticed by the patient himself. However, it is impossible to judge how dangerous this condition is only by appearance. On the one hand, dilated veins in the legs, which are clearly noticeable, can only be a manifestation of a cosmetic defect; on the other hand, there are dangerous deep vein thromboses, which the patient subjectively does not notice.
Currently, the gold standard in the diagnosis of varicose veins of the legs and its complications is the ultrasound technique of duplex scanning of veins. Using this technique, the functioning of the valves of the superficial, connecting and deep veins is assessed. Violations of vein patency and blood clots are detected. A timely ultrasound examination of the veins allows one to avoid serious complications and also provides valuable information regarding treatment planning for varicose veins.
Ultrasound of the veins can be useful in the differential diagnosis of skin lesions of the lower leg, in establishing the cause of swelling of the legs (for example, associated with heart failure), with pain in the legs, which can be associated with both joint diseases and arterial circulation disorders (with obliterating atherosclerosis leg vessels).
If necessary, our clinic can perform all examinations sufficient to answer the question about the symptom with which the patient came in. For example, if no signs of pathology are detected during a vein ultrasound, the patient can have his joints or heart examined, damage to which can cause similar symptoms. That is, in any case, we can figure out the reason.
Sometimes performing a vein ultrasound may not be enough. This is due to the patient’s physique or the expected localization of disorders in a segment that is not visualized using duplex scanning. For example, in obese patients or when a blood clot is localized in the iliac or pelvic vessels. In such cases, they resort to magnetic resonance venography or x-ray examination - contrast venography.
Due to any individual characteristics of the patient’s body, as well as during the development of the disease, diagnosing the disease can be somewhat difficult.
However, in order to prescribe complete and effective treatment, diagnostic studies must be carried out in full.
One of the common reasons that makes diagnosis difficult at an early stage of disease is the lack of complaints. According to the analysis, more than 50% of patients with diseases of the cardiovascular system did not present any complaints upon initial treatment.
Disorders of the circulatory system can occur in various forms and be accompanied by a wide range of symptoms, ranging from a deterioration in general condition to local manifestations in the affected area.
Based on this, disease diagnosis includes determining:
A certain difficulty for diagnosis is the branching of the subcutaneous venous network and the presence of connections with the deep central veins.
Varicose veins are a secondary disease that develops against the background of osteochondrosis, flat feet, and neurological disorders. Therefore, a common medical mistake is to deal with the consequences, leaving the cause of their development without due attention.
The main methods for diagnosing varicose veins in phlebology are:
(the doctor conducts an examination and tries to identify the causes of the disease, analyzes complaints)
(the method helps to determine the degree of damage to the veins, the presence and localization of blood clots in the vessels, and determine their size)
(the study is carried out using a Doppler scanner operating on the principle of an ultrasound machine)
(artificial sclerosis of veins after introducing a special connection into the lumen of the vessel under continuous scanner control)
(determining the pressure of circulating blood on the vessel wall)
(fluoroscopy using contrast agents)
(detection of deviations in the radiation intensity of an organ from the normal value using thermographic recording on a special photographic film)
(method based on the use of radionuclide isotopes)
(an idea of the stage of development of lymphatic vessel disease)
(drawing a graphic copy of the human vascular system)
We will look at each method in more detail in our next articles.
The success of treatment of diseases of the veins of the lower extremities depends on timely treatment. In later stages, accompanied by the development of a full-fledged clinical picture, longer treatment will be required, which, moreover, may be ineffective.
Based on the described features, the phlebologist must provide a thorough analysis of the patient’s condition, clarify all existing complaints and conduct a complete examination of the veins using modern high-precision diagnostic tools.
The data obtained will allow the doctor to make the correct diagnosis and prescribe the necessary treatment in a timely manner.
The medical history is of great value for diagnosis and correct assessment of the patient's health status. Superficial, insufficiently careful collection of anamnesis and examination of the patient can lead to an irreparable error in the choice of treatment tactics.
The doctor must clarify when and at what age the first signs of varicose veins appeared, in which areas, and what is the dynamics of the appearance of new veins within the foot, leg and thigh. The timing of the appearance of trophic skin changes, trophic ulcers, treatment, and recurrence of clinical manifestations are recorded.
In addition, you need to find out:
It is necessary to collect in detail information about the injuries that have occurred - from soft tissue bruises to bone fractures - specifying the location, characteristics of clinical manifestations and duration of treatment.
Data on previous operations, including those on the veins of the lower extremities, are clarified. It is important to take into account the following details of the medical history: features of work activity (long periods of standing or sitting), sports activity, concomitant diseases, hormonal therapy (including contraception), features of everyday clothing (tight trousers, underwear, etc.), wearing corsets .
A complete physical examination for varicose veins in most cases provides sufficient information about the condition of the superficial, deep and communicating veins.
Correct determination of the type of pathology at the stage of examining the patient allows you to optimize diagnostic tactics and avoid the use of unnecessary examination methods. A physical examination of a patient with suspected CVI is carried out in a standing position. The examination is not limited to one limb. It must be comparative, complete and also be carried out with the patient lying down.
It is necessary to examine simultaneously both lower extremities, the anterior abdominal wall and chest wall, the lateral walls of the abdomen, and the groin areas.
The appearance of the limb is assessed: the color of the skin, the presence, localization and severity of varicose veins of the saphenous veins, telangiectasia, edema, hyperpigmentation and induration of the skin of the leg.
The locations of surgical incisions, traces of bruises, the nature of trophic changes in the skin, and traces of healed ulcers are identified. After examination in a standing position, it is necessary to examine the patient in a horizontal position. At the same time, attention is paid to changes in skin color, collapse of venous nodes, disappearance of vascular cords, and a decrease in the volume of the limb.
Following the visual inspection, you should feel the skin, determine its moisture, density, temperature at different levels of the lower limb.
At the initial stages of the development of varicose veins, careful diagnosis reveals minor varicose veins. The veins are soft to the touch, easily collapse, the skin over them is not changed. Later, with a long course and progression of the disease, when examining patients, a moderate or severe degree of dilatation of the superficial veins is found. The walls of large veins are often sclerotic and intimately fused to the skin. When the nodes empty, depressions form on the surface of the skin.
It is important to note that in people with increased body weight it is difficult to visually detect varicose veins. Often in such people, problems in the venous system are detected randomly during ultrasound scanning of blood vessels.
During the examination, it is recommended to pay attention to the estuarine section of the great saphenous vein. This area is examined in the supine and standing positions. A healthy vein can be palpated as a cord, but only in thin people.
Aneurysmal dilatations can be found in the estuarine region in patients with varicose veins. An isolated lesion of the small saphenous vein is easily diagnosed by the serpentine-tortuous dilations of the veins prominently protruding on the skin on the outer or outer posterior surface of the leg with soft, painless nodes. Sometimes they are located in the popliteal fossa and even on the back of the thigh. In some cases, the nodes form a chain running obliquely to the anterior inner surface of the thigh.
The expansion of the trunk of the small saphenous vein is more easily determined in the lower third, in its suprafascial segment. In addition, in the popliteal fossa, by palpation it is possible to determine the enlarged estuarine section of the small saphenous vein. It is examined with the patient standing with the leg slightly bent at the knee joint. If the estuarine section of the small saphenous vein is incompetent, a roll of soft-elastic consistency is determined under the skin. A healthy vein can be palpated as a cord, but only in thin people.
The appearance of varicose veins initially on the thigh, anteromedial surface of the leg, posterior surface of the upper third of the leg, in the popliteal fossa indicates a leading role in the development of the disease of high venovenous discharge. The main trunks themselves are dilated and well palpated throughout, especially in thin subjects. High venovenous discharge does not exclude the presence of incompetent perforating veins, but their pathogenetic role is small.
Over time, the differences in the manifestation of varicose veins are leveled out and doctors have to observe patients with both stem varicose veins and with pronounced perforating discharge. Some researchers link the development of varicose veins to insufficiency of the deep vein valves. Thus, if the femoral vein is incompetent, the vessels of the lower third of the thigh, the knee area and the upper third of the leg are damaged earlier. Conversely, with insufficiency of the popliteal and tibial veins, varicose veins appear in the lower third of the leg and even on the foot.
With total insufficiency of the deep vein valves, varicose veins develop everywhere. It is concluded that the localization of varicose veins corresponds to the zone of hypertension in the deep veins.
st. Petropavlovskaya, 14-D
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Dilatation of the veins of the esophagus is a rare disease, but it is of considerable importance, since it can serve as a source of development of chronic inflammatory processes, phlebitis, and sometimes ulcers; varicose veins can cause fatal profuse bleeding. Diagnosis of varicose veins may play a role in determining whether the spleen is enlarged.
Relatively recently, radiologists have become interested in the dilation of esophageal vessels. Injection of the esophagus and x-ray examination of the resulting picture clarified the issues of etiology, symptoms and diagnosis of varicose veins of the esophagus. It has been established that dilation of the esophageal veins is the result of an increase in the volume of blood flowing through the veins and the inability of the muscle and elastic fibers of the vascular wall to withstand increased venous pressure.
Obstruction of outflow from the veins of the esophagus may depend on blockage of v. portae or its branches, as well as from obstructing the outflow of blood from v. gastrica sinistra, v. gastroepiploica sinistra or, finally, from v. lienalis. When one of these veins is blocked, blood enters the v. through adjacent pathways. cava superior, bypassing v. portae, through v. gastrica sinistra, v. diaphragmatica, v. oesophagi and v. gastrica brevis, which flow into v. azygos and v. thernyazygos. When the veins of the splenic or portal vein of the esophagus are blocked, they take on the brunt of unloading venous stagnation, especially in the lower part of the esophagus, which has a rich external venous plexus and the plexus of the entire submucosal membrane, connected by a whole group of anastomoses through the muscular layer to each other, as well as with the venous plexus of the stomach and middle third of the esophagus. The veins of the middle third of the esophagus anastomose with the semi-amygos and innominate veins, with the veins of the atria, mediastinum and diaphragm. The venous network of the upper third of the esophagus flows into the thyroid and innominate veins and into the superior vena cava.
The venous network of the lower part of the esophagus is most often subject to expansion, since it is the only path that cannot be bypassed.
The clinical symptoms of varicose veins are extremely scarce. Sometimes patients note a feeling of fullness behind the sternum, an extremely tense sensation when eating hot food. Most often, varicose veins manifest as bleeding. Observation indicates that varicose veins, creating congestion in the esophagus, leads to chronic proliferative processes.
The most serious complication of esophageal varices is bleeding. After the initial bleeding, the risk of another increases significantly. In some cases, the blood loss is so great that it leads to shock. This can become fatal.
With the improvement of the technique of X-ray examination of the relief of the mucous membrane of the esophagus, the possibility of X-ray diagnosis of varicose veins has arisen. However, this is associated with significant difficulties, since even a liquid contrast mass, filling the esophagus, easily compresses the varicose nodes of the mucosa. The best condition for obtaining distinct details of the mucous membrane is, in the early period, filling the esophagus with small portions of a contrast mass, and in later periods, with the development of infiltrative congestion and sclerotic phenomena, tightly filling the esophagus with contrast masses and examining the patient in a horizontal position. To create better viscosity, the contrast mass must be well sifted and digested. Barium should be used together with white clay. The solution must be taken warm. It is advisable to rinse the esophagus with a warm soda solution before the examination to remove mucus and gray deposits, often observed on the mucous membrane.
The X-ray picture of the mucous membrane is extremely polymorphic and appears different in each image; sometimes it is extremely similar to pneumatosis of the esophagus, when the patient swallows a significant amount of air along with the barium emulsion.
It is recommended to take photographs during exhalation, i.e., when there is no suction effect of inhalation on the veins.
From the X-ray data, the following signs of varicose veins of the esophagus can be identified: 1) the shadow of the esophagus resembles a lace plexus; 2) peristalsis is sluggish; 3) filling shadows prevail in the lower third; 4) breathing affects changes in the x-ray picture.
In general, the x-ray picture is very characteristic and rarely gives rise to confusion with other diseases of the esophagus.
Vein dilation should be differentiated from pneumatosis of the esophagus, sometimes with erosive esophagitis, which can give a similar picture; however, a distinctive feature of the latter is pronounced peristalsis, at times reaching a spasm. Local or secondary esophageal contraction, which gives the picture of a “corkscrew-shaped esophagus” in the case of esophagitis, disappears with a detailed study of the picture with relaxation of the esophagus; with varicose veins, filling defects are also observed in a relaxed state.
Differential diagnosis of esophageal varices and tumors is not difficult. The main feature of the X-ray picture of varicose veins is well-defined peristalsis, and in the affected areas there is no narrowing of the lumen, which is explained by the loss of elasticity of the esophageal wall. This is clearly visible on the screen when the esophagus is tightly filled with contrast mass.
Dilatation of the veins of the esophagus is important in the diagnosis of diseases of the spleen and liver. The dilation of veins deserves special attention as a factor that causes the development of chronic inflammatory processes in the esophageal mucosa, the formation of hyperplastic growths, as well as ulcers.
The main goal of treating esophageal varices is to prevent them from destruction.
Managing portal hypertension is usually the first step to reduce the risk of bleeding. This can be achieved through the use of the following means and drugs:
Beta blockers such as propranolol to lower blood pressure.
Endoscopic sclerotherapy . Using an endoscope, medication is injected into the varicose veins to shrink them.
Endoscopic ligation of varicose veins with an elastic band.
Endoscopic varicose vein ligation and endoscopic sclerotherapy are preventative treatments that can be used if bleeding has begun. The drug octreotide (Sandostatin) can be used to lower portal vein pressure by inhibiting the flow of blood from organs that drain into it.