Varicose veins are one of the most common diseases in industrialized countries. It affects only the human population and is absent in animals altogether.
It is believed that the formation of the disease is associated with being in an upright position. It is estimated that 10-40% of the world's population has varicose veins.
The disease is more common in women, and its prevalence increases with age. Other risk factors include lifestyle, work, pregnancy, heredity and geographic influences, heart disease, obesity, hypertension and diabetes.
Any vein in the body can be affected, but the disease is most common in the lower extremities due to high pressure when walking, standing or sitting.
If varicose veins are your problem, you may also experience the typical spider veins, swollen, painful legs, feeling tired and weak in the lower extremities.
Varicose veins are often accompanied by inflammation of the veins (varicothrombophlebitis). The skin may be dry, flaky, and often have pigment spots on its surface. In later stages of the disease, surgery is necessary.
Early diagnosis of varicose veins is very important because... With the help of timely prevention, you can successfully prevent the development of the disease, including tissue changes that accompany the disease and are irreversible.
In patients who do not show any signs of the disease, it can be diagnosed from age 18.
Diagnosis is extremely valuable for women before pregnancy. Removal of superficial veins improves blood flow to the fetus, thereby avoiding unnecessary complications during pregnancy, such as the common development of superficial phlebitis.
Another benefit of early diagnosis is proper treatment and prevention with compression stockings. Patients who received timely treatment and proper prevention are not at risk of developing venous ulcers with subsequent cancer.
Varicose veins in the legs are usually noticed by a person himself. He comes to the doctor with a specific problem. The main reason for this, especially among women, is unsatisfactory cosmetic effect.
In addition, some patients turn to the doctor with an already progressive disease of the venous system and its complications.
The difficulty does not always correspond to the size of the varicose veins. The phlebologist can decide on the choice of support measures or appropriate treatment only on the basis of a detailed examination.
An examination by a specialist, as a rule, has several interconnected or intertwined parts:
The doctor will ask you many questions before and during the examination. In addition to what brought you to him, he will be interested in the fact when the problems arose and how they developed, he will also ask about the presence of venous and vascular disease in your entire family. Your work, personal and social life, any allergies, medications and any previous illnesses are also important.
A thorough history does not mean asking unnecessary questions. According to old medical traditions, a properly completed history is halfway to diagnosis. This is also true in the case of varicose veins.
At the same time, some seemingly obvious symptoms are not so important. Sometimes when studying a disease, seemingly unrelated information (for example, the phase of the menstrual cycle) plays a role. Therefore, answer questions openly and honestly.
What does the history include:
During the examination, the doctor notes the general condition of the patient’s body. The function of the vascular system, i.e., the heart, arteries and veins, is indicated by basic procedures - examination of vision, hearing, palpation and percussion.
The actual varicose veins are examined while standing when they are filled with blood. The doctor checks their number and size using vision. At the same time, palpation of the legs may be performed. Usually, at this time, the patient stands on a hill so that his limbs are easily accessible to the doctor’s eyes.
In a standing position with bare limbs - front and back. Provided there is sufficient lighting.
To diagnose the extent of damage to the venous system, if necessary, special tests can be used based on gradual compression of the limbs and monitoring the rate of filling of the veins after the compression is released. Brief exercises consisting of raising your toes or doing a few squats will also give you an idea of the condition and functionality of the veins.
Functional tests were introduced into practice at the beginning of the last century. They were carried out to assess the feasibility of surgical treatment. Nowadays they have lost their importance and are used only as an auxiliary survey.
Among the functional tests, the following should be noted:
The main research methods include the so-called. duplex ultrasonography. The method is used to display the venous system and blood flow in it. It provides accurate information about the functionality of the veins, their possible dilation and the presence of reflux.
In addition to the superficial venous system, the deep system and its lesions (congenital malformations, postthrombophlebitic changes) are also displayed.
For diseases of the venous system, such research approaches as:
Non-invasive examination allows you to image vascular structures and, at the same time, assess the direction and speed of blood flow.
Duplex and triplex color sonography reports the status of the venous system with a high degree of reliability; displays an audible signal and a graphical record of blood flow.
Mutually combining pieces of information from each mode allows you to create more complex morphological and functional images. Sonography assesses the degree of development of varicose veins. In a standing position, the function of venous valves and perforators is assessed.
This is a modern diagnostic technique that combines ultrasound and Doppler. The advantage of this method is the ability to diagnose vascular diseases at a very early stage of development.
Duplex scanning is a three-dimensional ultrasound method that has a high degree of information content, which is important for determining the cause of the disease and making a diagnosis.
Of all examination methods, this process is completely safe and painless, as well as the absence of contraindications and side effects. To receive a diagnostic procedure, the patient does not need special preparation. This research allows:
Rheovasography of the extremities is a non-invasive examination of the blood supply to organs and tissues, according to the results of which circulation disorders and changes in the venous walls are determined.
Phlebography is a study that displays the condition and capacity of the superficial and deep venous system.
It is highly reliable, easy to carry out and does not burden the patient, therefore it is one of the main methods for diagnosing varicose veins and the venous system as a whole.
Phlebography does not require hospitalization and is performed on an outpatient basis.
Paid services for diagnosing varicose veins are offered by some clinics, including:
Free diagnostics of varicose veins can be carried out in some clinics:
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.
Duplex scanning remains one of the most informative methods for examining blood flow and the condition of veins and vessels. Some do not distinguish it from ultrasound or Doppler sonography, but all three of these diagnostic methods have a number of differences.
Painless and safe duplex scanning allows you to identify vascular and venous diseases in the early stages, as well as identify the cause of their occurrence.
Ultrasound scanning is a modern method of examining the condition of blood vessels
Duplex scanning is also called ultrasonic duplex scanning. This method combines ultrasound and Doppler ultrasound, making it one of the most informative in the study of veins and vessels.
Not everyone knows how duplex scanning of the veins of the lower extremities is performed, what it is and where it can be done. For the patient, in terms of sensations and external features of the procedure, there is no difference between ultrasound, ultrasound and Doppler ultrasound.
Conventional ultrasound will not assess the condition of the vessels, since it is not designed to examine moving blood flow. Ultrasound examines only motionless organs. Ultrasound scanning uses the ability of an ultrasonic wave to coincide with the direction of moving particles, namely blood units in the bloodstream. This allows you to evaluate the movement of blood through the vessels and veins.
The capabilities of ultrasound scanning are used in cardiology, phlebology, and neurology. Using ultrasound, you can evaluate not only the patency of blood vessels, but also the speed of blood flow. Unlike Doppler ultrasound, ultrasound allows not only to identify plaques and blood clots in blood vessels, but also to identify the cause of their occurrence and determine the cause of relapse of the disease.
Using ultrasound, you can see even small atherosclerotic plaques and blood clots in the lumen of blood vessels.
Ultrasound ultrasound shows blood flow online, that is, at the moment. The picture is displayed in light and allows you to determine the filling capacity of the vessel and its permeability. If Doppler ultrasound can only determine that the patency is impaired, ultrasound determines why it is impaired: whether there is an obstruction to blood flow, whether the lumen is narrowed, how much it is narrowed and what caused it.
Duplex scanning helps not only to make a diagnosis, but also to determine the stage of the disease. Duplex scanning is prescribed both for certain complaints and as a preventative measure for representatives of “sedentary” and “standing” professions: waiters, hairdressers, office workers.
Ultrasound scanning is a safe, non-invasive and informative diagnostic method
Duplex scanning has many advantages. Since the method is based on ultrasound, it is considered safe for pregnant women.
The ease of implementation and the lack of complex preparation make ultrasonic scanning popular and affordable. The price of the examination depends on the medical center, but compared to MRI, the cost is significantly lower.
No particular disadvantages of this method were identified. One can note the difficulty of carrying out such a procedure in villages where there is a lack of equipment, as well as the cost of the examination, which, however, remains lower than the cost of CT and MRI.
As a rule, duplex scanning of the veins of the lower extremities is prescribed by a doctor (therapist, phlebologist). As a preventive measure, this procedure is not performed often, since patients rarely go to doctors in the absence of complaints.
Using ultrasound, you can identify many diseases: varicose veins, atherosclerosis, thrombosis, endarteritis. The earlier the disease is detected, the higher the effectiveness of treatment.
It is necessary to consult a doctor for examination when the first symptoms of venous and vascular diseases appear:
There are no absolute contraindications for ultrasound scanning, but in some cases the examination may be difficult. For example, if the patient is highly obese or has painful ulcers that prevent the sensor from being touched.
Ultrasound scanning procedure of the veins of the lower extremities
Preparation before the ultrasound procedure is required only when examining internal organs. In this case, you need to adhere to a certain diet for 2-3 days and take anti-flatulence medications.
When duplex scanning of the veins of the lower extremities, no preparation is required. The patient can lead his usual lifestyle and not change his diet. All that is required of him is to come with a coupon at the appointed time to the ultrasound room.
The procedure itself is quite simple and does not require complex manipulations from the patient:
As a rule, the entire procedure takes no more than half an hour. During the examination, the doctor records certain indicators and enters them into the protocol. After the procedure is completed, the gel is removed from the skin with napkins, the patient receives the result in his hands, which he will need to show to his doctor.
The examination allows you to see blood clots and determine their location
During the examination, many indicators are assessed. A doctor should decipher the result.
The ultrasound specialist only assesses the condition of the vessels and blood flow, records the data, but the diagnosis is made taking into account the entire examination and all indicators:
More information about ultrasonic testing can be found in the video:
As a result of ultrasound scanning, it is possible to identify such a dangerous disease as atherosclerosis. With this pathology, cholesterol plaques block the lumen of blood vessels and veins, arteries, disrupting normal blood flow. Organs and tissues begin to suffer from oxygen starvation. Plaques in vital arteries can be fatal.
Ultrasound scanning is also often used to examine varicose veins. Varicose veins cause the vein walls to bulge. In the last stages of this disease, trophic ulcers form, the skin becomes abnormally black, and the pain in the legs becomes very severe.
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According to modern standards for diagnosing varicose veins , in the phlebology center of Dr. Savinov, an ultrasound scan of the veins of the lower extremities is mandatory when first visiting a doctor.
Our center diagnoses varicose veins, as well as diseases such as thrombophlebitis, deep vein thrombosis, trophic ulcers, lymphostasis of the lower extremities and others.
At Dr. Savinov’s phlebology center, ultrasound diagnostics are performed only by highly qualified doctors who are recognized as one of the best ultrasound specialists and have extensive experience in diagnosing venous diseases.
Ultrasound diagnostics doctor, ultrasound of veins and arteries. He completed his specialization with the chief specialist of the Ministry of Health in vascular ultrasound.
Surgeon – phlebologist, specialist in diabetes mellitus and diabetic foot.
Ultrasound diagnostics doctor of the highest category, one of the best ultrasound specialists in Crimea.
Specialization: Ultrasound of vessels and veins of the lower extremities, arteries, heart, abdominal organs, musculoskeletal system, etc.
It is very important that our phlebologist surgeons independently perform ultrasound of the veins on patients undergoing surgery.
Therefore, all patients undergo double control by an ultrasound specialist and a phlebologist surgeon. This allows you to avoid diagnostic errors and choose the most effective and safe method of treating varicose veins. Timely diagnosis of veins will allow you to avoid the occurrence of the disease or detect it at an early stage. Surgical interventions are performed strictly under ultrasound guidance.
A consultation with a phlebologist consists of several parts. At the first visit to the center, the patient undergoes an examination by a doctor and an ultrasound examination. Depending on the expected diagnosis, the doctor will prescribe an ultrasound scan of the veins or arteries of both lower extremities.
Moreover, the attending physician takes part in the examination of the patient. Such an integrated approach to diagnosing the veins of the lower extremities makes it possible to more accurately determine the condition of the veins and make the correct diagnosis.
Modern diagnostics of varicose veins allows not only to make a correct diagnosis already at the earliest stages of the disease, but even to predict the possibility of developing varicose veins in the legs in practically healthy people. Also, new diagnostic methods make it possible to correctly choose the most effective and safe method of treating varicose veins for each individual patient.
You can also contact our clinic if you need treatment for thrombophlebitis of the lower extremities.
You can find out the cost of examining varicose veins in the legs here.
You can make an appointment with a phlebologist by filling out a special form, or call +7 978 731 21 01 (Crimea, Simferopol).
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.
Varicose veins are a disease accompanied by thinning of the venous wall, an increase in the lumen of the veins and the formation of aneurysm-like nodular dilations. Usually, when talking about varicose veins, they mean an independent disease - varicose veins of the lower extremities. Varicose veins are manifested by a feeling of heaviness in the legs and their fatigue, swelling of the feet and legs, night cramps in the legs, visual subcutaneous dilation of the veins with the formation of venous nodes. The course of varicose veins can be complicated by phlebitis, thrombophlebitis, the development of chronic venous insufficiency and the formation of trophic ulcers. The main way to diagnose varicose veins and its complications is ultrasound.
Varicose veins (varicose veins) is a pathology of veins, manifested in their expansion, tortuousness, and destruction of the valve apparatus. The initial manifestations are the formation of spider veins, swelling of the saphenous veins, the formation of nodes, painful veins, and heaviness in the legs. As the disease progresses, signs of chronic venous circulation insufficiency appear: swelling of the feet and legs, cramps in the calf muscles, trophic ulcers, thrombophlebitis, ruptures of varicose veins.
Under certain conditions (certain diseases, congenital pathology), not only the veins of the lower extremities can expand. Thus, portal hypertension can cause dilation of the esophageal veins. With varicocele, varicose veins of the spermatic cord are detected, with hemorrhoids - dilation of the veins in the anus and lower part of the rectum. Regardless of the location of the process, there is a hereditary predisposition to the development of varicose veins, associated with congenital weakness of the vascular wall and insufficiency of the venous valves.
Separate articles are devoted to diseases accompanied by varicose veins in various areas of the human body, with the exception of the lower extremities. In this article we will talk about an independent disease - varicose veins of the lower extremities.
Varicose veins are a disease accompanied by dilation of superficial veins, incompetence of venous valves, the formation of subcutaneous nodes and impaired blood flow in the lower extremities. According to various studies in the field of phlebology, varicose veins affect from 30 to 40% of women and from 10 to 20% of men over the age of 18 years.
The veins of the lower extremities form a branched network, which consists of saphenous and deep veins, interconnected by perforating (communicant) veins. Through superficial veins, blood flows out from the subcutaneous tissue and skin, through deep veins - from other tissues. Communicating vessels serve to equalize the pressure between the deep and superficial veins. Blood normally flows through them only in one direction: from the superficial veins to the deep ones.
The muscle layer of the venous wall is weakly expressed and cannot force the blood to move upward. Blood flow from the periphery to the center is carried out due to residual arterial pressure and the pressure of the tendons located next to the vessels. The most important role is played by the so-called muscle pump. During physical activity, the muscles contract and the blood is squeezed upward because the downward movement is prevented by the venous valves. Maintaining normal blood circulation and constant venous pressure is influenced by venous tone. The pressure in the veins is regulated by the vasomotor center located in the brain.
Valve insufficiency and weakness of the vascular wall lead to the fact that blood, under the influence of a muscle pump, begins to flow not only up, but also down, putting excess pressure on the walls of blood vessels, leading to dilation of the veins, the formation of nodes and the progression of valvular insufficiency. The blood flow through the communicating veins is disrupted. Reflux of blood from deep vessels to superficial vessels leads to a further increase in pressure in the superficial veins. Nerves located in the walls of the veins send signals to the vasomotor center, which gives the command to increase venous tone. The veins cannot cope with the increased load; they gradually expand, lengthen, and become tortuous. Increased pressure leads to atrophy of the muscle fibers of the venous wall and death of the nerves involved in the regulation of venous tone.
Varicose veins are a polyetiological disease. There are several factors that increase the risk of developing varicose veins:
There are several classifications of varicose veins. This diversity is due to the polyetiology of the disease and the many variants of the course of varicose veins.
Russian phlebologists widely use a staged classification of varicose veins, a variant of which is the classification of V. S. Savelyev:
The modern Russian classification, proposed in 2000, reflects the degree of chronic venous insufficiency, the form of varicose veins and complications caused by varicose veins.
The following forms of varicose veins are distinguished:
There is a recognized international classification of varicose veins, used by doctors in many countries around the world:
Clinical manifestations of the disease depend on the stage of varicose veins. Some patients, even before visual signs of the disease appear, complain of heaviness in the legs, increased fatigue, and local pain in the lower legs. Telangiectasia may occur. There are no signs of venous outflow impairment. Often the disease in the compensation stage is asymptomatic, and patients do not seek medical attention. A physical examination may reveal local varicose veins, most often in the upper third of the leg. Dilated veins are soft, collapse well, the skin over them is not changed.
Patients with varicose veins in the subcompensation stage complain of transient pain and swelling that occurs during prolonged stay in an upright position and disappears when lying down. Physically (especially in the afternoon), pastiness or slight swelling in the ankle area may be detected.
Patients with varicose veins in the stage of decompensation complain of constant heaviness in the legs, dull pain, increased fatigue, and night cramps. Skin itching, more pronounced in the evening, is a harbinger of trophic disorders. An external examination reveals pronounced varicose veins and a global disturbance of venous hemodynamics. Deposition of a large volume of blood in the affected limbs in some cases can lead to dizziness and fainting due to a drop in blood pressure.
By palpation, dilated, tense, veins of a tight-elastic consistency are determined. The walls of the affected veins are fused to the skin. Local depressions in the area of adhesions indicate previous periphlebitis. Hyperpigmentation of the skin and foci of cyanosis are visually detected. The subcutaneous tissue in areas of hyperpigmentation is thickened. The skin is rough, dry, and cannot be folded. Dyshidrosis is noted (more often - anhidrosis, less often - hyperhidrosis). Trophic disorders especially often appear on the anterior-inner surface of the leg in the lower third. In the altered areas, eczema develops, against which trophic ulcers subsequently form.
Making a diagnosis is not difficult. To assess the severity of hemodynamic disorders, duplex angioscanning and ultrasound scanning of the veins of the lower extremities are used. X-ray, radionuclide research methods and rheovasography of the lower extremities can be used.
Three main methods are used in the treatment of patients with varicose veins:
Conservative therapy includes general recommendations (normalization of motor activity, reduction of static load), physical therapy, use of elastic compression products (compression hosiery, elastic bandages), treatment with phlebotonics (diosmin + hesperidin, horse chestnut extract). Conservative therapy cannot lead to a complete cure and restore already dilated veins. It is used as a prophylactic agent during preparation for surgery and when surgical treatment of varicose veins is impossible.
With this treatment method, a special drug is injected into a dilated vein. The doctor injects elastic foam into the vein through a syringe, which fills the affected vessel and causes it to spasm. The patient is then put on a compression stocking to keep the vein in a collapsed state. After 3 days, the walls of the vein stick together. The patient wears the stocking for 1-1.5 months until dense adhesions form. Indications for compression sclerotherapy are varicose veins, not complicated by reflux from deep vessels to superficial ones through communicating veins. In the presence of such pathological discharge, the effectiveness of compression sclerotherapy is sharply reduced.
The main treatment method for varicose veins complicated by reflux through the communicating veins is surgery. Many surgical techniques are used to treat varicose veins, including microsurgical techniques, radiofrequency and laser coagulation of the affected veins.
In the initial stage of varicose veins, photocoagulation or removal of spider veins with a laser is performed. In case of severe varicose veins, phlebectomy is indicated - removal of altered veins. Currently, this operation is increasingly performed using a less invasive technique - miniphlebectomy. In cases where varicose veins are complicated by thrombosis of the vein along its entire length and infection, the Troyanov-Trendelenburg operation is indicated.
An important preventive role is played by the formation of correct behavioral stereotypes (lying is better than sitting and walking is better than standing). If you have to stand or sit for a long time, you need to periodically strain the muscles of your legs and give your legs an elevated or horizontal position. It is useful to engage in certain sports (swimming, cycling). During pregnancy and during heavy work, it is recommended to use elastic compression products. When the first signs of varicose veins appear, you should contact a phlebologist.