Varicose veins (varicose veins) is a disease in which the superficial veins are enlarged or swollen. The disease in most cases occurs in people over 30 years of age. In the vast majority of cases, it is observed in the lower extremities. Varicose veins are characterized by an expansion of the lumen of the veins with a simultaneous change in their wall. The saphenous veins are well contoured, the direction of their course becomes "serpentine". The greater saphenous vein is usually affected, less frequently the small saphenous vein, and even less often its saphenous anastomoses.
Causes of varicose veins
The theories proposed to explain the causes and mechanisms of the onset of the disease can be reduced to three groups.
Theories of the first group explain the origin of varicose veins by the anatomical characteristics of the location and structure of these vessels in the lower extremities. The veins have valves that prevent the centrifugal flow of blood and therefore its excessive flow from the subcutaneous to the deep veins of the leg. With insufficiency of valves in the saphenous veins, more blood is deposited, which leads to their expansion.
Theories of the second group in the development of varicose veins attach importance to the stagnation of blood in the pelvis during pregnancy, constipation, the consequences of inflammatory processes, and also during prolonged stay in the legs.
Theories of the third group, which explain the origin of varicose veins by a constitutional predisposition, weakness of the mesenchyme, are the least well-founded.
With varicose veins, due to various reasons, their walls change, they become thinner, due to which the increased pressure causes the walls to bulge. It first manifests itself in the form of nodules, and at the same time, areas of compaction resulting from excessive growth of connective tissue are also noted. Mechanical factors only contribute to the development of the pathological process in the veins, but are by no means the main point of the pathogenesis, etiology and causes of varicose veins of the lower extremities.
Symptoms of varicose veins
With the dilation of the veins, patients often experience a feeling of fullness and heaviness in the lower extremities. Sometimes there is a short-term convulsive nature of the pain. There is often swelling. The sensation of fullness and heaviness in the extremities increases at night, since the edema usually increases at this time. Itching appears, there are often scratches on the legs. In the later stages of the disease, ulcers form, usually located in the lower third of the lower leg on its inner side.
The main objective symptom of the disease is visible varicose veins. Examination of the patient to identify this symptom is carried out in a standing position. At the same time, the dilated saphenous veins are clearly visible; in the lower part of the leg they appear more prominent, more convoluted; in the thigh, the veins are usually dilated only along the main vascular trunk. Sometimes there is a varicose vein in the thigh almost at the confluence of the greater saphenous vein with the femoral vein. Such a node may be mistaken for a femoral hernia, but the softness of the node, its rapid refilling with blood after the examiner's hand is removed, and the presence of dilated veins in the lower leg provide a basis for making the correct diagnosis.
There are a series of symptoms that indicate the presence of expansion of the venous trunk of the great saphenous vein. These include a symptom in which the patient is placed in a horizontal position, the leg is given a raised position. Carefully stroking the leg from the periphery to the center, the subcutaneous venous system is emptied, the place where the greater saphenous vein empties into the femoral vein is firmly pressed with a finger, and, holding the finger, the patient is transferred to a standing positionposition. If the filling of the veins occurs only after the removal of the finger, then this is a positive symptom. In such cases, the anastomoses between the network of superficial and deep veins are poorly expressed, and the operation can have a positive effect. If, in a vertical position in a patient, the veins on the periphery begin to slowly fill, this indicates a significant development of anastomosis - a negative symptom. In this case, the vein ligation operation will not be successful.
The Delbe-Perthes symptom indicates how pronounced the emptying of the saphenous veins is in the deep ones through the anastomoses. An elastic bandage is applied to the patient in a standing position on the edge of the middle and lower third of the thigh, then he is offered to walk a little. If the tension of the dilated veins decreases significantly, this indicates the presence of developed anastomoses between the superficial and deep veins.
Other symptoms of varicose veins include swelling, eczematous skin changes, and ulcers. The swelling is different: from a slight pastiness to a pronounced edema, when the skin loses its usual pattern and looks shiny, the circumference of the lower leg increases noticeably. Of the eczematous manifestations, dryness, peeling, and eventually eczematous rashes are noted. The skin of the lower leg is often affected. These changes occur as a result of trophic disturbances.
Prevention and treatment of varicose veins
Prevention of varicose veins is reduced to a change of profession, if it is associated with standing for a long time, taking measures to defecate regularly, bandaging the legs with an elastic bandage or wearing an elastic stocking. Leg binding or stocking should be done while lying down. For several minutes, the leg is held in an elevated position, and only after making sure that the veins are empty is a bandage or stocking put on. The bandage begins to be applied from the bottom and continues upwards, avoiding any stretching and compression that causes stagnation.
There are a number of methods for surgical treatment. Ligation of the great saphenous vein in Scarpov's triangle where it empties into the femoral vein is palliative. After this operation, relapses are often observed. Therefore, it is used only in combination with other surgical interventions.
During the Bebcock operation, a skin incision is made at the lower end of the dilated great saphenous vein, separated, and tied off. Above the bandage, it is opened and a long-belly catheter is inserted into the lumen. A second small incision is made in the skin above the upper end of the dilated vein. Its central end is tied and crossed, below the intersection the vein is tied tightly over the probe, after which it is carefully removed through the lower incision. At the same time, the probe removes a vein that has been turned inside out by the intima. The disadvantage of this method is that hematomas form at the site of torn anastomoses.
During the Madelung operation, the dilated veins are completely removed. Of all the operations, this intervention is the most radical, giving the best long-term results.
Complications of varicose veins
The most common and most difficult to treat complications of varicose veins are varicose ulcers. These ulcers usually occur in older people. They are located on the inner, less often the outer, surface of the lower third of the lower leg. These ulcers are the result of chronic tissue malnutrition. They are usually deep, have a foul-smelling, necrotic fundus of discharge, and high, calloused margins. Ulcers can reach large sizes, surround the entire lower leg. The surrounding skin is pigmented, sometimes inflamed, with eczematous irritation.
Varicose ulcers must be differentiated from syphilitic ulcers. Syphilitic ulcers are usually located in the upper third of the lower leg, more often on the anterior surface. Also, with syphilitic ulcers, other signs of syphilis can be detected. Tuberculosis of the skin (lupus) is most common on the face, much less frequently on the extremities. Lupus begins as isolated nodules that later ulcerate; in the future, deeper tissue damage occurs, sometimes with the formation of soft scars that strain neighboring tissues.
Since varicose ulcers develop against the background of circulatory and trophic disorders, their treatment must be persistent and prolonged. The constant position of the patient with the leg raised in most cases leads to rapid improvement. A bandage with a 0. 5% potassium permanganate solution, with penicillin ointment or balsamic liniment, should be put on the ulcer. When the wound is cleaned and the swelling around it subsides, it is recommended to remove the veins. Only a radical operation to remove the altered veins eliminates the risk of recurrence of ulcers.
As the disease progresses and the varicose nodes increase, their walls and the skin welded to them become thinner. As a result of this, usually when walking (when the nodes are especially tense), one of the nodes can rupture and venous bleeding can occur. Although these bleeds can be significant, they do not pose a great danger, since they stop quickly if the patient lies down and the leg is raised. In this position, negative pressure is created in the veins, they decrease and the bleeding stops. A light aseptic dressing is placed over the wound. Due to the fact that the bleeding can recur, surgery for the excision of the veins or their ligation and removal of the most thinned nodes is recommended. With bleeding from compensatory dilated veins, any operations associated with the ligation of the main trunk of the vein are categorically contraindicated.