Varicose veins: what they are, symptoms, causes, stages and treatment

Varicose veins of the lower extremities are a disease of the veins of the legs, characterized by pathological expansion and deformation of venous vessels, accompanied by the development of a number of complications.Varicose veins affect the superficial veins of the legs.

According to modern opinions, the main cause of the development of varicose veins is a defect (congenital or acquired) in the valvular apparatus of the veins of the lower extremities, which leads to the development of reverse flow of venous blood (reflux).Reflux causes venous overflow and pathological venous discharge (redirection of blood flow).Which, in turn, leads to clinical manifestations of chronic venous insufficiency, such as leg swelling, pain in varicose veins, itchy skin, and cramps in the calf muscles.

In advanced cases, the formation of skin pigmentation in the shin area, the formation of trophic ulcers, bleeding from varicose nodes and thrombophlebitis, inflammation of varicose veins with their thrombosis.Varicose veins develop gradually.

According to European statistics, chronic venous diseases are widespread throughout the world.It has been proven that among the adult population of different countries, the incidence of varicose veins varies from 2% to 60%.Surprisingly, in African countries, as well as in the Pacific region, despite multiple pregnancies, the incidence of varicose veins in women does not exceed 6%.At the same time, in European countries the incidence of varicose veins among the adult population reaches tens of percent.It follows that the tendency to develop varicose veins depends on ethnic origin.

There is also a clear trend towards an increase in incidence.This may be due to the prevalence of a sedentary lifestyle, obesity and, in part, smoking.Patients in "public" hospitals are often deprived of the opportunity to receive modern diagnostics and treatment for varicose veins of the lower extremities.The lack of modern high-tech methods for the diagnosis and treatment of varicose veins in the public medical sector explains why combined phlebectomy remains the main method of varicose vein treatment in public hospitals.That is, a very traumatic stationary operation with many incisions (and sutures) and mechanical removal of the trunk of the incompetent vein.

This operation is performed under general anesthesia or spinal anesthesia.World statistics state that the vast majority of patients suffering from varicose veins can receive surgical treatment on an outpatient basis, without hospitalization and without spinal anesthesia or anesthesia.Conclusion: high-quality treatment of varicose veins is impossible without timely diagnosis and innovative treatment technologies.

Symptoms of varicose veins of the lower extremities.

The symptoms (manifestations) of varicose veins are signs that allow us to suspect the disease with sufficient certainty.Symptoms can be subjective (it seems to me) and objective (I see).

Subjective symptoms of varicose veins include:

• Feeling of heaviness in the legs.As a rule, in the calf area.This symptom is more pronounced at night.
• Pain in the calf muscles.Most of the time it is a painful, low intensity pain, sometimes a discomfort.
• Pain along varicose veins.As a general rule, it is not intense, it manifests itself more in the afternoons, after a day of work.
• Leg fatigue.Fatigue is a decrease in tolerance (susceptibility) to physical activity, both static and dynamic.
• "Venous claudication."Venous claudication is called increased pain in the calf muscles when walking.
• Swelling of the lower extremities in the legs and feet area.
• Skin hyperpigmentation.
• Burning, tingling, itching along the path of varicose veins.
• Trophic venous ulcer of the leg.

All symptoms of varicose veins, despite their heterogeneity, have common characteristics:

• Symptoms intensify when the patient stands or sits for a long time.This happens because the musculovenous pump does not work in a static position);
• symptoms decrease after walking, after resting in a horizontal position and also when elastic compressions are used;
• change the intensity of manifestation depending on the season of the year.As a general rule, symptoms intensify in summer;
• The manifestations of the disease can intensify before or during menstruation.

All of the above symptoms are nonspecific, that is, they can also appear in other diseases.Therefore, when diagnosing varicose veins, one must rely on objective signs:

• Dilated intradermal and saphenous veins (telangiectasias, reticular veins).Clearly visible to the naked eye.This is what patients usually pay attention to.The presence of only telangiectasias (spider veins) without other signs of varicose veins is generally not dangerous.However, this is a clear reason for the review.
• Saphenous varicose veins.Easily visible without equipment.The presence of varicose veins is a clear sign of varicose veins.However, ordinary people often confuse common veins visible through the skin with varicose veins.In the first case no treatment is required, in the second it is necessary.
• Swelling of the affected limb.This is also a nonspecific symptom, but in the presence of varicose veins it can lead the doctor to believe that these events are interconnected.
• Changes in skin color and texture.In advanced forms of varicose veins, we often find hyperpigmentation (the skin turns brown or bluish).There may be areas of lipodermatosclerosis.The extreme manifestation is the appearance of a venous trophic ulcer.

Risk factors for varicose veins in the legs.

• Nonspecific: age, female sex, obesity, hereditary predisposition.
• Specific: pregnancy, taking hormonal drugs (estrogens, progestogens), menopause.

Stages of development of varicose veins.

Like any chronic disease, varicose veins develop gradually.There is no clear staging, but we can talk about the initial stage (compensation) and the stage of development of chronic venous insufficiency.At the initial stage of the development of varicose veins there are no subjective manifestations.The appearance of varicose veins, detected visually, is not usually accompanied by swelling, pain or cramps.

At this stage, the disease can remain unchanged for a long time.And maybe progress.In this case, the patient, accustomed to seeing varicose veins and accustomed to the idea that they do not cause harm, cannot associate the appearance of pain, swelling of the legs, itching and night cramps with the progression of varicose veins.This, in turn, can lead to the development of varicose vein complications, such as inflammation of the varicose veins (thrombophlebitis), the formation of trophic venous ulcers, and bleeding from the varicose nodes.

To standardize the diagnosis of varicose veins and make it as accurate and understandable as possible for a doctor anywhere in the world, phlebologists use the CEAP classification.The CEAP classification takes into account the clinical manifestations (C – clinical), the etiology (cause of the disease) (E – etiology), the anatomical location (A – anatomy) and the pathogenesis (P – pathogenesis).

As a general rule, the CEAP diagnosis is complemented by a decoding (nosological formulation), which facilitates understanding for therapists, general practitioners and specialists.This approach allows the doctor to quickly navigate when studying the patient's medical documents.

Diagnosis of varicose veins.

Modern diagnosis of varicose veins of the lower extremities poses the following tasks:

• Determination of the presence of chronic venous disease.Many patients who suspect they have varicose veins do not have them.And vice versa.The first task of a phlebologist is to determine whether the patient suffers from this disease or not.
• Determination of the type of venous disease.Doctors say it is "nosological" in nature.You need to know exactly which venous vessels are affected, how serious it is and what it has led to or can lead to.
• Determine treatment tactics: what specific technique (or combination of techniques) should be applied in this particular case.Treatment tactics should be discussed with the patient and reflected in treatment recommendations.
• Evaluation of the effectiveness of the treatment is carried out during treatment and at the end of it.

We prefer to carry out all stages of diagnosis and treatment in contact with the patient.

We believe that the patient has the right to accessible and understandable information about his or her illness and treatment methods.In response to a patient's question "why," we never say "because" or "because I always do it this way."We adhere to the principles of modern evidence-based medicine.

Methods to diagnose varicose veins.

1. Clinical study.It includes clarification of the patient's complaints, examination and palpation (examination with hands).
2. Ultrasound angioscanning (ultrasound of veins - duplex and triplex scanning).
3. Plethysmography.
4. X-ray phlebography (ascending and descending).
5. Phlebography with radionuclides (radiophlebography).
6. Computed tomography (CT venography).
7. Magnetic resonance imaging (MR-venography).
8. Intravascular ultrasound examination.
9. Thermography.

In the vast majority of cases, to diagnose varicose veins and develop a correct treatment strategy, a clinical examination and ultrasound angiography by a phlebologist is sufficient.At the same time, the main instrumental study for diseases of the veins of the legs is ultrasound angiography - an ultrasound of the veins.

During the study, it is clearly explained to the patient what exactly “his” disease is and how to combat it.

The study is performed standing (if necessary, also lying down), simultaneously using two or three scanning modes (B-mode, color coding of blood flow and pulsed Doppler mode).The ultrasound angioscanning method allows you to visualize the vessel under study, determine the direction of blood flow and its parameters (speed, type of flow).

Both limbs are examined, not just the “sick” one, and we always observe both the superficial and deep venous vessels.If necessary, the patient may be prescribed additional research methods listed above.

Treatment of varicose veins

Specialists of the leading phlebology center use only the best and most modern methods of treating varicose veins of the lower extremities.

Today, phlebologists use the following innovative treatment methods:

• Thermoobliteration (laser and radiofrequency).
• Non-thermal methods to treat varicose veins.
• Sclerotherapy.
• Miniphlebectomy.
• A combination of these techniques.

These methods comply with European state standards.They allow you to treat varicose veins effectively, non-traumaticly and on an outpatient basis, without hospitalization.No anesthesia or spinal anesthesia is required.It is this approach that provides the best treatment results.