Читать книгу VARICOSE VEINS AND VEIN DISEASES - Nikos Aledzhanov - Страница 7

“Of the constitutions of the year, the dry, upon the whole, are more healthy than the rainy, and attended with less mortality”

Hippocrates / Ιπποκράτης

Varicose veins of the lower extremities (from the Latin varix – “knot”) – one of the most common diseases of the vessels of the lower extremities, according to various sources, 20% – 40% of the adult population of developed countries suffer from varicose. Only superficial veins (saphenous) are subject to varicose veins, deep veins do not suffer from varicose veins. Diseases of veins are very multiple, it has different clinical symptoms and prognosis. For example, spider veins cause cosmetic problems for young women. Blood clots in deep veins can be asymptomatic and when they rupture, a very serious complication can occur – pulmonary embolism. One of the main symptoms of the disease is the appearance of varicose veins, the formation of varicose nodes – nodular extensions, which gave the name of this disease (varix – “knot”) and the thinning of the venous wall and it loses its elasticity as a result of the vessels stretch, which leads to the appearance of valvular insufficiency veins and the development of the symptoms of chronic venous insufficiency (CVI). CVI is occured by such symptoms as heaviness in the legs, ooedema, fatigue, burning sensation, cramps at night, violation of the trophism of the skin and soft tissues. Eventually, venous insufficiency develops in all patients with varicose veins.

How does varicose veins occur?

The circulatory system consists of a large number of large and small blood vessels. The blood fluid flows to the tissues and organs through the arteries, and back through the veins. The veins of the lower extremities have the largest number of valves. Blood normally flows upward through the veins – to the heart and lungs – because muscle contractions help it. With any movement, the contracting muscles act as a kind of pump, squeezing blood out of the veins and pushing it towards the heart. But according to the laws of physics, the liquid tends to go down. To prevent this from happening, there are valves in the veins. They open in the direction of the blood flow and close to keep it out. If the valves do not work properly, they do not close completely, and blood flows down the veins – a reverse flow (reflux) is formed. The vessels do not contain all this blood, they stretch, become longer and visible above the skin and acquire a tortuous shape. And there is a situation of varicose veins (varicose veins).

Etiology – causes of the disease?

Varicose veins are a person’s reward for walking upright. Compared to the blood vessels of four-legged animals that never suffer from varicose veins, the venous system of the lower extremities of a bipedal person is not in the best position.

Unproven reasons in the development of the disease from the point of view of science

An inactive lifestyle, wearing high-heeled shoes, working while sitting or standing, thermal procedures, sitting “cross-legged”, hormonal contraceptives or drugs do not lead to varicose veins. Some contraceptives be a risk factor for venous thrombosis.

Proven causes of varicose veins

– Family history – heredity

During of various and long-term studies of this pathology, it was noted that varicose veins is a hereditary disease and is the main factor in the development of varicose veins. When both parents have varicose veins, the offspring has a 90% chance of having varicose veins. By inheritance, a predisposition to the occurrence of the disease is transmitted and evidence of this is cases when young people or athletes develop an ailment. Inheritance usually occurs from mother to daughter. In patients, there is a congenital weakness of the venous wall and valves, due to a violation of the structure of the connective tissue, which ensures the strength of the venous vessels. It is interesting to note that varicose veins in these patients are combined with hemorrhoids, hernias, flat feet, varicocele (enlargement of the veins of the spermatic cord). If one of the parents has varicose veins, then the children inherit this disease in 60% of cases, if both, then in 90% of cases. Varicose veins can be not only in relatives, but also in several family members. Although varicose veins are “heredity”, it does not mean that it will show itself in 100% of cases. It develops under the influence of negative factors, lifestyle and work.

– Pregnancy and tendency to varicose veins in women

Pregnancy and childbirth can cause illness. Progesterone lowers the tone of the veins and develops an inferiority of the venous valves.In addition, the pregnant uterus compresses the veins of the abdominal cavity, disrupting the venous outflow and increasing the pressure in the veins of the legs, which increase in volume.

– Obesity

Visceral fat increases intra-abdominal pressure. It is transmitted to the veins of the lower extremities, which expand and valvular insufficiency appears. Although the factor with “being overweight” is controversial, it is only known for certain that obesity aggravates varicose veins and obese people with varicose veins have a higher percentage of complications.

How to find out if there are varicose veins or other vein diseases?

Veins are twisted and dilated, nodes are visually visible – this is varicose veins. In case of problems in deep veins, the elasticity of the skin in the lower parts of the legs changes and the skin becomes darker in color. For venous diseases, pain and discomfort in the lying position, disorders of skin sensitivity, tingling sensation are not characteristic. Pain disturbs in the evening. Varicose veins are most often seen in the lower leg and thigh area. In order to make a diagnosis, you need to find out the patient’s complaints, the history of the disease, conduct an examination, palpation, perform laboratory and instrumental studies.

There are no special tests (blood and others) for making a diagnosis.

On examination, varicose veins are revealed. Clinical evaluation should focus on visible signs of venous disease. The results of the physical examination such as the size, location and distribution of the dilated veins should be documented. Only the presence of varicose veins – gives the right to diagnose “varicose veins of the lower extremities.”

For a complete assessment of the disease, an objective examination should be supplemented with instrumental methods for diagnosing the lower extremities.

These include ultrasound, MRI and phlebography. Ultrasound is the most common research method and is the gold standard for the diagnosis of varicose veins. The most informative ultrasound method for venous pathology is duplex ultrasound in a special mode (B-mode). This method is most often used to diagnose, plan, conduct and evaluate the results of treatment of chronic venous diseases. Ultrasound should, if possible, be carried out in a standing position. The horizontal position is not suitable for detecting reflux and measuring vein diameters. Other tests (MRI, tomography, phlebography / venography) can be used in exceptional cases (for example, in case of congenital anomalies).

When there is no reason to worry?

– Unpleasant sensations in the legs, but outwardly the vessels are not changed, there is no ooedema – venous disease is unlikely;

– On the skin, “meshes” and “spider veins” are cosmetic defects.

When to see a doctor?

With the appearance of bulging, convoluted veins, formations similar to varicose veins. For any unilateral oedema. If the ooedema is bilateral and symmetrical, then they are not venous, but other reasons for the appearance, such as cardiovascular failure or etc.

Visit a doctor urgently!

The sudden, rapid appearance of unilateral ooedema is suspiciously similar to acute deep vein thrombosis, and it is this condition that should always be ruled out in the first place for unilateral ooedema. It is necessary to urgently call an ambulance, even if you feel normal, in extreme cases – to independently consult a doctor as a matter of urgency.

Which doctor do you need?

Varicose veins are treated by “cardiovascular surgeons”, “general” surgeons, but more specialized still “phlebologists”. The best option is to get to him. As a rule, a phlebologist himself conducts an ultrasound examination and owns all modern minimally invasive technologies for treating veins (laser ablation, sclerotherapy, etc.)

At the doctor’s appointment and after it.

The doctor finds out complaints, examines the limbs, discusses the treatment with you. The doctor performs ultrasound in standing position. In the lying position, the pelvic veins and the veins in the abdominal cavity are examined. The drug can be prescribed in tablet form, topical ointment and compression garment. But this appointment is more suitable for the treatment of chronic venous insufficiency. At the end, a conclusion is issued with the diagnosis, treatment, ultrasound protocol and a recommendation to be observed by a phlebologist to control the development of the disease in order to adjust the treatment at the right time.

Will varicose veins develop if it is not treated?

If you do not receive treatment for varicose veins, the condition can be worse and progress to the next stage of the disease. Several complications may occur, one of which is thrombophlebitis, trophic changes, and others. In addition, by delaying the treatment period, it will become more and more expensive.

The goals of varicose veins treatment

Depending on your symptoms, your doctor may recommend lifestyle changes, a procedure to remove or close varicose veins, compression therapy, or medication. The goal of treatment is to relieve symptoms, improve appearance, and prevent complications such as trophic ulcers, thrombosis and bleeding.