Varicose veins (varicose veins)

Varicose veins most commonly affect the venous system of the legs. External appearances (protruding, knotty blue veins, swelling) are not just a cosmetic problem, but signs of a serious illness that worsens over time.

What are varicose veins: definition of the disease

The word "varicose veins" comes from the Latin varix - "swelling". The name fully reflects the pathological process: the walls of the veins become thinner and in some places dilations (sac-like swellings) form - nodules.

The first case of varicose veins was recorded in a document from 86 BC. mentioned. 400 BC: The Roman general Gaius Marius complained of pain in his legs due to "blue, swollen veins".

The main reason for the development of varicose veins (varicose veins, varicose veins) is an increase in pressure in the system of superficial vessels. This is promoted by certain illnesses, hormonal changes and a sedentary lifestyle.

Even under the influence of these factors, the vessels initially function normally, but gradually they deform, change their structure and can no longer transport blood completely.

Varicose veins can occur on almost any part of the body, but they most commonly occur in the lower extremities. Therefore, when it comes to varicose veins, by default they mean the problem of the legs.

Code for varicose veins in ICD-10

The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), includes several types of varicose veins.

I83 - Varicose veins of the lower extremities:

• I83. 0 – Varicose veins of the lower extremities with ulcers;
• I83. 1 – Varicose veins of the lower extremities with inflammation;
• I83. 2 – Varicose veins of the lower extremities with ulcers and inflammation.

85 - Varicose veins of the esophagus:

• I85. 0 - varicose veins of the esophagus with bleeding;
• I85. 9 – Varicose veins of the esophagus without bleeding.

I86 - Varicose veins of other localizations:

• I86. 0 - varicose veins of the sublingual veins;
• I86. 1 - varicose veins of the scrotum (anatomical formation in men – a container for the testicles and their appendages);
• I86. 2 - varicose veins of the pelvis;
• I86. 3 – varicose veins of the vulva (external genitals of a woman);
• I86. 4 – Varicose veins of the stomach.

O22. 0 – Varicose veins of the lower extremities during pregnancy.

In our country, 30 million people suffer from various forms of varicose veins. A third of them have complications – trophic ulcers. An open defect in the skin or mucous membrane that occurs due to impaired blood circulation and tissue innervation.

The mechanism of the development of varicose veins

The body's pathological reactions are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels helps understand how and why the disease develops.

How blood moves through the body

There are two types of vessels in the human body - veins and arteries. Blood flows from the heart to all organs and tissues through the arteries. This occurs under high pressure (70-120 mm Hg) and at high speed.

Blood from organs and tissues flows through the veins and is delivered to the heart under low pressure (0-20 mm Hg).

The walls of veins are less thick and elastic than the walls of arteries and, unlike arteries, do not contain such a developed layer of muscles. Therefore, varicose veins are only possible in veins, but not in arteries.

Human arterial and venous circulatory system. Veins are shown in blue, arteries in red.

In order to transport blood from the periphery to the center, low pressure in the veins is necessary. But at the same time, the blood flow encounters an obstacle on the way to the heart - gravity. This force forces the blood to flow back through the veins.

You often hear that varicose veins are humanity's retribution for walking upright. The longest distance that blood has to travel in the body to overcome gravity is from the feet to the heart. The movement of blood through the veins is ensured by contractions of the heart, the muscular pump of the surrounding muscles and the negative pressure in the chest during inhalation.

In healthy vessels, the backflow of blood is prevented by valves on the inner walls of the veins. The valves act like one-way swinging doors - they open and allow blood to flow to the heart and close immediately when gravity tries to push the blood back out.

It's not just the valves that help the veins carry blood to the heart, but also the muscles that surround the vessels. By contracting and relaxing, the muscles help move blood through the veins. This mechanism only works when a person is moving. When standing or sitting for a long time, the muscle pump is practically inactive.

The cusps of the venous valves always point in the direction of blood flow - towards the heart

How failures and illnesses occur

An increase in pressure in the venous system disrupts the function of your valve system and leads to a backflow of blood through the vessels. As a result, as well as due to stagnation of excess blood, weakness of the valve apparatus (for example, in diseases of the connective tissue), the lumen of the veins expands, the walls deform, become thinner and locally sac-like. Protrusions - nodes are formed.

The process is similar to inflating a balloon: if you don't let the air escape, the balloon continues to inflate.

Normal blood flow can be seen on the left side; right - multidirectional blood flow due to dysfunction of the venous valves, vascular deformation

There are superficial and deep veins in the legs. 85-90% of the total blood volume flows through the deep ones, only 10-15% through the superficial ones. The walls of the deep veins are denser and better adapted to increased blood volume. And the superficial veins of the legs are thinner and more prone to varicose veins.

There are large venous plexuses in the pelvis and in the lower part of the esophagus, which can also undergo varicose vein transformation. In the veins of the small pelvis, the mechanism of development of the disease is the same as in the lower extremities. But varicose veins of the esophagus arise for another reason: due to portal hypertension - increased pressure in the portal venous system, which develops in liver cirrhosis, hepatitis, parasitic liver lesions, fatty hepatosis, etc.

Causes of varicose veins

A number of factors contribute to the development of varicose veins in the legs. The most important ones areHeart valve insufficiencyAndInheritance. It is known that a quarter of patients had close relatives suffering from one of the forms of varicose veins.

Overweight. The more extra pounds a person has, the greater the strain on the venous system. Over time, the veins can no longer withstand this pressure: the lumen of the vessels increases and the valves on their walls no longer close completely. The result is blood stagnation and the development of varicose veins.

pregnancy. Hormonal changes occur in a woman's body, body weight, intra-abdominal pressure and the volume of circulating blood increase - this leads to disruption of outflow, stretching of the venous walls and changes in the functioning of the valve apparatus.

After birth, the diameter of dilated veins decreases but does not always return to its original value. With subsequent pregnancies, the risk of developing varicose veins increases.

Old. Varicose veins often affect people over the age of 50. The older a person is, the more the venous valves wear out, while the recovery processes slow down and the mechanism of pathological expansion of the veins is triggered - the development of varicose veins.

Venous refluxVenous refluxBackflow of blood through the veins due to resistance to blood flow, from Latin refluo - "flow backwards". Occurs in 10-15% of schoolchildren aged 12-13 years. "Rejuvenated" by a sedentary lifestyle and excess weightthe disease develops.

Varicose veins of the lower extremities develop more quickly when additional risk factors are present.

Risk factors that contribute to the development of varicose veins on the legs:

• lack of physical activity - when exercising, the muscles stimulate blood flow through the veins, and without exercise, blood circulation in the veins can be difficult;
• Smoking – chemicals contained in tobacco smoke damage the walls of blood vessels, as a result of which their lumen narrows, blood flow becomes difficult and stagnation occurs, which leads to varicose veins;
• Occupations that require long periods of standing or sitting – hairdressers, surgeons, chefs, waiters, drivers, office workers – are at risk;
• Menopause – in women aged 40-50 years, the production of sex hormones (estrogen and progesterone) decreases and at the same time the tone of the venous wall decreases. This increases the likelihood of varicose veins.

Women suffer from varicose veins 3-4 times more often than men. This happens due to hormonal fluctuations (menstrual cycle, pregnancy, menopause).

During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva

Varicose veins can occur not only in the lower extremities, but also in other parts of the body.

The main causes of varicose veins in different places

Varicose veins of the esophagus

Changes in the veins of the esophagus with an uneven increase in their lumen, protrusion of the wall and the development of a nodular tortuosity of the vessels. Often leads to a life-threatening complication – bleeding.

Reasons:

• cirrhosis
• Liver cancer
• other diseases that cause increased pressure in the portal system – it collects blood from the abdominal organs

Varicose veins of the scrotum (varicocele)Pathological expansion of the veins of the pampiniform plexus of the testicle. Manifested by varicose veins in the scrotum and circulatory disorders

Reasons:

• congenital insufficiency of the valves of the testicular veins (usually the left one)
• mechanical compression of the testicular vein (inguinal hernia)

Varicose veins of the pelvis

It is characterized by dilatation of the ovarian veins and intrapelvic venous plexuses of different diameters. The condition is also known as pelvic congestion syndrome

Reasons:

• Polycystic ovary syndrome
• two or more pregnancies
• hormonal dysfunction

Varicose veins of the vulva

Varicose veins of the pelvis, affecting the vessels of the labia and perineum

Reasons:

• Compression of retroperitoneal vessels by the uterus during pregnancy
• significant physical activity
• Tumors of the uterus and ovaries

Varicose veins of the sublingual veins (sublingual varicose veins)

Asymptomatic damage to the veins under the tongue. It is manifested by a slight bulging of the blood vessels and a color change from deep blue to purple

Reasons:

• hypertension
• Smoke
• Old

Varicose veins of the stomach

Isolated change in the stomach veins or combined with varicose veins of the esophagus

Reasons:

• cirrhosis
• Portal hypertension syndrome – increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thrombosis, venous development disorders)

Symptoms of varicose veins

In rare cases, only the aesthetic side of the disease occurs - bluish veins. Most patients with varicose veins on their legs report at least one or more unpleasant symptoms.

Symptoms of varicose veins of the lower extremities:

• Tiredness, pain or heaviness in the legs - this is caused by blood congestion and its pressure on the surrounding tissues;
• Burning, tingling or pulsating in the legs – a response to slowing of blood flow and overflow of the venous system of the lower extremities;
• nocturnal muscle cramps in the legs – painful cramps occur due to stagnation of blood and accumulation of metabolic products in the tissues;
• Swelling of the feet and ankles – due to stagnation in the veins, the liquid part of the blood seeps through the changed vascular wall into the subcutaneous tissue;
• Itching of the skin around damaged veins – dilated and altered blood vessels do not provide normal blood circulation and nutrition to the skin, causing it to dry out and become rough.

Unpleasant sensations in the legs in patients with varicose veins increase in the evening, especially after sitting or standing for a long time.

The appearance of altered veins is not always proportional to the severity of the symptoms. Therefore, veins that are barely noticeable to the eye and affected by varicose veins can cause severe discomfort, while nodular and thickened veins may cause minimal concern.

Varicose veins affect different veins: from small skin vessels to large saphenous veins

Symptoms of other types of varicose veins largely depend on the underlying cause of the disease. Often patients complain about nothing and the doctor only discovers the problem during the examination. This happens, for example, with varicose veins in the sublingual veins.

In some cases, as with varicose veins of the esophagus or stomach, the pathology immediately manifests itself as a life-threatening complication – bleeding.

Classification of venous diseases

In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation consisting of the first letters of the main sections of the classification:

• C – clinic (clinical changes);
• E – Etiology (origin of the disease);
• A - anatomy (anatomical localization of varicose veins);
• P - pathogenesis (mechanism of venous circulatory disorders).

Complications of varicose veins on the legs

Typically, varicose veins themselves are not life-threatening. But sometimes the disease can cause complications.

Thrombophlebitis- Inflammation of the venous walls, which is accompanied by the formation of a thrombus (blood clot) that closes the lumen of the vessel. It manifests itself as swelling and redness along the affected vein. The patient feels pain, the skin in the affected area turns red and feels hot.

Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue along the thrombosed vein.

Venous trophic ulcer- an open defect of the skin and soft tissue due to blood stasis, edema and impaired cell nutrition. The ulcer occurs on the legs and ankles near varicose veins. Swelling is more pronounced in the lower areas of the legs, meaning the tissue is compressed more than in other areas. Ulcers take a long time to heal and often contain bacteria that increase inflammation.

Trophic ulcers heal very poorly due to impaired blood circulation and tissue nutrition

Bleeding- occurs when a vein ruptures and dilates due to varicose veins. In the later stages of the disease, the skin over such veins is very thin and dry - a minor injury is enough to compromise the integrity of the vessel and cause bleeding. Sometimes a spontaneous vein rupture occurs in the area of varicose veins.

Diagnosis of varicose veins of the legs

A phlebologist deals with the diagnosis, treatment and prevention of venous diseases. The doctor makes a diagnosis based on the patient's complaints, examinations and instrumental examinations. If the varicose vein symptoms are severe, an examination is usually not carried out; a medical examination is sufficient.

The doctor may order laboratory tests to prepare for surgery or to rule out concomitant diseases that affect the condition of the blood vessels.

One of these diseases is diabetes mellitus. It can significantly worsen the course of varicose veins and increase the risk of complications (especially trophic ulcers).

For an accurate diagnosis and determination of treatment tactics, you need a duplex ultrasound examination - the gold standard for diagnosing vascular diseases. The method allows you to assess the structure, function, patency of the superficial and deep veins, the consistency of the valves, and also determine the direction of blood flow.

If the secondary nature of varicose veins is suspected (can occur after deep vein thrombosis), the doctor prescribes venography, CT or MRI venography.

Phlebography is an X-ray examination that determines the patency of deep veins and valve function.

Using computer or magnetic resonance venography, the venous system is displayed in three-dimensional projection and with very high spatial resolution.

Treatment of varicose veins on the legs

The goal of treating varicose veins is to relieve or eliminate symptoms, improve the appearance of the veins, and prevent complications.

The doctor chooses the treatment method depending on which vessels are affected and how serious the patient's disease with varicose veins is.

Non-invasive treatments

Noninvasive treatments for varicose veins include compression therapy, drug therapy, and lifestyle changes.

During compression therapy, special socks, stockings and tights are worn. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the right knitwear.

Compression jersey on the lower legs compresses more than on the thighs - this pushes the blood towards the heart and avoids stagnation

Effects of compression therapy for varicose veins:

• the manifestations of symptoms decrease – feeling of heaviness, fatigue in the legs, night cramps, burning or pain;
• the severity of edema is reduced due to improved blood circulation;
• Healing of trophic ulcers is accelerated as elastic compression improves blood circulation and tissue nutrition.

Drug therapy – the doctor can prescribe phlebotropic drugs (phleboprotectors, venotonics). Biologically active substances that increase venous tone and reduce the severity of veno-specific symptoms. (venotropic) medications.

The main groups of phlebotropic drugs used for varicose veins:

• Angioprotectors: improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the likelihood of blood clots;
• Antithrombotics: reduce the risk of dangerous blood clots (thrombi) forming in the lumen of blood vessels and promote the dissolution of existing blood clots;
• Bioflavonoids: natural plant substances that improve venous tone and reduce venous congestion.

Lifestyle changes for varicose veins significantly slow down the development of the disease and, in combination with other recommendations from the attending physician, help stop the pathological process.

Important tips for changing the lifestyle of patients with varicose veins:

• Medium intensity exercises: walking, swimming, water aerobics, leg exercises, yoga. Strengthening muscles helps to normalize blood circulation in the vessels, relieve venous stagnation and edema;
• Weight control: Normalizing body weight reduces the load on blood vessels and facilitates the return of blood through the veins to the heart;
• Give up bad habits: Nicotine and alcohol damage the inner walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of the veins and valve function.

Invasive methods for treating varicose veins

Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure in which a special sclerotherapy solution (sclerosing agent) is used. The solution is injected through a thin needle into the problematic vein, which leads to its sclerosis - "adhesion". The vein is switched off from the blood circulation and becomes invisible over time; its function is taken over by neighboring veins. Sclerotherapy is carried out without hospitalization– after the procedure the patient can go home.

Sclerotherapy lasts 5 to 30 minutes, depending on how many varicose veins need to be filled with sclerosant and their size

Endovenous laser thermal obliteration (EVLO). A catheter with a laser light guide is inserted into the vessel through a tiny incision. The thermal energy of the laser heats the vein and it becomes obliterated - "sealed". After a few months, the vessel is replaced by connective tissue and disappears. The procedure is carried out on an outpatient basis.

Radiofrequency venous obliteration (RFO) is the effect of radiofrequency current on the inner surface of blood vessels. A catheter is inserted into the vein through a micropuncture, which is connected to a device that generates radiofrequency pulses. Inside the vessel, the radio wave is converted into heat energy, which "closes" the vein.

With EVLO, the vein is briefly exposed to a high temperature; with RFO the temperature is lower but the session lasts longer. Both procedures are effective and safe.

NTNT obliteration or non-thermal, non-tumescent methods:

• Vein sclerotherapy with cyanoacrylate glue;
• Mechanochemical obliteration, in which mechanical and chemical effects on the vessel occur simultaneously.

NTNT obliteration is the most modern, low-trauma method for treating varicose veins with a short rehabilitation period.

Phlebectomy involves the removal of saphenous veins that have suffered from varicose veins. It can be performed as a standalone operation or in combination with other techniques. The varicose vein is removed using small punctures under local anesthesia.

Prevention of varicose veins on the legs

You can prevent the development of varicose veins if you follow simple prevention rules in everyday life.

A combination of provoking factors - sitting cross-legged for a long time, wearing uncomfortable shoes - increases the risk of varicose veins in the legs.

Prevention of varicose veins – what you need to know:

• moderate physical activity (walking, swimming, leg exercises) and resting with legs elevated improves the free flow of blood through the vessels and helps avoid stagnation in the veins;
• rational nutrition and normalization of weight lead to strengthening of blood vessels;
• Wearing loose clothing that does not restrict movement helps improve blood circulation.
• A cool shower in the warm season helps to tighten the veins.
• comfortable shoes with a low heel (no more than 3 cm) make it possible to avoid incorrect loads on the foot and circulatory disorders;
• A sensible approach to visiting saunas and steam rooms allows maintaining normal blood circulation (long-term thermal procedures greatly expand the veins, so blood circulation slows down).