Varicose veins of the lower limbs is extremely common, and if, before the patients of the doctor once more, made him older, but now she a lot of times people suffer from 25-45 years. Your symptoms, according to various reports, statistics, are observed in 66% of men and 90% of the women population of the developed countries. This disease takes the character, and can be combined with venous insufficiency.
Varicose veins of the lower limbs, accompanied by pathological the extension surface of the vein, which is caused by insufficiency of the venous valves and accompanied by a violation of fundamental hemodynamic. In the future, this pathology may be exacerbated thrombophlebitis, leading to an increased risk of development of phlebothrombosis and thromboembolism arterial (with pe).
The mechanism of development
The first firing mechanism in the development of this pathology of the veins of the lower limbs is the malfunction of the venous valves, which leads to the reflux of the blood. As a result of a slowdown in the blood react with endothelial cells, and they are fixed cells, white blood cells that activate the inflammatory process in the vessel wall, spreads by venous bed. In parallel with inflammation is broken functions endothelial layer of veins, and then and all the layers of the venous wall.
In the first place, and is especially noted from the above pathological processes suffers from the valve system of the veins. The first usually affect the maximum area load: at the mouth of the big and small hypodermic veins or in large punch bowls. In the future, due to the excess of thrombosis venous bed occurs hyperextension of venous wall, the amount of venous blood in the surface venous vessels of the lower limbs increases. In addition, this exceeded the volume comes through a special system in the deepest part of vienna and stretches them. In the future, they develops dilatation and failure of the venous valves.
Such pathological changes takes horizontal reflux (backflow of the blood in the subcutaneous venous network) and the work of the venous pump completely loses its efficiency. Later, develops venous hypertension leading to venous insufficiency. Initially, the patient has what appear swollen, and then from the bed blood in the soft tissues, penetrate, and data elements of the blood, which lead to hyperpigmentation and general characteristics. When the progression of the disease on the surface of the skin appears trophic plague, which can be complicated secondary to infection.
The doctors point to several reasons that may lead to pathological disruptions in the functioning of the venous system. Divide into two main groups:
- I – genetic predisposition;
- II – a number of reasons, due to the influence of adverse factors or a combination of both.
Hereditary predisposition to varicose veins, the disease may be defined as women, and men, despite the fact that in the majority of cases, this pathology may occur is that the women. The disease can a long time nothing if not demonstrate, but, in certain circumstances (for example, under the intense physical effort) is the failure of the valves of the veins.
Also the doctors highlighted a series of adverse factors that can cause varicose veins:
- the hormonal imbalance;
- diabetes mellitus;
- frequent constipation;
- put a surgical operation or trauma;
- drinking and smoking;
- professional risks (increase in the load, very stimulated a standing position);
- wearing compression body garment;
- prolonged use of high heeled shoes;
- pregnancy and childbirth;
- constitutional features and congenital anomalies circulatory system;
- accommodation in adverse weather conditions.
Signs and symptoms
Varicose veins in the majority of cases develops slowly and gradually. At an earlier stage, it manifests in some few and non-specific signs that you can combine the "syndrome of heavy legs":
- feeling of heaviness in the legs;
- rapid fatigue of the feet;
- a burning sensation and flatulence in the area of the veins;
- pain pain;
- intermittent edema in the posterior part of the foot and ankle, increasing the night and disappear after a night's sleep.
The main, and the first sign of the beginning of varicose veins, the disease become introduced to the sectors advanced from the surface of the veins. This symptom is accompanied by rapid fatigue of the lower limbs, burning, and the sensation of flatulence in the panel of the passage of the veins, and a constant feeling of heaviness in the legs. Advanced vessels become circular and begin to act on the surface of the skin in the area stop and the cinnamon, and after a long walk or intense physical work load and become more visible. Also the patient may upset the swelling, which is especially clearly manifested in the evening in the region of the ankles, the lower part of the leg and the back of the foot. At night, the patient can arise seizures. And in the later stages of the disease due to insufficient circulation of the leather in the feet may deteriorate.
In some cases, the first signs of varicose veins, and only appear in the so-called "asterisks" (spider's web advanced of veins thickness not exceeding 0.1 mm), and the sick for a long time did not have a clue about the onset of the disease. Some women perceive the symptom as just a cosmetic defect, and the men simply don't notice. Despite the absence of other signs of varicose veins, the disease is "varicose veins", are in the first place and, in some cases, the only symptom of varicose veins of the disease and treatment to the doctor at this stage of the disease can help the patient decrease the progression of pathological varicose veins.
More often, the doctors apply to the form of classification of varicose veins, disease, proposed in 2000, which takes into consideration the form of the disease and the degree of chronic venous insufficiency:
- I – intradermal or to target varicose veins without veno-venous relief;
- II – to target varicose veins with the low tide in punching and/or supercial veins;
- III – common varicose veins with the low tide in the drill or supercial veins;
- IV – varicose veins with the low tide in the deep veins.
Varicose veins can be:
- ascending – vienna begin to pathologically move with the foot;
- low – the development of varicose veins begins with the mouth of a large fabric of vienna.
Also in the identification of varicose veins feet for the definition of tactics of treatment, it is important to consider the degree of chronic venous insufficiency:
- 0 – CVI missing;
- 1 – the patient can only occur with the syndrome of "heavy legs";
- 2 – the patient has present change the swelling;
- 3 – the patient has the present of persistent edema, eczema, hypo-or hyperpigmentation;
- 4 – on the surface of the feet is formed trophic ulcers.
In the early stages of its development varicose veins aggravates substantially the patient's quality of life and gives you unpleasant moments in a visible cosmetic problem. Later, when the progression of the pathology, the members may form trophic ulcer, which are often complicated by secondary infection. Initially, the surface of the skin that usually appear in the lower third of the leg), the areas with fragile, dry, intense and a brilliant surface. Later, they appear on areas of hyperpigmentation and develops a small ulcer, increasing in size and delivers the sensation of pain. In the future, their edges become more dense, and the bottom covered with a hint of color dirty, and periodically bleeds. With the minimum of injury to their limits to increase significantly the plague infects by.
Thrombophlebitis and thrombosis
When the end or unskilled treatment of varicose veins of the lower limbs can be complicated the development of thrombosis or thrombophlebitis. These diseases occur suddenly and are not concerned with the impact of external adverse factors (for example, with a intense physical exercise). The patient receives significant and rapidly spreads throughout the leg swelling, which is accompanied by strong pain arching nature. Some areas of the skin can appear local pain, redness or lividity. When the migration is detached from a blood clot in the vessels of the lung, may develop if this is the most difficult complication of thrombosis of the lower limbs, as well as having pe.
Typically, the diagnosis of varicose veins", it becomes evident to phlebologist already during the first test of the patient. After studying the complaints of the patient, inspection of the lower limbs and holding a series of special samples doctor will prescribe a series of studies to clarify the diagnosis and definition of tactics of treatment additional:
- clinical and biochemical analysis of blood;
- duplex scan;
- occlusal plethysmography;
- venography (only one is assigned to the dubious index of non-invasive methodologies).
The main objectives of the treatment of varicose veins of the lower limbs for stabilization and recovery of normal flow of venous blood, improving the quality of life of the patient and prevent the development of complications caused by venous insufficiency. Therapeutic activities may include:
- therapy conservative: it can be applied in the early stages of the disease (when the lesion of the skin of the feet is still not evident, and the ability to work patient reduced moderately), in the perioperative period, or when contra-indications to the surgical treatment;
- surgical treatment: this is assigned when expressed signal or the execution stages of the disease and can be performed with the help of minimally invasive techniques, by means of radical surgery.
Conservative techniques of treatment of varicose veins, disease involving the realization of a complex of events:
- The reduction of risk factors for the progression of the disease. Patients with varicose veins, disease, and individuals in a high risk group of development of varicose veins, we recommend continuing pharmacy surveillance of a doctor.
- Fight with adynamia. Patients that there are no signs of thrombophlebitis or thrombosis, showing one of the regular therapy for exercise and some sports, aiming to strengthen and exercise the veins of the lower limbs. The intensity of the load must be secured with a health care provider-physical therapist. The beneficial effect on the state of the blood vessels of the feet are: hiking, biking, jogging, swimming. Therefore, patients are encouraged to perform the exercises (except those that run on water), under conditions of gain compression generated special bed or bandages elastic. Before training, the patient is advised to lie down for a few minutes with the raised feet. Patients with varicose veins, disease of counter-classes traumatic for the feet sports: various security forces of martial arts and sports, is associated with a lifting weights, skiing, tennis, basketball, volleyball, and soccer.
- Compression therapy. To administered contractions of muscles, which favors the resolution of blood clotting and normalize the venous circulation, apply the compression bandages and hosiery of different compression class. When the 0 and the 1 degree of chronic venous insufficiency is recommended-mesh I-class II, as a 2 – class II, when 3 and 4, II, or III (and in severe cases (IV) of a class. Depending on the degree of injury of the vein, compression therapy when varicose veins of the lower limbs can be attributed to both, and in the long term.
- The medical therapy. Patients with varicose veins of the lower limbs, accompanied by 1-4 degree of venous insufficiency, shows courses of medicines. It should be remembered that the assignment of a medical therapy can only be performed by a doctor, t. to. occasional unexpected application of drugs will not be able to rid the patient of venous insufficiency and will only aggravate the disease. When appropriate and competent for the selected copperparaAmentsnom treatment and you follow the doctor's recommendations for compression and physiotherapy the patient may, within a period of 3-4 weeks to achieve the elimination of clinical symptoms, complications and compensation of venous insufficiency. In the scheme of therapy may be included in such medicines: desegregats, anticoagulants, nonsteroidal anti-inflammatory drugs. If complicated the development of the disease and trombase veins schema therapy can be supplemented with special tools for the application site, and with the development of a tRoycesparatheir ulcers and their infected – antibiotics and wound healing means.
- Physiotherapy. In the complex of therapeutic procedures when variparaof ozno extended veins of the lower limbs may include a variety of treatments, contributing to the normalization of the tonus of the walls of the veins, micro-circulation and lymphatic drainage poor. For this, the patient can be assigned to: local darsonvalization, magneto therapy, laser therapy hiperbaricasparath oxygenation and hydro-and balneotherapy (general and local baths of mineral waters, of contrast, of pearls and of oxygen of the bath). Also in the absence of contraindications, the patient can be shown the courses of light massage that must be performed by a specialist or by yourself (after learning a simple technique from an experienced massage therapist). Many patients varicose veins, the disease may suggest such insufficient common methods of treatment as girudotArabia.