Varicose veins on the legs - symptoms, signs, treatment, do's and don'ts for varicose veins

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Varicose veins (VV) is a fairly common disease that affects both men and women. It can affect the lower limbs of a person, as well as deep veins, leading to the development of thrombosis and post-thrombophlebitis disease.

Spider veins that appear on a person’s legs as a result of the development of the disease become the reason that he begins to feel unattractive. In addition to external ones, there are also internal manifestations of explosives, which are expressed in the appearance of discomfort and pain in the calf muscles of the leg. The development of the disease increases the risk of other pathologies of the circulatory system.

The key to success in the fight against pathology lies in timely diagnosis and competent treatment. A big mistake on the part of a person is the independent use of various ointments and creams, which in most cases do not bring the desired effect. As a result, time was lost that could have been spent on proper and effective therapy.

In order to get rid of varicose veins, you need to solve the following problems:

Elimination of symptoms.
Removal of varicose veins.
Prevention of the development and reappearance of explosives.

Only a highly qualified specialist with sufficient experience in the treatment and prevention of pathologies of this kind can successfully cope with each of the above tasks. These are the specialists who work at the Yuzhny Medical Center. The high level of qualifications of doctors in combination with the latest equipment will make it possible to make the correct diagnosis and carry out competent therapy, guaranteeing the absence of progression or recurrence of varicose veins of the lower extremities.

Symptoms of varicose veins

Symptoms of a disease are signs that clearly indicate its development. They are divided into:

Subjective: Mild and aching pain in the calf muscles.
A burning sensation and itching along the veins affected by varicose veins.
Heaviness in the legs, increasing towards the end of the day.
Skin hyperpigmentation.
Increased fatigue of the lower extremities.
Trophic venous ulcer of the leg.
Pain in the calf muscles, aggravated by walking.
The appearance of swelling in the lower legs and feet.

Objective:

Varicose veins of the saphenous veins, which are clearly visible even without the use of special equipment.

Clearly visible dilated intradermal and saphenous veins.

Presence of spider veins.

Changes in the structure and color of the skin, the appearance of lipodermatoscoerosis and venous trophic ulcers.

What veins look like

The very first warning sign of problems with the veins is swelling of the lower extremities at the end of the day. Swelling is especially pronounced if a person spends most of the day standing on his feet. It can disappear in the morning after a night spent resting.

However, if you do not pay due attention to this problem, the condition can worsen significantly. Intradermal veins in the legs with varicose veins become dark blue, protruding above the surface of the skin of the legs and feet. Outwardly, they look like bunches of red grapes that are overripe. Such external manifestations of pathology are accompanied by pain in the calves, a feeling of heat in the legs, swelling and cramps in the calf muscles. Over time, these symptoms are accompanied by a change in the appearance of the skin.

Deep veins of the legs

The inferior vena cava system originates from the veins of the fingers, the venous arch of the sole and the dorsum of the foot.

Varicose veins of the lower extremities: stages, causes, symptoms and treatment

From the venous arch of the dorsum of the foot, blood flows into the deep anterior tibial veins (DATIVs).

From the venous arch of the sole, the posterior tibial veins (PTV) and peroneal veins (MPV) are born.

The deep veins of the leg follow with the artery two, rarely four or more; merge before PKV.

PBBV lie in the anterior muscle bed of the leg; through the interosseous membrane they merge into the BBBV.

The internal and external marginal veins of the sole in the calcaneal canal will form two trunks of the BBBV.

ZBBV on n/3 of the leg immediately behind the muscular fascia, then between the flexors and the triceps muscle.

The MBV arises from the posterolateral calcaneus, superiorly between the MBV and the flexor pollicis longus.

On the third third of the leg, the deep veins merge, thus giving rise to the short trunk of the popliteal vein (PCV).

Drainage of the soleus and gastrocnemius muscles into the soleus and gastrocnemius (sural) veins.

The structure of the human heart and its functions

Close to the joint space of the knee joint, the soleus and gastrocnemius veins merge into the PCV.

The SVC lies posterior to the RCA, from its junction with the thigh, called the superficial femoral vein (SFE).

The SMV from its confluence with the deep femoral vein (DFE) is called the common femoral vein (CFV).

The EIVs collect blood from the lower extremities and continue into the external iliac veins (ELVs).

At L5, the iliac vein and internal iliac vein (Iiliac vein) join to form the common iliac vein (CIV).

At L4, the IVCs drain into the inferior vena cava (IVC); The IVC runs to the right of the aorta and has no valves.

Causes of varicose veins of the lower extremities

VV of the lower extremities can develop under the influence of a number of factors and circumstances, the main ones being:

Pregnancy. This is a key risk factor for the disease. This explains the fact that varicose veins occur several times more often in women than in men. In this case, the disease develops under the influence of an increase in the volume of circulating blood and compression of the retroperitoneal veins of the pregnant uterus.
Obesity. The connection of this condition with the development of VV has been proven by a number of studies. At the same time, a direct connection was found between increased body weight and an increased risk of developing pathology.
A lifestyle characterized by prolonged static loads with regular heavy lifting or prolonged immobility in a standing or sitting position.
Dishormonal conditions. Their role in the development of the disease has increased significantly over recent years. This is due to the widespread use of hormonal contraceptives, the spread of hormone replacement treatment for osteoporosis and during the premenopausal period
Heredity. The role of this factor in the development of varicose veins on the legs has not been unambiguously confirmed today.
A disorder of the valvular apparatus of the veins, leading to a downward flow of blood under the influence of gravity every time a person stands up. The muscles that are located around the deep veins contract as you walk. These veins are subject to emptying, causing venous pressure to increase. Blood enters the superficial veins through communicating vessels with insufficient valves. As a result, they are filled with blood, which leads to their stretching and expansion (varicose veins).

Basics of the venous system of the lower extremities

The peculiar structure of venous vessels and the composition of their walls determines their capacitive properties. Veins differ from arteries in that they are tubes with thin walls and lumens of relatively large diameter. Just like the walls of arteries, the composition of the venous walls includes smooth muscle elements, elastic and collagen fibers, among which there are much more of the latter.

In the venous wall, structures of two categories are distinguished: - supporting structures, which include reticulin and collagen fibers; - elastic-contractile structures, which include elastic fibers and smooth muscle cells.

Under normal conditions, collagen fibers maintain the normal configuration of the vessel, and if the vessel is exposed to any extreme impact, then these fibers maintain it. Collagen vessels do not take part in the formation of tone inside the vessel, and they also do not affect vasomotor reactions, since smooth muscle fibers are responsible for their regulation.

Veins consist of three layers: - adventitia - outer layer; - media - middle layer; - intima - inner layer.

Between these layers there are elastic membranes: - internal, which is more pronounced; - external, which differs very little.

The middle lining of the veins consists mainly of smooth muscle cells, which are located along the perimeter of the vessel in the form of a spiral. The development of the muscle layer depends on the width of the diameter of the venous vessel. The larger the diameter of the vein, the more developed the muscle layer is. The number of smooth muscle elements increases from top to bottom. The muscle cells that make up the tunica media are located in a network of collagen fibers that are highly convoluted in both the longitudinal and transverse directions. These fibers straighten only when a strong stretch of the venous wall occurs.

Superficial veins, which are located in the subcutaneous tissue, have a very developed smooth muscle structure. This explains the fact that superficial veins, unlike deep veins located at the same level and having the same diameter, perfectly resist both hydrostatic and hydrodynamic pressure due to the fact that their walls have elastic resistance. The venous wall has a thickness that is inversely proportional to the size of the muscle layer surrounding the vessel.

The outer layer of the vein, or adventitia, consists of a dense network of collagen fibers, which create a kind of frame, as well as a small number of muscle cells that are longitudinally located. This muscle layer develops with age and can be most clearly observed in the venous vessels of the lower extremities. The role of additional support is played by venous trunks of more or less large size, surrounded by dense fascia.

The structure of the vein wall is determined by its mechanical properties: in the radial direction the venous wall has a high degree of extensibility, and in the longitudinal direction it has a low degree. The degree of vessel distensibility depends on two elements of the venous wall - smooth muscle and collagen fibers. The rigidity of the venous walls during their strong dilatation depends on collagen fibers, which prevent the veins from stretching too much only under conditions of a significant increase in pressure inside the vessel. If changes in intravascular pressure are physiological in nature, then smooth muscle elements are responsible for the elasticity of the venous walls.

Venous valves

Venous vessels have an important feature - they have valves, with the help of which centripetal blood flow in one direction is possible. The number of valves, as well as their location, serves to ensure blood flow to the heart. On the lower limb, the largest number of valves are located in the distal sections, namely slightly below the place where the mouth of the large inflow is located. In each of the trunks of the superficial veins, the valves are located at a distance of 8-10 cm from each other. Communicating veins, with the exception of valveless perforators of the foot, also have a valve apparatus. Often, perforators can flow into deep veins with several trunks that resemble candelabra in appearance, which prevents retrograde blood flow along with the valves.

Vein valves usually have a bicuspid structure, and how they are distributed in a particular segment of the vessel depends on the degree of functional load. The framework for the base of the venous valve leaflets, which consist of connective tissue, is the spur of the internal elastic membrane. The valve leaflet has two endothelial-covered surfaces: one on the sinus side, the second on the lumen side. Smooth muscle fibers located at the base of the valves, directed along the axis of the vein, as a result of changing their direction to transverse, create a circular sphincter that prolapses into the sinus of the valve in the form of a kind of attachment rim. The valve stroma is formed by smooth muscle fibers, which run in fan-shaped bundles onto the valve leaflets. Using an electron microscope, you can detect oblong-shaped thickenings - nodules, which are located on the free edge of the valve leaflets of large veins. According to scientists, these are peculiar receptors that record the moment when the valves close. The leaflets of an intact valve are longer than the diameter of the vessel, so if they are closed, longitudinal folds are observed on them. The excessive length of the valve leaflets, in particular, is due to physiological prolapse.

The venous valve is a structure that has sufficient strength that can withstand pressures of up to 300 mmHg. Art. However, part of the blood is discharged into the sinuses of the valves of large veins through the thin tributaries that do not have valves flowing into them, which is why the pressure above the valve leaflets decreases. In addition, the retrograde blood wave is scattered against the rim of the attachment, which leads to a decrease in its kinetic energy.

With the help of fibrophleboscopy performed during life, you can imagine how the venous valve works. After the retrograde wave of blood enters the sinuses of the valve, its leaflets begin to move and close. The nodules transmit a signal that they have touched to the muscle sphincter. The sphincter begins to expand until it reaches the diameter at which the valve flaps open again and reliably block the path of the retrograde blood wave. When the pressure in the sinus rises above the threshold level, the opening of the draining veins occurs, which leads to a decrease in venous hypertension to a safe level.

Anatomical structure of the venous system of the lower extremities

The veins of the lower extremities are divided into superficial and deep.

The superficial veins include the cutaneous veins of the foot, located on the plantar and dorsal surfaces, large and small saphenous veins and their numerous tributaries.

The saphenous veins in the foot area form two networks: the cutaneous venous plantar network and the cutaneous venous network of the dorsum of the foot. The common dorsal digital veins, which enter the cutaneous venous network of the dorsum of the foot, as a result of the fact that they anastomose with each other, form the cutaneous dorsal arch of the foot. The ends of the arch continue in the proximal direction and form two trunks running in the longitudinal direction - the medial marginal vein (v. marginalis medialis) and the marginal lateral vein (v. marginalis lateralis). On the lower leg, these veins are continued in the form of the large and small saphenous vein, respectively. On the plantar surface of the foot, a subcutaneous venous plantar arch stands out, which, widely anastomosing with the marginal veins, sends the intercapitate veins to each of the interdigital spaces. The intercapitate veins, in turn, anastomose with those veins that form the dorsal arch.

The continuation of the medial marginal vein (v. marginalis medialis) is the great saphenous vein of the lower limb (v. saphena magna), which along the anterior edge of the inner side of the ankle passes to the lower leg, and then, passing along the medial edge of the tibia, goes around the medial condyle, exits to the inner thigh at the back of the knee joint. In the area of the lower leg, the GSV is located near the saphenous nerve, through which the skin on the foot and lower leg is innervated. This feature of the anatomical structure must be taken into account during phlebectomy, since damage to the saphenous nerve can cause long-term and sometimes life-long disturbances in the innervation of the skin in the lower leg area, as well as lead to paresthesia and causalgia.

In the thigh area, the great saphenous vein can have from one to three trunks. In the area of the oval-shaped fossa (hiatus saphenus) there is the mouth of the GSV (saphenofemoral anastomosis). At this point, its terminal section bends through the seropid process of the lata fascia of the thigh and, as a result of perforation of the cribriform plate (lamina cribrosa), flows into the femoral vein. The location of the saphenofemoral anastomosis can be 2-6 m below where the pupart's ligament is located.

Along its entire length, the great saphenous vein is joined by many tributaries that carry blood not only from the area of the lower extremities, from the external genitalia, from the area of the anterior abdominal wall, but also from the skin and subcutaneous tissue located in the gluteal region. In normal condition, the great saphenous vein has a lumen width of 0.3 - 0.5 cm and has from five to ten pairs of valves.

Permanent venous trunks that drain into the terminal portion of the great saphenous vein:

v. pudenda externa - external genital, or pudendal, vein. The occurrence of reflux along this vein can lead to perineal varicose veins;
v. epigastrica superfacialis - superficial epigastric vein. This vein is the most constant tributary. During surgery, this vessel serves as an important landmark by which the immediate proximity of the saphenofemoral anastomosis can be determined;
v. circumflexa ilei superfacialis – superficial vein. This vein is located around the ilium;
v. saphena accessoria medialis – posteromedial vein. This vein is also called the accessory medial saphenous vein;
v. saphena accessoria lateralis – anterolateral vein. This vein is also called the accessory lateral saphenous vein.

The external marginal vein of the foot (v. marginalis lateralis) continues with the small saphenous vein (v. saphena parva). It runs along the back of the lateral malleolus, and then goes up: first along the outer edge of the Achilles tendon, and then along its back surface, located next to the midline of the back surface of the leg. From this moment on, the small saphenous vein may have one trunk, sometimes two. Next to the small saphenous vein is the medial cutaneous nerve of the calf (n. cutaneus surae medialis), thanks to which the skin of the posteromedial surface of the leg is innervated. This explains the fact that the use of traumatic phlebectomy in this area is fraught with neurological disorders.

The small saphenous vein, passing through the junction of the middle and upper thirds of the leg, penetrates the zone of deep fascia, located between its layers. Reaching the popliteal fossa, the SVC passes through a deep layer of fascia and most often connects with the popliteal vein. However, in some cases, the small saphenous vein passes over the popliteal fossa and connects with either the femoral vein or tributaries of the deep femoral vein. In rare cases, the SVC flows into one of the tributaries of the great saphenous vein. In the area of the upper third of the leg, many anastomoses are formed between the small saphenous vein and the system of the great saphenous vein.

The largest permanent estial tributary of the small saphenous vein, which has an epifascial location, is the femoropopliteal vein (v. Femoroplitea), or vein of Giacomini. This vein connects the SVC with the great saphenous vein located on the thigh. If reflux occurs along the Giacomini vein from the GSV basin, this can cause varicose veins of the small saphenous vein. However, the opposite mechanism can also work. If valvular insufficiency of the SVC occurs, then varicose transformation can be observed in the femoropopliteal vein. In addition, the great saphenous vein will also be involved in this process. This must be taken into account during surgery, since if preserved, the femoropopliteal vein may be the reason for the return of varicose veins in the patient.

Deep venous system

Deep veins include veins located on the back of the foot and sole, on the lower leg, as well as in the knee and thigh area.

The deep venous system of the foot is formed by paired companion veins and arteries located near them. The companion veins encircle the dorsum and plantar region of the foot in two deep arcs. The dorsal deep arch is responsible for the formation of the anterior tibial veins - vv. tibiales anteriores, the plantar deep arch is responsible for the formation of the posterior tibial (vv. tibiales posteriores) and receiving peroneal (vv. peroneae) veins. That is, the dorsal veins of the foot form the anterior tibial veins, and the posterior tibial veins are formed from the plantar medial and lateral veins of the foot.

In the lower leg, the venous system consists of three pairs of deep veins - the anterior and posterior tibial veins and the peroneal vein. The main load for the outflow of blood from the periphery is placed on the posterior tibial veins, into which, in turn, the peroneal veins drain.

As a result of the fusion of the deep veins of the leg, a short trunk of the popliteal vein (v. poplitea) is formed. The knee vein receives the small saphenous vein, as well as the paired veins of the knee joint. After the knee vein enters this vessel through the lower opening of the femoropopliteal canal, it begins to be called the femoral vein.

The sural vein system consists of the paired gastrocnemius muscles (vv. Gastrocnemius), which drain the sinus of the gastrocnemius muscle into the popliteal vein, and the unpaired soleus muscle (v. Soleus), which is responsible for drainage into the popliteal vein of the sinus of the soleus muscle.

At the level of the joint space, the medial and lateral gastrocnemius veins flow into the popliteal vein through a common mouth or separately, emerging from the heads of the gastrocnemius muscle (m. Gastrocnemius).

Next to the soleus muscle (v. Soleus) the artery of the same name constantly passes, which in turn is a branch of the popliteal artery (a. poplitea). The soleus vein drains independently into the popliteal vein or proximal to the place where the opening of the gastrocnemius veins is located, or flows into it. The femoral vein (v. femoralis) is divided by most specialists into two parts: the superficial femoral vein (v. femoralis superfacialis) is located further from the place where the deep vein of the thigh flows into it, the common femoral vein (v. femoralis communis) is located closer to the place where it the deep vein of the thigh enters. This division is important both anatomically and functionally.

The most distal major tributary of the femoral vein is the deep femoral vein (v. femoralis profunda), which joins the femoral vein approximately 6-8 cm below where the inguinal ligament is located. A little lower is the place where the tributaries, which have a small diameter, enter the femoral vein. These tributaries correspond to small branches of the femoral artery. If the lateral vein that surrounds the thigh has not one trunk, but two or three, then at the same place its lower branch of the lateral vein flows into the femoral vein. In addition to the above vessels, the femoral vein, in the place where the mouth of the deep vein of the thigh is located, most often contains the confluence of two companion veins, forming a para-arterial venous bed.

In addition to the great saphenous vein, the common femoral vein also receives the medial lateral vein, which runs around the thigh. The medial vein is more proximal than the lateral vein. The place of its confluence can be located either at the same level with the mouth of the great saphenous vein, or slightly above it.

Perforating veins

Venous vessels with thin walls and varying diameters - from a few fractions of a millimeter to 2 mm - are called perforating veins. These veins are often characterized by an oblique course and are 15 cm long. Most perforating veins have valves that serve to direct the movement of blood from the superficial veins to the deep veins. Along with perforating veins, which have valves, there are valveless, or neutral, veins. Such veins are most often located in the foot. The number of valveless perforators compared to valved ones is 3-10%.

Direct and indirect perforating veins

Direct perforating veins are vessels through which the deep and superficial veins are connected to each other. The most typical example of a direct perforating vein is the saphenopopliteal anastomosis. The number of direct perforating veins in the human body is not so large. They are larger and in most cases are located in the distal areas of the limbs. For example, on the lower leg in the tendon part there are the perforating veins of Cockett.

The main task of indirect perforating veins is to connect the saphenous vein with the muscular vein, which has a direct or indirect connection with the deep vein. The number of indirect perforating veins is quite large. These are most often very small veins, which are mostly located where muscle masses are located.

Both direct and indirect perforating veins often communicate not with the trunk of the saphenous vein itself, but only with one of its tributaries. For example, the perforating veins of Cockett, which run along the inner surface of the lower third of the leg, where the development of varicose and post-thrombophlebic disease is quite often observed, is not connected to the deep veins by the trunk of the great saphenous vein itself, but only by its posterior branch, the so-called vein of Leonardo. If this feature is not taken into account, this can lead to relapse of the disease, despite the fact that the trunk of the great saphenous vein was removed during the operation. In total, there are more than 100 perforators in the human body. In the thigh area, as a rule, there are indirect perforating veins. Most of them are in the lower and middle third of the thigh. These perforators are located transversely, with their help the great saphenous vein is connected to the femoral vein. The number of perforators varies – from two to four. Under normal conditions, blood through these perforating veins flows exclusively into the femoral vein. Large perforating veins can most often be found immediately near the place where the femoral vein enters (Dodd's perforator) and where it exits (Gunther's perforator) from the Gunter's canal. There are cases when, with the help of communicating veins, the great saphenous vein is connected not to the main trunk of the femoral vein, but to the deep vein of the femur or to a vein that runs next to the main trunk of the femoral vein.

Classification and stages

Like any disease, VV has several stages, differing from each other in the degree of spread of the pathology and symptoms. Among them, the following stages are distinguished:

Initial (or compensation).
Second (or subcompensation).
Third (or decompensation).

A detailed description of each stage can be found here.

It is worth noting that complications can occur at any of the above stages, but their greatest likelihood is inherent in the last two. VV can serve as an impetus for the development of diseases such as:

Thrombophlebitis.
Erysipelas.
Deep vein thrombosis.
Trophic eczema.

A visit to a specialist, made at the first signs of the disease, will help reduce the risks of worsening the situation and begin removing varicose veins. You should not ignore even minor symptoms, because this can lead to undesirable and extremely negative consequences.

Varicose veins of the lower extremities - stages

First. Spider veins appear;
Second. Nodules are visible;
Third. Swelling of the legs is added;
Fourth. Skin color becomes darker, almost purple;
Fifth and sixth. Ulcers form, which may not heal as a result.

This is what varicose veins look like in stage II of the disease

Diagnostics

Diagnosis of varicose veins, the symptoms of which are described above, poses the following tasks:

Determining the presence of pathology in each individual patient. It often happens that people who do not have varicose veins are confident in their presence, and vice versa. However, only an experienced phlebologist, based on an external examination and a series of comprehensive studies, can make an accurate diagnosis.
Establishing the type characteristic of venous pathology. The doctor determines exactly which veins have undergone pathological damage, and also establishes the extent of this damage and possible or already occurring consequences.
Prescribing the correct course of treatment. Based on the diagnosis and the characteristics of each specific organism, the attending physician makes a choice in favor of one or another treatment or a set of therapeutic measures.
Assessment of the level of effectiveness of therapy, which is carried out by the attending physician during the elimination of the disease or after the patient’s complete recovery.

The main methods for diagnosing VV include:

Plethysmography.
Thermography.
Magnetic resonance imaging.
Ultrasound angioscanning.
Computed tomography.
Clinical studies: conversation with the patient, his external examination and manual examination.
Radionuclide phlebography.
Intravascular ultrasound.
X-ray phlebography.

Most often, it is enough for a professional specialist to conduct a clinical examination and ultrasound angiography in order to diagnose varicose veins in the legs. At the Yuzhny clinic, you can undergo a full examination in order to make an accurate diagnosis by an experienced phlebologist. Our specialists work closely with clients, clearly explaining to each of them the specifics of the disease and possible ways to combat it.

Varicose veins of the lower extremities - diagnosis

In addition to reviewing your medical history as well as a physical examination, testing for vein disease may include the following:

Duplex scanning is a type of procedure that evaluates the blood flow and structure of the veins in the legs.
Triplex ultrasound is a procedure similar to duplex ultrasound, which uses color to highlight the direction of blood flow.
Magnetic resonance venography (MRV) is a diagnostic procedure that uses magnetic resonance technology and intravenous contrast material to visualize veins.

Diagnosis of varicose veins of the lower extremities is carried out with the patient standing

Diagnostics is necessary so that the doctor can prescribe a treatment method that is most suitable for the patient.

Treatment methods

Modern methods of treating varicose veins are aimed at reducing the degree of disability and trauma, which contributes to a faster recovery of the patient. Main therapeutic techniques include:

Sclerotherapy. This method involves introducing a special medication into the lumen of varicose veins of the legs, causing a chemical burn of the internal venous wall. This leads to their gluing and cessation of pathological blood flow through them. Can be used alone or in combination with other types of manipulation. It is carried out without prior anesthesia with skin punctures using a thin needle. The duration depends on the scale of the lesion.
Foam sclerotherapy, which involves the preparation by a specialist of a special medication of foam that can use an impressive area of the internal walls of the affected venous vessels. Used to treat large diameter veins.
Endovenous laser coagulation, which is performed using a laser device on the main trunks of the leg veins and allows you to stop the pathological flow of blood through the affected veins due to the burn of their inner walls and their subsequent gluing. Laser treatment for varicose veins is available at the Yuzhny Medical Center.
Miniphlebectomy, aimed at eliminating subcutaneous nodes and tributaries enlarged by varicose veins through punctures of the skin. It has excellent cosmetic effects and is used alone or in combination with other therapeutic methods under local anesthesia.
Elimination of incompetent perforating veins, performed for the prevention of venous insufficiency and treatment of trophic disorders, including ulcers.
Combined phlebectomy, which is a combination of some methods of treating veins, based on the indications and nature of venous pathologies.

Yuzhny Medical Center offers its clients modern approaches to the treatment of varicose veins. Qualified specialists work here, ready to conduct a competent examination in order to make a diagnosis and carry out effective treatment, more about which you can read here.

Methods for diagnosing the disease

The diagnosis is made by a phlebologist. He examines the patient lying and standing. The doctor needs to distinguish reticular varicose veins from telangiectasia, the initial stage of livedo reticularis, Klippel-Trenaunay syndrome, Maffucci syndrome, Bloom's syndrome, and port wine stain.

Ultrasound in duplex mode is prescribed. Using ultrasound, the condition of the vein valves is assessed. The diagnosis is established if a violation of the reticular blood flow is confirmed, i.e., there is obstruction and reflux of the superficial vessels.

An ultrasound scan is performed. Dopplerography shows the direction of blood movement. During the scan, the doctor asks you to hold your breath, strain, and simulate walking while lying down. An image of green and red vessels is displayed on the screen. The red color shows the extent of the pathological area, and the green color shows the functionality of the venous valve. The direction and speed of blood movement is indicated.

Complications with varicose veins

It is worth understanding that improper treatment of the disease or complete refusal of it can lead to complications. The latter appear not only in cosmetic defects of the lower extremities, but also in more serious forms. Among them:

Trophic eczema, which subsequently develops into an ulcer.
Thrombotic lesions of the venous system, including thrombophlebitis of the superficial veins and deep vein thrombosis of the lower extremities.

Venous blood is a kind of “sewer” for the body’s tissues and is saturated with substances and products of cell metabolism that are relatively harmful to the human body. Cells of the skin and subcutaneous tissue, as well as muscles and bones, discharge products of tissue respiration and other waste material into the venous system, which carries them to the heart, lungs, kidneys and liver. In case of disturbances in the functioning of the venous system, the content of these products in the tissues of the body increases.

A vein dilated by varicose veins leads not only to an increase in the concentration of harmful products in the tissues, but also to an increase in their swelling. This disruption of the outflow of harmful products, combined with swelling observed over a long period of time, leads to the death of skin cells and subcutaneous tissue and their subsequent replacement by venous eczema, represented by a dense and dotted structure of a dark color. The death of the surface layer of the skin is the cause of trophic ulcers.

Functions of the leg veins

The veins of the legs have a difficult task - without contractility, they must deliver a mass of blood from the most distant parts of the body to the heart.
This is what predetermined the structure of the network, divided into superficial and deep vessels, connected by a network of perforating ducts. Their walls consist of three layers:

Intima is the inner layer of endothelium, separated from the middle layer by a thin membrane.
The medial layer is the middle “layer” of the tube, represented by elastic fibers and a small proportion of muscle fibers. It is this layer that gives them strength and stretchability.
The outer layer, consisting of connective tissue bordering the membrane that separates the blood tubes from the muscle tissue.

Despite the fact that in the lower extremities the drainage network is represented by tubes of different diameters (from 1.5 to 11 mm), the anatomy of the veins is almost the same. The only difference is the thickness of each layer and the number of valves. For example, the veins of the lower leg have more valves, but their diameter is 2 times smaller than that of the great saphenous vein.

In addition to blood pressure, superficial vessels experience significant stress due to external influences, so the thickness of their middle layer is much greater than that of deep-lying tubes. For example, the walls of the great saphenous vein are 1.3 times thicker and stronger than those of the deep vein.

The main functions of the VNK are:

Ensuring uninterrupted outflow of blood, in which carbon dioxide and waste products of tissues located within their reach are dissolved.
Delivery to tissues of hormones, organic compounds (enzymes, amino acids, proteins), vitamins and microelements coming from the intestines.
Regulation of general blood pressure.

It is the variety of tasks assigned to the VNK that has led to close attention to the condition of the blood vessels. Any deviation in their functionality can cause irreparable harm to health.

Prevention

Varicose veins on the legs, which are treated today using various methods, can be avoided by following preventive measures. Due to the fact that the risk of developing VV is much higher in women, it is they who need to not ignore the prevention of this disease. However, men should also not ignore preventive measures aimed at preventing the development of varicose veins in the legs. Key activities include:

The use of local preparations (gels, ointments, creams) that help strengthen the walls of blood vessels, optimize the functioning of valves, reduce the risk of blood clots, eliminate swelling and heal wounds.
The use of knee socks, tights, stockings and elastic bandages that have a compression effect. This is an excellent tool in the fight against varicose veins. These products can be purchased in specialized stores after consultation with a doctor, which is necessary due to the relative difficulty in independently determining the required type of compression garments.
Specific exercises performed on a daily basis. They are able to stop even the dilation of blood vessels that has already begun. It should be borne in mind that if you have a tendency to BB, you will have to give up heavy physical activity, but in no case should you ignore an active lifestyle. For example, light jogging, swimming, yoga and skiing help maintain healthy leg veins.
Preventive tablets for varicose veins are recognized as a more effective method of preventing VVs than the use of local drugs. However, any oral medication should be used only as directed and under the strict supervision of a competent specialist.

In order to prevent the situation from worsening, you should stop self-medicating at the first manifestations of the disease and consult a doctor. This will make it possible to make a correct diagnosis in a timely manner and prescribe adequate treatment, which will stop the progression of the disease and reduce to zero the risks of developing other pathologies.

Causes and risk factors for the development of reticular varicose veins

Most often the disease is observed in women. The trigger mechanism is hemodynamic disturbance. Due to the fact that the valve is deformed, blood begins to circulate in the opposite direction. The plexus of blood vessels becomes overcrowded, and the blood stagnates. Because of this, the walls of the blood vessels expand, become brighter and more noticeable through the skin.

This condition may be preceded by:

Hormonal surge. A decrease in estrogen and an increase in progesterone leads to a loss of venous tone and expansion of the lumen of blood vessels, rapid blood clotting, and a decrease in antithrombin in plasma. Phlebopathy develops. This process is often observed in pregnant women, as well as in women who take oral contraceptives.
Heredity. Changes in connective tissue are transmitted through the female line, therefore, with varicose veins in a mother or grandmother, the risk of dilation of reticular vessels increases at a young age.
Load on the legs. In people who work sitting or standing, the diagnosis is made more often. Reticular varicose veins of both extremities are observed in office workers, accountants, loaders, hairdressers, and teachers.
Frequent air travel. During air travel, due to changes in atmospheric pressure, vascular tone and blood flow in the reticularities change.

The development of the disease is aggravated by smoking, obesity, arterial hypertension, second and subsequent pregnancy, taking corticosteroids, liver cirrhosis, systemic scleroderma.

FAQ

Very often people are interested not only in the question of how to treat varicose veins. Many patients suffering from this disease are interested in what they can do and what they cannot do, in order not to worsen their health condition and not provoke the emergence of other health problems. Below are frequently asked questions of interest to people with VV.

Is it possible to get vaccinated against coronavirus if you have varicose veins?

The answer to the question of whether coronavirus vaccination is allowed for varicose veins is yes. This pathology is not a limitation for vaccination against COVID-19 in the absence of its exacerbation. If a person does not suffer from acute thrombophlebitis, then this refers to decompensation of varicose veins of the legs, and he is not prohibited from being vaccinated against coronavirus infection.

Is it possible to drink coffee if you have varicose veins?

Caffeine has the ability to increase blood pressure and increase heart rate, which are unfavorable factors for fragile, swollen veins damaged by varicose veins. Coffee has the following effects on blood vessels:

Increased load on the vein walls.
Increased blood pressure.
Short-term venous expansion.

Therefore, with varicose veins, you can drink coffee, but not exceeding the daily norm. Completely giving up your favorite tonic drink will not lead to the restoration of veins affected by pathology, so you should not torture yourself and not drink coffee. You just shouldn't drink more than 1-2 cups a day. It is also recommended to dilute coffee with milk.

Is massage allowed?

Comprehensive treatment of varicose veins at an early stage includes massage. However, it requires proper execution.

For varicose veins, you can only do a light massage of the lower extremities. It is also indicated for patients with uncomplicated forms of varicose veins.

It is advisable to perform a professional manual massage for patients with varicose veins, but it is imperative to take into account all the features of the course of the disease. It is recommended that you consult with a specialist before you begin massaging the area where the veins are affected by varicose veins.

Is it possible to warm your feet?

When the legs are heated, the veins expand, blood circulation increases and the load on the venous walls only increases. This can worsen the already poor condition of varicose veins. This is why it is recommended to limit hot baths for patients with varicose veins. It will be better to reduce the temperature of the water from hot to warm, which will not cause vasodilation and will not lead to a worsening of the person’s condition. You should always remember that consultation with a specialist is necessary regardless of whether we are talking about hot baths or vaccination for varicose veins.

Are running and squatting allowed?

Experts recommend starting jogging at the first signs of developing VV. It is important to ensure that these activities are systematic. During running, the blood is saturated with oxygen. Therefore, it is better to give preference to jogging in the forest or park, where the air is always clean.

However, you should adequately assess your capabilities and endurance, and avoid excessive stress, which is contraindicated for varicose veins. It is important to monitor a gradual increase in loads that do not exceed values that are comfortable for the body.

A person with BB should not feel tired while jogging. Only short-distance running using compression socks is allowed. In case of thrombophlebitis, jogging should be avoided. The admissibility of running and squats with pelvic varicose veins should be discussed with your doctor.

What is the best treatment for varicose veins?

Today there is no clear answer to the question of which therapeutic method is the most effective for varicose veins. The fact is that success in treatment depends on a number of factors that must be assessed by a qualified specialist in each specific case. Only after this can they make a final decision on prescribing one or another treatment for IV.

The danger of reticular varicose veins

In many cases, patients do not pay attention to spider veins and do not rush to see a doctor. There are practically no symptoms, so women attribute the visibility of veins to a cosmetic defect.

If treatment is not started at the initial stage, valvular insufficiency of the deep main veins will develop. Reticular varicose veins of the GSV tributaries are especially dangerous. The great saphenous vein runs along the medial side of the legs and connects with the femoral vein. As the GSV valves deform, varicose veins develop.

If the problem is ignored for a long time, the vascular network deepens and the risk of trophic ulcers increases.

Varicose veins. Radio frequency treatment

What to do if you have severe varicose veins of the lower extremities? RFA treatment in Moscow is the safest method, which involves heating the venous wall using radiofrequency energy. Varicose veins of the lower extremities disappear permanently. RFA treatment is very convenient.

How quickly do varicose veins of the lower extremities disappear? RFO treatment in Moscow will convince you of its rapid effect. You will remove varicose veins of the lower extremities. RFO treatment is performed at the highest level. Look at the photos and results - make sure the procedure is effective.

Primary risk factors for thrombosis:

frequent or extensive surgical operations;
wearing a central venous catheter;
severe injuries to the legs or pelvis;
prolonged immobility (bed rest, wearing a cast);
individual blood characteristics (high blood clotting, high levels of homocysteine or fibrinogen);
oncology;
heredity (antithrombin deficiency, pathologies of the system, blood circulation or homeostasis, problems with the secretion and absorption of proteins C and S).

Important:

congenital hereditary and individual characteristics are the most dangerous risk factors for thrombosis.

Varicose veins. Laser treatment in Moscow

Life does not end if you have varicose veins of the lower extremities. Laser treatment will help. The doctor inserts a tiny fiber into the varicose veins through a catheter. The fiber sends out energy that destroys the affected part.

This is a tiny laser fiber that completely eliminates varicose veins

Do varicose veins of the lower extremities remain? Laser treatment, which may seem expensive, is very effective, so the answer is no. Not every patient worries if he has varicose veins of the lower extremities. However, laser treatment leaves only positive reviews. With it, varicose veins of the lower extremities will be defeated! Laser treatment (you will find out the cost at the clinic from the administrator) is short-lived and inexpensive.

Material and methods

Since the beginning of 2015, MSCT venography was performed on 121 people. Initially, 30 lower extremities were examined in individuals without signs of CVD (control group). The study group included 91 patients (52 women and 39 men aged 32 to 65 years) with CVD with clinical class C0-C6. Class C0—C1 occurred in 15 (16.5%) patients, C2—C3 — in 45 (49.5%). 31 (34%) patients had various trophic skin disorders (C4-C6).

All studies were performed on a 128-slice Philips Ingenuity CT multislice computed tomograph with the Intell Space Portal image processing software package, followed by reconstruction of a volumetric image in 3D mode.

The scanning was carried out in an automatic program mode, which implied sequential non-stop administration of a bolus of contrast agent and saline solution.

Scan mode: collimation 64×0.625; pitch 0.923; kilovoltage 100 kV; mAS 188; reconstruction parameters: axial + cranial orientation.

MSCT venography was performed according to the method we developed. In a clean dressing room or in a study room, the vein of the dorsum of the foot was catheterized using an intravenous catheter G22-G24. The patient was placed on the table on his back. One of two infusion syringes (A) was filled with 50 ml of non-ionic contrast agent (Ultravist). An isotonic sodium chloride solution was drawn into the second infusion syringe (B) at the rate of 1 ml of 0.9% saline per 1 cm of height of the subject. Both infusion syringes were inserted into the auto-injector. Using an infusion line, the injector was connected to an intravenous catheter and the infusion mode was switched on from A to B, with an injection rate of the radiopaque mixture of 4 ml/s.

Computer marking of the scanned limb was carried out, including the pelvis and foot. After preliminary scanning, the scanning area was finally set (the entire lower limb and pelvic area) with a direction from the pelvis to the foot. The scanning time parameters were entered into the program.

A pneumatic cuff was placed over the ankles, the pressure in which was raised to 60 mm Hg, and the administration of a radiopaque mixture began, which, depending on the calculated volume, lasted about 40 s. After completing the administration of the entire volume of contrast and isotonic sodium chloride solution, the pressure in the second cuff placed at the mid-thigh was raised to 60 mmHg, and the patient took a deep breath, held his breath and tensed the muscles of the anterior abdominal wall. From this moment, the first main scan began, the total duration of which was 12-15 s. After this, the patient exhaled and performed five dorsiflexion movements of the foot. After completing the test, the patient returned to the starting position. After 40 s, the second main scan began, after which the study was completed and a three-dimensional image of the limb and veins was reconstructed using automatic Intell Space Portal data processing protocols embedded in the computer.

Varicose veins of the lower extremities - drug treatment

It is not always necessary, but if you are concerned about pain, ulcers or just discomfort, then, as a rule, you need to go to the hospital. But do not forget about complications, some of which lead to death, therefore, in order not to worsen the general condition, do not ignore treatment and seek medical help if you have varicose veins of the lower extremities. The doctor will explain conservative treatment and its essence.

One of the most popular venotonic drugs

Varicose veins of the lower extremities, treatment. Operation?

Don't panic if you are diagnosed with varicose veins of the lower extremities. Sclerotherapy treatment may help. This procedure is based on the use of a special solution that is injected into varicose veins. Varicose veins of the lower extremities disappear quite quickly. Sclerotherapy treatment is suitable for treating small veins such as spider veins. Are you afraid of a knife? Varicose veins of the lower extremities can be removed (treatment without surgery). You just need to find a decent doctor.