Varicose veins.

What are varicose veins?

Varicose veins (in common parlance - varicose veins ) are overstretched, irregularly shaped, tortuous blood vessels that have lost their elasticity. They are increased in length and width and look like thick, convoluted blue strands that are visible under the skin. Veins become this way when the venous valves are missing or for some reason cannot perform their functions. If the valves do not work properly, blood flows through the veins in the opposite direction, downwards, accumulating in the lower sections of the veins and bursting their walls. As a result, the veins lose their natural shape, and a pathological chain of various complications begins.

Blood vessels

Blood vessels have different shapes, structures and volumes, depending on their role in the body.

1. Arteries are the strongest vessels in the human body. Their walls are dense and elastic, consisting of three layers - endothelium, smooth muscle fibers and fibrous tissue. The task of the arteries is to saturate all organs and tissues with blood enriched with oxygen and nutrients. An exception is the arteries of the pulmonary circulation, through which venous blood flows from the heart to the lungs. The largest arterial vessel is the aorta.

2. Veins perform the function of transporting waste blood, saturated with carbon dioxide, back to the heart. This vein fluid is obtained from capillaries. Like an artery, a vein consists of several layers - endothelial, soft connective, dense connective and muscle. Venous walls are several times thinner and more vulnerable than arterial walls. For this reason, as you move away from the heart, the movement of venous blood may be disrupted - the pressure in the capillaries is almost equal to atmospheric pressure, and a normal flow is not created. Therefore, in hemodynamics, the vessels are assisted by the venous valves and the venous pulse.

3. Capillaries are the thinnest vessels, similar in volume to human hair. They are branches of large peripheral arteries. It is through them that tissues and organs are supplied with oxygen and nutrients. They also communicate with the veins to carry cellular waste. Consequently, these tiny vessels are at the same time the breadwinners and caretakers of our body.

Normal blood circulation within the vascular system is ensured by blood pressure.

How common are varicose veins?

Varicose veins are one of the most common diseases of the vascular system. According to some statistical estimates, from varicose veins . The number of people who have varicose veins increases with age, and women are affected much more often than men. According to statistics, in the age group under 25 years only 8% of women suffer from varicose veins, and in the older age group - 55 years and older - 64% of women are affected by varicose veins.

How can you recognize varicose veins in yourself?

The most common sign of varicose veins is fatigue, dull pain, a feeling of heaviness and fullness in the legs after sitting or standing for a long time. Often these symptoms appear or worsen in the evening. However, it is usually impossible to determine exactly where it hurts. And if these unpleasant symptoms - fatigue, heaviness, pain - go away after resting with your legs elevated, then they are really caused by varicose veins (unless some other cause is reliably identified).

However, do not rush to blame everything on varicose veins, especially if there are no external signs in the form of dilated veins. Some other painful conditions may also exhibit the same symptoms.

Leg cramps

With varicose veins, painful nighttime cramps in the leg muscles can actually occur (in other words, “leg cramps”). Most often, cramps appear in the calf muscles and can sometimes be so painful that the patient wakes up. Moreover, night cramps usually occur after a hard day, when the patient had to stand or sit a lot.

Is varicose veins inherited?

It is now known that varicose veins are hereditary. Scientists even believe that they were able to isolate a separate gene responsible for the development of varicose veins. It is not yet clear whether this gene causes malformations of the venous valves or malformations of the vein walls themselves. But there is no doubt that these studies will help develop a gene therapy technique - perhaps the most promising way to prevent and treat varicose veins. Unfortunately, this is still a matter of the rather distant future, and gene therapy is not yet available to patients with varicose veins.

Varicose veins during pregnancy

Pregnancy does not cause varicose veins, but it is often a trigger for the appearance of varicose veins in those women who are predisposed to it. For example, in people with congenital insufficiency or even absence of venous valves. This fact has already been established quite definitely, because many pregnant women do not develop any varicose veins. Sometimes varicose veins appear only during the fourth, fifth or tenth pregnancy.

And in some women, they appear during pregnancy and disappear immediately after the birth of the child. Pregnancy acts as a triggering factor for varicose veins due to the fact that during pregnancy the content of sex hormones - estrogen and progesterone - in a woman’s blood increases sharply. These hormones, in high concentrations, help soften the venous walls, the veins stretch, and the valves cannot close normally because of this.

Physiology/hemodynamics

Normally, oxygenated blood leaves the left side of the heart through very large arteries. Which then branch into smaller and smaller arteries, then into arterioles and capillaries, which penetrate all organs and tissues of the human body. They are visible only under a microscope. The capillary bed connects the smallest arteries (arterioles) with the smallest veins (venules). Capillaries are very small vessels with very thin walls, thanks to which oxygen and nutrients easily flow from the blood into the tissues of the body. The tissues, in turn, release carbon dioxide and various waste products into the blood, which returns through the veins to the heart (Figure 1).

Picture 1.

Blood from the heart enters the large arteries (indicated in red), then it flows into smaller arteries and arterioles of the upper and lower extremities, as well as other organs and systems of the human body. Then the blood enters a network of tiny vessels - capillaries, which penetrate all human tissues and organs. The blood releases oxygen and various nutrients, and then returns through the veins (highlighted in blue) to the heart.

The venous system of the lower extremities consists of superficial and deep veins. Deep veins are large vessels through which the bulk of the blood moves due to the work of muscles. Superficial veins are smaller vessels that collect blood from the skin and subcutaneous tissue, and, due to the work of venous valves, move it upward, back to the heart. The superficial and deep veins communicate with each other through communicating or perforating veins, which are also equipped with valves. It is due to the operation of the valves that blood moves from the bottom up and from the superficial veins to the deep ones; such one-way movement is the key to the proper functioning of the veins.

Regulation of blood flow through the vessels is carried out by the nervous, endocrine system, as well as local vasoactive substances produced in tissues. This complex regulation allows blood flow to increase or decrease depending on the body's needs, for example, increased blood flow in the muscles during exercise, and decreased at rest. By changing the tone of skin vessels, body temperature is regulated. When it is cold, the blood vessels in the skin constrict, blood moves closer to the center of the body, due to this mechanism the body retains heat. On the contrary, when it is hot, the blood vessels in the skin dilate and the body gives off more heat. Various body injuries and injuries trigger processes that can cause blood flow to increase or decrease, for example, in the area of ​​a skin burn or in a sprained area.

The walls of the veins are very thin and pliable, so the venous system can change its capacity to accommodate different amounts of blood. Blood volume is proportional to the pressure inside the veins. When the amount of blood in the veins decreases or its pressure on the vein walls decreases, the veins collapse like an empty balloon. When the volume of blood or its pressure on the walls of the vein increases, the veins expand, like an inflated balloon. If the pressure in the veins becomes very high, the venous wall stretches, its permeability increases and the vein allows fluid to pass through, which rushes into the tissue. This is how swelling occurs.

To maintain normal blood circulation in the body, the following 4 components are very important:

1. Normal functioning of the heart, which, when contracting, works like a pump
2. Pressure gradient between areas of low and high venous pressure
3. “Muscular-venous pump” - the muscles of the lower extremities contract and work like a pump, pushing blood to the heart
4. Normal, non-dilated, completely patent veins, with functioning venous valves

(1) The heart is the main pump of the human circulatory system. Blood moves through the arteries due to rhythmic heart contractions. It is important to understand that venous blood, after returning to the heart, must be pumped to the lungs, where it is enriched with oxygen. If the vein does not perform this function, as happens with heart failure, then venous blood stagnates and edema can appear even with absolutely normal veins.

(2) According to the laws of physics, any liquid moves from a high pressure zone to a lower pressure zone. The pressure difference between different zones is called gradient. There are such zones in the human body, thanks to which blood can move against the force of gravity. For example, the pressure in the veins of the lower extremities is higher than in the veins of the pelvis and abdominal cavity, and in the right parts of the heart it is even lower and may even be negative, which is why venous blood moves towards the heart. With some diseases of the lungs and heart, the pressure in the right parts of the heart may be increased, which can also lead to edema.

(3) “Muscular-venous pump” - like the heart, which pumps blood through the arteries, the muscles of the lower extremities contract to pump blood through the veins. The most important muscles performing the pumping function are the gastrocnemius muscles. There is also a venous network in the foot area; the muscles and ligaments of the foot also act as an additional pump. With each step, the muscles of the foot and lower leg contract rhythmically, pushing blood through the veins towards the heart, overcoming the effects of gravity. If a person leads a sedentary lifestyle and there is not enough activity in his life, the muscular-venous pump ceases to function normally and edema may appear. It can also occur as a result of injury or after a stroke. Sometimes the gait of older people changes, it becomes shuffling, the old people seem to shift from one foot to another. In this case, the muscular-venous pump also stops working and swelling may appear.

(4) Most veins in the human body are equipped with valves that allow blood to flow in only one direction. For the normal functioning of the venous system, the valves must be intact, that is, not damaged, and functioning correctly. As a result of contraction of the leg muscles, a portion of blood moves up through the veins, the valves allow blood to pass upward, and immediately close. They work like the rungs of a ladder, allowing blood to move forward towards the heart.

Figure 2.

The work of the “muscular-venous pump” is similar to a pump that pumps blood from the lower extremities to the heart. Due to the many valves with which the veins of the lower extremities are equipped, blood moves only in one direction: from the more superficial layers to the deep ones and from bottom to top, towards the heart. (a) When muscles contract, blood is forced out of the veins and moves upward. (b) When the muscles relax, the valves close, preventing blood from flowing back.

Each venous valve consists of two thin elastic flaps located opposite each other, opening and closing synchronously. If the vein dilates more than normal, as happens with varicose veins, the valve flaps cannot close and block the lumen of the vein, as a result, the blood moves in the opposite direction - this is called reflux. The flow of blood through a vein can also be disrupted if a blood clot forms that blocks the lumen of the vein. In both cases, venous pressure increases significantly, the vein wall becomes thinner as it stretches, and the liquid part of the blood seeps into the tissue, causing swelling. Edema is one of the main signs (symptoms) of improper functioning of the venous system.

If venous outflow is disrupted for a short time, for example after an air flight or prolonged static exercise, the main manifestation is swelling, which completely disappears overnight. If venous edema persists for a long time, for months, the skin and subcutaneous tissue begin to change, thickening and darkening may appear in the lower leg area, and subsequently infection, erysipelas, and microbial eczema may occur. All this can lead to the formation of long-term non-healing trophic ulcers.

Other causes of varicose veins

Such a widespread prevalence of varicose veins in highly developed Western countries is probably associated with the lifestyle of the population. For example, we spend a lot of time sitting on chairs. From kindergarten until graduation, a person sits for at least 40 hours a week (counting approximately 5 hours during the day in class, 3 hours in the evening doing homework, watching TV, and so on 5 days a week). Now let's multiply these hours by 10 months a year, and so on - up to 17 years. Then - work in some institution where you have to sit even longer. When a person sits in a chair, the veins running along the back of the thighs are compressed, and the calf muscles (the rhythmic contractions of which help move venous blood to the heart) do not work.

Another important factor is nutrition. In Western countries, people prefer a low fiber diet. With such a diet, fecal matter becomes denser, and constipation often occurs. When straining to move hard stool, the abdominal muscles tense and the pressure in the abdominal cavity increases significantly. High pressure spreads to the veins running along the back of the abdominal cavity and to the veins of the legs, which dilate, causing the venous valves to leak.

Anatomy of the veins of the lower extremities

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

Superficial veins of the lower limb

The superficial venous system of the lower extremities begins from the venous plexuses of the toes, forming the venous network of the dorsum of the foot and the cutaneous dorsal arch of the foot. From it originate the medial and lateral marginal veins, which pass into the greater and lesser saphenous veins, respectively. The plantar venous network anastomoses with the deep veins of the fingers, metatarsals and the dorsal venous arch of the foot. Also, a large number of anastomoses are located in the area of ​​the medial malleolus.

The great saphenous vein is the longest vein in the body, contains from 5 to 10 pairs of valves, and its normal diameter is 3-5 mm. It originates in front of the medial epicondyle and rises in the subcutaneous tissue behind the medial border of the tibia, bends around the medial femoral condyle behind and passes to the anteromedial surface of the thigh, parallel to the medial border of the sartorius muscle. In the area of ​​the oval window, the great saphenous vein pierces the ethmoidal fascia and flows into the femoral vein. Sometimes the great saphenous vein on the thigh and leg can be represented by two or even three trunks. From 1 to 8 large tributaries flow into the proximal portion of the great saphenous vein, the most constant of which are: the external genital, superficial epigastric, posteromedial, anterolateral veins and the superficial vein surrounding the ilium. Typically, tributaries flow into the main trunk in the area of ​​the fossa ovale or somewhat distally. In addition, muscle veins can flow into the great saphenous vein. The small saphenous vein begins behind the lateral malleolus, then it rises in the subcutaneous tissue, first along the lateral edge of the Achilles tendon, then along the middle of the back surface of the leg. Starting from the middle of the leg, the small saphenous vein is located between the layers of the fascia of the leg (N.I. Pirogov’s canal) accompanied by the medial cutaneous nerve of the calf. That is why varicose veins of the small saphenous vein are much less common than the large saphenous vein. In 25% of cases, the vein in the popliteal fossa pierces the fascia and flows into the popliteal vein. In other cases, the small saphenous vein can rise above the popliteal fossa and flow into the femoral, large saphenous vein, or into the deep vein of the thigh. Therefore, before the operation, the surgeon must know exactly where the small saphenous vein flows into the deep one in order to make a targeted incision directly above the anastomosis. The constant estuarine tributary of the small saphenous vein is the fenopopliteal vein (vein of Giacomini), which flows into the greater saphenous vein. Many cutaneous and saphenous veins flow into the small saphenous vein, most in the lower third of the leg. It is believed that the small saphenous vein drains blood from the lateral and posterior surface of the leg.

Deep veins of the lower limb

The deep veins begin as the plantar digital veins, which become the plantar metatarsal veins, which then drain into the deep plantar arch. From it, blood flows through the lateral and medial plantar veins into the posterior tibial veins. The deep veins of the dorsum of the foot begin with the dorsal metatarsal veins of the foot, which drain into the dorsal venous arch of the foot, from where blood flows into the anterior tibial veins. At the level of the upper third of the leg, the anterior and posterior tibial veins merge to form the popliteal vein, which is located lateral and somewhat posterior to the artery of the same name. In the area of ​​the popliteal fossa, the small saphenous vein and the veins of the knee joint flow into the popliteal vein. Then it rises in the femoral-popliteal canal, now called the femoral vein. The femoral vein is divided into the superficial vein, located distal to the deep vein of the thigh, and the common vein, which is located proximal to it. The deep vein of the thigh usually flows into the femoral vein 6-8 cm below the inguinal fold. As you know, the femoral vein is located medial and posterior to the artery of the same name. Both vessels have a single fascial sheath, while doubling of the trunk of the femoral vein is sometimes observed. In addition, the medial and lateral veins surrounding the femur, as well as muscular branches, flow into the femoral vein. The branches of the femoral vein widely anastomose with each other, with the superficial, pelvic, and obturator veins. Above the inguinal ligament, this vessel receives the epigastric vein, the deep vein surrounding the ilium and passes into the external iliac vein, which merges with the internal iliac vein at the sacroiliac joint. This section of the vein contains valves, in rare cases, folds and even septa, which causes thrombosis to be frequently localized in this area. The external iliac vein does not have many tributaries and collects blood mainly from the lower limb. Numerous parietal and visceral tributaries flow into the internal iliac vein, carrying blood from the pelvic organs and pelvic walls. The paired common iliac vein begins after the confluence of the external and internal iliac veins. The right common iliac vein, somewhat shorter than the left, runs obliquely along the anterior surface of the 5th lumbar vertebra and has no tributaries. The left common iliac vein is slightly longer than the right and often receives the median sacral vein. The ascending lumbar veins flow into both common iliac veins. At the level of the intervertebral disc between the 4th and 5th lumbar vertebrae, the right and left common iliac veins merge to form the inferior vena cava. It is a large vessel without valves, 19-20 cm long and 0.2-0.4 cm in diameter. In the abdominal cavity, the inferior vena cava is located retroperitoneally, to the right of the aorta. The inferior vena cava has parietal and visceral branches, which supply blood from the lower extremities, lower torso, abdominal organs, and pelvis. Perforating (communicating) veins connect the deep veins with the superficial ones. Most of them have valves located suprafascially and thanks to which blood moves from the superficial veins to the deep ones. About 50% of the communicating veins of the foot do not have valves, so blood from the foot can flow from deep veins to superficial ones, and vice versa, depending on the functional load and physiological conditions of outflow. There are direct and indirect perforating veins. Direct ones directly connect the deep and superficial venous networks, indirect ones connect indirectly, that is, they first flow into the muscular vein, which then flows into the deep vein. The vast majority of perforating veins arise from tributaries rather than from the trunk of the great saphenous vein. In 90% of patients, there is incompetence of the perforating veins of the medial surface of the lower third of the leg. On the lower leg, incompetence of the perforating veins of Cockett, which connects the posterior branch of the great saphenous vein (vein of Leonardo) with the deep veins, is most often observed. In the middle and lower thirds of the thigh there are usually 2-4 most permanent perforating veins (Dodd, Gunter), directly connecting the trunk of the great saphenous vein with the femoral vein. With varicose transformation of the small saphenous vein, incompetent communicating veins of the middle, lower third of the leg and in the area of ​​the lateral malleolus are most often observed. In the lateral form of varicose veins, the localization of perforating veins is very diverse.

Varicose veins in older people

Why varicose veins more common in older people, and especially common in women?

1. To answer briefly - because their vascular system wears out with age and, sooner or later, fails. However, there are still many objective reasons why older women suffer from varicose veins more often than younger men and women. Firstly, since women generally live somewhat longer than men, there are correspondingly more elderly women than elderly men, and their veins have been working harder for a longer period of time.

2. Men don't get pregnant. Even if varicose veins that appeared in a woman during pregnancy disappear soon after the birth of the child, these veins were still abnormally enlarged within a few months. And with age, all the muscles of the human body, including the smooth muscles of the vascular walls, become less elastic than in youth. And the veins, which had already expanded once, during pregnancy, in old age again become a little wider than normal.

3. Nowadays, many women over the age of 30 are resorting to hormone replacement therapy, which was originally intended to relieve the unpleasant symptoms of menopause. There is no doubt that hormone replacement therapy helps women look younger, feel better, and generally cope with the menopause years more easily. Doctors' observations also confirm that hormone replacement therapy to some extent reduces the frequency of angina attacks and prevents a decrease in bone strength due to osteoporosis.

However, hormonal supplements at the same time soften the vein walls in the same way as increased levels of estrogen and progesterone during pregnancy. This side effect of hormonal pills is all the more dangerous because the walls of the veins are already becoming weaker - due to natural age-related changes in the muscle layer. So, additional clinical studies are needed to definitively clarify this issue.

Veins of the lower extremities

Vienna

- these are vessels that ensure the outflow of blood from organs and tissues to the heart. The wall of the veins consists of three layers: internal (endothelium), middle (muscular) and external (adventitia). Unlike arteries, the walls of veins are thinner and contain few elastic fibers. Therefore, the veins are less elastic and collapse easily. In this case, the diameter of the veins is larger than that of the arteries. The peculiarity of the veins is that their diameter depends on many factors: body position, blood pressure, blood flow speed, condition of the valves and breathing phase.

The peculiarity of the veins in the legs is that they have valves. Venous valves are folds of the inner lining; they allow blood to flow towards the heart and prevent it from flowing back.

The flow of blood is carried out due to respiratory movements, the existence of constant muscle tone of the venous wall, constant support of blood from the arterial end of the capillary bed, and the suction action of the right parts of the heart. The main role in moving blood is played by the so-called “muscular-venous pump”. The deep veins that run in the legs are surrounded on all sides by muscles. When walking and physical activity on the legs, the muscles contract and squeeze blood upward.

If the valves are malfunctioning, during the operation of the muscle pump, there is no drop in pressure in the deep veins during muscle contraction. Venous blood is retained in the sinuses and venules, which leads to changes in capillary exchange parameters and the development of edema, pigmentation, itching and other symptoms of venous insufficiency.

The outflow of blood from the lower extremities is provided by three interconnected and clearly interacting systems: superficial veins, deep veins and communicating veins (perforators) connecting them.

Superficial veins

and their tributaries form venous networks under the skin. They can be felt and are quite visible. This network is especially clearly visible on the dorsum of the foot. From the superficial veins of the leg, it is customary to distinguish the large and small saphenous veins of the leg. Both saphenous veins receive other superficial veins along their path. Varicose veins on the legs concern the superficial veins.

Deep veins

. These veins are located between the muscles and connective tissue. The main outflow of blood (85-90%) is through the deep veins. These veins have valves that prevent blood from flowing back.

Superficial and deep veins are connected to each other by communicating veins

. The reason for the existence of these veins is to equalize the pressure between them. Damage to the valves of the communicating (perforating) veins leads to blood flowing from the deep veins to the superficial ones. Normally, the valves of these veins allow blood to flow in only one direction - from superficial to deep.

Types of varicose veins

Varicose veins are divided into two main groups:

1. The first group includes primary varicose veins, caused by a hereditary predisposition to varicose veins.
2. The second group includes varicose veins that appear after damage to the venous walls as a result of injury with the formation of blood clots in the veins or thrombosis.

When a clot or thrombus passes through a vein, the integrity of the venous valves is disrupted and secondary varicose veins are formed.

The heart is the basis of the circulatory system

The heart is a muscular organ about the size of a human fist that is located on the left side of the chest, just in front of the lungs. This organ is actually a powerful double pump with four chambers that pumps blood and keeps it moving throughout the body.

The right side of the heart consists of an upper (atrium) and lower (ventricle) chamber. The atrium receives processed venous blood, saturated with carbon dioxide, and then sends it to the ventricle. From there it enters the pulmonary arteries, where it is again saturated with oxygen. “Fresh” blood circulates to the left upper chamber (atrium), from where it enters the aorta and begins renewed transportation throughout the body.

The heart muscle beats more than 3 billion times during a lifetime.

Varicose veins

Varicose veins are bundles of thin, purple or red veins that appear around the knees or ankles. (Sometimes such vascular “webs” can appear on the face, near the nose.) These vessels cannot be called varicose veins, since, by definition, varicose veins are veins that are increased in length and in diameter. In fact, these are slightly dilated venules (vessels connecting capillaries to the veins themselves), which are located close to the surface of the skin.

Such dilated venules appear due to increased levels of female sex hormones in the blood and are often found in women taking oral contraceptives. But venules can expand even in the presence of varicose veins of larger veins that do not appear externally. However, women with varicose veins often experience symptoms very similar to those of varicose veins.

Cellular structure of blood

Blood consists of two components: plasma (50-60%) and suspended formed elements (40-50%).

The second category includes:

· Erythrocytes (red blood cells) are the most numerous of the formed elements. According to official studies, one drop of blood contains about 5 million red blood cells. Red blood cells are responsible for transporting gases - oxygen and carbon dioxide. They contain the protein hemoglobin, which binds oxygen molecules in the lungs. Red blood cells deliver oxygen to all tissues and organs, after which they absorb carbon dioxide and carry it to the lungs. It is removed from the body during respiration.

· Leukocytes (white blood cells) - elements that protect our body from foreign bodies and compounds, are part of the immune system. White blood cells recognize and attack pathogens through the production of antibodies and macrophages. When an infection enters the body, the production of leukocytes increases significantly. Normally, their quantity is inferior to the concentration in the blood of other formed elements.

· Platelets (blood platelets) are cells that provide coagulation (clotting) of blood flowing from a damaged vessel and protect the body from heavy blood loss. They stick to the hole in the damaged vessel, forming a “sealing” plug to stop bleeding. It is the platelets that can stick together and form pathological blood clots inside the vessels, called thrombi.

All formed elements are synthesized by the bone marrow and distributed through plasma, the liquid part of the blood.

Treatment of varicose veins

Treatment depends on the severity of the disease. If the disease does not manifest itself too strongly, then conservative treatment is best:

• regular rest with your feet up,
• elastic bandaging (or special elastic stockings),
• physical exercises for leg muscles.

If these measures are not enough, the veins affected by varicose veins must be surgically removed at the Phlebology Center. Or using new, experimental methods - elastic strengthening of the venous walls is carried out surgically. That is, a special elastic plastic cover is placed on the outer surface of the affected veins in places of varicose veins, where incompetent venous valves are located. And finally, to treat dilated venules or varicose veins of small veins remaining after surgery, sclerotherapy - that is, the introduction of sclerosing substances into the areas of dilation, which causes clogging of the pathological vein. Blood returns to the heart through normal venous vessels.

Introduction:

The circulatory system is responsible for moving blood throughout the body. The main components of this system are the heart and blood vessels. The heart is the central organ of the circulatory system. With each heartbeat, blood is pumped through the arteries and delivers oxygen and nutrients to various organs and tissues, after which the blood returns back to the heart through other blood vessels - veins.

There are three types of blood vessels that play different roles. The two main types are arteries and veins. Arteries carry oxygenated and nutrient-rich blood away from the heart, and veins return waste blood back to the heart. Lymphatic vessels are the third component; they filter and “purify” the liquid part of the blood - plasma, before returning it to the general bloodstream.

Complications during treatment

The main danger with conservative treatment (elastic stockings, exercise and resting with legs elevated) is its possible ineffectiveness.

Surgical treatment of varicose veins of the lower extremities should currently be performed by experienced vascular surgeons and phlebologists . Often complications and relapses after surgical treatment are caused by the fact that the operation was not performed by a specialist from the phlebology center.

With sclerotherapy, the main nuisance is small dark spots that can remain at the injection sites for several months, or in some cases forever.

Vein structure

Their structure has a thinner layer of muscle mass and is less elastic, since the blood pressure in them is several times lower than in the artery.

The veins contain valves that are responsible for the correct direction of blood circulation. Arteries, in turn, do not have valves. This is the main difference between the anatomy of the veins of the lower extremities and the arteries.

Pathologies may be associated with disruption of the functioning of arteries and veins. The walls of blood vessels are modified, which leads to serious disturbances in blood circulation.

Dilated veins after surgical treatment

If varicose veins have been removed, varicose veins will no longer appear in their place. However, sometimes varicose veins are found after surgery - in veins that were not previously affected, or in small veins that were not identified during the preoperative examination. Varicose veins after surgery appear because the blood is forced to find new outflow paths. At the same time, a larger volume of blood is redistributed to the remaining veins than before, and if there were any defects in the valves or walls, then new problems arise. New varicose veins, as a rule, bring cosmetic inconvenience and can be easily eliminated by a phlebologist using modern sclerotherapy techniques.

Varicose veins.

Menopause

Climax

3575 March 23

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Varicose veins of the lower extremities: causes, symptoms, diagnosis and treatment methods.

Directly varicose veins without chronic venous insufficiency is a chronic disease with varicose veins of the saphenous veins of the lower extremities without the phenomena of chronic venous insufficiency (edema, hyperpigmentation, venous eczema, lipodermatosclerosis, trophic ulcers).

According to statistics, about 30% of middle-aged and older people have varicose veins of the lower extremities.

Often the early stages of varicose veins are missed because the ability to work is not yet impaired and the person is only concerned about a cosmetic defect.

Later stages of chronic venous disease significantly reduce quality of life and require long-term treatment.
Causes
There is no exact answer to the question of the reasons for the development of varicose veins, but it has been established that hereditary predisposition plays a significant role. Scientists have identified gene regions that are responsible for changes in the structure of the venous wall.

The development of the disease is based on a violation of the venous outflow in the lower extremities. With healthy hemodynamics, blood moves from the legs to the heart due to the pumping (pulling) function of the heart, contraction of the muscles of the lower extremities and venous valves.

An important mechanism for the development of varicose veins is disruption of the valvular apparatus of the veins.

In this case, a reverse discharge of blood occurs under the influence of gravity down the venous bed, or venous reflux. Gradually, blood stagnation occurs, causing expansion of the saphenous veins.

Classification

Doctors use the CEAP classification of chronic venous diseases. Each letter in the abbreviation indicates a specific section of the classification.

The letter “C” codes for the clinical class of the disease.

• C0 – there are no manifestations of the disease.
• C1 – the appearance of telangiectasia and reticular varicose veins (reticular veins are medium-sized vessels, larger than capillaries). Telangiectasia is an expansion of venules that are located deep in the skin, and reticular varicose veins are an expansion of veins up to 3 mm in diameter.
• C2 – varicose veins of the saphenous veins more than 3 mm.
• C3 – the appearance of edema of the lower limb.
• C4a – the above symptoms are accompanied by trophic changes in the skin in the form of hyperpigmentation (darkening of the skin area) and/or varicose eczema (damaged areas of the skin with blisters and weeping).
• C4b – lipodermatosclerosis (varicose dermatitis) – excessive skin thickening and/or white skin atrophy (formation of small white scars).
• C5 – healed trophic (venous) ulcer.
• C6 – open (active) venous ulcer.

The letter “E” in the classification stands for etiology, or cause of the disease.

• Ec is a congenital disease.
• Ep – primary disease.
• Es – secondary varicose veins as a consequence of another pathology, for example, due to occlusion by a venous thrombus or due to trauma.
• En – the cause of varicose veins has not been established.

The next letter “A” indicates the anatomical localization of the pathological process.

• As – superficial veins are affected.
• Ap – perforating veins connecting the superficial and deep veins of the lower extremities are affected.
• Ad – deep veins of the lower extremities are affected.
• An – changes in the venous system cannot be detected.

The letter “P” denotes the pathophysiological section of the classification, which reflects the characteristics of hemodynamic disorders in the veins of the lower extremities.

• Pr – reflux.
• Po – occlusion, or blockage of the lumen of a vessel.
• Pr, o – a combination of reflux and occlusion.
• Pn – it is not possible to detect changes in the venous system.

Symptoms of varicose veins
One of the first symptoms that attracts attention is the expansion of small veins and venules in the form of stars (telangiectasia and reticular varicose veins).

Then, a feeling of tightness and squeezing appears in the legs, itching and burning in the legs and ankles, as well as dryness and flaking of the skin of the legs often occur.

These symptoms are caused by gradually developing stagnation of blood, lack of oxygen in the tissues, as well as a delay in the removal of metabolic products from the tissues.

A common symptom of varicose veins is swelling: marks from shoes and elastic socks remain on the skin. With a progressive deterioration in blood outflow, throbbing or aching pain, muscle spasms appear, and leg cramps may occur at night.

In advanced cases, in addition to the indicated symptoms, the color (pigmentation) of the skin in the area of ​​the legs and ankles changes to brownish.

Sometimes local redness of the skin develops and the risk of developing trophic ulcers in this area increases.

A trophic ulcer is an extreme degree of skin malnutrition and often occurs as a complication of varicose veins. The term “trophic” indicates that the ulcer arose as a result of tissue malnutrition and in the affected area the ability to heal independently is sharply reduced. This is why trophic ulcers are extremely difficult to treat, and chronic infection in this area can lead to the development of dermatitis and eczema. In severe cases, the purulent process can spread deep into the tissues, affecting the subcutaneous tissue and muscles.

Trophic ulcers occur in chronic venous insufficiency.
Diagnostics
Primary diagnosis of varicose veins of the lower extremities is primarily based on the patient’s typical complaints and external manifestations:

• Heaviness in the legs;
• Rapid fatigue of the legs;
• The appearance of edema;
• Itching, burning, numbness, cramps;
• Enlarged veins visible to the naked eye (“stars”, varicose veins, swollen veins on the legs);
• Changes in skin color and structure;
• Long-healing ulcers.

The diagnosis is confirmed using instrumental examination methods and excluding other causes of dilated veins.

• Ultrasound of the veins of the lower extremities (Doppler);