Varicose veins of the lower limbs

Varicose veins of the lower limbs is extremely common, and if, previously, the patients of a doctor are more likely to become elderly, so now it very often, people suffer from 25-45 years. Her symptoms, on a variety of data statistics, it has been observed that 66% of men and 90% of the women population in developed countries. This disease is progressive in nature and can be combined with a venous insufficiency.

Varicose veins of the lower limbs is accompanied by an extension of the superficial veins, which is caused by the venous insufficiency of the valve and is accompanied by a fundamental violation of hemodynamics. Subsequently, this pathology may be exacerbated thrombophlebitis, leading to the increase in the risk of developing phlebothrombosis and pulmonary embolism (pe).

The mechanism of development

The first amorage in the development of this disease of the veins of the lower limbs is to disrupt the functioning of the valves of the veins, which leads to reflux of blood. As a result, the slowing of the blood stream react with endothelial cells, and they are fixed to the cells, which activate inflammatory processes in the vessel wall, spread through the venous bed of the river. In parallel with the ignition is broken, the endothelial function of the layer of veins, and then all the layers of the wall of the vein.

In the first place, and especially of any pathological process suffers from the technology of the veins. First of all, generally assigned to the zone of maximum charge: at the mouth of the great and the small saphenous veins or large perforation of the vessels. In the following, due to the overflow of the bed venous is hyperextension of venous wall, and the volume of venous blood in the surface waters of the vessels venous of the lower limbs increases. In addition, this surpassed the volume from particularly the system in depth in the veins and stretching. In the future, develops the dilation and venous insufficiency of the valves.

These pathological changes led to the horizontal at reflux (casting the blood into the subcutaneous venous network) and the work of the venous pump completely loses its effectiveness. In the future, the development of a venous hypertension leading to venous insufficiency. First, the patient will appear swollen, and then blood bed in the soft tissues penetrate and blood cells, which lead to hyperpigmentation and the skin. With the progression of the disease on the surface of the skin appears ulcer trophic, which can be complicated by a secondary infection.

The reasons

Doctors have several reasons that may lead to abnormal disturbances in the functioning of the venous system. They are divided into two main groups:

• I – genetic predisposition;
• II – a number of reasons, caused by exposure to factors, or a combination of the two.

A hereditary predisposition to varicose disease can be defined as among women and among men, despite the fact that, in most cases, this condition can occur in women. The disease can be extended to time-anything not to be, but in certain circumstances (for example during intensive exercise) starts a failure of the valves of the veins.

In addition, the doctors emit a number of unfavorable factors, which may cause varicose veins:

• a hormonal imbalance;
• age;
• diabetes mellitus;
• frequent constipation;
• deferred to a surgical operation or an injury;
• the hypercoagulability;
• obesity;
• addiction to alcohol and tobacco;
• professional risks (increase in the load, the long distress standing);
• the wearing of a compression body of the machine;
• long wear high-heeled shoes;
• pregnancy and childbirth;
• constitutional features and congenital anomalies of the circulatory system;
• accommodation in adverse weather conditions.

The signs and symptoms

The varicose disease in most cases develops slowly and gradually. Early, it manifests as few and specific signs, which can be combined in "the syndrome of the feet, heavy":

• a feeling of heaviness in the legs;
• fatigue of the legs;
• burning sensation and bloating in the area of the veins;
• a throbbing pain;
• periodic swelling of the back of the foot and ankle, increasing in the evening, and disappear after a night's sleep.

The main and the first sign of the bursting of the varicose disease become apparent cylindrical sites extended superficial veins. This symptom is accompanied by fatigue rapid of the lower limbs, a burning sensation and the sense of bloating in the area of passage of the veins and the constant feeling of heaviness in the legs. Advances, the vessels become round and begin to occur on the surface of the skin in the area of the feet and lower leg, and after a long walk or a physical stress intense, they become more visible. The patient can disturb swelling, which are particularly evident in the evening in the area of the ankles, the lower part of the leg and the back of the foot. In the night, the patient may appear convulsions. And stages of the disease, because of the insufficiency of the blood circulation of the skin on the legs may deteriorate.

In some cases, the first signs of varicose veins visible as the so-called "vascular stars" (spider web of varicose veins in a thickness of 0.1 mm), and the sick for long time has no idea of the beginning of the disease. Some women perceive this symptom as cosmetic defects, and the men have simply not noticed. Despite the absence of other signs of the varicose illness, it is the "veins" are first and, in some cases, the only symptom of varicose disease and the use of a doctor at this stage of the disease can help the patient greatly slow the progression of the disease varicose veins.

Classification

Most often, doctors use a form of classification of venous disease, which was proposed in 2000, which takes into account the form of the disease and the degree of chronic venous insufficiency:

• I – intradermal or segmental varicose veins without veno-venous refusals;
• II – segmental varicose veins and reflux in perforation and/or the surface of the veins;
• III – a varicose veins and reflux in perforation or to the surface of the veins;
• IV – varicose veins reflux in the deep veins.

The varicose disease may be:

• rising – vienna begin to pathologically change with the feet;
• the decline – the development of varicose veins begins at the mouth of the great saphenous vein.

Also in cases of varicose veins of the feet to determine the tactics of treatment it is important to take into account the degree of chronic venous insufficiency:

• 0 – CVI;
• 1 – the patient is observed only in the syndrome of "heavy legs";
• 2 – the patient are present to move from the swelling,
• 3 – the patient are present, continued swelling, eczema, hypo - or hyperpigmentation;
• 4 – on the surface of the feet formed ulcer trophic.

Complications

Ulcers trophic

In the early stages of its development, the varicose disease significantly affects the patient's quality of life, and presented him with the unpleasant things under the visible form of the cosmetic problem. Subsequently, the progression of the pathology, on the members can form ulcers trophic, which are often complicated by a secondary infection. First, on the surface of the skin appear (usually in the area of the lower third of the leg) sites with fragile, dry, taut, shiny surface. Later on appear the areas of hyperpigmentation and develops a small wound increase in size and gives a painful sensation. In the following, its edges are becoming more dense, and the bottom is covered by the touch of color, dirty, and periodically bleeds. With a minimum injury to its borders increase significantly and the wound is infected.

Thrombophlebitis and thrombosis

In the event of a failure or non-skilled the treatment of varicose veins of the lower limbs can be the development of a thrombosis or phlebitis. These diseases occur suddenly and are not related to the exposure to adverse external factors (for example, with the intense physical activity of the load). The patient has a considerable and rapidly spreads to the entire leg swelling, which is accompanied by strong pain, arching of the nature. Some areas of skin may appear as local pain, redness or cyanosis of the. When the migration is detached from a blood clot in the vessels of the lungs can develop this complication of a bloody thrombosis of the lower limbs, such as TELA.

The diagnosis

Usually, a diagnosis of varicose vein disease" is evident for vein specialists already when the first survey of the patient. According to the study of the patient's complaints, inspection of the lower limbs, and of several individual samples, the doctor will prescribe you a number of studies to refine the diagnosis and the definition of the tactics of further treatment:

• the clinical examination and the biochemical analysis of blood;
• UZ-doppler;
• duplex scanning;
• occlusal under the name of plethysmography;
• reovazografija;
• venography (is assigned only to dinara indicator of non-invasive methods).

Treatment

The main objectives of the treatment of varicose veins of the lower limbs are directed on the stabilization and reconstruction of the normal flow of venous blood, the improvement of the quality of life of the patient and to prevent the development of complications of venous insufficiency. Treatment measures may include:

• conservative treatment: can be applied on the initial stages of the disease (when lesions of the skin of the feet is not yet pronounced, and the working capacity of the patient reduces moderately), in the post-operative period or contra-indications to surgical treatment;
• surgical treatment: attributed expressed by signs or in advanced stages of the disease and can be performed using minimally invasive techniques, and radical surgery.

Conservative treatment

The conservative methods of treatment of the varicose disease involve a combination of:

1. The reduction of risk factors of progression of the disease. The patient with varicose disease and persons at increased risk of development of varicose veins, it is recommended that permanent observation of your doctor.
2. The fight against adynamia. Patients who do not have signs of phlebitis or thrombosis, showing regular PHYSIOTHERAPY sessions and some sports, is aimed at strengthening and training of the veins of the lower limbs. The intensity of the load shall be submitted to a doctor-physiotherapist. A beneficial influence on the state of the blood vessels of the legs: walking, cycling, jogging, swimming. Of such patients, it is recommended to perform exercises (with the exception of those which are executed in the water) in terms of the greater the compression, created special sheets or bands. Prior to the formation of a patient, it is recommended to lie down for a few minutes with the legs raised. Patients with varicose disease is contra-indicated during traumatic to the legs sports: the different forces in martial arts and sports, associated with lifting heavy objects, skiing, tennis, basketball, volley-ball, football.
3. The Compression therapy. For spraying compression of the muscle, which helps to eliminate stagnation of the blood and normalizes the blood circulation, apply elastic bandages and compression different from the compression class. At 0 and 1 degree of chronic venous insufficiency, it is recommended to knit I-II class 2 class II, 3 and 4 – II or III (and in severe cases (IV) to the class. Depending on the degree of invasion of the vein, the compression therapy when the varicose veins in the lower limbs can be affected in both limited and long-term.
4. The drug therapy. Patients with varicose veins of the veins of the lower limbs, accompanied of 1-4 the degree of venous insufficiency, shows a stability in medicines. It must be remembered that the appointment of a medical treatment can be performed by a physician, because indiscriminate use of drugs is not able to rid the patient of venous insufficiency and will only exacerbate the illness. When adequate and properly selected pharmacotherapy and the implementation of the recommendations of the doctor on the compression and the physiotherapy patient may, within a period of 3-4 weeks to achieve the elimination of clinical symptoms, complications and the compensation of venous insufficiency. In the scheme of treatment may include medication such as: dezagreganti, anticoagulants, nonsteroidal anti-inflammatory drugs. If also complicated the evolution of the disease, and thrombosis of the veins diagram of the therapy may be supplemented by special means for the local applications, and with the development of ulcers trophic, and their infection – antibiotics and wound healing means.
5. Physiotherapy. In all medical procedures when varicose extended veins of the lower limbs may include a variety of procedures that contribute to normalize the tonus of the wall of the veins, the microcirculation and the lady. To do this, the patient, can be named: the darsonvalization, magnetotherapy, laser therapy, hyperbaric oxygen therapy and hydro and balneotherapy (general and local baths of mineral waters, in contrast, beads, and oxygen bathroom). In the absence of contra-indications to a patient can be displayed during a light massage, which must be performed by a specialist or yourself (after a simple training technique for an experienced masseur). Many patients varicose veins can be rented such enough the treatment methods as girudoterapiya.