Varicose veins on the lower leg is a disease of the leg veins, which is characterized by the pathological expansion and deformation of the venous vessels, accompanied by the development of several complications.Varicose veins affect the superficial veins of the legs.
According to the modern view, the main cause of the development of varicose veins is a defect (congenital or acquired) in the valve apparatus of the veins of the lower leg, which leads to the development of venous blood backflow (reflux).Reflux leads to venous overflow and pathological venous drainage (redirection of blood flow).
Which, in turn, leads to clinical manifestations of chronic venous insufficiency - such as swelling of the legs, pain along the varicose veins, itching on the skin, cramps in the calf muscles.
In advanced cases, the formation of skin pigmentation in the shin area, the formation of trophic ulcers, bleeding from varicose nodes, as well as thrombophlebitis - inflammation of varicose veins with their thrombosis.Varicose veins develop gradually.
According to European statistics, chronic venous disease is widespread throughout the world.It has been proven that among the adult population in different countries, the incidence of varicose veins varies from 2% to 60%.Surprisingly, in African countries, as well as the Pacific region, despite multiple pregnancies, the incidence of varicose veins in women is no more than 6%.At the same time, in European countries the incidence of varicose veins among the adult population reaches tens of percent.It follows that the tendency to develop varicose veins depends on ethnicity.
There is also a clear trend towards an increase in incidence.This may be due to the prevalence of an inactive lifestyle, obesity, and partly smoking.Patients in "public" hospitals often lose the opportunity to receive modern diagnostics and modern treatment for varicose veins on the lower legs.The lack of modern high-tech methods for diagnosing and treating varicose veins in the public medical sector explains that combined phlebectomy remains the main method of treating varicose veins in public hospitals.That is, a very traumatic stationary operation with many incisions (and sutures) and inefficient mechanical removal of the venous trunk.
The operation is performed under general anesthesia or spinal anesthesia.World statistics claim that the majority of patients suffering from varicose veins can receive surgical treatment on an outpatient basis - without hospitalization, and also without spinal anesthesia and anesthesia.Conclusion - high-quality treatment of varicose veins is impossible without timely diagnosis and innovative technology in treatment.
Symptoms of varicose veins on the lower legs
Symptoms (manifestations) of varicose veins are signs that allow a person to suspect the disease with sufficient certainty.Symptoms can be subjective (it seems to me) and objective (I see).
Subjective symptoms of varicose veins include:
- Heaviness in the legs.As a rule - in the calf area.These symptoms are more pronounced in the evening.
- Pain in the calf muscles.Most often, it is pain, low-intensity pain, sometimes discomfort.
- Pain along the varicose veins.As a rule, it is not intense, it shows itself more in the evening, after a working day.
- Leg fatigue.Fatigue is a decrease in tolerance (tendency) to physical activity - static and dynamic.
- "Venous claudication."Venous claudication is called increased pain in the calf muscles when walking.
- Swelling on the bottom of the legs in the area of the feet and legs.
- Skin hyperpigmentation.
- Burning, tingling, itching along the course of varicose veins.
- Trophic venous ulcers on the legs.
All symptoms of varicose veins, despite their diversity, have common characteristics:
- symptoms intensify when the patient remains in a standing or sitting position for a long time.This happens because the muscle-venous pump does not work in a static position);
- symptoms decrease after walking, after resting in a horizontal position, and also when using elastic compression;
- changing the intensity of the manifestation depending on the season of the year.As a rule, symptoms increase in summer;
- the manifestation of this disease may worsen before or during menstruation.
All the above symptoms are non-specific, that is, they can also appear in other diseases.Therefore, when diagnosing varicose veins, one should rely on objective signs:
- Dilated intradermal and saphenous veins (telangiectasia, reticular veins).Clearly visible to the naked eye.This is what patients often pay attention to.The presence of only telangiectasia (spider veins) without other signs of varicose veins is usually harmless.However, this is a clear reason for the exam.
- Varicose saphenous veins.Easy to see without equipment.The presence of varicose veins is a clear sign of varicose veins.However, ordinary people often confuse normal veins visible through the skin with varicose veins.In the first case, treatment is not required, in the second case, it is necessary.
- Swelling in the affected limb.This is also a non-specific symptom, but with the presence of varicose veins it can lead doctors to believe that these facts are interconnected.
- Changes in skin color and texture.With more advanced forms of varicose veins, we often face hyperpigmentation (the skin turns brown or bluish).There may be areas of lipodermatosclerosis.An extreme manifestation is the appearance of venous trophic ulcers.
Risk factors for varicose veins in the legs
- Non-specific: age, female gender, obesity, hereditary predisposition.
- Specifically: pregnancy, taking hormonal drugs (estrogens, gestagens), menopause.
Stages of development of varicose veins
Like any chronic disease, varicose veins develop gradually.There is no clear staging, but we can talk about the initial stage (compensation) and the stage of development of chronic venous insufficiency.In the early stages of the development of varicose veins there are no subjective manifestations.The appearance of varicose veins, detected visually, is usually not accompanied by swelling, pain, or cramping.
At this stage, the disease may remain unchanged for a long time.And maybe it will grow.In this case, the patient, who is used to the sight of varicose veins and accustomed to the idea that they do not cause him harm, may not associate the appearance of pain, leg swelling, itching and night cramps with the development of varicose veins.This, in turn, can lead to the development of complications of varicose veins, such as inflammation of varicose veins (thrombophlebitis), the formation of trophic venous ulcers and bleeding from varicose nodes.
To standardize the diagnosis of varicose veins and make it as accurate and easy to understand for doctors from anywhere in the world, phlebologists use the CEAP classification.The CEAP classification takes into account clinical manifestations (C - clinical), etiology (cause of the disease) (E - etiology), anatomical localization (A - anatomy) and pathogenesis (P - pathogenesis).
As a rule, the diagnosis of CEAP is supplemented with decoding (nosological formulation), which facilitates understanding for therapists, general practitioners and specialists.This approach allows practitioners to navigate quickly when reviewing a patient's medical document.
Diagnosis of varicose veins
Modern diagnosis of varicose veins on the lower leg raises the following tasks:
- Determine the presence of chronic venous disease.Many patients who suspect they have varicose veins do not.And vice versa.The first task of the phlebologist is to determine whether the patient has this disease or not.
- Determine the type of venous disease.Doctors say it is a form of "nosology".You need to know exactly which vein is affected, how bad it is and what it has caused or can lead to.
- Determining treatment tactics - specific techniques (or combinations of techniques) that should be used in this case.Treatment tactics must be discussed with the patient and reflected in the treatment proposal.
- Evaluation of treatment effectiveness is carried out during treatment and after completion.
We prefer to carry out all stages of diagnosis and treatment in contact with patients.
We believe that patients have the right to obtain accessible and understandable information about their disease and treatment methods.In response to a patient's question "why," we never say "because" or "because I've always done it this way."We adhere to the principles of modern evidence-based medicine.
Methods for diagnosing varicose veins
- Clinical studies.Includes explanation of patient complaints, examination and palpation (examination by hand).
- Ultrasound angioscanning (vein ultrasound - duplex and triplex scan).
- Plethysmography.
- X-ray phlebography (ascending and descending).
- Radionuclide phlebography (radiophlebography).
- Computed tomography (CT venography).
- Magnetic resonance imaging (MR-venography).
- Intravascular ultrasound examination.
- Thermography.
In most cases, to diagnose varicose veins and develop the right treatment strategy, clinical examination and ultrasound angiography are sufficient for a phlebologist.At the same time, the main instrumental study for leg vein disease is ultrasound angiography - vein ultrasound.
During the study, it is clearly explained to the patient what exactly "his" disease is and how to fight it.
The study is carried out in a standing position (if necessary, also lying down), using two or three simultaneous scanning modes (B-mode, color coding of blood flow and pulsed Doppler mode).The ultrasound angioscanning method allows you to visualize the vessel being studied, determine the direction of blood flow and its parameters (speed, type of flow).
Both limbs are examined, not just the "sick" one, and we always look at both the superficial and deep venous channels.If necessary, the patient can be prescribed additional research methods listed above.
Treatment of varicose veins
Specialists at leading phlebology centers use only the most modern and best methods to treat varicose veins on the lower legs.
Today, phlebologists use the following innovative treatment methods:
- Thermoablation (laser and radiofrequency).
- Non-thermal methods to treat varicose veins.
- Sclerotherapy.
- Miniphlebectomy.
- A combination of these techniques.
This method meets the state European standard.They allow you to treat varicose veins effectively, non-traumatically and on an outpatient basis - without hospitalization.No anesthesia or spinal anesthesia is required.This approach provides the best treatment results.