Varicose veins (varicose veins)

Varicose veins most often affect the venous system of the legs. External manifestations (protruding nodular blue veins, swelling) are not just a cosmetic problem, but a sign of a serious disease that worsens over time.

What are varicose veins: definition of the disease

The word "varicose veins" comes from the Latin varice – "swelling". The name fully reflects the pathological process: the walls of the veins become thinner and expansions (sac-shaped swellings) - nodes - form in certain areas.

The first case of varicose veins was recorded in a document dating back to 86 BC. AD: The Roman general Gaius Marius complained of pain in his legs due to "swollen blue veins. "

The main reason for the development of varicose veins (varicose veins, varicose veins) is an increase in pressure in the superficial vascular system. This is facilitated by certain diseases, hormonal changes and a sedentary lifestyle.

At first, even under the influence of these factors, the vessels function normally, but gradually they deform, change their structure and can no longer completely transport blood.

Varicose veins can develop in almost any part of the body, but most often appear in the lower extremities. Therefore, when it comes to varicose veins, we by default mean the problem of the legs.

Varicose veins code in ICD-10

The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.

I83 - varicose veins of the lower limbs:

• I83. 0 - varicose veins of the lower extremities with ulcers;
• I83. 1 - varicose veins of the lower extremities with inflammation;
• I83. 2 - varicose veins of the lower limbs with ulcers and inflammation.

85 - varicose veins of the esophagus:

• I85. 0 - esophageal varices with bleeding;
• I85. 9 - esophageal varices without bleeding.

I86 - varicose veins of other locations:

• I86. 0 - varicose veins of the sublingual veins;
• I86. 1 - varicose veins of the scrotum (anatomical formation in men - a receptacle for the testicles and their appendages);
• I86. 2 - varicose veins of the pelvis;
• I86. 3 - varicose veins of the vulva (external genitalia of a woman);
• I86. 4 - varicose veins of the stomach.

O22. 0 - varicose veins of the lower limbs during pregnancy.

In our country, 30 million people suffer from various forms of varicose veins. A third of them have complications - trophic ulcers. An open defect of the skin or mucous membrane that occurs due to impaired blood circulation and tissue innervation.

The mechanism of development of varicose veins

The pathological reactions of the body are the same for all types of varicose veins, regardless of the cause of the problem. Understanding the anatomical features of blood vessels will help understand how and why the disease develops.

How blood circulates in the body

There are two types of vessels in the human body: veins and arteries. Blood circulates through the arteries, from the heart to all organs and tissues. This occurs under high pressure (70-120 mm Hg) and high speed.

Blood flows through veins from organs and tissues and is directed to the heart under low pressure (0 to 20 mm Hg).

The walls of veins are less thick and less elastic than the walls of arteries and, unlike arteries, do not contain as developed a muscular layer. Varicose veins are therefore only possible in the veins, but not in the arteries.

Human arterial and venous circulatory system. Veins are shown in blue, arteries in red.

Low pressure in the veins is necessary to transport blood from the periphery to the center. But at the same time, on the way to the heart, blood flow encounters an obstacle: the force of gravity. This force forces the blood back into the veins.

We often hear that varicose veins are humanity's punishment for walking upright. After all, the longest distance blood has to travel in the body to overcome gravity is the path from the feet to the heart. The movement of blood in the veins is provided by the contractions of the heart, the muscular pump of the surrounding muscles and the negative pressure in the chest during inspiration.

In healthy vessels, reverse blood flow is prevented by valves on the inner walls of the veins. The valves act like one-way swinging doors: they open and allow blood to flow to the heart and close immediately if gravity tries to push the blood away.

It's not just the valves that help the veins carry blood to the heart, but also the muscles that surround the vessels. By contracting and relaxing, muscles help circulate blood through the veins. This mechanism only works when a person moves. When standing or sitting for prolonged periods, the muscle pump is practically inactive.

The cusps of the venous valves always face the direction of blood flow – towards the heart

How failure and illness occur

An increase in pressure in the venous system disrupts the functioning of their valve apparatus and leads to reverse blood flow in the vessels. For this reason, as well as due to stagnation of excess blood, weakness of the valve apparatus (for example, in connective tissue diseases), the lumen of the veins expands, the walls become deformed, become thinner and resemble local bags. protrusions - knots - form.

The process is similar to inflating a balloon: if you don't let the air escape, the balloon inflates more and more.

On the left is normal blood flow; right - multidirectional blood flow due to dysfunction of venous valves, vascular deformation

There are superficial and deep veins in the legs. 85 to 90% of the total blood volume passes through the depths, only 10 to 15% through the superficial ones. The walls of deep veins are denser and better adapted to increased blood volumes. And the superficial veins of the legs are thinner and more susceptible to varicose veins.

In the pelvis and lower parts of the esophagus there are large venous plexuses, which can also undergo varicose transformation. In the veins of the small pelvis, the mechanism of development of the disease is the same as in the lower extremities. But varicose veins of the esophagus occur for another reason: due to portal hypertension - increased pressure in the portal vein system, which develops with cirrhosis of the liver, hepatitis, parasitic liver damage, fatty hepatosis, etc.

Causes of varicose veins

A number of factors contribute to the development of varicose veins in the legs. The main ones arevalve insufficiencyAndheredity. It is known that a quarter of the patients had close relatives suffering from one of the forms of varicose veins.

Overweight. The more extra pounds a person has, the greater the load on the venous system. Over time, the veins cease to resist such pressure: the lumen of the vessels increases, and the valves on their walls cease to close completely. As a result, blood stagnation occurs and varicose veins develop.

Pregnancy. Hormonal changes occur in a woman's body, body weight, intra-abdominal pressure and the volume of circulating blood increase - this leads to disruption of outflow, causes stretching of the walls of veins and changesin the functioning of the valvular apparatus.

After childbirth, the diameter of the dilated veins decreases, but does not always return to its initial value. During subsequent pregnancies, the risk of developing varicose veins increases.

Age. Varicose veins often affect people over the age of 50. The older a person is, the more venous valves wear out, while recovery processes slow down and the mechanism of pathological expansion of veins is triggered - the development of varicose veins.

Venous refluxVenous refluxReturn of blood in the veins due to resistance to blood flow, from lat. refluo – "flowing backwards". found in 10 to 15% of schoolchildren aged 12 to 13 years. The disease "gets younger" due to a sedentary lifestyle and excess weight.

Varicose veins of the lower extremities develop more quickly if there are additional risk factors.

Risk factors that contribute to the development of varicose veins of the legs:

• lack of physical activity - during movement, the muscles stimulate blood circulation in the veins and without movement, blood circulation in the veins can be difficult;
• smoking - chemicals contained in tobacco smoke damage the walls of blood vessels, which leads to their lumen narrowing, blood circulation becomes difficult and stagnation occurs, which leads to varicose veins;
• occupations that require standing or sitting for long periods – hairdressers, surgeons, cooks, waiters, drivers, office workers are at risk;
• menopause - in women 40-50 years old, the production of sex hormones (estrogen and progesterone) decreases and at the same time the tone of the vein wall decreases. This increases the risk of varicose veins.

Women suffer from varicose veins 3 to 4 times more often than men. This is due to hormonal variability (menstrual cycle, pregnancy, menopause).

During pregnancy, varicose veins can affect different parts of the body: legs, thighs, vulva.

Varicose veins can appear not only in the lower extremities, but also in other parts of the body.

The main causes of varicose veins in various places

Esophageal varices

Changes in the veins of the esophagus with an uneven increase in their lumen, protrusion of the wall and the development of nodular tortuosity of the vessels. Often leads to a potentially fatal complication: bleeding.

Reasons:

• cirrhosis
• liver cancer
• other diseases that cause increased pressure in the portal vein system - it collects blood from the abdominal organs

Varicose veins of the scrotum (varicocele)Pathological dilatation of the veins of the pampiniform plexus of the testicle. Manifested by varicose veins in the scrotum and impaired blood circulation

Reasons:

• congenital incompetence of the valves of the testicular veins (usually the left one)
• mechanical compression of the testicular vein (inguinal hernia)

Pelvic varicose veins

It is characterized by dilation of the ovarian veins and intrapelvic venous plexuses of different diameters. The condition is also known as pelvic congestion syndrome.

Reasons:

• polycystic ovary syndrome
• two or more pregnancies
• hormonal dysfunction

Vulvar varicose veins

Varicose veins of the pelvis, which affect the vessels of the lips and perineum

Reasons:

• compression of the retroperitoneal vessels by the uterus during pregnancy
• significant physical activity
• tumors of the uterus and ovaries

Varicose veins of the sublingual veins (sublingual varicose veins)

Asymptomatic damage to the veins located under the tongue. Manifested by a slight protrusion of blood vessels and a change in color from deep blue to purple

Reasons:

• hypertension
• smoking
• old age

Stomach varicose veins

Isolated change in the veins of the stomach or associated with varices of the esophagus

Reasons:

• cirrhosis
• portal hypertension syndrome - increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thrombosis, abnormalities of venous development)

Symptoms of varicose veins

In rare cases, only the aesthetic side of the disease appears - bluish veins. Most patients suffering from varicose veins of the legs report at least one or more unpleasant symptoms.

Symptoms of varicose veins of the lower limbs:

• fatigue, pain or a feeling of heaviness in the legs - this is caused by stagnation of blood and its pressure on the surrounding tissues;
• burning, tingling or throbbing in the legs - reaction to slowing of blood flow and overflow of the venous system of the lower extremities;
• night muscle cramps in the legs - painful spasms occur due to stagnation of blood and accumulation of metabolic products in the tissues;
• swelling of the feet and ankles - due to stagnation of the veins, the liquid part of the blood seeps into the subcutaneous tissue through the impaired vascular wall;
• itchy skin around damaged veins - dilated and impaired blood vessels do not provide normal blood circulation and nutrition to the skin, so it dries out and becomes rough.

Unpleasant sensations in the legs in patients with varicose veins intensify in the evening, especially after long periods of sitting or standing.

The appearance of venous changes is not always proportional to the severity of the symptoms. So, veins that are barely noticeable to the naked eye and affected by varicose veins can cause severe discomfort, while lumpy and thickened veins can cause minimal concern.

Varicose veins affect different veins: from small vessels in the skin to large saphenous veins

Symptoms of other types of varicose veins largely depend on the underlying cause of the condition. Often, patients do not complain about anything, and the doctor only identifies the problem during the examination. This happens for example with varicose veins of the sublingual veins.

In some cases, as in the case of varicose veins of the esophagus or stomach, the pathology immediately manifests itself with a potentially fatal complication: bleeding.

Classification of venous diseases

In clinical practice, doctors rely on the international classification of venous diseases - CEAP. This is an abbreviation formed by the initials of the main sections of the classification:

• C — clinical (clinical changes);
• E — etiology (origin of the disease);
• A - anatomy (anatomical location of varicose veins);
• P - pathogenesis (mechanism of venous blood flow disorders).

Complications of varicose veins on the legs

Typically, varicose veins themselves are not life-threatening. But sometimes the disease can cause complications.

Thrombophlebitis- inflammation of the walls of the veins, which is accompanied by the formation of a thrombus (blood clot) closing the lumen of the vessel. This manifests itself as swelling and redness along the affected vein. The patient feels pain, the skin in the affected area becomes red and hot to the touch.

Thrombophlebitis is an inflammatory reaction of the skin and subcutaneous tissue to a thrombosed vein.

Venous trophic ulcer- an open defect of the skin and soft tissues due to blood stagnation, edema and impaired cellular nutrition. The ulcer appears on the legs and ankles, near the areas of varicose veins. In the lower parts of the legs, the swelling is more pronounced, meaning the tissues are more compressed than in other areas. Ulcers take a long time to heal and often contain bacteria that increase inflammation.

Trophic ulcers heal very poorly due to impaired blood circulation and tissue nutrition

Bleeding- occurs when a vein ruptures, dilated due to varicose veins. In later stages of the disease, the skin of these veins is very thin and dry - all it takes is a minor injury for the integrity of the vessel to be compromised and bleeding to occur. Sometimes a spontaneous rupture of a vein occurs at the level of varicose veins.

Diagnosis of leg varicose veins

A phlebologist deals with the diagnosis, treatment and prevention of venous diseases. The doctor makes a diagnosis based on the patient's complaints, examination and instrumental studies. If the symptoms of varicose veins are pronounced, tests are generally not prescribed: a medical examination is sufficient.

The doctor may prescribe laboratory tests in preparation for surgical intervention or to exclude concomitant diseases affecting the condition of blood vessels.

One of these diseases is diabetes mellitus. It can considerably worsen the development of varicose veins and increase the risk of complications (notably trophic ulcers).

For an accurate diagnosis and determination of treatment tactics, you will need a duplex ultrasound - the gold standard in the diagnosis of vascular conditions. The method allows you to assess the structure, function, patency of superficial and deep veins, consistency of valves, as well as determine the direction of blood flow.

If a secondary character of varicose veins is suspected (may occur after deep vein thrombosis), the doctor prescribes venography, CT venography or MRI.

Venography is an X-ray examination used to determine deep vein patency and valve function.

Computer phlebography or magnetic resonance allows the venous system to be visualized in three-dimensional projection and at very high spatial resolution.

Treatment of varicose veins on the legs

The goal of treating varicose veins is to reduce or eliminate symptoms, improve the appearance of the veins, and prevent complications.

The doctor chooses a treatment method based on the affected vessels and the severity of the patient's condition with varicose veins.

Non-invasive treatments

Non-invasive treatments for varicose veins include compression therapy, drug therapy, and lifestyle changes.

Compression therapy involves wearing special socks, stockings and tights. The choice of model, type of fabric and degree of compression depends on the symptoms. The doctor will help you choose the appropriate knitwear.

Compression jersey in the lower legs compresses more than in the upper legs, pushing blood towards the heart and eliminating stagnation

Effects of Compression Therapy for Varicose Veins:

• the manifestations of symptoms decrease - heaviness, fatigue in the legs, night cramps, burning sensation or pain;
• the severity of edema is reduced due to improved blood circulation;
• Healing of trophic ulcers is accelerated because elastic compression improves blood circulation and tissue nutrition.

Drug therapy - the doctor may prescribe phlebotropic drugs Phlebotropic drugs (phleboprotectors, venotonics) Biologically active substances that increase venous tone and reduce the severity of veno-specific symptoms. medications (venotropics).

The main groups of phlebotropic drugs used for varicose veins:

• angioprotectors: improve microcirculation, normalize increased capillary permeability, reduce blood viscosity and the risk of blood clots;
• antithrombotic agents: reduce the risk of dangerous blood clots (thrombi) forming in the lumen of blood vessels and promote the dissolution of existing ones;
• bioflavonoids: natural plant compounds that improve venous tone and reduce venous congestion.

Lifestyle changes in case of varicose veins significantly slow down the development of the disease and, in combination with other recommendations of the attending physician, help to stop the pathological process.

Important directions for changing the lifestyle of patients with varicose veins:

• moderate intensity exercises: walking, swimming, aqua aerobics, leg exercises, yoga. Muscle strengthening will help normalize blood circulation in the vessels, relieve venous stagnation and edema;
• weight control: thanks to the normalization of body weight, the load on the blood vessels is reduced and the return of blood through the veins to the heart is facilitated;
• give up bad habits: nicotine and alcohol damage the internal walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of the veins and valve function.

Invasive methods to treat varicose veins

Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure using a special sclerosing solution (sclerosant). The solution is injected into the problem vein using a thin needle, which causes its sclerosis - "sticking". The vein is cut off from blood flow and becomes invisible over time; its function is carried out by neighboring veins. Sclerotherapy is carried out without hospitalization - after the procedure, the patient can go home.

The sclerotherapy procedure lasts from 5 to 30 minutes, depending on the number of varicose veins to be filled with sclerosant and their size.

Endovenous laser thermoobliteration (EVLO). A catheter with a laser light guide is inserted into the vessel through a small incision. The thermal energy from the laser heats the vein and it becomes obliterated – "sealed". After a few months, the vessel is replaced by connective tissue and disappears. The procedure is performed on an outpatient basis.

Radiofrequency venous obliteration (RFO) is the effect of high-frequency current on the inner surface of blood vessels. Through a micropuncture, a catheter is inserted into the vein, which is connected to a device generating radiofrequency pulses. Inside the ship, the radio wave is converted into thermal energy, which "seals" the vein.

With EVLO, the vein is briefly exposed to a high temperature; with RFO, the temperature is lower, but the session is longer. Both procedures are effective and safe.

NTNT obliteration or non-thermal non-tumescent methods:

• venous obliteration using cyanoacrylate glue;
• mechanochemical obliteration, in which mechanical and chemical effects on the container occur simultaneously.

NTNT obliteration is the most modern and least traumatic method of treating varicose veins with a short rehabilitation period.

Phlebectomy is the removal of saphenous veins that have suffered from varicose veins. It can be performed independently or combined with other techniques. The varicose vein is removed under local anesthesia using small punctures.

Prevention of varicose veins of the legs

You can prevent the development of varicose veins if you follow simple prevention rules every day.

A combination of provoking factors – sitting for long periods with legs crossed, wearing uncomfortable shoes – increases the risk of varicose veins in the legs.

Varicose vein prevention – what you need to know:

• moderate physical activity (walking, swimming, leg exercises) and rest with elevated legs improve the free circulation of blood in the vessels and help avoid stagnation in the veins;
• rational nutrition and normalization of weight lead to strengthening of blood vessels;
• wearing loose clothing that does not restrict movement helps improve blood circulation;
• a cool shower in the hot season helps keep veins toned;
• comfortable shoes with low heels (no more than 3 cm) help to avoid inappropriate load on the foot and disruption of blood circulation;
• A reasonable approach to visiting saunas and steam baths allows you to maintain normal blood flow (long-term thermal procedures significantly expand the veins, which slows down blood flow).