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 signs of a serious disease that worsens over time.

What are varicose veins: definition of the disease

The word "varicose vein" comes from the Latin varix - "swelling". The name fully reflects the pathological process: the walls of the veins become thinner and in some areas expansions (swellings in the form of a bag) - nodes are formed.

The first case of varicose veins was recorded in a document from 86 BC. BC: 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 some diseases, hormonal changes and a sedentary lifestyle.

At first, even under the influence of these factors, the vessels function normally, but gradually they are deformed, change their structure and can no longer fully 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, by default they mean the problem of the legs.

Code for varicose veins 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 extremities:

• 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 extremities with ulcers and inflammation.

85 - varicose veins of the esophagus:

• I85. 0 - varicose veins of the esophagus with bleeding;
• I85. 9 - varicose veins of the esophagus without bleeding.

I86 - varicose veins of other locations:

• I86. 0 - varicose veins of sublingual veins;
• I86. 1 - varicose veins of the scrotum (anatomical formation in men - a container 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 extremities 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 in the skin or mucous membrane that occurs due to impaired blood circulation and tissue innervation.

The mechanism of development of varicose veins

The body's pathological reactions 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 to understand how and why the disease develops.

How blood moves through the body

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

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

The walls of veins are less thick and elastic than the walls of arteries and, unlike arteries, do not contain such a developed muscular layer. Therefore, varicose veins are possible only in veins, but not in 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, the blood flow encounters an obstacle - the force of gravity. This force forces the blood back through the veins.

You can often hear that varicose veins are humanity's punishment for walking straight. After all, the longest distance that blood has to travel in the body, overcoming gravity, is the path from the legs to the heart. The movement of blood through the veins is ensured by the contractions of the heart, the muscular pump of the surrounding muscles and the negative pressure in the chest during inhalation.

In healthy vessels, reverse blood flow is prevented by valves in the inner walls of the veins. Valves act like one-way doors - they open and allow blood to flow into the heart, and close immediately if gravity tries to push the blood back out.

It's not just the valves that help the veins send blood to the heart, but also the muscles that surround the vessels. By contracting and relaxing, muscles help move blood through the veins. This mechanism works only when a person moves. When you stand or sit for a long time, the muscle pump is practically inactive.

The cups of venous valves are always directed in the direction of blood flow - towards the heart

How failure occurs and how disease occurs

An increase in pressure in the vein system disrupts the functioning of their valve apparatus and leads to the reverse flow of blood through the vessels. Due to this, as well as due to excessive blood stagnation, weakness of the valve apparatus (for example, in diseases of the connective tissue), the lumen of the veins expands, the walls are deformed, they become thinner and locally bag-shaped. extensions are formed - joints.

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

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

There are superficial and deep veins in the legs. 85-90% of the total volume of blood passes through the deep ones, only 10-15% through the superficial ones. The walls of the deep veins are denser and better adapted to the increase in blood volume. And the superficial veins of the legs are thinner and are 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 disease development is the same as in the lower extremities. But esophageal varices arise for another reason: due to portal hypertension - increased pressure in the portal vein system, which develops with cirrhosis of the liver, hepatitis, parasitic lesions of the liver, fatty hepatosis, etc.

Causes of varicose veins

A number of factors contribute to the development of varicose veins in the legs. The main ones arevalvular insufficiencyANDheritage. It is known that a quarter of patients had close relatives who suffered from one form of varicose veins.

Overweight. The more extra pounds a person has, the greater the load on the venous system. Over time, the veins stop coping with such pressure: the lumen of the vessels increases, and the valves in their walls stop closing completely. As a result, blood stagnates and varicose veins develop.

pregnant. Hormonal changes occur in a woman's body, body weight, intra-abdominal pressure and the volume of circulating blood increase - this leads to an interruption of flow, causes stretching of the vein walls and changes in the functioning of the valve apparatus.

After birth, the diameter of dilated veins decreases, but does not always return to its original value. With subsequent pregnancies, the risk of developing varicose veins increases.

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

Venous refluxVenous reflux Return of blood through the veins due to resistance to blood flow, from lat. refluo - "to flow back". it is found in 10-15% of students aged 12-13 years. The disease "comes back" 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 - when you move, the muscles stimulate blood flow through 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, as a result their lumen narrows, blood flow becomes difficult and stagnation occurs, which leads to varicose veins;
• professions that involve standing or sitting for long periods of time - 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 venous wall decreases. This increases the possibility of varicose veins.

Women suffer from varicose veins 3-4 times more often than men. This happens 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 different places

Varicose veins of the esophagus

Changes in the veins of the esophagus with an uneven increase in their lumen, lengthening of the wall and the development of nodular tortuosity of the vessels. It often leads to a life-threatening complication - bleeding.

Reasons:

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

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

Reasons:

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

Varicose veins of the pelvis

It is characterized by the expansion of 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

Varicose veins of the vulva

Varicose veins of the pelvis, affecting the vessels of the labia and perineum

Reasons:

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

Sublingual varicose veins (sublingual varicose veins)

Asymptomatic damage to the veins located under the tongue. Manifests as a slight dilation of the blood vessels and a change in color from deep blue to purple

Reasons:

• hypertension
• smoking
• old age

Varicose veins of the stomach

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

Reasons:

• cirrhosis
• portal hypertension syndrome - increased pressure in the portal vein system in other gastrointestinal diseases (neoplastic tumors, thromboses, anomalies 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 report at least one or more unpleasant symptoms.

Symptoms of varicose veins of the lower extremities:

• 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 - a reaction to the slowing of blood flow and the overflow of the venous system of the lower extremities;
• night muscle cramps in the legs - painful spasms occur due to blood stagnation and the accumulation of metabolic products in the tissues;
• swelling of the legs and joints - due to stagnation in the veins, the liquid part of the blood penetrates into the subcutaneous tissue through the altered vascular wall;
• itching of the skin around damaged veins - dilated and altered blood vessels do not provide normal blood circulation and nutrition to the skin, so it becomes dry and 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 altered veins is not always proportional to the severity of symptoms. Thus, veins that are barely visible to the eye and affected by varicose veins can cause severe discomfort, while nodular and thick veins can cause minimal discomfort.

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

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

In some cases, as with varicose veins of the esophagus or stomach, the pathology appears immediately as a life-threatening complication - bleeding.

Classification of vein diseases

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

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

Complications of varicose veins in the legs

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

Thrombophlebitis- inflammation of the vein walls, which is accompanied by the formation of a thrombus (blood clot) that closes the lumen of the vessel. It manifests as swelling and redness along the affected vein. The patient experiences 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 along the thrombosed vein.

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

Trophic ulcer heals very poorly due to impaired blood circulation and tissue nutrition

bloodshed- occurs when a vein ruptures, enlarged due to varicose veins. In the later stages of the disease, the skin over such veins is very thin and dry - a small injury is enough for the vessel's integrity to be compromised and bleeding to appear. Sometimes spontaneous rupture of a vein occurs in the area of varicose veins.

Diagnosis of varicose veins of the legs

A phlebologist deals with the diagnosis, treatment and prevention of vein 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 usually not prescribed: a doctor's examination is sufficient.

The doctor can prescribe laboratory tests in preparation for surgery or to rule out concomitant diseases that affect the condition of the blood vessels.

One of these diseases is diabetes mellitus. It can significantly worsen the flow of varicose veins and increase the risk of complications (especially trophic ulcers).

For an accurate diagnosis and determination of treatment tactics, you will need a duplex ultrasound scan - the gold standard for diagnosing vascular diseases. The method allows you to evaluate the structure, function, patency of superficial and deep veins, stability of valves, as well as determine the direction of blood flow.

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

Phlebography is an X-ray examination used to determine the patency of the deep veins and the function of the valves.

Computer or magnetic resonance venography is used to visualize the venous system in three-dimensional projection and with very high spatial resolution.

Treatment of varicose veins in 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 depending on the affected vessels and how serious the condition of the patient with varicose veins is.

Non-invasive treatments

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

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

Leg compression compresses the bottom of the legs more than the top - pushing blood towards the heart and eliminating stagnation

Effects of compression therapy for varicose veins:

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

Drug therapy - the doctor can prescribe phlebotropic phlebotropic drugs (phleboprotectors, venotonics) Biologically active substances that increase the tone of the veins and reduce the severity of venospecific symptoms. drugs (venotropic).

The main groups of phlebotropic drugs used for varicose veins:

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

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

Important guidelines in changing the lifestyle of patients with varicose veins:

• Moderate intensity exercise: walking, swimming, water aerobics, leg exercises, yoga. Strengthening the muscles 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;
• giving up bad habits: nicotine and alcohol damage the inner walls of blood vessels and disrupt the regulation of vascular tone. Quitting smoking and drinking alcohol improves the condition of the veins and the function of the valves.

Invasive method for treating varicose veins

Invasive treatments include medical procedures that affect the integrity of the skin or mucosa. Sclerotherapy is a procedure that uses a special sclerosant (sclerosant) solution. The solution is injected into the problem vein through a thin needle, which causes its sclerosis - "sticking". The vein turns off from the blood circulation and becomes invisible over time, its function is taken over by the neighboring veins. Sclerotherapy is performed 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 that need to be filled with sclerosant and how big they are.

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

Radiofrequency vein 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 that generates radiofrequency pulses. Inside the vessel, the radio wave is converted into thermal energy, which "seals" the vein.

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

NTNT disappearance, or non-thermal non-tumescent methods:

• venous obliteration using cyanoacrylate glue;
• mechanical chemical extinction, in which both mechanical and chemical effects occur simultaneously in the vessel.

The elimination of NTNT is the most modern, low-trauma method for the treatment of varicose veins with a short rehabilitation period.

Phlebectomy is the removal of saphenous veins that have suffered from varicose veins. It can be performed as an independent operation or combined with other techniques. Varicose veins are removed with local anesthesia through small punctures.

Prevention of varicose veins of the legs

You can prevent the development of varicose veins if you follow simple prevention rules in everyday life.

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

Prevention of varicose veins - what you need to know:

• Moderate physical activity (walking, swimming, leg exercises) and resting with elevated feet improves the free movement of blood through the vessels and helps to avoid stagnation in the veins;
• rational nutrition and weight normalization lead to strengthening of blood vessels;
• wearing loose clothes that do not restrict movement helps to improve blood circulation;
• a cool shower in the warm season helps to keep the veins toned;
• comfortable shoes with a low heel (no more than 3 cm) make it possible to avoid undue load on the feet and interruption of blood flow;
• A reasonable approach to visiting saunas and steam baths allows you to maintain normal blood flow (long-term thermal procedures greatly expand the veins, so blood flow slows down).