Varicose veins: what they are, symptoms, causes, stages and treatment

Varicose veins of the lower extremities is a disease of the leg veins, characterized by pathological expansion and deformation of the venous vessels, accompanied by the development of a number of complications.Varicose veins affect the superficial veins of the legs.

According to modern views, 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 extremities, which leads to the development of reverse flow of venous blood (reflux).Reflux leads to excess venous flow and pathological venous secretion (redirection of blood flow).This, in turn, leads to clinical manifestations of chronic venous insufficiency - such as swelling of the legs, pain along the varicose veins, itching of the skin, cramps in the calf muscles.

In advanced cases, the formation of skin pigmentation in the tibia area, the formation of trophic ulcers, bleeding from varicose nodes and thrombophlebitis - inflammation of varicose veins with their thrombosis.Varicose veins develop gradually.

According to European statistics, chronic venous diseases are widespread throughout the world.It has been shown that among the adult population of different countries the incidence of varicose veins varies from 2% to 60%.Surprisingly, in African countries and the Pacific region, despite multiple pregnancies, the incidence of varicose veins in women does not exceed 6%.At the same time, in European countries, the incidence of varicose veins among the adult population reaches tens of percentage points.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 a sedentary lifestyle, obesity and, in part, smoking.Patients in “public” hospitals are often deprived of the opportunity to receive modern diagnostics and modern treatment for varicose veins of the lower extremities.The lack of modern high-tech methods for the diagnosis and treatment of varicose veins in the field of public medicine explains that combined phlebectomy remains the main method for the treatment of varicose veins in public hospitals.That is, a very traumatic stationary operation with many incisions (and sutures) and mechanical removal of the trunk of the incompetent vein.

This operation is performed under general anesthesia or spinal anesthesia.World statistics state that the vast majority of patients suffering from varicose veins can receive surgical treatment on an outpatient basis - without hospitalization and even without spinal anesthesia and anesthesia.Conclusion: High-quality treatment of varicose veins is impossible without timely diagnosis and innovative technologies in treatment.

Symptoms of varicose veins of the lower extremities

Symptoms (manifestations) of varicose veins are signs that allow you 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:

• Feeling of heaviness in the legs.As a rule, in the calf area.This symptom is more pronounced in the evening.
• Calf muscle pain.Most often it is aching pain, low intensity, sometimes discomfort.
• Pain along varicose veins.As a rule it is not intense, it manifests itself more in the evening, after a working day.
• Leg fatigue.Fatigue is a decrease in tolerance (susceptibility) to physical activity, both static and dynamic.
• "Venous claudication."Venous claudication is called increased pain in the calf muscles when walking.
• Swelling of the lower limbs in the legs and feet area.
• Hyperpigmentation of the skin.
• Burning, tingling, itching along the course of varicose veins.
• Trophic venous leg ulcer.

All symptoms of varicose veins, despite their heterogeneity, have common characteristics:

• the symptoms intensify when the patient remains in a standing or sitting position for a long time.This happens because the musculovenous pump does not work in a static position);
• the symptoms decrease after walking, after resting in a horizontal position, and also using elastic compression;
• change the intensity of the event depending on the season of the year.As a rule, symptoms intensify in summer;
• manifestations of the disease may intensify before or during menstruation.

All the symptoms listed above 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 (telangiectasis, reticular veins).Clearly visible to the naked eye.This is what patients often pay attention to.The presence of only telangiectasias (varicose veins) without other signs of varicose veins is in most cases not dangerous.However, this is a clear reason for examination.
• Saphenous varicose veins.Easily visible without equipment.The presence of varicose veins is a clear sign of varicose veins.However, ordinary people often confuse ordinary veins visible through the skin with varicose veins.In the first case the treatment is not necessary, in the second it is necessary.
• Swelling of the affected limb.This is also a non-specific symptom, but in the presence of varicose veins it can lead the doctor to believe that these facts are interconnected.
• Changes in the color and texture of the skin.In advanced forms of varicose veins, hyperpigmentation (the skin becomes brownish or bluish) is often found.Areas of lipodermatosclerosis may be present.The extreme manifestation is the appearance of a venous trophic ulcer.

Risk factors for varicose veins on the legs

• Non-specific: age, female gender, obesity, hereditary predisposition.
• Specific: 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 developmental stage of chronic venous insufficiency.In the initial stage of development of varicose veins there are no subjective manifestations.The appearance of varicose veins, detected visually, is usually not accompanied by swelling, pain or cramps.

At this stage, the disease can remain unchanged for a long time.And maybe it will progress.In this case the patient, accustomed to the sight of varicose veins and accustomed to the idea that they do not cause him any harm, may not associate the appearance of pain, swelling in the legs, itching and night cramps with the progression 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 understandable as possible for a doctor from any part of the world, phlebologists use the CEAP classification.The CEAP classification takes into account the clinical manifestations (C – clinical), the etiology (cause of the disease) (E – etiology), the anatomical localization (A – anatomy) and the pathogenesis (P – pathogenesis).

As a rule, the CEAP diagnosis is supplemented by a decoding (nosological formulation), which facilitates understanding by therapists, general practitioners and specialists.This approach allows the professional to quickly navigate when studying the patient's medical documents.

Diagnosis of varicose veins

Modern diagnosis of varicose veins of the lower extremities poses the following tasks:

• Determine the presence of chronic venous disease.Many patients who suspect they have varicose veins do not have them.And vice versa.The first task of the phlebologist is to determine whether the patient has this disease or not.
• Determination of the type of venous disease.Doctors say that it is a "nosological" form.It is necessary to know exactly which venous vessels are affected, how severe it is and what it has led or can lead to.
• Determining treatment tactics: what specific technique (or combination of techniques) should be applied in this particular case.Therapeutic tactics should be discussed with the patient and reflected in treatment recommendations.
• The evaluation of the effectiveness of the treatment is carried out during the treatment and at its completion.

We prefer to carry out all phases of diagnosis and treatment in contact with the patient.

We believe that patients have the right to accessible and understandable information about their disease and treatment methods.In response to the patient's question “why,” we never say “why” or “because I always do it this way.”We adhere to the principles of modern evidence-based medicine.

Methods for diagnosing varicose veins

1. Clinical study.It includes clarification of the patient's complaints, examination and palpation (examination with hands).
2. Ultrasound angioscanning (ultrasound of the veins - duplex and triplex scanning).
3. Plethysmography.
4. X-ray phlebography (ascending and descending).
5. Radionuclide phlebography (radiophlebography).
6. Computed tomography (CT venography).
7. Magnetic resonance imaging (MRI-venography).
8. Intravascular ultrasound examination.
9. Thermography.

In the vast majority of cases, to diagnose varicose veins and develop a correct therapeutic strategy, a clinical examination and an ultrasound angiography by a phlebologist are sufficient.At the same time, the main instrumental study for diseases of the leg veins is ultrasound angiography - ultrasound of the veins.

During the study, the patient is clearly explained what exactly "his" disease is and how to fight it.

The study is carried out in a standing position (if necessary, even lying down), using two or three scanning modes simultaneously (B-mode, color coding of blood flow and pulsed Doppler mode).The ultrasound angioscanning method allows you to visualize the vessel under study, determine the direction of blood flow and its parameters (speed, type of flow).

Both limbs are examined, not just the "ill" one, and both the superficial and deep venous vessels are always looked at.If necessary, the patient can be prescribed additional research methods listed above.

Treatment of varicose veins

Specialists of the leading phlebology center use only the most modern and best methods for the treatment of varicose veins of the lower extremities.

Today, phlebologists use the following innovative treatment methods:

• Thermoobliteration (laser and radio frequency).
• Non-thermal methods for the treatment of varicose veins.
• Sclerotherapy.
• Miniphlebectomy.
• A combination of these techniques.

These methods meet state European standards.They allow varicose veins to be treated effectively, non-traumatically and on an outpatient basis, without hospitalization.No anesthesia or spinal anesthesia is required.It is this approach that provides the best treatment results.