Varicose veins of the lower extremities

The peculiar structure of veins helps to redistribute blood during exercise and not make the return of blood flow.

Loss of elasticity of the vessel wall of the venous type, with the expansion of its lumen, with the development of vascular insufficiency of the valves, leading to disruption of normal blood flow - has received a separate nosological unit in the form of the disease called varicose veins or varicose veins from the Latin varix .

 

In the walls of affected vessels develop sclerotic, degenerazione changes induced by stretching, thinning, with subsequent formation of globular extensions (nodes) along their path. The folds of the valves in the initial stages of the disease, still preserved, but complete closure of the lumen of the vessel with their help is not happening. Further, when joining the local inflammation and thrombosis, the valves disappear, exacerbating the clinical picture of venous insufficiency.

The disease is quite common: the average "coverage" of the population - 10-18%, with a predominance in females (2-3 times more often).

Most varices changes affected the veins of the lower extremities. However, varicose veins can be observed in the vessels of the walls of large and small pelvis. Almost not found the disease in the blood vessels of the upper extremities.

The extension of the lumen of the veins, as a manifestation and complication of other diseases of internal organs can be observed in the submucosal veins of the esophagus in diseases of the liver, mucous membrane of the rectum for hemorrhoids, the veins in seminiferous tubules and testis with varicocele. The overlap of the lumen of the large venous vessel growing tumor from adjacent organs can also cause varicose veins, unusual for this disease localization.

The reasons for the development of varicose veins and the risk factors

1. Heredity.

Observed in genetically transmitted in the family, functional immaturity of the valve apparatus veins and underdevelopment connective tissue component of blood vessel walls. This leads to increased pressure inside blood vessels and the development of varicose veins already in early childhood, with the appearance of the first exercise.

2. Disorders of blood coagulation.

This group includes congenital factors associated with hypercoagulation. Formed in these cases, the blood clots, create obstacles to the normal blood flow, with subsequent enlargement of the lumen of the vessel.

3. Changing hormonal levels.

This factor is the most marked in women in Association with changing levels of hormones during pregnancy and menopause. Decrease estrogen while increasing progesterone, in physiological and dysfunctional conditions, increase the production of clotting factors. Furthermore, such hormones leads to changes in protein and lipid metabolism with a decrease in the synthesis of elastic and collagen fibers with subsequent reduction in tone of the wall of the venous vessel. The overall result is reduced blood flow with blood clots and valve insufficiency.

4. Increased body mass.

General obesity has mechanical effects on the wall of the vein, which is especially observed in case of abdominal type, causing an increase in venous pressure below the zone of compression. In addition, the events and dysmetabolic dishormonal changes in extreme degrees of obesity, distort normal rheological properties of blood. This again leads to mechanical blockage of blood vessels from the inside (thrombosis). Sedentary lifestyle with obesity, it also contributes to the slowing of blood circulation.

5. Diabetes.

As a result of complex metabolic disorders due to hyperglycemia, relative insulin deficiency – there is decreased elasticity of the vein wall with subsequent expansion of its lumen.

6. Alcoholism. Constant dehydration observed in alcoholism, increases blood clotting with subsequent disruption of blood flow. 7. Professional factors associated with high physical activity and prolonged vertical position. This applies to porters, conductors, salesmen, surgeons, barbers, workers in the service production lines, etc. the Risk of developing varicose veins in these people due to the stagnation of blood in the lower extremities due to persistent high intra-abdominal pressure, impeding the delivery of blood to the heart. 8. Mechanical compression of the veins close linen. Observed at constant wearing of this type of clothing. 9. Frequent constipation. Lead to increased intra-abdominal pressure during straining, and subsequent logical chain of the development of varicose veins lumen. 10. Wearing shoes with high heels. Dangerous, first of all, the limitation of motion of the ankle joint, and so reduced leg muscles that help move blood upwards. 11. Climatic factors. Stay in conditions of high ambient temperature without adequate replenishment of fluid loss becomes a cause of thrombosis with consequent impairment of the venous outflow. 12. Incorrect prescription and uncontrolled intake of drugs with a primary or side effect in acceleration of blood clotting. 13. Migrated abdominal surgery. Threat increased risk of minor and major venous thrombi leading to violation of the outflow of blood from the extremities. 14. Severe cardiovascular disease with symptoms of circulatory failure as a consequence of a reduction in myocardial contractile function. 15. Transferred earlier trauma of the limbs and surgical intervention on them. Here have a value of cicatricial processes, preventing the outflow of blood. 16. Constitutional peculiarities. The marked predisposition to varicose veins from tall people, especially in combination with excessive body weight. 17. Race. The development of varicose veins is mainly observed among Caucasians. 18. Chronic inflammatory processes of organs of the pelvic cavity.

As a rule, it concerns the diseases of internal genital organs (prostate in men and inflammation of appendages in women). The mechanism is due to the involvement in the inflammatory process of small venules. The resulting swelling of the inner lining, hinders the flow of blood, forcing the disclosure of the communicative vessels that join the arterial and venous bed. The blood in veins enters with a significant increase in intravascular pressure and volume. After this, repeated the previously described mechanism: the extension of the lumen of the veins and insufficiency of venous valves.

Varicose veins of the lower extremities: the symptoms

1. External changes of the saphenous veins. The most striking manifestation of varicose veins is to change the shape and contour of intradermal and subcutaneous vessels of the lower extremities.

Veins take focal saccular or uniform thickening of the diameter, with the formation of a kind of knots and tangles of vessels. The modified vessels are colored dark purple or blue in color. Small, not previously decernit the veins show through circuits in the form of intradermal venous "veins".

Often such changes are veins of feet and lower leg. As the progression of the process, a similar pattern is detected in the venous vessels of the thighs.

2. Pain. Pain</2_img>

Patients report early fatigue, heaviness in the legs. Appears dull pain expander nature in the calf muscles. Over time, the pain becomes more intense, with the possible occurrence of muscle cramps of the calf. It is noted that after finding some time, legs in a horizontal position, the described symptoms for a time subsides, which would then, in the vertical condition, again to resume . The pain increases on palpation of the tibia. In the absence of changes in the superficial veins, in this situation, you should suspect the presence of varicose changes in the deep veins of the leg.

3. Swelling of the subcutaneous tissue. There is swelling of the feet (pasty) proliferation in the lower third of the tibia, accompanied by itching of the skin in the projection of defeat. If the night pasty with subcutaneous tissue at the level of the ankle the ankle joint is not coming, then you should think about what the symptoms of venous insufficiency has passed the stage of decompensation. In these situations, it should also exclude the accession of secondary infection and the debut of the sores. 4. Itching of the skin. May appear before the onset of clear clinical symptoms of varicose veins, but most often occurs at the phenomena of the expressed violations of the outflow of venous blood. 5. Hyperpigmentation. Occurs when the expanded clinical picture of the disease. The skin becomes darker in the course of the diseased vein and perifocal from them, in places of mechanical damage during injuries. In the future, all the skin in the distal limb becomes bluish color (indurate). The surface epithelium becomes thinner and underlying structures atrophy. 6. Hypothermia end sections of the leg. On palpation the skin of the extremities cold. Patients also feel a constant "freezing" of the limbs. 7. Trophic ulcers. Part clinicians regard this symptom as a complication of varicose veins. The other part feels the appearance of defects in the skin in the form of open sores in the background induratsionno modified sections is the last stage of the disease.

Complications of varicose veins:

  1. Thrombophlebitis.
  2. Joining a secondary infection (most often erysipelas) to the existing trophic ulcers and with the development of wet gangrene of the limb.
  3. Deep vein thrombosis with subsequent life-threatening thromboembolism of the pulmonary veins.
  4. Eczema (dermatitis).
  5. Bleeding from the damaged varicose veins.

Classification of varicose veins

1. Primary. The changes relate primarily to the superficial veins. Violation of the structure of the deep veins and the change in the execution of their functions originally available. 2. Secondary.

Develops as a complication of primary diseases deep vein, after which changes occur in the superficial veins of the lower extremities. It occurs in the presence of birth defects in the venous system (cardiovascular dysplasia, fistula), as well as the outcome of migrated phlebothrombosis of the deep veins. The reasons for the formation of blood clots in the veins was discussed above.

In addition, there is a separation of varicose disease according to clinical forms.
  1. Varicose side (lateral) veins of the femur and tibia.
  2. Reticular varices.
  3. Varicose telangiectasia.

Varicose veins lateral veins of the lower limb occurs both independently and in combination with other clinical varieties. Reverse reset the venous blood is carried to the deep vein of the thigh by subcutaneous veins and surrounding.

Reticular (net) and telangiectasia (nodules intradermal capillary blood vessels), varicose veins, isolated in his options, to the development of venous insufficiency does not. These forms of varicose disease takes only cosmetic discomfort.

Recently, surgeons have started to allocate more and idiopathic venous insufficiency ( IVN). The veins in this disease, unlike other forms of the disease have initially increased venous tone with no specific reason. Symptoms of IVN is no different from the classic symptoms of varicose veins.

The compensation stage.

The pain is minimal or non-existent. Is defined discomfort in the legs during long sitting or upright position. In parts of the surface of the skin revealed small spider veins. Occasionally there is minor swelling of feet and ankles. They speed after the adoption of the limb horizontal position.

The stage subcompensation. Already a superficial glance at the limb, the presence of a vein with expanded lumen noteworthy.

Complaints of patients at the same time more specific: foot pain expander nature, fatigue. Night cramps calf muscles suddenly, or against a sense of "pins and needles" (paresthesia). Swelling in the lower third of the leg and feet are more pronounced, however, after a night's sleep they disappear.

Stage of decompensation.

The clinical picture is compounded by local changes in the skin: it takes the form of a dry and smooth surface, there is a loss of hair, hyperpigmentation of the skin .

Swelling becoming a permanent rise above.

Frequent small intradermal hemorrhage make the pigmentation more intense due to the deposition of hemosiderin (a blood pigment). Small wounds and abrasions heal very long, passing gradually into ulcers.

In 2000, the Russian Phlebology was proposed pathogenetic classification of varicose veins. She also received wide recognition.

Forms:
  1. Partial (segmental) changes of subcutaneous and intradermal veins of the limbs without back flow (reflux).
  2. Segmental varicose veins with reflux in communication and/or surface vessels.
  3. Total varicosity with the reflux of blood into superficial and communicative vein.
  4. The varicosity with the reflux of blood through the deep veins of the extremities.
10.08.2018