Varicose disease of the lower extremities: symptoms, causes, and treatment of

Varicose disease of the lower extremities is a chronic disease of the superficial veins of the legs, which is characterized by the elongation and deformation of some boats and the causes of chronic venal insufficiency, has been progressing. This is a common feature of pathology – suffers every fourth inhabitant. According to statistics, surgical interventions in hospitals, women suffer 6-7 times more often than men. However, some authors consider that this information is incorrect and to assume that men suffer from varicose veins in equality with women as, however, a cosmetic issue that concerns less, so they go to the doctor less often – only when there are pronounced symptoms of venous insufficiency chronic.

treatment of varicose veins in the legs

In our article, learn about the causes, mechanism of development of this pathology, symptoms, principles of diagnosis and treatment, including methods of physical therapy.

The causes and mechanism of development of the disease

Varicose disease of the lower extremities can be primary (occurring due to congenital alterations of the structure of the wall of the vein or insufficiency of the valve is a disease) and secondary (develops as a complication of deep vein disease, for example, with PTS).

There are a number of factors that increase the load on the veins, reducing a tonus of the wall vein, thus increasing the likelihood of developing varicose veins. This:

  • heavy physical work;
  • hormonal body changes in puberty, menopause);
  • the use of combined oral contraceptives;
  • long stay in a standing position;
  • the period of development of a child.

Under the influence of the causal factors in venous vessels increases the hydrostatic pressure, which leads to an increase of its diameter and of the progression of the dysfunction of the valve apparatus. As a result, the output of blood through the veins surface is hard, the blood from the deep vein occurs on the surface – that are overflowing, too stretched, wriggled and in the form of extensions for different cylindrical, in the form of a bag, the hybrid. With the progression of the disease the blood stagnation leads to problems of nutrition (trophism) of the tissues of the lower parts of the extremities – the skin reddens, dries, there is dermatitis, eczemas, and in an advanced stage – trophic ulcer.

Scientists believe that varicose veins – a kind of "payback" human bipedalism.

In 3 of the 4 patients is determined by the extension of the main saphenous veins (trunk), the rest is diffuse dilatation (including intradermal). In 8 of 10 cases the lesion is determined in the basin of the great saphenous vein, the remaining 20% must defeat the small saphenous vein and mixed defeat equally.

Clinical manifestations

Depending on the severity of the chronic insufficiency of venous function in varicose veins disease distinguish 3 stages:

  • And – the phase of relative compensation;
  • II stage – subcompensation;
  • III – the phase of decompensation.

In the first stage of the disease, the patients complain only cosmetic imperfections such as spider veins, serpentine deformation of the subcutaneous venous trunks, which appears in the vertical position of the patient, often after exercise or static loads, as well as in the night. Subjective sensations in this stage patients do not exist.

In the second phase of the complaints of the patients are added, which are symptoms of disorders of the regional circulation. Patients note:

  • fatigue;
  • heaviness in the lower extremities, especially after exercise or in the night;
  • a sensation of tingling, pins and needles in the lower part of the legs;
  • swelling of the feet and the lower third of the tibia;
  • pain in these parts of the legs, of medium intensity, full of character;
  • muscle cramps of the foot and the leg, especially at night.
varicose veins

After the patient some time he goes to bed with the limb affected was raised, he noted the relief – complaints "go away" or be less pronounced.

Visually, in the second stage varicose disease is determined by the significant expansion, the ornateness of the saphenous veins, which is the highest expressed in the patient to a standing position, that is to say, when the greater burden in the venous apparatus.

In the third stage, the veins are determined constantly have a constant swelling of the limb below the site of localization of the pathology. These symptoms are added, and disorders of trophism nutrition of the skin is dry and thin, very red; perhaps the appearance of ulcers, mainly in the anterior-medial (internal) surface of the lower third of the leg (often on the inside of the ankle).

Patients worried about fatigue severe heaviness in the limbs, especially noticeable in the upright position and during walking and inflammation.

Doctors to apply in your practice and the international classification of diseases, chronic venous insufficiency, a fully reflecting symptoms of the disease:

  • grade 0 – signs of chronic insufficiency of vein function is not available;
  • class 1 – visible on the skin spider veins (telangiectasia) and reticular veins,
  • class 2 – define twisted veins with deformations in the form of a bag;
  • class 3 – we have the varicose veins and swelling of the extremities;
  • class 4 – define trophic disorders of the skin - – - increase in the pigmentation, with symptoms of dermatitis, eczema;
  • class 5 – changes which are characteristic of the class 4, in addition to trophic ulcer, which is healed;
  • class 6 – changes characteristic of the class 4, in addition to open trophic ulcer.

Complications of varicose vein disease

As a result of the damage thinned, the affected varicose veins which are welded, the skin can open the bleeding. While the outbreak of the host blood is poured out in the midst of the stream, which can lead to significant blood loss.

The second serious complication is acute thrombosis. It is manifested by the redness of the skin over the affected vein, painful seal in the form of a cord in the way. This is a condition that is dangerous because the clot or part of it can break through the vessel wall and the bloodstream to get in the blood vessels of the lungs or the brain, covering them.

To establish the diagnosis of varicose vein disease of a person skilled in the majority of cases, it is not easy. He can do it on the basis of complaints of patient, anamnesis of life and diseases, as well as the results of the evaluation, the goal of the state. It is important not only to accept the existence of this disease, and to determine the state of the valves of the veins, which is the vascular permeability – depends on tactics of treatment.

Assessing the state of the valves is to help the patient performs functional tests:

  • test Troyanova-Trendelenburg;
  • sample Pratt-2;
  • proof of Chania.

To evaluate the patency of deep veins will help show Pratt-1 and-be-pertise.

To describe the technique and the principle of the evaluation of the results of the samples that are not, because it takes the reader to the topic of the article.

Of great value in the diagnosis of varicose veins is ultrasound. Allows the maximum to characterize the pattern of blood flow. Apply:

causes of varicose veins
  • ultrasonic dopplerography (by the judge patency of a vein and the presence/absence of reflux of the blood from the deep veins to superficial);
  • duplex scanning with color to be determined by streams (this is the "gold standard" of diagnosis, which is easy to assess the condition of the superficial and deep veins and see the valves, to determine the diameter of the vessel to verify the presence or absence of thrombi in Vienna).

In advanced cases of varicose veins apply a procedure particular to assess the state of the muscle-venous pump of the line.

Treatment

There are 2 main types of treatment conservative and surgical. Conservative includes the normalization of life, the compression of the therapy, the treatment and sclerotherapy. Conservative treatment will not help to get rid of the disease, and is designed to slow down its subsequent evolution.

And as part of the conservative treatment, and in the phase of rehabilitation after surgery widely used the therapy of physical factors.

Lifestyle

The patient should be in all senses of the word to take care of your veins:

  • avoid prolonged static position;
  • avoid heavy physical effort;
  • wear shoes, not tightening the foot, comfortable, stiff sole, a small heel;
  • if the nature of the activity provides the patient a long stay in a sitting position, use a support under the feet to give the feet in elevated position, and each 1-1.5 hours to make a break in work during which to walk or rise on the toes 10-20 times.

In addition, if the weight of the body of the patient above the norm, has to be reduced. In the diet, it is recommended to limit the consumption of salt and hydration.

Compression therapy

Elastic compression improves the blood flow in the deep veins and reduces it to the subcutaneous veins, prevents edema, activates the microcirculation and metabolism in tissues.

Apply bandages, elastic and stockings. It is important to choose an instrument with the patient requires a specific degree of compression. Equally important to know the patient, the technique of proper bandaging of the limb. Bandaging begin in the morning, before getting out of bed in the direction from the toes to the thigh, grabbing the heel and the ankle. Bandaging should be done in such a way that each subsequent half turn of the bandage overlaps the previous one.

The medication

Your doctor may prescribe the patient a course of use of this type of drugs:

  • it means improving the tone of veins,
  • improves the microcirculation;
  • prevent the formation of blood clots;
  • nonsteroidal anti-inflammatory drugs.

Sclerotherapy

Indications for the realization of sclerosing therapy are:

  • the categorical refusal of the patient after the surgery;
  • recurrence after surgery individual of varicose veins;
  • the first stage of varicose vein disease;
  • contraindications of the surgery.
treatment of varicose veins

The essence of the method consists in the introduction into the affected vein of a substance that damages the inner lining of the vessel and leads to the development of inflammation of the vein with subsequent obliteration (obstruction) of the light. That is to say, after the treatment, Vienna, stops working.

Surgical treatment

Surgery is the main method of treatment of varicose veins of the lower extremities. It can be performed at any stage in the absence of contraindications. The essence of the intervention is to remove the affected saphenous veins with specially made individual cuts. In recent years, the use of endoscopic the procedure of removing diseased veins through an endoscope – a flexible tube with an optical device and tools on the end.

Rehabilitation after surgery

To reduce to a minimum the risk of a specific syndrome of all patients in the postoperative period should be carried out the rehabilitation activities. The main one is the overlay at the bottom of the leg and the foot of zinc-gelatin bandage. Made immediately after the surgery or if the patient has installed drainage, 24 hours after its period of 7-9 days, then removed and the suture is removed. The patient is prescribed massage, exercise therapy.

Physical therapy

Methods of treatment of varicose veins is aimed at the strengthening of the wall vein and improve its tone, the improvement of blood rheology and outflow of the veins.

Increase the tone of the vein walls:

  • electrophoresis in the fabric of the special medications that the patient is taking the tablet form of the drug, or receives it by injection, then, in the region of the affected ship location the electrodes to the cross-cutting technique and perform the procedure, the duration of which is up to 1 hour frequency of sessions – every day or 1 every 2 days; course of treatment – up to 10 effects;
  • therapy segmental (the patient places the limb in a pressure chamber where they are exposed to the pressure of 113 KPa; the procedure takes up to half an hour; keep the sessions of each day or 1 every 2 days rate of 20-25 influences).
prevention

Improve the flow of blood and lymph of the extremities:

  • magnetotherapy low frequency (limb located in a unit solenoids and the effect of the magnetic field; the duration of the session: 20 minutes frequency – 1 time a day, the treatment course is 13-15 effects);
  • electrophoresis of enzymes-proteolytic – a procedure lasting 15 to 20 minutes is done along the technique cross every day course of 12-15 treatments;
  • therapeutic massage (exercise in accordance with the method of extraction with gentle techniques in the field of pathology; is done 1 time a day course 12-15 effects).
05.10.2018