Varicose veins (varicose veins) is a condition in which superficial veins become enlarged or swollen. The disease occurs in most cases in people over 30 years of age. In the vast majority of cases, it is observed on the lower extremities. Varicose veins are characterized by an expansion of the lumen of the veins with a simultaneous change in their wall. The trunk veins are well contoured, the direction of their course becomes "snake-like". The saphenous vein is usually affected, more rarely the saphenous vein and even more rarely its anastomoses.
Causes of varicose veins
Theories that have been proposed to explain the causes and mechanisms of the onset of the disease can be reduced to three groups.
Theories of the first group explain the origin of varicose veins by the anatomical features of the location and structure of these vessels of the lower extremities. The veins have valves that prevent centrifugal blood flow and thus its excessive flow from the hypodermis into the deep veins of the legs. With insufficiency of the valves in the trunk veins, more blood is deposited, which leads to their expansion.
Theories of the second group in the development of varicose veins emphasize blood congestion in the pelvis during pregnancy, constipation, the consequences of inflammatory processes, and also with a long stay on the legs.
Theories from the third group, which explain the development of varicose veins through a constitutional predisposition, a weakness of the mesenchyme, are the least well-substantiated.
With varicose veins, their walls change for various reasons, become thinner, so increased pressure leads to bulging of the walls. It first manifests itself in the form of nodules, at the same time areas of compaction are also noted, resulting from excessive growth of connective tissue. Mechanical factors only contribute to the development of the pathological process in the veins, but are by no means the main point of the pathogenesis, etiology and causes of varicose veins of the lower extremities.
Symptoms of varicose veins
With the expansion of the veins, patients usually experience a feeling of fullness and heaviness in the lower extremities. Sometimes there is short-term, cramping pain. There is often swelling. The feeling of fullness and heaviness in the limbs increases in the evening, since the edema usually increases around this time. Itching appears, there is often scratching on the legs. Ulcers form in later stages of the disease, usually on the inside of the lower third of the lower leg.
The main objective symptom of the disease is visible varicose veins. Examination of the patient to identify this symptom is carried out while standing. At the same time, dilated trunk veins are clearly visible; on the lower leg they appear more prominent, more intertwined; on the thigh, the veins are usually only dilated in the course of the main vascular trunk. Sometimes there is a varicose vein on the thigh almost at the confluence of the largest trunk vein with the femoral vein. Such a lump can be confused with a femoral hernia, but the softness of the lump, its rapid filling with blood after removing the examiner's hand, and the presence of dilated veins on the lower leg provide a basis for making the correct diagnosis.
There are a number of symptoms that indicate dilation of the venous trunk of the great saphenous vein. These include a symptom in which the patient is placed in a horizontal position, the leg is given an elevated position. By gently stroking the leg from the periphery to the middle, the subcutaneous venous system is emptied, the point where the largest saphenous vein opens into the femoral vein is firmly pressed with a finger, and the patient, holding the finger, is placed in the standing position. If the filling of the veins appears only after removing the finger, then this is a positive symptom. In such cases, the anastomoses between the superficial and deep vein networks are poorly developed, and the operation can have a positive effect. If, in a patient in a vertical position, the veins on the periphery nevertheless slowly fill, this indicates a significant development of anastomoses - a negative symptom. In this case, vein ligation surgery is unsuccessful.
The Delbe-Perthes symptom indicates the extent to which the trunk veins drain deep into the anastomoses. The patient is put on an elastic bandage on the border of the middle and lower third of the thigh while standing, then he is offered to walk a little. If the tension of the dilated veins decreases significantly, this indicates the presence of developed anastomoses between the superficial and deep veins.
Other symptoms of varicose veins include swelling, eczematous lesions and ulcers. The situation is different with swellings – from a slight pulpiness to pronounced edema, when the skin loses its usual pattern and looks shiny, the circumference of the lower leg increases significantly. Of the eczematous manifestations, dryness, peeling, and finally eczematous rashes are observed. The skin on the lower leg is usually affected. These changes occur as a result of trophic disturbances.
Prevention and treatment of varicose veins
Prevention of varicose veins is reduced to a job change if it involves prolonged standing, measures to ensure regular bowel movements, bandaging the legs with an elastic bandage or wearing an elastic stocking. Bandaging the legs or putting on a stocking must be done lying down. The leg is held in an elevated position for a few minutes and only after making sure that the veins are drained is a bandage applied or a stocking put on. The bandage begins to be applied from below and continues upwards, avoiding any stretching and squeezing that causes stagnation.
There are a number of methods of surgical treatment. The palliative operation is the operation of ligating the great saphenous vein in Scarpov's triangle at the junction with the femoral vein. After this operation, relapses are often observed. Therefore, it is used only in combination with other surgical interventions.
In the Bebcock operation, a skin incision is made at the lower end of the enlarged trunk vein, which is severed and tied off. Above the bandage, it is opened and a long-bellied probe is inserted into the lumen. A second small incision is made over the top of the dilated vein. Its central end is tied and crossed, below the crossing the vein is tightly tied over the probe, after which it is carefully removed through the lower incision. At the same time, the probe pulls a vein that has been everted from the intima. The disadvantage of this method is that hematomas form at the site of ruptured anastomoses.
During the Madelung operation, dilated veins are continuously removed. Of all surgeries, this is the most radical and provides the best long-term results.
Complications of varicose veins
The most common and most difficult to treat complications of varicose veins are varicose veins. These ulcers usually appear in older people. They are located on the inner, less often on the outer surface of the lower third of the lower leg. These ulcers are the result of chronic tissue malnutrition. They are usually deep, with a necrotic, foul-smelling floor of discharge, and high, calloused edges. Ulcers can reach large sizes and surround the entire lower leg. The skin around them is pigmented, sometimes inflamed, with eczematous irritation.
Varicose veins should be distinguished from syphilis. Syphilitic ulcers are usually located in the upper third of the lower leg, more often on the front surface. In addition, with syphilitic ulcers, other signs of syphilis can be noted. Tuberculosis of the skin (lupus) occurs more frequently on the face and much less frequently on the extremities. Lupus begins as isolated nodules that then ulcerate; In the future, deeper tissue damage occurs, sometimes with the formation of smooth scars that tighten neighboring tissues.
Since varicose veins develop against the background of circulatory disorders and trophic disorders, their treatment must be persistent and lengthy. The constant positioning of the patient with the leg raised leads to rapid improvement in most cases. A bandage with a 0. 5% solution of potassium permanganate, with penicillin ointment or balsamic liniment should be put on the ulcer. When the wound is cleaned and the swelling around it disappears, it is recommended to remove the veins. Only radical surgery to remove altered veins eliminates the risk of ulcer recurrence.
As the disease progresses and varicose veins increase, their walls and the skin soldered to them thin. As a result, one of the knots can tear, usually during walking (when the knots are particularly tight), and venous bleeding can occur. Although such bleeding can be significant, it does not pose a great danger as it stops quickly when the patient is laid down and the leg is raised. In this position, a negative pressure is created in the veins, they relax and the bleeding stops. A light aseptic bandage is placed on the wound. Due to the fact that bleeding can be repeated, surgery to excise the veins or their ligature and remove the most thinned nodes is recommended. In the case of bleeding from compensatory dilated veins, any operation involving ligation of the main venous trunk is generally contraindicated.