Varicose veins (varicose veins) is a disease in which superficial veins are enlarged or swollen. The disease in most cases occurs 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 saphenous veins are well contoured, the direction of their course becomes "serpentine". The great saphenous vein is usually affected, less often the small saphenous vein, and even less often their saphenous anastomoses.
Causes of varicose veins
Theories 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 the centrifugal flow of blood and thus its excessive flow from the subcutaneous into the deep veins of the leg. With insufficiency of valves in the saphenous veins, a larger amount of blood is deposited, which leads to their expansion.
Theories of the second group in the development of varicose veins attach importance to stagnation of blood in the pelvis during pregnancy, constipation, the consequences of inflammatory processes, and also during prolonged stay on the legs.
Theories of the third group, which explain the origin of varicose veins by a constitutional predisposition, weakness of the mesenchyme, are the least substantiated.
With varicose veins, due to various reasons, their walls change, become thinner, so increased pressure leads to bulging of the walls. It first manifests itself in the form of nodes, and at the same time, areas of compaction resulting from excessive growth of connective tissue are also noted. Mechanical factors only contribute to the development of the pathological process in the veins, but in no way are the main point of the pathogenesis, etiology and causes of the 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 are short-term, convulsive nature of pain. Often there is swelling. The feeling of fullness and heaviness in the limbs increases in the evening, as usually by this time the swelling increases. Itching appears, there are often scratching on the legs. In the later stages of the disease, ulcers form, usually located in the lower third of the lower leg on its inner side.
The main objective symptom of the disease are visible varicose veins. Examination of the patient to identify this symptom is performed in a standing position. At the same time, dilated saphenous veins are clearly visible; on the lower leg they appear more prominent, more convoluted; on the thigh, the veins are usually dilated only along the course of the main vascular trunk. Sometimes there is a varicose vein on the thigh almost at the confluence of the largest saphenous vein into the femoral vein. Such a node can be mistaken for a femoral hernia, but the softness of the node, its rapid filling with blood after taking away the examiner's hand and the presence of dilated veins on the lower leg provide a basis for establishing the correct diagnosis.
There are a number of symptoms indicating the presence of expansion 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 carefully stroking the leg from the periphery to the center, the subcutaneous venous system is emptied, the place where the largest saphenous vein flows into the femoral vein is firmly pressed with a finger and, holding the finger, the patient is transferred to a standing position. If the filling of the veins occurs only after the removal of the finger, then this is a positive symptom. In such cases, the anastomoses between the superficial and deep vein network are poorly expressed, and the operation may have a positive effect. If, in a vertical position in a patient, the veins on the periphery nevertheless begin to slowly fill up, this indicates a significant development of anastomoses - a negative symptom. In this case, the vein ligation operation will be unsuccessful.
The Delbe-Perthes symptom indicates how pronounced the emptying of the saphenous veins into the deep ones through the anastomoses. An elastic bandage is applied to the patient in a standing position on the border of the middle and lower third of the thigh, then they are 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 skin changes, and ulcers. Puffiness is different - from a slight pastiness to pronounced edema, when the skin loses its usual pattern and looks glossy, the circumference of the lower leg increases markedly. 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 change of profession, if it is associated with prolonged standing, taking measures for 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 while lying down. For several minutes, the leg is kept in an elevated position and, only after making sure that the veins are empty, they apply a bandage or put on a stocking. The bandage begins to be applied from below and continues upward, avoiding any stretching and squeezing that causes stagnation.
There are a number of methods for surgical treatment. The operation of ligation of the great saphenous vein in the Scarpov triangle at the place where it flows into the femoral vein is palliative. After this operation, relapses are often observed. Therefore, it is used only in combination with other surgical interventions.
During the Babcock operation, a skin incision is made at the lower end of the dilated great saphenous vein, it is separated and tied up. Above the dressing, it is opened and a long bellied probe is inserted into the lumen. A second small skin incision is made above the upper end of the dilated vein. Its central end is tied up and crossed, below the intersection 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 turned inside out by the intima. The disadvantage of this method is that hematomas are formed at the site of torn anastomoses.
During the Madelung operation, dilated veins are excised throughout. Of all the operations, this intervention is the most radical, giving the best long-term results.
Complications of varicose veins
The most common and most difficult to treat complications of varicose veins are varicose ulcers. These ulcers usually occur in the elderly. 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, have a necrotic, foul-smelling discharge bottom, and high, callused edges. Ulcers can reach large sizes, encircle the entire lower leg. The skin around them is pigmented, sometimes inflamed, with eczematous irritation.
Varicose ulcers should be differentiated from syphilitic. Syphilitic ulcers are usually located in the upper third of the lower leg, more often on the anterior surface. In addition, with syphilitic ulcers, other signs of syphilis can be detected. Tuberculosis of the skin (lupus) is more common on the face, much less often on the extremities. Lupus begins as isolated nodules that then ulcerate; in the future, a deeper tissue damage occurs, sometimes with the formation of smooth scars that tighten neighboring tissues.
Given that varicose ulcers develop against the background of circulatory and trophic disorders, their treatment should be persistent and lengthy. The constant position of the patient with a raised leg in most cases leads to rapid improvement. 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 cleared and the swelling around it disappears, it is recommended to excise the veins. Only a radical operation to remove altered veins eliminates the risk of recurrence of ulcers.
As the disease progresses and the varicose nodes increase, their walls and the skin soldered to them become thinner. As a result of this, usually during walking (when the nodes are especially tense), one of the nodes may rupture and venous bleeding may occur. Although such bleeding can be significant, they do not pose a great danger, as they quickly stop if the patient is laid down and the leg is raised up. In this position, negative pressure is created in the veins, they subside and the bleeding stops. A light aseptic bandage is placed on the wound. In view of the fact that bleeding can be repeated, surgery is recommended for excision of the veins or their ligation and removal of the most thinned nodes. With bleeding from compensatory dilated veins, any operation associated with ligation of the main trunk of the vein is categorically contraindicated.