Varicose veins of the lower extremities in modern medicine

Modern healthcare faces many different challenges, but despite rapid advances in medicine, there are diseases that continue to affect millions of people. Varicose veins of the lower limbs is a problem in ICD 10 - I83 that practically cannot be solved over time.

Prevalence in numbers

The disease is widespread in developed countries such as the USA, France, Belgium, Germany, etc. The number of patients with this diagnosis is almost a quarter of the population of each country.

Half of the patients are over 55 years old, while the other part is able to work, most often employed in the manufacturing industry. As any VD disease progresses, complications develop, patients lose their jobs due to disability, so the problem becomes not only medical but also economic and social. The occurrence of varicose veins can be related to the age of the patient. Lower extremity varicose veins occur more often in people over 70 than in people before retirement age.

In four out of one hundred patients over 80 years of age, the development of varicose veins takes the form aggravated by concomitant diseases, in the form of trophic ulcers, various types of dermatitis or eczema. At this age, other diseases of the cardiovascular system and the bronchopulmonary system also occur, thus ruling out the possibility of surgical intervention.

Important!At the first symptoms of the disease, it is better to see a doctor, the younger the patient, the lower the risk if surgical treatment is required.

The origin of the disease

Despite the fact that the disease progresses gradually, there are still etiological factors in the development of varicose veins.

So what are the causes of varicose veins:

• heredity;
• endocrinological causes;
• mechanical factor;
• infection;
• intoxication;
• non-specific inflammatory process;
• factors causing venous hypertension.

Complaints and symptoms

Strangely, visible abnormalities appear at the beginning of the disease, which are often ignored. If they mistake small vascular defects for a minor external abnormality that "goes away on its own", patients provoke the development of the disease.

Additional symptoms develop gradually:

• feeling of tiredness/heaviness in the legs;
• swelling in the leg area;
• night cramps;
• numbness, tingling, "stingy" feeling;
• pain in the area of varicose veins.

Diagnosing varicose veins is an important condition at any stage of the disease

At any stage of the disease, a diagnosis must be made, and it is the diagnosis that suggests which treatment option is most acceptable to the patient. Clinical and instrumental diagnostic methods are used in parallel. Depending on the course of the disease, all or only a part of the method can be used.

Clinical research methods - examination and discussion

Clinical methods are used not only for varicose veins, but also for any other disease:

1. History collection. The anamnesis contains all the basic facts about your life (age, heredity, bad habits, type of full-time job).
2. Definition of Complaints. Complaints may indicate how far the varicose veins have progressed by the time of the examination. The duration of the illness will be an important condition. When did the first symptoms of foot disease appear?
3. Control.During the examination, the doctor must pay attention not only to the blood vessels, but also to the condition of the skin in order to rule out the presence of complications and concomitant pathologies. It is also important to determine the degree of damage, the temperature at the site of the varicose vein, as well as the tightness and elasticity of the vessel.

A phlebologist is the first doctor to see your leg.

Prerequisite for instrumental test methods

One examination will not be enough to prescribe treatment. Varicose veins of the lower limbs require mandatory instrumental diagnosis. Instrumental research methods determine the foci of varicose veins, the length of the damaged vessel, the insufficiency of the venous valves, the speed of blood flow, etc.

This:

1. Ultrasound.The standard B-mode examination provides a complete picture of the anatomical structure and location of the vessel, as well as those adjacent to it. Ultrasound also reveals pathologies of the vein wall.
2. Doppler ultrasound.The test determines the speed of blood flow, thereby identifying pathologies of the valves in the vessel.
3. X-ray contrast venography. A more complicated type of diagnosis using X-rays. The procedure is rarely used due to the possible occurrence of complications.
4. Computed tomography venography. It is performed in the same way as X-ray contrast, by introducing a contrast material into the lumen of the vessel. Unlike an X-ray, a CT image is three-dimensional.
5. MRI.The method is justified and informative, it is performed without the use of contrast material or other drugs. However, this method is still expensive, so it is extremely rarely used.

Note!Contrast material cannot be given to patients with an iodine allergy, in which case an MRI may be necessary.

Diagnosis according to classification

Like other diseases, varicose veins are divided into classes, taking into account several factors:

External manifestations	telangiectasia; Varicose veins; Edema; Hyperpigmentation; Ulcer in the healing phase; The ulcer is in an active stage.
The cause of the disease	Congenital; Unknown etiology; Acquired (injuries, etc. ).
Anatomical location of veins	Superficial; Deep; Perforating varicose veins are distinguished separately.
Mechanism of disease	Casting into nearby ships; Obstruction of venous blood flow.

The most common reason for contacting specialists is varicose veins of the 2nd degree of the lower limbs, when the external manifestations of the disease become significant. Perhaps, if the disease does not manifest itself externally, the detection of varicose veins would occur at a later stage.

Note!The concept of "internal varicose veins of the lower limbs" is only used colloquially, it means varicose veins of the deep veins, which can only be diagnosed with instrumental methods.

To treat or not to treat, that is the question

The gradual progression of the disease sooner or later makes patients realize that treatment is necessary. The doctor's task is often to convince the patient to start treatment at the initial stage of the disease. The course of treatment can be different and depends on many factors (age, symptoms, degree of illness, etc. ).

Thus, treatment can be aimed at:

• improving the quality of life; cosmetic surgery procedures.
• prevention of complications; affects microcirculation.
• elimination of symptoms; hemodynamically significant treatment.

One way or another, the treatment is always selected by a specialist (phlebologist, vascular surgeon). Complexity is important in the treatment of varicose veins, so it cannot be limited to only surgical intervention or only therapeutic and preventive physical training. It is important to follow all of your doctor's instructions.

Lifestyle tips

Varicose veins oblige patients to abandon the factors that cause complications. Sometimes such a measure is necessary, since untreated varicose veins greatly affect the quality of life.

Do-it-yourself practice is useless, but it is worth paying attention to your lifestyle so that varicose veins do not develop so quickly.

What to do in case of varicose veins:

• Women should give up high heels;
• Give up bad habits, especially smoking;
• Move, if you have to sit or stand for a long time, try to change your position;
• Avoid tight/tight clothing and shoes;
• Avoid exposure to high temperatures (sunbathing, hot wax, bath, sauna);
• Control your weight;
• Do not lift heavy objects;
• Take a contrast shower;
• Walk, run, swim more often;
• If possible, keep your legs elevated (sleeping, resting).

Compression therapy

Regardless of the etiology, patients with varicose veins should wear a medical garment or use an elastic bandage.

1. The use of knitwear is the most comfortable, stockings or knee socks made of special material usually do not cause discomfort. The compression level of medical stockings should be recommended by a doctor. The only downside to compression garments is their price.

   Note!Medical knitwear manufacturers may have different brands, so you should choose carefully. Make sure that the elastic of the knee socks or tights is not too tight.

2. Alternatively, patients often prefer a short, medium or long elastic bandage. The choice of expandability also depends on the stage of the disease and should be recommended by a doctor. The first few uses can be a bit difficult as you have to adjust the tension of the bandage yourself.

Compression therapy is used daily, and wearing underwear or bandages greatly relieves stress on the legs throughout the day.

Physical education and sports as treatment

Varicose veins require movement, which is why therapeutic and preventive physical education is an important component. Of course, it is better not to do the exercises blindly, but to choose a series of exercises with a specialist. Some health facilities offer group exercise therapy classes.

Exercise therapy exercises most often do not require special training and are available regardless of age; for the sake of clarity, a series of gymnastics exercises:

• Tighten and relax the thigh muscles (10 times);
• Inhaling, lifting the abdominal wall, exhaling, pulling in the stomach (4 times);
• Bend and straighten the leg at the ankle (10 times);
• While inhaling, raise your arms through the sides, while exhaling, lower them (4 times);
• Bend and straighten your toes (15 times);
• Raise your arms as you inhale and lower them as you exhale.

Even from this small series of exercises, it is clear that anyone can do it, regardless of age. It is important to take your time and do everything at a slow pace without holding or speeding up your breathing.

Athletes can also perform this series of exercises before the main training. It is especially important if the patient plays sports that are not recommended for varicose veins.

Sports are also suitable as an alternative to exercise for varicose veins of the lower extremities, but you should consult a doctor and personal trainer. Some exercises should be excluded from training.

Athletes are sometimes simply forced to stop their professional careers, especially in jumping, powerlifting and heavyweight boxing. On the other hand, those who like to swim, run and walk can continue to do so.

Medicines prescribed by a doctor

The goals of pharmacology in the treatment of varicose veins are different, namely:

• improving the tone of the veins;
• correction of microcirculation;
• improvement of lymphatic drainage;
• prevention of thrombotic complications;
• reducing the development of complications.

Therefore, all medicines must be prescribed by a doctor. This is the guarantee for the successful resolution of the disease.

Drug treatment is used at different stages: during the preparation of the patient for the upcoming operation, in the postoperative period, and in case of obvious contraindications to the operation. The drugs can be systemic or local and can be used together or separately.

Phlebosclerotic treatment

Phlebosclerosis also refers to methods of drug treatment, however, its use is often unjustified, since the positive effect does not apply to all patients. The method is mostly used for aesthetic correction.

It should be noted that the use of this method is associated with relapses and complications, so the procedure is performed by surgeons who have undergone special training.

Physiotherapy in the treatment of varicose veins

Physiotherapy methods are not the primary treatment for varicose veins, but they are successfully used to alleviate the symptoms of the disease. D'arsonval, electrophoresis, barotherapy, magnet therapy for varicose veins of the lower limbs can only be used under the supervision of a doctor, as all physiotherapy has a number of indications and contraindications.

All physiotherapy procedures are not used continuously, but in 10-20 day courses. In most cases, physiotherapy delays the progression of the disease, but it is not the main treatment method, and certainly cannot be used as monotherapy.

Surgical treatment

Despite the many therapeutic methods, surgery remains practically the most basic and significant. Vascular surgeons perform successful operations on many patients.

Traumatic venectomies have become a thing of the past as modern, minimally invasive methods have become available. The Brunner approach, Müller dissection, and mini-phlebectomy with Varad hooks make treating patients with varicose veins easier and often within a day.

Of course, surgical intervention also has contraindications, the main group includes patients over 75 years of age who have tissue trophic disorders, microcirculation and/or lymphatic drainage disorders, or excessive changes in venous vessels. There are special instructions for performing operations on such patients. Sometimes you have to abandon surgery altogether, and sometimes doctors still operate with a combined phlebectomy.

Drug treatment

The treatment plan for varicose veins is determined by the doctor. For this, conservative methods and surgical methods are used, it all depends on the stage of development of the disease, as well as the presence of complications.

The simultaneous use of drugs and ointments makes it possible to alleviate the symptoms of the pathology and achieve good results in the treatment. Currently, on the shelves of pharmacies there is a wide selection of drugs that are effective in combating the pathology at an early stage of development.

Medicinal treatment of varicose veins of the legs is effective.

Important!Only a doctor can prescribe medicines, their dosage and the course of their use.

Sclerotherapy

Sclerotherapy is currently one of the best methods for treating varicose veins. Specially administered drugs make it possible to destroy the internal stagnation of the vein. After a while, it begins to stick together and dissolve, and blood circulation is transferred to healthy veins.

The treatment is carried out in a course consisting of up to six sessions on each painful leg. You can notice a positive result in two weeks at the earliest. However, patients should be prepared to experience pain and tingling.

The unpleasant symptoms will soon disappear, and the diseased veins will disappear. The dose of the drug is selected taking into account the individual characteristics of the patient.

Complications and side effects are extremely rare. A properly performed procedure gives a high chance of recovery.

Echosclerotherapy is the same as sclerotherapy, the difference is in the use of an ultrasound scanner. This method is preferable because the movement of the syringe can be tracked and the medicine is distributed evenly.

Foam sclerotherapy is another type of sclerotherapy. Medicines are administered in the form of microfoam, so the procedure allows for better results. The fact is that the drug is much closer to the walls of the veins and does not mix with the blood.

Surgical treatment methods

Surgical treatment of varicose veins is used only when conservative methods do not achieve the desired result. Patients receive local anesthesia and can go home after a few hours.

There are practically no hematomas, and there is no poisoning typical of general anesthesia. The result obtained lasts for several years.

Phlebectomy is a type of surgery that is performed during a local surgical intervention. Two small punctures are made to remove the affected vein. Sometimes this method can replace sclerotherapy. After a few weeks, the patient can return to their normal lifestyle.

Laser treatment is the gentlest treatment method and can only be performed by a qualified specialist. Using an ultrasound scanner, a light guide is inserted into the vein.

The procedure is controlled by special tools. As a result of the laser beam, the plasma boils, the diseased vein closes and does not participate in blood circulation. The price of such an intervention is high, so it is not available to everyone.

Darsonvalization

The D'arsonval device can be used to normalize blood circulation and eliminate congestion in diseased veins. The increased tone gradually decreases, the tone of the veins increases. Patients get relief from pain and itching.

Full lymph circulation, as well as full blood circulation, allows the tissues to receive adequate nutrition and the amount of oxygen in them increases. The veins narrow or dilate; gymnastics can increase their flexibility.

The device moves from bottom to top. Lymph and blood flow from ankle to thigh and congestion is relieved. In order to achieve the desired result, a complete treatment should be carried out, which includes at least twenty procedures.

Home Remedies

Advice!Varicose veins can also be effectively treated with home remedies.

The most common methods are the use of herbs. You can buy them at the pharmacy or collect them yourself in the summer.

White acacia

An alcoholic tincture is made from the flowers of the plant. Soak a cotton ball in it and wipe the affected areas several times a day.

sage

Gather the fresh herbs and grind them in a mortar. Separate a spoonful of herbs and mix with the same amount of sour cream. Apply the resulting mixture to the painful places and put a bandage on top. After two hours, remove the poultice. Repeat the manipulations for five days, take a short break, and then repeat the treatment.

Kalanchoe

Wash the Kalanchoe leaves, place them on a paper towel and let them dry. Cut the leaves and put them in a glass jar. Pour alcohol on top and leave to cook for seven days, stirring occasionally. Strain the tincture and apply to painful veins for several months in a row.

Apple vinegar

Dissolve two tablespoons of vinegar in a glass of water and drink it twice a day. We recommend that you rub undiluted apple cider vinegar on the painful areas twice a day. After a month, the veins will be smaller.

Cream

Grind part of the garlic, add two parts of butter. Apply the resulting cream in its pure form to the sore spots, cover with baking paper and apply a bandage. Leave the poultice on overnight, wash off in the morning, and wrap your feet with an elastic bandage. Repeat the process throughout the month.

Garlic

In order to consolidate the results of the treatment, you can also take garlic internally. Mix 250 grams of chopped garlic and 350 grams of honey, let it stand for five days. Take one spoon three times a day.

Tomato

Cut a fresh tomato into slices, apply it to the problem area and wrap it with a bandage. Keep the poultice on for four hours, then take it off and wash your feet. The duration of the course is two weeks, then a ten-day break must be taken and repeated.

Prevention

It is much easier to prevent a disease than to fight it later, which is why prevention is necessary. If you have a hereditary tendency to develop varicose veins, you should pay double attention to your health.

First of all, you need to give up bad habits and follow the recommendations listed above. The diet should include foods rich in vitamins.

Vitamin E

The vitamin can be found in many foods: salad, vegetable oil, legumes. The walls of the veins should be strengthened and their elasticity should be increased. Vitamin C has exactly the same property.

Copper

The synthesis of elastin is supported by foods rich in copper. This includes seafood. In order to maintain your weight, you must give up sugary foods.

To prevent varicose veins, you must follow the following rules:

1. It is not recommended to put a lot of effort on your legs during the day. People who work in a standing position must spend several minutes in a sitting position every hour. Ideal: take a horizontal position, raise your legs above your head and hold for twenty minutes.
2. If you work in a sitting position, you should stand up for a few minutes once an hour and spend that time standing. This increases the speed of blood movement through the veins. Rotate your legs in different directions regularly.
3. It is not recommended to lift heavy objects.
4. Massage your feet daily using a cold water jet.
5. Do not use too many saunas and baths.

Good results can be achieved with effective methods of treating varicose veins. Patients quickly return to full life.

How complicated is the disease?

Complications of varicose veins are always unpredictable, although they develop gradually. Without medical supervision and therapeutic treatment, the risk of complications increases many times over.

1. Trophic ulcers with ascending and descending varicose veins.Most often, they are located on the lower third of the inner leg, but they can also be observed on the outside, although this manifestation occurs quite rarely. The deeper the trophic ulcer, the greater the risk of bleeding.
2. Thrombophlebitis.It can occur with any type of varicose veins, the occurrence of such complications directly depends on the coagulation properties of the blood. This complication can be prevented by laboratory monitoring.
3. Eczema.It occurs due to a violation of tissue trophism. Eczema and trophic ulcers can occur together or separately.
4. Bleeding from varicose veins of the lower extremities.This type of complication can occur against the background of deep trophic ulcers, as described above; such bleeding is external. Internal (subcutaneous) bleeding can be observed in case of prolonged course of varicose veins.

What you should know about varicose veins

Varicose veins become a test for patients, because the more they are ignored, the more aggressively the disease behaves. The course of varicose veins depends not only on the doctor's instructions, but also on how strictly the patient follows them. Varicose veins are a chronic disease, so the treatment often does not end even after surgery.

What the doctor advises should be done and followed, be it a lower extremity varicose vein magnet, medication or exercise therapy. This is a complex treatment that gives a positive result, and you should not ignore even the most insignificant point.