Varicose veins - what is it, symptoms, causes, stages and treatment

Varicose veins of the lower extremities are a disease of the veins of the legs, characterized by pathological expansion and deformation of the venous vessels, accompanied by the development of a number of complications.Varicose veins affect the superficial veins of the legs.

According to modern views, the main cause of the development of varicose veins is a defect (congenital or acquired) in the valve apparatus of the veins of the lower extremities, leading to the development of backflow of venous blood (reflux).Reflux leads to venous overflow and pathological venous outflow (redirection of blood flow).Which, in turn, leads to clinical manifestations of chronic venous insufficiency - such as swelling of the legs, pain along varicose veins, itchy skin, cramps in the calf muscles.

In advanced cases, the formation of skin pigmentation in the shin area, the formation of trophic ulcers, bleeding from varicose lymph nodes, as well as thrombophlebitis - inflammation of varicose veins with their thrombosis.Varicose veins develop gradually.

According to European statistics, chronic venous diseases are widespread throughout the world.It has been proven that among the adult population of different countries, the incidence of varicose veins ranges from 2% to 60%.Surprisingly, in African countries as well as in the Pacific region, despite multiple pregnancies, the incidence of varicose veins in women does not exceed 6%.At the same time, in European countries, the incidence of varicose veins among the adult population reaches tens of percent.It follows that the tendency to develop varicose veins depends on ethnic origin.

There is also a clear trend of increasing incidence.This may be due to the prevalence of a sedentary lifestyle, obesity and partly smoking.Patients in “public” hospitals are often deprived of the opportunity to benefit from modern diagnostics and treatment for varicose veins of the lower extremities.The lack of modern high-tech methods for diagnosing and treating varicose veins in the public medical sector explains why combined phlebectomy remains the main method of treating varicose veins in public hospitals.That is to say a very traumatic stationary operation with numerous incisions (and sutures) and mechanical removal of the trunk of the incompetent vein.

This operation is performed under general anesthesia or spinal anesthesia.World statistics claim that the vast majority of patients suffering from varicose veins can receive surgical treatment on an outpatient basis - without hospitalization, but also without spinal anesthesia and anesthesia.Conclusion - high-quality treatment of varicose veins is impossible without timely diagnosis and innovative treatment technologies.

Symptoms of varicose veins of the lower limbs

Symptoms (manifestations) of varicose veins are signs that allow you to suspect the disease with sufficient certainty.Symptoms can be subjective (it seems to me) and objective (I see).

Subjective symptoms of varicose veins include:

• Feeling of heaviness in the legs.Generally, at the calves.This symptom is more pronounced in the evening.
• Pain in the calf muscles.Most often, it is aching pain, of low intensity, sometimes discomfort.
• Pain along varicose veins.As a rule, it is not intense, it manifests itself more in the evening, after a day of work.
• Leg fatigue.Fatigue is a reduction in tolerance (susceptibility) to physical activity, both static and dynamic.
• “Venous claudication.”Venous claudication is called increased pain in the calf muscles when walking.
• Swelling of the lower limbs in the legs and feet.
• Hyperpigmentation of the skin.
• Burning, tingling, itching during varicose veins.
• Trophic venous ulcer of the leg.

All symptoms of varicose veins, despite their heterogeneity, have common characteristics:

• symptoms intensify when the patient remains in a standing or sitting position for a long time.This happens because the musculovenous pump does not work in a static position);
• symptoms decrease after walking, after rest in a horizontal position and also when using elastic compression;
• change the intensity of the manifestation depending on the season of the year.Typically, symptoms intensify in summer;
• manifestations of the disease can intensify before or during menstruation.

All of the above symptoms are non-specific, that is, they can also appear in other diseases.Therefore, when diagnosing varicose veins, one should rely on objective signs:

• Dilated intradermal and saphenous veins (telangiectasia, reticular veins).Clearly visible to the naked eye.This is what patients often pay attention to.The presence only of telangiectasias (spider veins) without other signs of varicose veins is most often not dangerous.However, this is an obvious reason for a review.
• Saphenous varicose veins.Easily visible without equipment.The presence of varicose veins is a clear sign of varicose veins.However, ordinary people often confuse ordinary veins visible through the skin with varicose veins.In the first case, treatment is not necessary, in the second it is necessary.
• Swelling of the affected limb.This is also a non-specific symptom, but in the presence of varicose veins it may lead the doctor to believe that these facts are related.
• Changes in skin color and texture.In advanced forms of varicose veins, we often encounter hyperpigmentation (the skin becomes brownish or bluish).There may be areas of lipodermatosclerosis.The extreme manifestation is the appearance of a venous trophic ulcer.

Risk factors for varicose veins on the legs

• Non-specific: age, female gender, obesity, hereditary predisposition.
• Specific: pregnancy, taking hormonal medications (estrogens, gestagens), menopause.

Stages of development of varicose veins

Like any chronic disease, varicose veins develop gradually.There is no clear stage, but we can talk about the initial stage (compensation) and the stage of development of chronic venous insufficiency.At the initial stage of the development of varicose veins, there are no subjective manifestations.The appearance of varicose veins, detected visually, is usually not accompanied by swelling, pain or cramping.

At this stage, the disease may remain unchanged for a long time.And maybe it will progress.In this case, the patient, accustomed to the sight of varicose veins and the idea that they do not harm him, cannot associate the appearance of pain, swelling of the legs, itching and night cramps with the progression of varicose veins.This, in turn, can lead to the development of complications of varicose veins, such as inflammation of the varicose veins (thrombophlebitis), the formation of trophic venous ulcers and bleeding from the varicose lymph nodes.

In order to standardize the diagnosis of varicose veins and make it as accurate and understandable as possible for a doctor around the world, phlebologists use the CEAP classification.The CEAP classification takes into account clinical manifestations (C – clinical), etiology (cause of the disease) (E – etiology), anatomical location (A – anatomy) and pathogenesis (P – pathogenesis).

As a general rule, the CEAP diagnosis is supplemented by decoding (nosological formulation), which facilitates understanding for therapists, general practitioners and specialists.This approach allows the practitioner to find their way quickly when studying the patient's medical documents.

Diagnosis of varicose veins

Modern diagnosis of varicose veins of the lower extremities poses the following tasks:

• Determination of the presence of chronic venous disease.Many patients who suspect they have varicose veins do not have them.And vice versa.The first task of a phlebologist is to determine whether the patient has this disease or not.
• Determine the type of venous disease.Doctors say it is a “nosological” form.You need to know exactly which venous vessels are affected, how serious they are and what this has led to or can lead to.
• Determine treatment tactics - which specific technique (or combination of techniques) should be applied in this particular case.Treatment tactics should be discussed with the patient and reflected in the treatment recommendations.
• Evaluation of treatment effectiveness is carried out during and after treatment.

We prefer to carry out all stages of diagnosis and treatment in contact with the patient.

We believe that the patient has the right to accessible and understandable information about their illness and its treatment methods.In response to a patient’s “why” question, we never say “because” or “because I always do it that way.”We adhere to the principles of modern evidence-based medicine.

Methods for diagnosing varicose veins

1. Clinical study.Includes clarification of patient complaints, examination and palpation (hand examination).
2. Ultrasound angioscanner (ultrasound of veins - duplex and triplex scanning).
3. Plethysmography.
4. X-ray venography (ascending and descending).
5. Radionuclide phlebography (radiophlebography).
6. Computed tomography (CT venography).
7. Magnetic resonance imaging (MR-venography).
8. Intravascular ultrasound examination.
9. Thermography.

In the vast majority of cases, to diagnose varicose veins and develop a correct treatment strategy, a clinical examination and ultrasound angiography are enough for a phlebologist.At the same time, the main instrumental study of diseases of the veins of the legs is ultrasound angiography - ultrasound of the veins.

During the study, it is clearly explained to the patient what exactly “his” disease is and how to fight it.

The study is carried out in a standing position (if necessary, also lying down), using two or three scanning modes simultaneously (B-mode, color coding of blood flow and pulsed Doppler mode).The ultrasound angiography method makes it possible to visualize the vessel studied, to determine the direction of blood flow and its parameters (speed, type of flow).

Both limbs are examined, not just the “diseased” one, and we always examine the superficial and deep venous vessels.If necessary, the patient may be prescribed additional research methods listed above.

Treatment of varicose veins

Specialists of the leading phlebology center use only the most modern and best methods to treat varicose veins of the lower extremities.

Today, phlebologists use the following innovative treatment methods:

• Thermoobliteration (laser and radiofrequency).
• Non-thermal methods of treating varicose veins.
• Sclerotherapy.
• Miniphlebectomy.
• A combination of these techniques.

These methods meet European state standards.They allow varicose veins to be treated effectively, non-traumaticly and on an outpatient basis – without hospitalization.No anesthesia or spinal anesthesia is required.It is this approach that gives the best treatment results.