Varicose veins of the lower limbs is a medical issue where the diameter of the veins is growing accompanied by the formation of local extensions. This is one of the most common pathological conditions in the world. Its incidence is 25% in the USA and Western Europe, and 15% in the developing countries.
Varicose veins poses a risk to one’s life. Lots of people die because of the consequential effects of varicose veins. Blood clots are formed at a certain stage of the pathological process. They can break away and move with the blood flow, blocking the pulmonary artery branches.
Causes of varicose veins
Main role in the development of varicose veins is the issue of heredity and the lifestyle of the person. The following prove to significant risk factors:
- Genetic predisposition. It is assumed that a person may inherit some structural defects of the connective tissue that are more likely to lead to varicose veins.
- The ethnic factor. The incidence is different in different countries. The lowest risk is among African American people. In some African countries the incidence of varicose veins is only 0.2-1%. 0,2-1%.
- Obesity or overweight. If a person's body mass index is greater than 27 kg / m2 that’s increasing the risk of disease by a third.
- Prolonged static posture. People most susceptible to varicose are the those who’s jobs require a lot of standing or being sedentary. The men, who work in the vertical position, have the prevalence of varicose veins of 20%, and in the absence of static loads pathology risk is only 8%. For women who work standing up, the risk of varicose veins is 63% and sitting - 37%.
- Pregnancy. The risk of varicose veins during this period of time is increasing by 3-4 times. This is connected to a number of factors: hormonal changes, increased blood volume, changes in blood rheology, mechanical compression of blood vessels by increasing uterus, and then by the baby.
Other factors that contribute to varicose veins:
- Tight underwear, compressing the veins
- Low content of raw vegetables in one’s diet
- The use of hormonal contraception
Symptoms of varicose veins
Symptoms of the disease depend on the stage of the pathological process. According the international clinical classification there are 8 stages as follows.
- S0. Asymptomatic, can be detected only with the help of the instrumental diagnostics. Usually, remains undiagnosed at this stage.
- S1. Telangiectasia ( "spider veins") and reticular veins (net of the extended tortuous veins) are observed on the legs.
- S2. Varicose veins are obvious on the legs.
- S3. There is swelling of subcutaneous fat, which is associated with symptoms of severe chronic venous insufficiency.
- S4a. Trophic disorders are noticeable. The skin receives pigmentation, hair falls out, and venous eczema can be configured. These symptoms are associated with disruption of the normal blood supply to the skin and subcutaneous fat of the lower extremities.
- S4b. Lipodermatosclerosis develops. This condition manifests itself in duration (hardening) of subcutaneous fat. The skin is brown, with a brilliant, if lacquered surface. The leg looks like a bottle of champagne or pin bowling.
- S5. There are healed trophic ulcers on the legs that are a result of the tissues trophic (nutrition).
- S6. On the legs there is at least one active (unhealed) trophic ulcer.
All of these symptoms are determined by the doctor during the patient's examination. There are subjective sensations that can be experienced by the patient. Complaints may be present, even if the legs do not have any visible changes.
Patients may complain of:
- Pain in the legs, which is amplified in a standing position
- Itchiness (usually along the veins)
- Swelling that appears at the end of the day and disappears by the morning
- Leg muscle cramps during the night
The presence of subjective sensations and the absence of visible changes in the veins is more common in people who are overweight. Telangiectasia and dilated blood vessels are notseen, because its hidden under the layer of subcutaneous fat.
Diagnostics of varicose veins
To determine the presence of varicose veins, its enough to look at the patient’s legs. Diagnosis is aimed at answering a number of questions:
- Is there damage to the deep veins?
- Is the blood reflux present through safenofemoral junction or a fistula?
- What condition are the valves of small and large saphenous veins in?
- Is there a perforator reflux (through the veins connecting the superficial and deep veins), and if so, where?
In general, this information is necessary for establishing the right kind of treatment. The following methods of varicose veins diagnostics are used for that:
- Doppler ultrasound
- Duplex ultrasound angioscanning
- Occlusion plethysmography
- Radiopaque venography
- Direct flebotonometry
- Reflective rheography and photoplethysmography
The first two methods are main ones. The others are additional. They are recommended only due to the indications.
Treatment of varicose veins abroad
Conservative or surgical treatment of varicose veins is used that is aimed at the temporary elimination of the symptoms and slowing down the progress of the disease. To reach the goal, the medications and compression clothes are used to shrink the veins and get rid of the swelling. Massage, physiotherapy, gymnastics are also recommended as a supportive therapy.
Surgical treatment is the basic for varicose veins treatment. The following operations and minimally invasive procedures are used:
- Photocoagulation. Spider veins can be removed using laser treatment on the legs. This procedure does not affect the prognosis of the disease, but it makes it easy to remove a cosmetic defect.
- Sclerotherapy. Sclerosing agent is injected inside the vessel. It damages the endothelium of the veins. Then tight bandage or wearing compression stockings are worn for a week. During this time, the vessels grow together, and blood flow through the damaged veins stops.
- Laser therapy. Essentially similar method, though endothelium is damaged not by the chemicals, but by the laser beam.
- Crossectomy. Liquidation of the saphenofemoral anastomosis is held. A ligation of the great saphenous vein and its branches is performed for that and as a result of the operation venous reflux (backflow of blood casts) is eliminated.
- Stripping. Vein is removed without a large incision. It is intersected, and then removed from the body via the probe.
These methods may well be combined with each other, including the performance of a surgical procedure.
In case of non-healing venous ulcers a surgical removal is carried out. The patient may require transplantation of skin to close the defect.
Varicose veins - Prognosis
Non-treated varicose veins may be complicated by thrombophlebitis, that in turn is the cause of pulmonary embolism. This can be fatal in 30-60% of cases.
The prognosis is positive with timely surgical treatment. 90-95% of patients can achieve good results (elimination of symptoms). There is a 15% risk of recurrence within two years after surgery.