Varicose veins of the lower limbs

Varicose veins

Of all the known species of malocclusion vascular most common is varicose veins. We draw attention to the title of the article: this material is considered to be the most frequent, its time - localization "varicose veins", i.e. the extension of the veins of the legs. Other options are relatively less, but in the field of view of profile and related professionals are also constantly; these are, for example, varicose veins of the esophagus, spermatic cord, pelvic, etc. in Other words, to associate the term "varicose" only and exclusively with the lower limbs, which is practiced in the common language, it would be misleading. However, and in a professional environment so far has seen some of the terminologies discordant voices: in some sources it is used it is not correct to reduce the "varicose veins", in other "varicose" detaches from "varicose veins", etc.

Varicose veins of the lower limbs - very unpleasant polisindromnoe disease, accompanied by obvious external manifestations. Aesthetic defects in the foot usually progresses with the passing of the years, and many people (especially women) is concerned, much more than in reality hemodynamic impairment and organic alterations of the venous wall. Such patients or, rather, patients tend to resort to the most different nemedicinsko methods and techniques to remove varicose veins", in the best of cases, harmless, and sometimes substantially aggravating the situation. In the meantime, untreated, running forms of malocclusion venous full of the most serious consequences, and when the first symptoms (see below) see the doctor must be soon: as the vast majority of other diseases, varicose veins are much better treatable in the early stages.

Returning to the question of prevalence, to note the wide dissemination of published epidemiological assessments. In part, this is due to regional differences and age trends (the oldest sample of respondents, the greater the proportion of clinically significant cases), in part, the difference in the diagnostic approaches, but the main cause of the statistical ambiguity is, apparently, the same research design in the course and in some cases is analyzed, for example, reporting of medical documentation (which reflects, in essence, the prevalence and frequency of help requests with this disease), in others - especially those or other categories of the population, in which are recorded the characteristic symptoms and then assessed the actual frequency of their prevalence in the general population. Even if we put aside the extreme of the rating, the situation with the varicose veins of the lower limbs is very depressing: in varying degrees, are suffering, as a minimum, 55-65% of women and 15-25% of men of mature age. So deep disparities between the sexes is due to anatomical differences and the hormonal and also the reproductive function of the woman (pregnancy, childbirth), which in many cases becomes a direct premise for the development of disorders venous.

Can not not to alarm the tendency to the "rejuvenation" of this type of malocclusion: the average age of onset of the disease, the majority of sources calls range from 20 to 30 years, however, year-to-year are becoming more frequent cases of varicose veins in the legs in children, including young people: the impact of the increasing changes in lifestyle (reduced physical activity) and diet (fast food, chips, drinks, effervescent and other malosedobnaya substance).

Causes

First of all, it should be noted that in respect of the arteries varicose undiagnosed: is the "curse" is located on the veins. Artery, of course, also vulnerable and prone to various pathological changes, but in this case, are observed in aneurysm (local vbuhanie), the atherosclerosis, a different kind of obliteration (narrowing of the lumen), thromboembolism (blocking), and so on, In comparison with arterial, venous walls are less resistant and flexible, and less resistant to deformation, elongation under load or internal pressure; they are easier to become thinner and become partially permeable, with the result that it can begin leaking blood or of individual fractions through the vein wall. The fact that varicose veins occur most often in the lower limbs, many researchers believe one of the side effects of the evolutionary step to keep erect (another serious "tribute one", that humanity pays for the release of the hands, is a malocclusion of the spinal column). The whole mass of the body is based on the feet, that creates abnormally high load on the joints and the circulatory system. It is known that varicose veins, the people were already in the antiquity; then the dominant reason was, apparently, the constant carrying weights. This is a factor and today (some types of sports and working activities), but as the development of civilization, especially in the last hundred-two hundred years, load many times are increased with the advent of the "sedentary" and "walk" professions: any congestion in the veins disastrous. Direct risk factors are obesity, lack of plant foods in the diet, injury (including surgical, e.g. the consequences of orthopaedic surgery), congenital vascular malformations, genetic predisposition, age, and sex (see above). To heavy changes in the venous system of the legs causes deep vein thrombosis and concomitant inflammation (thrombophlebitis); so, as a form of varicose veins in western literature is considered to be syndrome, post-thrombotic. A large group of factors is composed of, and the state of the disease, help increase intra-abdominal pressure: the tendency to constipation, chronic coughing, etc., in these cases, the varicose veins is detected, as a general rule, not only at the ends.

We will have to say about the use of tobacco, which is rightly called the "killer of the veins". The link is so obvious and close, that many experts definitely put the condition of complete abstinence from smoking, before starting any treatment. The ethical aspects of professional position, you can argue (lately also appeared demagogic the term "chauvinism not smoking"), but in the fact that failure to comply with this condition, the treatment becomes automatically useless and pointless, there is no doubt. A chain-smoker, which requires in this case, the realization of the right to medical assistance, as an addict, that you can count on to eliminate dependence and withdrawal syndrome, but intends to continue to take the drugs.

In organic, anatomical level, the main cause of varicose veins is the failure of the venous valves, which must exclude the reflux (the flow of blood in a direction opposite to that of the normal, which creates an excess of pressure in the veins). In reality, with the study of the causes and mechanisms of development of venous-dysfunction-valvular af, with the development of the first methods of its surgical correction at the end of the NINETEENTH century and the beginning of the modern phlebology as a medical science on diseases of the veins, as their treatment and prevention.

In general, you must recognize that the abundance of the above-described reasons, the importance of each of these several times, and authentically confirmed by studies on a large scale, so far does not constitute a single system. So, almost equal, perfectly equal, apparently, to a combination of risk factors - a person's varicose veins of the lower extremities develops and progresses rapidly, and the other in vienna for decades remain intact. This suggests that, to date, the etiopathogenesis until the end not to be cleared, and any, even the most effective modern therapeutic strategies remains, in fact, palliative. However, phlebology today is developing very quickly, and the "missing links" in our understanding of varicose veins will, with all probability, identified and studied in the near future.

The symptoms

Often the forebears or the first symptoms of disorders of the venous circulation acting subcutaneous asterisk or a retina extended and visible small blood vessels. Then on the calves form wybuchowa nodes, winding, or which are clustered. Walk to the varicose veins swell and be weary, and many patients complain of frequent, excruciating leg cramps (including night), itching, warmth, crawling "chills" and the like, In the absence of treatment of varicose veins can be complicated, thrombophlebitis, acute perforations nodes (sometimes just a little mechanical exposure to the stretched and thinned out the wall of the vein burst); bleeding in this case can be very strong and cause a massive loss of blood.

Diagnostics

Expert flebologo recognizes the varicose veins with a first quick look. However, through a supplemental, of course, equally necessary, as the collection of detailed medical history and complaints. There are a number of special functional tests and instrumental methods of highest value has the x-ray contrast angiography and ULTRASONOGRAPHY in the duplex mode, color doppler scan.

Treatment

In the decades prior to the specialty, "phlebology" is usually interpreted as a synonym of vascular surgery. In this way, implicit implicit, that non-surgical treatment of malocclusion venous, can not be. However, today the situation has changed radically, and the main changes concern the last 15-20 years. The course for the application - if possible and where indicated, high - tech long - and microinvasive methods to mature in all the surgical specialties and treatment of varicose veins in the legs today does not necessarily imply a "large" operation. Usually, the therapy is complex and begins with the most conservative of activities - according to the testimony prescribe medications-venotonic, anticoagulant agents and antiplatelet, anti-inflammatory drugs. Apply an elastic bandage or compression stockings is only possible after consultation with the doctor (in particular, it must be in detail explained the technique of bandaging - starting from the tip of the fingers, with the obligation to attack the heel and the progressive weakening of the higher compression near the knee). Effective physiotherapy exercises, hydrotherapy, diet, (also need to normalize the weight of the body), § irudoterapia.

However, the varicose veins still surgical of the disease, i.e. radical effect can only be achieved by an operation. There are many techniques that are specific to flebectomia - vein removal, functional residual validity of which does not reach 10% of normal. However, the increasing diffusion receives the above-mentioned minimally invasive methods which have a number of advantages (less so the invasiveness of the possibility of outpatient treatment "a day", the lack of scarry cosmetic defects, etc.). The most promising and effective of these methods include sclerotherapy (pu obliteration, "gluing" the vein wall with a special solution that is injected microneedles), laser therapy (incl. intravenous), radiofrequency ablation (injected into a vein thin probe, with the gradual recovery of the wall of which is "welded").

It should be clear that the effectiveness of any treatment in this case depends on the phase in which the patient turns for help. It is not necessary to bring the matter to the "big" surgery: varicose veins of the lower limbs now healed completely, but the "self" this disease does not pass.