Varicose veins (varicose veins)

Varicose veins most commonly affect the venous system of the legs. The external manifestations (prominent nodular blue veins, swelling) are not simply a cosmetic problem but are signs of a serious disease that worsens over time.

What Are Varicose Veins: Definition of the Disease

The word "varicose veins" is derived from the Latin varix - "swelling". The name fully reflects the pathological process: the walls of the veins become thinner, and in some areas dilations (cystic swellings) - nodules - form.

The first case of varicose veins was documented in 86 BC. BC: Roman general Gaius Marius complained of pain in his legs from "bruised veins. "

The main cause of the development of varicose veins (varicose veins, varicose veins) is increased pressure in the superficial vasculature. Certain diseases, hormonal changes, and a sedentary lifestyle can promote this condition.At first, even under the influence of these factors, blood vessels function normally, but gradually they deform, change their structure, and are no longer able to adequately transport blood.Varicose veins can occur almost anywhere in the body, but are most common in the lower limbs. Therefore, when it comes to varicose veins, by default it is a problem in the legs.

ICD-10 Varicose Vein Codes

The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) includes several types of varicose veins.I83-Varicose veins of lower limbs:

• I83. 0 - Varicose veins of lower limbs accompanied by ulcers;
• I83. 1 - Varicose veins of lower limbs with inflammation;
• I83. 2 - Varicose veins of the lower limbs, with ulceration and inflammation.

85 - Esophageal varices:

• I85. 0 - Esophageal varices with bleeding;
• I85. 9 - Esophageal varices without bleeding.

I86 - Varicose veins elsewhere:

• I86. 0 - Sublingual varicose veins;
• I86. 1 - Varicose veins of the scrotum (anatomy of the male - container of the testicles and their appendages);
• I86. 2 - Pelvic varicose veins;
• I86. 3 - Varicose veins of the vulva (female external genitalia);
• I86. 4 - Gastric varices.

O22. 0 - Varicose veins of the lower limbs during pregnancy.In our country, 30 million people suffer from various forms of varicose veins. A third of them had a complication - trophic ulcer. An open defect in the skin or mucous membrane due to impaired blood circulation and tissue innervation.

The mechanism of varicose veins

With all types of varicose veins, regardless of the cause of the problem, the body's pathological reaction is the same. Understanding the anatomy of blood vessels will help understand how and why disease occurs.

How blood flows in the body

The human body has two types of blood vessels - veins and arteries. Blood flows from the heart to all organs and tissues through arteries. This occurs at high pressure (70–120 mm Hg) and high speed.Blood flows from organs and tissues through veins at low pressure (0-20 mm Hg) toward the heart.The walls of veins are less thick and elastic than arterial walls, and unlike arteries, vein walls do not contain such a well-developed muscle layer. Therefore, varicose veins can only appear in veins, not arteries.Arteries and veins of the human circulatory system. Veins are shown in blue and arteries in red.The low pressure in the veins is necessary to carry blood from the periphery to the center. But at the same time, on its way to the heart, blood flow encounters an obstacle—gravity. This force forces blood back through the veins.You'll often hear that varicose veins are the retribution of humans walking upright. After all, the furthest distance blood has to travel in the body against gravity is the path from the feet to the heart. The movement of blood through the veins is ensured by the contraction of the heart, the muscular pump of the surrounding muscles, and the negative pressure in the chest during inspiration.In healthy blood vessels, valves in the lining of the veins prevent blood from flowing backwards. These valves act like a one-way revolving door - they open and allow blood to flow toward the heart, and they immediately close if gravity tries to push blood back toward the heart.It's not just the valves that help the veins carry blood to the heart, but also the muscles surrounding the blood vessels. By contracting and relaxing, muscles help blood move through veins. This mechanism only works when the person is moving. When standing or sitting for long periods of time, the muscle pump has little activity.The tips of the venous valves always face the direction of blood flow - towards the heart

How failure and disease occur

Increased pressure in the venous system disrupts the function of the valvular apparatus and causes reverse flow of blood in the vessels. As a result, as well as due to excessive stagnation of blood, the valvular apparatus weakens (for example, in connective tissue diseases), the venous lumen becomes dilated, the walls become deformed, thinned and locally cystic, forming protuberances - nodes.The process is similar to inflating a balloon: If you don't let the air escape, the balloon will expand larger and larger.On the left is normal blood flow; on the right - multidirectional blood flow due to impaired venous valve function and vessel deformationThere are superficial and deep veins in the legs. 85-90% of the total blood volume flows through the deep layer, and only 10-15% flows through the superficial layer. Deep vein walls are denser and better suited to increasing blood volume. Moreover, the superficial veins in the legs are thinner and more prone to varicose veins. There are large venous plexuses in the pelvis and lower part of the esophagus, and varicose transformation can also occur. In the veins of the small pelvis, the mechanism of disease development is the same as in the lower limbs. But there is another reason for the occurrence of esophageal varices: portal hypertension - elevated pressure in the portal venous system, which is related to cirrhosis, hepatitis, parasitic liver disease, fatty liver, etc.

causes of varicose veins

Many factors contribute to the development of varicose veins in the legs. Mainly includeValvular insufficiencyandgenetics. It is known that one in four patients has a close relative with one of these varicose veins.overweight. The more weight a person carries, the greater the load on the venous system. Over time, the veins become unable to cope with this pressure: the lumen of the blood vessel enlarges, and the valves in the vessel wall no longer close completely. As a result, blood stagnation occurs and varicose veins develop.Pregnant. Hormonal changes, body weight, intra-abdominal pressure and increased circulating blood volume in women - this leads to disruption of outflow, leading to stretching of the vein walls and changes in the function of the valve apparatus.After delivery, the diameter of the dilated veins decreases but does not always return to its original value. The risk of developing varicose veins increases with subsequent pregnancies.age. Varicose veins usually affect people after the age of 50. The older a person gets, the more severe the wear of the venous valves slows down the recovery process and triggers the development of varicose veins - the mechanism of pathological dilation of veins.venous returnVenous Return The return of blood from latitude through veins due to resistance to blood flow. refluo - "flow backwards". It affects 10-15% of schoolchildren aged 12-13 years. The disease "gets younger" due to a sedentary lifestyle and excess weight.Varicose veins in the lower limbs can develop more quickly if other risk factors are present.Risk factors for the development of varicose veins in the legs:

• Lack of physical activity - When you exercise, your muscles stimulate blood flow in your veins, and without exercise, blood circulation in your veins may be difficult;
• Smoking - The chemicals in tobacco smoke can damage the walls of blood vessels, causing the lumen of the blood vessels to narrow and blood flow to become difficult and stagnant, leading to varicose veins;
• Occupations that require standing or sitting for long periods of time - hairdressers, surgeons, chefs, waiters, drivers, office workers are all at risk;
• Menopause - In women aged 40-50 years, the production of sex hormones (estrogen and progesterone) decreases, along with a decrease in the tone of the vein walls. This increases the likelihood of varicose veins.

Women are 3-4 times more likely to develop varicose veins than men. This occurs due to hormonal changes (menstrual cycle, pregnancy, menopause).During pregnancy, varicose veins can affect different parts of the body: calves, thighs, vulvaVaricose veins can occur not only in the lower limbs, but also in other parts of the body.The main causes of varicose veins in various parts of the bodyEsophageal varicesThe esophageal veins change, the luminal unevenness increases, the tube wall protrudes, and the blood vessels appear nodular and tortuous. A life-threatening complication called bleeding often results.reason:

• Cirrhosis
• liver cancer
• Other conditions that cause increased pressure in the portal system - which collects blood from the abdominal organs

Varicose veins in the scrotum (varicocele)Pathological dilation of testicular pampiniform plexus veins. Presents with scrotal varicose veins and impaired blood flowreason:

• Congenital testicular venous valve insufficiency (usually left side)
• Mechanical compression of the testicular veins (inguinal hernia)

pelvic varicose veinsIt is characterized by dilation of the ovarian veins and the intrapelvic venous plexus of varying diameters. This condition is also called pelvic congestion syndrome

reason:

• polycystic ovary syndrome
• two or more pregnancies
• hormonal imbalance

vulvar varicose veinsPelvic varicose veins, affecting blood vessels in the labia and perineumreason:

• Uterine compression of retroperitoneal vessels during pregnancy
• important physical activity
• Uterine and ovarian tumors

Sublingual varicose veins (sublingual varicose veins)

Asymptomatic injury to the sublingual vein. Symptoms include slight protrusion of blood vessels and color change from dark blue to purplereason:

• hypertension
• smoking
• old age

gastric varicesIsolated changes in gastric veins or associated esophageal varicesreason:

• Cirrhosis
• Portal Hypertension Syndrome - Other gastrointestinal disorders (tumors, thrombosis, venous dysplasia) cause increased pressure in the portal venous system

Symptoms of varicose veins

In rare cases, only the cosmetic aspect of the disease appears - blue veins. Most patients with varicose veins in the legs report at least one or more unpleasant symptoms.Symptoms of varicose veins in the lower limbs:

• Fatigue, soreness or heaviness in the legs - this is caused by stagnant blood and the pressure it puts on surrounding tissues;
• Burning, stinging or throbbing in the legs - a reaction to slowing and overflow of blood in the venous system of the lower limbs;
• Nocturnal muscle cramps in the legs - painful cramps that occur due to stagnation of blood and accumulation of metabolic products in the tissues;
• Swelling of the feet and ankles - due to venous stasis, the fluid portion of the blood leaking into the subcutaneous tissue through altered vessel walls;
• Itchy skin around damaged veins - dilated and altered blood vessels are unable to provide normal blood circulation and nutrients to the skin, so the skin dries out and becomes rough.

People with varicose veins experience discomfort in their legs that worsens at night, especially after sitting or standing for long periods of time.

The presence of venous changes is not always proportional to the severity of symptoms. Therefore, veins that are barely visible to the naked eye and those affected by varicose veins may cause significant discomfort, while nodular and thickened veins may cause little concern.Varicose veins affect different veins: from small cutaneous vessels to the great saphenous veinThe symptoms of other types of varicose veins depend largely on the underlying cause of the disease. Often the patient doesn't complain about anything and the doctor only discovers the problem during an examination. This occurs, for example, with sublingual varicose veins.In some cases, such as esophageal or gastric varices, the pathology manifests immediately as a life-threatening complication - bleeding.

Classification of venous diseases

In clinical practice, physicians rely on the International Classification of Venous Diseases—CEAP. This is an abbreviation consisting of the first letters of the main parts of the classification:

• C - clinical (clinical changes);
• E - etiology (origin of disease);
• A - Anatomy (anatomical location of varicose veins);
• P - Pathogenesis (mechanism of venous blood flow disturbance).

Complications of varicose veins in the legs

Typically, varicose veins themselves are not life-threatening. But sometimes the disease can cause complications.thrombophlebitis- Inflammation of the vein walls, accompanied by the formation of thrombus (blood clot), which closes the lumen of the vessel. It manifests as swelling and redness of the affected vein. The patient experiences pain and the skin in the affected area becomes red and warm to the touch. Thrombophlebitis is an inflammatory reaction in the skin and subcutaneous tissue along thrombosed veins.venous trophic ulcer- Open defects in the skin and soft tissues due to stagnation of blood, edema and impaired cell nutrition. Ulcers occur near varicose veins in the legs and ankles. Swelling is more pronounced in the lower parts of the legs, which means the tissues are compressed more than elsewhere. Ulcers take a long time to heal and often contain bacteria that can exacerbate inflammation.Trophic ulcers heal poorly due to impaired blood circulation and tissue nutrition.bleeding- Occurs when veins rupture and become dilated due to varicose veins. In the later stages of the disease, the skin over these veins is very thin and dry—slight damage is enough to compromise the integrity of the blood vessels and cause bleeding. Sometimes, spontaneous rupture of veins occurs in the area of varicose nodules.

Diagnosis of varicose veins in the legs

Phlebologists are responsible for the diagnosis, treatment, and prevention of venous disease. Doctors make a diagnosis based on the patient's complaint, examination, and instrumental studies. If symptoms of varicose veins are obvious, no tests are usually needed: a doctor's examination will suffice.The doctor may order laboratory tests to prepare for surgery or to rule out concomitant diseases affecting the condition of the blood vessels.One of these diseases is diabetes. It significantly worsens the course of varicose veins and increases the risk of complications, especially trophic ulcers.To accurately diagnose and determine treatment strategies, you need a dual-function ultrasound scan—the gold standard for diagnosing vascular disease. This method allows you to evaluate the structure, function, patency, valve consistency of superficial and deep veins, and determine the direction of blood flow.If secondary varicose veins are suspected (which may occur after deep vein thrombosis), doctors will perform venography, CT, or MRI venography.Venography is an X-ray test used to determine the patency and valve function of deep veins.Computed or magnetic resonance venography is used to visualize the venous system in three-dimensional projection and very high spatial resolution.

Treatment of varicose veins in legs

The goals of treating varicose veins are to reduce or eliminate symptoms, improve the appearance of the veins, and prevent complications.Doctors choose treatments based on the blood vessels affected and the severity of the patient's condition.

non-invasive treatment

Non-invasive treatments for varicose veins include compression therapy, medications, and lifestyle changes. Compression therapy involves wearing special socks, stockings and tights. The choice of model, fabric type, and compression level depends on the symptoms. Your doctor can help you choose the right knitwear.Compression jerseys for the calves are more compressive than those for the thighs - thus pushing blood towards the heart and eliminating stagnationEffects of Compression Therapy on Varicose Veins:

• Reduction in the manifestations of symptoms - heaviness, leg fatigue, night cramps, burning or soreness;
• The severity of edema is reduced due to improved blood circulation;
• Since elastic compression improves blood circulation and tissue nutrition, it accelerates the healing of trophic ulcers.

Medication - Physicians may prescribe venotropic drugs (vein protectants, venous supplements) bioactive substances that increase venous tone and reduce the severity of vein-specific symptoms. (venotropic) drugs.The main intravenous medications used to treat varicose veins:

• Vascular protectant: improves microcirculation, normalizes increased capillary permeability, and reduces blood viscosity and the possibility of blood clots;
• Antithrombotic agents: Reduce the risk of the formation of dangerous blood clots (thrombosis) in the lumen of blood vessels and promote the dissolution of existing clots;
• Bioflavonoids: Natural plant compounds that improve venous tone and reduce venous congestion.

Lifestyle changes for varicose veins can significantly slow down the progression of the disease and, combined with other recommendations from the attending physician, help to halt the pathological process.Important directions for changing the lifestyle of patients with varicose veins:

• Moderate intensity exercise: walking, swimming, water aerobics, leg exercises, yoga. Strengthening the muscles will help normalize blood circulation within the vessels and relieve venous stagnation and edema;
• Weight control: Due to normalization of body weight, the load on blood vessels is reduced, which facilitates the return of blood to the heart through veins;
• Break bad habits: Nicotine and alcohol can damage the lining of blood vessels and disrupt the regulation of blood vessel tone. Quitting smoking and drinking alcohol can improve vein condition and valve function.

Invasive methods of treating varicose veins

Invasive treatments include medical procedures that affect the integrity of the skin or mucous membranes. Sclerotherapy is a procedure using a special hardening solution (sclerotherapy). The solution is injected through a fine needle into the problematic vein, causing it to harden - "glue". Over time, veins become disconnected from the blood flow and become invisible; their functions are taken over by neighboring veins. Sclerotherapy can be performed without hospitalization—patients can go home after surgery. The sclerotherapy process takes 5 to 30 minutes, depending on the number of varicose veins that need to be filled with sclerotherapy and their sizeEndovenous laser thermal ablation (EVLO). A catheter with a laser light guide is inserted into the blood vessel through a tiny incision. The laser's thermal energy heats the vein, causing it to be eliminated - "sealed". After a few months, the blood vessels are replaced by connective tissue and disappear. The procedure is performed on an outpatient basis.Radiofrequency venous occlusion (RFO) is the application of high-frequency electric current to the inner surface of blood vessels. Through micropuncture, a catheter is inserted into a vein and connected to a device that generates radiofrequency pulses. Within the blood vessel, the radio waves are converted into heat energy, thereby "sealing" the vein.

With EVLO, the vein is briefly exposed to high temperatures; with RFO, the temperature is lower but lasts longer. Both procedures are effective and safe.

NTNT elimination or non-thermal non-expansion method:

• Venous occlusion using cyanoacrylate glue;
• Mechanochemical elimination, in which mechanical and chemical effects on the container occur simultaneously.

NTNT obliteration is the most modern, low-invasive method of treating varicose veins with a short recovery period.Phlebectomy is the removal of the saphenous vein with varicose veins. It can be performed as a stand-alone operation or in combination with other techniques. Varicose veins are removed through a small puncture under local anesthesia.

Prevent varicose veins in legs

You can prevent the development of varicose veins if you follow simple preventive rules in your daily life.Various triggers, such as sitting cross-legged for long periods of time and wearing uncomfortable shoes, can increase the risk of varicose veins in the legs.Preventing Varicose Veins – What You Need to Know:

• Moderate physical activity (walking, swimming, leg exercises) and resting with your legs elevated can improve the free flow of blood through your blood vessels and help avoid venous stagnation;
• Proper nutrition and normalization of body weight strengthen blood vessels;
• Wearing loose-fitting clothing that does not restrict movement can help improve circulation;
• Taking a cool bath during the warm season can help keep your blood vessels healthy;
• Comfortable low-heeled shoes (no more than 3 cm) avoid undue loading on the feet and interruption of blood flow;
• Proper sauna and steam bathing can help you maintain normal blood flow (long-term heat therapy greatly dilates veins, so blood flow slows).