Varicose veins of the lower limbs

Varicose veins

Of all the known species of vascular pathology, the most common is varicose veins. We draw attention to the title of the article: in this article, is considered to be one of the most frequent, in its turn, the location of the "varicose veins", i.e. the extension of the veins of the legs. Other options are relatively less often, but in profile view and categories professionals are also continuously; such are, for example, varicose veins of the esophagus, the spermatic cord, the pelvis and other in Other words, associate the term "varicose veins" only and exclusively with low members, which is practiced in the word, would be incorrect. Moreover, and in a professional environment up to now, there is some terminology discrepancy: in the sources is not used quite correctly of the reduction of the "varicose veins", other "varicose veins" is separated from the varicose disease, and so on

Varicose veins of the lower limbs very unpleasant polisindromnoe disease, accompanied by visible external manifestations. Cosmetic defects on the legs usually with the years, progresses, and many patients (mainly women), this is a concern a lot more than cleanly hemodynamic the violation and of the organic alterations of venous wall. Such patients, or rather, the patient is likely to use a variety of nemedicinsko processes and methods of resolution of varicose veins", in the best case harmless, and sometimes considerably worsening the situation. Meanwhile, non-processed, the execution of a form of venous pathology fraught with serious consequences, and when the first symptoms (see below) to consult a doctor should be as soon as possible: as the absolute majority of other diseases, varicose veins much better treatable in the initial stages.

Returning to the question of prevalence, it should be noted the high variability of epidemiological evaluations published. This is in part due to the regional differences and age, the trends (more three-dimensional sampling, the more they share clinically significant case), in part, to a difference of approaches of diagnosis, but the main reason for statistics of the ambiguity is, apparently, the design of the research project: in some cases, analyzed, for example, a posteriori of medical documentation (which reflects, in effect, the prevalence and frequency of assistance requests from this disease), in other, specially examined, or the other categories of the population, in which are recorded the characteristic symptoms and then assessed the actual frequency of their occurrence in the general population. Even if we leave aside the extreme case of evaluation, the situation of the varicose veins of the lower limbs is very depressing: to a certain extent, suffer from at least 55% to 65% of women of 15 to 25% of middle-aged men. If deep disparity between the sexes is due to anatomical and hormonal differences, as well as the reproductive function of the woman (pregnancy, birth), that, in many cases, it becomes a direct prerequisite for the development of venous disorders.

Can not do not disturb the tendency to the "rejuvenation" of this type of pathology: the mean age of onset of the disease most of the sources called the range of 20 to 30 years, but year-to-year economic frquent case of varicose veins on the legs among students, including among young people: the growing impact of changes in lifestyle (reduced physical activity) and food (fast food, potato chips, the soft drinks and other malosedobnaya of the substance).

The reasons

First of all, it should be noted that, with respect to the arteries unite their efforts varicose veins are not diagnosed: this "curse" is found on the veins. The board of trustees of the arteries, of course, also vulnerable and are susceptible to a variety of pathological changes, but in this case, the most frequently observed aneurysm (local vbuhanie), atherosclerosis, of a different kind of erasure (narrowing), thrombo-embolism (obstruction), etc., In comparison with the venous wall less strong and resilient, less resistant to deformation that stretches under load or internal pressure; they are easier to refine, and economic partially permeable, in consequence of which may start oozing blood or some of its fractions through the wall of the vein. "The fact that varicose veins are most often observed in the lower limbs, many researchers consider it to be one of the side effects of the evolutionary transition to walking upright (another heavy toll", that humanity pays for the liberation of the hands, is a pathology of the spine). The whole mass of the body relies on the feet, which creates abnormally high load on the joints, and the circulatory system. We know that the varicose veins of people suffer already in antiquity; it is then that the dominant cause was, apparently, the constant carrying of heavy loads. This factor is still relevant (some sports and professional life), but, to the extent of the civilization development, especially in the last one hundred to two hundred years, the load to be repeatedly increased with the advent of "sedentary" and "standing" professions: the stagnant effects for the veins disastrous. Direct risk factors are obesity, the deficiency of plant food in the diet, trauma (including surgical, e.g. the consequences of orthopaedic surgery), vascular malformations, a genetic predisposition, age and sex (see above). Serious changes in the venous system of the leg leads to deep vein thrombosis and accompanies inflammation (thrombophlebitis); thus, as a form of varicose veins in the western literature is considered to be post-thrombotic syndrome. A large group of triggering factors to represent the disease and the state, subjects the increase in abdominal pressure: a tendency towards constipation, chronic cough, etc; in such cases, the varicose veins are manifested, in general, not only in the members.

It is necessary to say about the consumption of tobacco, which is by right called "the killer of veins. The link is so obvious and to show that many professionals to move forward the condition of a total failure of smoking before you start treatment. On the ethical medical aspects of the position, you can pretend (even recently appeared demagogic the term "chauvinism no"), but in the fact that in case of non compliance of this condition, the treatment is automatically absurd and unnecessary, it is possible not to doubt. The chain smoker, requiring in this case, the implementation of the right to medical aid, is similar to a drug addict, who counts on the elimination of dependence and withdrawal syndrome, but will continue to take the drug.

Biological, anatomical level of the main cause of varicose veins is insolvency venous valves, which should exclude the reflux (flow of blood in the opposite direction of the normal, which creates an excess of pressure in the veins). In fact, the study of the causes and mechanisms of development of venous-of the valve dysfunction, with the development of the first method of its surgical correction at the end of the NINETEENTH century and started the modern phlebology as a medical science on diseases of veins, the means of treatment and prevention.

In general, it is necessary to recognize that the abundance of the above factors, the importance of each to repeatedly and reliably confirmed by the large-scale studies, up to the present it does not form a single system. Thus, during the quasi-equality of condition is quite the same, apparently, the combination of risk factors for a person to varicose veins of the lower extremities develops and progresses rapidly, and other vienna for decades remain intact. It is said, that, to date, etiopathogenesis until the end is not clarified, and any, even the most effective modern therapeutic strategies remains, in effect, palliative care. Moreover, phlebology today develops extremely dynamic, and the "missing links" in our knowledge about the varicose veins will, in all probability, are identified and studied in the foreseeable future.

The symptoms

Often, the precursors or early symptoms of disorders of the venous circulation are under the skin, an asterisk or a hairnet of and became visible small blood vessels. Then, on the calves are trained wybuchowa knots, twists, or are the flus. The feet in The varicose veins swell and get tired, a lot of patients often complain of painful cramps in the legs (including the night), sensations of itching, hot flashes, of insects, "" chills, " and so on In the absence of treatment of varicose veins can be complicated, thrombophlebitis, acute and perforations nodes (sometimes, just the slightest mechanical impact to be stretched thin, and the thinning of the wall of vienna in burst); bleeding in this case, it can be very strong and lead to a loss of blood massive.

The diagnosis

Experienced phlebology recognizes the varicose veins with the first quick glance. However, additional review, of course, it is also necessary, as a comprehensive overview of the history and complaints. There are a number of special features of the samples and instrumental methods more important spectrometry contrasting angiography and ULTRASOUND doppler mode duplex scanning.

Treatment

In previous decades, with a specialization in "phlebology" is generally interpreted as a synonym of vascular surgery. Thus implicitly the idea was that the non-surgical treatment of venous disease can not be. However, until now, the situation has changed radically, and the main changes relate to the last 15 to 20 years. The course on the application, wherever it is possible and indicated, - high-tech bit and microinvasive methods aged in all the surgical specialties and the treatment of varicose veins on the legs of today is not necessarily the "big" operation. Generally, the treatment is complex and begins with conservative measures - for reasons of prescribing drugs-venotonics principles, anticoagulants and antiplatelet drugs, anti-inflammatory. Apply an elastic bandage or compression, you can only after consultation with the doctor (in particular, should be explained in detail the technique of bandage from the fingers, with the obligation crisis of the heel and the gradual disappearance of the compression closer to the knee). Effective, therapeutic exercises, water treatments, food (also it is necessary to normalize the mass of the body), girudoterapiya.

However, varicose veins is still to the surgery of the disease, that is to say, the effect of radical can carry out the transaction. There are many specific methods the phlebectomy - the removal of vienna, functional residual solvency of less than 10% of the standard. However, more widespread above-mentioned minimally invasive methods, which have a number of advantages (less traumatic, the possibility of outpatient treatment of "a day", the lack of scarring, cosmetic defects, etc). The most promising and efficient of these methods include sclerotherapy (artificial obliteration, a collage of the wall of the vein with a special solution, which is entered micro-needles), laser therapy (including intravenous), radiofrequency ablation (in the vein introduced a thin probe, progressive excerpts from the wall "one soda").

It is important to understand that the efficacy of the treatment in this case is directly dependent on the stage at which the patient requests help. It is not necessary to bring the case before the "big" surgery: varicose veins of lower extremities now healed, but "him" this disease does not pass.