Varicose veins varicose veins or lower limb primary varicose transformation of a superficial veins of the lower limbs, in which "bumps" or "knots" on his feet.
Varicose disease is very widespread throughout the world. A frequency of up to 60% of the adult population, depending on the country. It is interesting that the African population of a continent, the Asia-pacific region are suffering from varicose veins is much less than people in European countries, in the USA.
A relationship is lack of clear reasons for the varicose veins in the lower extremities is customary to talk about its risk factors, i.e., which increases the likelihood of developing this is a pathology (property characteristics, or the human body effects on the body). Common risk factors to consider age, female gender, obesity, and heredity. Typical "portrait" of a patient's symptoms a varicose veins — a woman in that state, the menopause, excessive body mass index, multiple pregnancy, and birth history.
The symptoms a varicose veins in the legs
The vast majority of cases of varicose veins without a can of special medical education. Definite sign of A goal pathology — an appearance of "bumps" or "nodes" of the lower limbs, while the skin over them is usually not distinguished by any special color. Blue veins generally is not a disease in the literal sense, although it will often bring patients (most often women) unpleasant aesthetic in nature.
However, in advanced cases, varicose veins may be accompanied by skin discoloration, venous eczema because of it which is reflected in the different itchy skin rash (blisters, nodules), as well as the redness.
Ezek a signal, and a swelling of the legs, which doesn't disappear in the night indicates that the formation of chronic venous insufficiency.
The subjective symptoms of varicose veins, noted must be that a is not unique. Complaints are indicators of the disease, but it can be a sign of overload of the venous system of the lower limbs. The most Commonly patients suffer from headaches, bloating, mild non-localized aching pain in a calf. Sometimes complaints are a pain, a territory, a varicose veins and fatigue legs.
Burning, tingling, muscle cramps at night or restless legs syndrome (unpleasant sensations in the legs the rest of the motion if the to this a ease discomfort) were the most common nervous system disease, for example, radiculáriszt syndrome and should be considered a warning.
In the pathogenesis of varicose veins in the legs
Pathogenesis of varicose veins of the lower limbs is quite complicated and versatile. The main mechanism of disease play a role in a development damage walls, valves the veins. As a result, an irregular work flow developed a blood (reflux), then there is a loss of the endothelium (a lining of a ship), which is accompanied by inflammation.
Later, a pathological process in a center, the inner layer of a vein wall, there is a proliferation of the connective tissue, the muscular layer of a vein and an atrophy, which leads to a gradual destruction of the collagen in a vessel. Ezek events disrupt the elastic properties of Vienna, contribute to the further expansion of a lumen of a spiral winding along the length of. At the same time, a similar changes are observed in the venous valves.
Noted should be that a vein visible "bumps" and "knots" in general, the presence of an invisible source of a varicose veins are large vein saphenous. The vast majority of cases this is a great little rare vein saphenous. The above pool ezek a changes in the blood vessels of the varicose veins.
Complications of varicose veins in the legs
Complications of varicose veins include the eating disorders (venous ulcers), thrombosis or varicose changed veins (thrombophlebitis) or bleeding from the varicose "bumps", and "node".
Eating disorders, which are a consequence of a disease progression, in the absence of treatment, often for years and decades. The cutaneous manifestations of hyper pigmentation (brown spots), venous eczema and lipodermatosclerosis (seal skin).
A main localization ezek a changes in a tibia, although venous eczema may occur in any region of varicose veins, including the thigh. Depending on whether the source is a varicose veins (great or small saphenous veins), the venous disease is localized or has an internal or an external surface of the lower one third of leg, iii. The result is malnutrition of the soft tissues with the formation of venous ulcers prior to the changes. Ulcer or one or more of an irregular shape, sloping edges and a flat, smooth bottom. It should be noted, a slight discharge, often purulent in nature. The sores are accompanied by itching, pain. Venous ulcers it is remarkable that there exists a long (art), as well as the frequent recurrence.
Thrombophlebitis superficial venous thrombosis are not to be confused with deep venous thrombosis. In the second case, the situation is much more serious. However, a thrombotic lesions, varicose veins symptoms are very unpleasant. A region is a thrombosed vein painful threadlike forms a seal, it is characterized by redness, local rise in temperature, and increased sensitivity, and sometimes a seal to restrict movement of a limb. The clinical picture or, more reminiscent of ulcer abscess.
Thrombophlebitis can be particularly dangerous if they take up the nature of fog to move in a superficial system, a deep. In this case, may develop as pulmonary embolism, deep vein thrombosis.
Bleeding the varicose veins are very scary, because due to the high venous pressure stream of blood strong enough. In some cases, this can lead to significant blood loss.
Diagnosis a varicose veins in the legs
Diagnosis of varicose veins of the lower limbs usually do not cause any problems. A fundamental feature of the disease is the presence of a venous "bumps" and/or "nodes". Although excessive development of a subcutaneous fat on the lower limbs can be difficult to see them.
Further confirmed by the different methods of instrumental diagnostics, a still, which is an ultrasound duplex scanning (Usd) is. This allows you to quickly, accurately and safely determine the source of a varicose veins, to assess the size, structure, a ship, a function of a venous valve, a scale distribution of the current back to the blood to detect the presence of blood clots. At the same time look deep and superficial venous system. You need to Continue the research in the standing position or, if a patient's condition does not allow sitting with the feet. A study of a supine position can lead to errors in determining reflux, and blood clots.
To further evaluate a function of a valve, or the length of the back driver's blood is used for:
- compression test pressure for different segments of the lower limbs;
- a sample straining (Valsalva test);
- a simulated walk;
- welcome to paraná is easy to attempt to remove the patient from the equilibrium, with the aim to raise the tension in the calf muscles.
Summary duplex ultrasound examination of the lower limb veins is necessary to repair in the form of opinion, and a table, a drawing, a "vein map". A study results provide invaluable successfully disbursed by the eu structural a design for further treatment. However, it should be taken into account only in conjunction with clinical data, as changes in the ultrasound pattern in the absence of objective signs of illness (varicose veins) should be considered functional (i.e. not associated with the pathology of the veins). Also noted should be that the ultrasound scan undertaken if not necessarily the diagnosis is clear, if not ill plan surgical treatment of varicose veins.
Additional diagnostic methods:
- Doppler ultrasound — Doppler ultrasound (not to be confused with the usd a);
- plethysmography;
- radiopaque venography;
- radio telegraph way;
- computed tomography (CT);
- the magnetic resonance imaging (MRI);
- thermography;
- intravascular ultrasound (IVUS) is a new method.
Treatment of varicose veins in the legs
The goal of The primary treatment of varicose veins of the lower limbs, all eliminate the defective veins. This is only possible, means that the invasive intervention. Three methods:
- Deleted — combined phlebectomy short vein Stripping, mini phlebectomy, dissection of perforating veins;
- "Bandage" — sclerotherapy, mechanochemical ablation, cyanoacrylate oblivion;
- "Beer" — endovenous laser or radio frequency ablation.
A goal of a achieving treatment must perform two tasks: remove a source of varicose veins (so-called vertical reflux), then remove the varicose veins. For a long time the most commonly used method for combined phlebectomy. A construction technical includes two stages:
- Ligation anastomosis — a connection, a big vein saphenous a common femoral veins (crossectomy);
- Remove the trunk, the vein saphenous a probe (Strip).
This intervention is a radical a number of disadvantages associated with any operations: common required anesthesia, the presence of incisions in the stitches, as well as a significant rehabilitation period and increased in comparison with other methods the risk of complications.
However, about twenty years ago, there was a "phlebology revolution." It became possible thanks to the widespread adoption of ultrasound scanning the appearance of fine techniques — endovenous thermal ablation. The essence lies in the fact that the high temperature effect of a vein wall from the inside. This is achieved, the radiation (evl o) or RFR (RFO), "safari ways to" a lumen of a vein.
Vienna immediately ceases operation, and then gradually cease. This method allows you to without incision, fast, efficient, safe, aesthetically pleasing vertical to eliminate reflux without the need for further rehabilitation. That is a bright representative of "office surgery", endovenous thermal ablation ten years ago is considered the most optimal method of treatment of a varicose veins around the world.
Sclerotherapy (affected binding to blood vessels substance by injecting) is established, uncle sanyi circle used for the elimination of varicose veins. However, to achieve desired results, careful selection of a disease due to increased risk of recurrence.
The conservative treatments, compression therapy, phlebotrophic drugs, as well as a local therapeutic (gels, ointments), is merely supplementary in nature, affecting mostly the symptoms of a varicose veins without eliminating the source.
Forecast. Prevention
Considering that a modern methods of treatment, the prognosis of varicose veins is favourable. Even a seemingly special case, to remove the varicose transformed veins leads to a rapid improvement of the patient's condition.
However, if the planning of treatment, assessing the risks is important, as with any procedure still carries with it the possible side effects. The duty doctor is a minimizing probability. Before any manipulation, to talk to the patient all aspects of the procedure to obtain the signature of the informed consent.
All adverse events can be divided into risks of surgery, including the anesthesia, the risk as well as a patient.
The risks of a surgery may be small, such as inflammation (phlebitis) in the "cooked", or sklerozirovanie veins, and a seal, a forecast of moderate pain. It could be that areas of the skin, decreased sensitivity, as well as the hyper-pigmentation of the skin. Ezek a side effects temporary is usually over relatively quickly without consequences.
Major complications include deep vein thrombosis, allergic or toxic reactions to anesthetics. They occur very rarely, but patient is the only one who suffered complications, the case is 100%, even then if a statistics 1% 10 000 cases of operation.
Venous thrombosis mainly in the calculation, the risk of the so-called balance-point scale using table capri the. It contains the various risk factors, which are the gradation. Into account all factors in the removal of a total score to determine the degree of risk, therefore, the prevention. A main means that the following venous thromboembolism:
- to minimize the morbidity of the operation;
- early activation of the patient;
- compression stockings;
- pharmacological prophylaxis, i.e. a task according to the anticoagulants — drugs that thin the blood.
As for the prevention of varicose veins, it simply doesn't exist, because it is still not clear that the main cause of the pathology, which may affect, prevent its formation. In this regard, as well as the often recurrence of varicose veins after any type of intervention. However, Since all the advantages of minimally invasive treatment, this is not a serious problem. To maintain one's legs is fairly simple, the main time refer to phlebologist