Modern healthcare faces many different challenges, but despite the rapid advances in medicine, there are diseases that continue to affect millions of people. Varicose disease of the lower extremities ICD 10 - I83 is just such a problem that practically cannot be resolved over time.
Prevalence in numbers
The disease has become widespread in various developed countries, such as the USA, France, Belgium, Germany, etc. The number of patients with this diagnosis is almost a quarter of the population of each country.
Half of all patients are over 55 years of age, but the other part are able-bodied workers, most often employed in manufacturing. As any VD disease progresses, complications form, patients lose their jobs due to disability, so the problem becomes not only medical, but also economic and social. The occurrence of varicose veins can be correlated with the age of the patient. In people over 70 years of age, varicose veins of the lower extremities are more common than in people before retirement age.
In four out of a hundred patients over 80 years of age, varicose veins take on a form aggravated by concomitant pathologies, in the form of trophic ulcers, various dermatitis or eczema. Also at this age, other diseases of the cardiovascular and bronchopulmonary systems occur, thereby excluding the possibility of surgical intervention.
Important!At the first symptoms of the disease, it is better to consult a doctor; the younger the patient’s age, the lower the risks if surgical treatment is necessary.
Origins of the disease
Despite the fact that the disease progresses gradually, there are still etiological factors for the development of varicose veins.
So, what are the causes of varicose veins:
- heredity;
- endocrinological reasons;
- mechanical factor;
- infection;
- intoxication;
- nonspecific inflammatory process;
- factors contributing to venous hypertension.
Complaints and symptoms
Oddly enough, at the very beginning of the disease, visible disorders appear, which are often ignored. Mistaking small vessel defects for a minor external disorder that will "go away on its own, " patients provoke the development of the disease.
Further symptoms develop progressively:
- feeling of fatigue/heaviness in the legs;
- swelling in the area of the feet;
- night cramps;
- numbness, tingling, "pins and needles" sensation;
- pain in the area of varicose veins.
Diagnosis of varicose veins is an important condition at any stage of the disease
The disease at any stage requires diagnosis; it is diagnosis that suggests which treatment option is most acceptable for the patient. Clinical and instrumental diagnostic methods are used in tandem. Depending on the course of the disease, all methods or only part of them can be used.
Clinical examination methods - examination and conversation
Clinical methods are used not only for varicose veins, but also for any other disease:
- History taking. The anamnesis includes all the basic facts about his life (age, heredity, bad habits, type of main job).
- Definition of complaints. Complaints may indicate how much varicose veins have progressed by the time of examination. The duration of the disease becomes an important condition. When did the first symptoms of leg disease appear?
- Inspection.During the examination, the doctor should pay attention not only to the blood vessels, but also to the condition of the skin, to exclude the presence of complications and concomitant pathologies. It is also important to determine the degree of damage, the temperature at the location of the varicose veins, as well as the tension and elasticity of the vessel.
A phlebologist is the first doctor who should see your feet.
Instrumental examination methods are a prerequisite
To prescribe treatment, one examination will not be enough. Varicose veins of the lower extremities require mandatory instrumental diagnosis. During instrumental research methods, foci of varicose lesions, the length of the damaged vessel, insufficiency of venous valves, blood flow speed, etc. are determined.
This:
- Ultrasound.A standard B-mode study provides a complete picture of the anatomical structure and location of the vessel, as well as those adjacent to it. Ultrasound also reveals pathologies of the vein wall.
- Doppler ultrasound. The study determines the speed of blood flow, thereby identifying pathologies of the valves in the vessel.
- X-ray contrast venography. A more complex type of diagnosis using x-rays. The procedure is rarely used due to the possible occurrence of complications.
- Computed tomographic venography. It is carried out in the same way as X-ray contrast, with the introduction of a contrast agent into the lumen of the vessel. A CT image, unlike an X-ray, is three-dimensional.
- MRI.The method is justified and informative, and is carried out without the administration of contrast or other medications. However, this method remains expensive, so it is used extremely rarely.
Note!In patients with an allergy to iodine, contrast agents cannot be administered, in which case MRI may be necessary.
Diagnosis according to classification
Like other diseases, varicose veins are divided into classes, taking into account many factors:
| External manifestations |
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| Cause of the disease |
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| Anatomical location of veins |
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| Mechanism of the disease |
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The most common reason for contacting specialists is grade 2 varicose veins of the lower extremities, when the external manifestations of the disease become significant. Perhaps, if the disease did not manifest itself externally, then the detection of varicose veins would occur at later stages.
Note!The concept of "internal varicose veins of the lower extremities" is used only colloquially, meaning varicose veins of the deep veins, which can only be diagnosed by instrumental methods.
To treat or not to treat, that is the question
The gradual progression of the disease sooner or later prompts patients to the idea that treatment is necessary. Often the doctor’s task is to convince the patient to begin treatment at the initial stages of the disease. The direction of treatment can be different and depends on many factors (age, symptoms, degree of disease, etc. ).
Thus, treatment can be aimed at:
- improving quality of life; cosmetic surgical interventions.
- preventing complications; impact on microcirculation.
- elimination of symptoms; hemodynamically significant treatment.
One way or another, the treatment is always selected by a specialist (phlebologist, vascular surgeon). In the treatment of varicose veins, complexity is important, so you cannot limit yourself to only surgical intervention, or only therapeutic and preventive physical training. It is important to follow all doctor's instructions.
Lifestyle Tips
Varicose veins oblige patients to abandon factors that provoke complications. Sometimes such a measure is necessary, since untreated varicose veins greatly affect the quality of life.
Do-it-yourself treatment is a useless exercise, however, you should pay attention to your lifestyle so that varicose veins do not progress so rapidly.
What needs to be done for varicose veins:
- Women need to give up high-heeled shoes;
- Give up bad habits, in particular smoking;
- Move, if you have to sit or stand for a long time, then try to change your position;
- Avoid tight/tight-fitting clothing and shoes;
- Avoid exposure to high temperatures (sunbathing, hot wax, baths, saunas);
- Control your weight;
- Do not lift heavy objects;
- Take a contrast shower;
- Walk, run, swim more often;
- Keep your legs elevated whenever possible (sleeping, resting).
Compression therapy
Regardless of the etiology, patients with varicose veins should wear medical knitwear or apply elastic bandages.
- The use of knitwear is most convenient; stockings or knee socks, made of special material, most often do not cause inconvenience. The level of compression of medical hosiery should be recommended by a doctor. The only disadvantage of compression garments is its price.
Note!Brands of medical knitwear manufacturers may be different, so you need to choose carefully. Make sure that the elastic on your knee socks or stockings is not too tight.
- As an alternative, patients often prefer to use short, medium, or long stretch elastic bandages. The choice of distensibility also depends on the stage of the disease and should be recommended by a doctor. The first few uses may be a little difficult as you will need to control the tension level of the bandage yourself.
Compression therapy is used daily, wearing underwear or bandages greatly eases the load on the legs throughout the day.
Physical education and sports as treatment
Varicose veins require movement, so therapeutic and preventive physical education is an important component. Of course, it is better not to perform exercises blindly, but to choose a set of exercises with a specialist. Some medical institutions offer group exercise therapy classes.
Most often, exercise therapy exercises do not require special training and are available regardless of age; for clarity, a set of exercise therapy exercises:
- Tighten and relax the thigh muscles (10 times);
- Inhale, lifting the abdominal wall, exhaling, draw in the stomach (4 times);
- Bend and straighten your legs at the ankle (10 times);
- Inhaling, raise your arms up through the sides, while exhaling, lower them (4 times);
- Bend and straighten your toes (15 times);
- Raise your arms up as you inhale and lower as you exhale.
Even from this small set of exercises it is clear that anyone can do them, regardless of age. It is important to take your time and do everything at a slow pace, without holding or speeding up your breathing.
Athletes can also perform this set of exercises before main training. It is especially important if the patient is involved in any sport that is not recommended for varicose veins.
Sports, as an alternative to exercise therapy for varicose veins of the lower extremities, are also appropriate, but you need to consult a doctor and personal trainer. Some exercises will have to be excluded from training.
Athletes are sometimes simply forced to leave their professional careers, especially in jumping, powerlifting, and heavyweight boxing. Those who like to swim, run and walk, in turn, can continue to do this.
Medicines, after being prescribed by a doctor
The objectives of pharmacology in the treatment of varicose veins are different, namely:
- improvement of vein tone;
- correction of microcirculation;
- improvement of lymphatic drainage;
- prevention of thrombotic complications;
- suppression of the development of complications.
That is why all medications must be prescribed by a doctor. It is in this vein that there is a guarantee of successful resolution of the disease.
Treatment with drugs is used at different stages: when preparing the patient for an upcoming operation, in the postoperative period, as well as in cases of obvious contraindications to surgery. The drugs can be systemic or local and used both in tandem and separately.
Phlebosclerosing treatment
Phlebosclerosis also refers to methods of pharmacological treatment, however, its use is often unjustified, since the positive effect does not apply to all patients. For the most part, the method is used for correction in an aesthetic sense.
It should be noted that the use of this method is fraught with relapses and complications, so the procedure is performed by surgeons who have undergone special training.
Physiotherapy in the treatment of varicose veins
Physiotherapeutic methods are not the main ones in the treatment of varicose veins, but are successfully used to relieve the symptoms of the disease. D'arsonval, electrophoresis, barotherapy, magnetic therapy for varicose veins of the lower extremities are used only under the supervision of a doctor, since any physiotherapy has a number of indications and contraindications.
All physiotherapy procedures are not applied continuously, but in courses of 10-20 days. In most cases, physiotherapy provides a delay in the progression of the disease, but is not the main method of treatment, and certainly cannot be used as monotherapy.
Surgical treatment
Despite the many methods of therapy, surgery remains practically the most basic and significant. Vascular surgeons perform successful operations on many patients.
Traumatic venectomies became a thing of the past as modern minimally invasive methods became available. The Brunner approach, Müller dissection, and mini-phlebectomy with Varadi hooks all facilitate the management of patients with varicose veins and often last within one day.
Of course, there are also contraindications for surgical intervention; the main group is patients over 75 years of age who exhibit tissue trophic disorders, microcirculation and/or lymphatic drainage disorders, or excessive lesions of the venous vessels. There are special instructions for performing operations on such patients. Sometimes you have to abandon the operation altogether, and sometimes doctors still operate through a combined phlebectomy.
Drug treatment
The treatment regimen for varicose veins is determined by the doctor. For this, conservative methods and surgical methods are used, it all depends on the stage of development of the disease, as well as the presence of complications.
The simultaneous use of medications and ointments allows you to relieve the symptoms of the pathology and achieve good results in treatment. Currently, there is a large selection of medications on the shelves of pharmacies; they are effective in combating pathology at its early stages of development.
Drug treatment for varicose veins in the legs is effective.
Important!Only a doctor can prescribe medications, dosage and course of their use.
Sclerotherapy
Sclerotherapy is one of the best methods of treating varicose veins today. Specially administered drugs allow you to destroy the stagnation of the vein inside. After some time, it will begin to stick together and dissolve, and blood circulation will be transferred to healthy veins.
Treatment is carried out in a course, which includes up to six sessions for each sore leg. You can notice a positive result no earlier than two weeks. However, patients should be prepared to experience pain and tingling.
Soon the unpleasant symptoms will disappear, the diseased veins will disappear. The dosage of the drug is selected taking into account the individual characteristics of the patient.
Complications and side effects are extremely rare. A properly performed procedure gives a high chance of recovery.
Echosclerotherapy is the same as sclerotherapy, the difference is in the use of an ultrasound scanner. This method is preferable because the movement of the syringe can be monitored, and the medicine will be distributed evenly.
Foam-form sclerotherapy is another type of sclerotherapy. Medicines are administered in the form of microfoam, so the procedure allows you to achieve better results. The thing is that the medicine is much closer to the walls of the veins and does not mix with the blood.
Surgical methods of treatment
Surgical treatment of varicose veins is used only if conservative methods do not achieve the desired result. Patients are given local anesthesia, and after a couple of hours they can go home.
There are practically no hematomas, and there is no intoxication characteristic of general anesthesia. The result obtained lasts for several years.
Phlebectomy is a type of operation performed under local surgery. Two small punctures are made to remove the affected vein. Sometimes this method can replace sclerotherapy. After just a couple of weeks, the patient will be able to return to his usual lifestyle.
Laser treatment is the most gentle method of treatment and can only be carried out by a qualified specialist. Using an ultrasound scanner, a light guide is inserted into the vein.
The procedure is controlled by special devices. The laser beam causes the plasma to boil, the diseased vein closes and does not participate in the blood circulation. The price of such an intervention is high, so it is not available to everyone.
Darsonvalization
With the help of the D'arsonval apparatus, it is possible to normalize blood circulation, as well as eliminate congestion in diseased veins. The increased tone gradually decreases, the tone of the veins increases. Patients get relief from pain and itching.
Full circulation of lymph, as well as full blood circulation, allows tissues to receive adequate nutrition, and the amount of oxygen in them increases. The veins either narrow or expand; gymnastics can increase their elasticity.
The device moves from bottom to top. Lymph and blood flow out from the ankle to the thigh, and congestion stops. In order to achieve the desired result, you need to undergo a full course of treatment, which includes at least twenty procedures.
Home Remedies
Advice!Varicose veins can also be effectively treated using home remedies.
The most common methods are the use of medicinal herbs. You can buy them at the pharmacy or collect them yourself in the summer.
White acacia
An alcohol tincture is prepared based on the flowers of the plant. Soak cotton swabs in it and wipe the affected areas several times a day.
Sagebrush
Collect fresh herbs and grind them in a mortar. Separate a spoonful of herbs and mix it with the same amount of sour cream. Apply the resulting mixture to the sore spots and apply a bandage on top. After two hours, remove the compress. Repeat the manipulations for five days, take a short break, and then repeat the course of treatment again.
Kalanchoe
Wash the Kalanchoe leaves, place on a paper towel and let dry. Chop the leaves and place in a glass jar. Pour alcohol on top and let it brew for seven days, stirring occasionally. Strain the tincture and lubricate sore veins for several months in a row.
Apple vinegar
Dissolve two tablespoons of vinegar in a glass of water and drink it twice a day. It is recommended to rub apple cider vinegar undiluted into sore areas twice a day. After a month, the veins will begin to become smaller.
Cream
Grind part of the garlic, add two parts of butter. In its pure form, place the resulting cream on the sore spots, cover with parchment paper on top and apply a bandage. Leave the compress on all night, wash off in the morning, and wrap your legs with an elastic bandage. Repeat the procedures throughout the month.
Garlic
In order to consolidate the results of treatment, you can take garlic internally. Mix 250 grams of chopped garlic and 350 grams of honey, let it brew for five days. Take one spoon three times a day.
Tomatoes
Cut a fresh tomato into slices, apply to the problem area and wrap with a bandage. Keep the compress on for four hours, then remove and wash your feet. The duration of the course of treatment is two weeks, then a ten-day break is taken, and it is repeated.
Prevention
It is much easier to prevent a disease than to fight it later, which is why prevention is necessary. If you have a hereditary predisposition to the development of varicose veins, you need to pay redoubled attention to your health.
First of all, you need to give up bad habits and follow the recommendations listed above. Your diet should include foods rich in vitamins.
Vitamin E
The vitamin is found in many foods: lettuce, vegetable oil, legumes. It is necessary to strengthen the walls of the veins, as well as increase their elasticity. Vitamin C has exactly the same property.
Copper
Elastin synthesis is helped by foods rich in copper. Seafood is included here. In order to maintain your body weight, you need to give up sugary foods.
To prevent varicose veins, you must follow the following rules:
- It is not recommended to put much strain on your legs during the day. People who work in a standing position need to spend several minutes per hour in a sitting position. Ideal: take a horizontal position, raise your legs above your head and hold for twenty minutes.
- If you work in a sitting position, you need to get up for a few minutes once an hour and spend this time standing. Thus, the speed of blood movement through the veins will be increased. Periodically rotate your feet in different directions.
- It is not recommended to lift heavy objects.
- Massage your feet daily using a stream of cool water.
- Do not overuse visits to saunas and baths.
Effective methods of treating varicose veins can achieve good results. Patients quickly return to a full life.
How is the disease complicated?
Complications of varicose veins are always unpredictable, although they develop gradually. Without medical supervision and therapeutic treatment, the risk of developing complications becomes many times greater.
- Trophic ulcers with ascending and descending varicose veins.They are most often located on the lower third of the leg on the inside, however, they can also be observed on the outside, although this manifestation occurs quite rarely. The deeper the trophic ulcer, the higher the risk of bleeding.
- Thrombophlebitis.It can occur with any type of varicose veins; the occurrence of such a complication depends directly on the coagulatory properties of the blood. This complication can be prevented by using laboratory monitoring.
- Eczema.Occurs due to a violation of tissue trophism. Eczema and trophic ulcers can occur both together and separately.
- Bleeding from varicose veins of the lower extremities.This type of complication can appear against the background of deep trophic ulcers, as described above; such bleeding will be external. Internal (subcutaneous) bleeding is observed with prolonged course of varicose veins.
What is important to know about varicose veins
Varicose veins become a test for patients, because the more they ignore it, the more aggressive the disease will behave. The course of varicose veins depends not only on the doctor’s instructions, but also on how scrupulously the patient follows them. Varicose veins are a chronic disease, so even after surgery, treatment often does not end.
What the doctor advises must be done and followed, be it a magnet for varicose veins of the lower extremities, medications or exercise therapy. It is complex treatment that gives a positive result, and you should not ignore even one, the most insignificant point.