Of all the known types of vascular pathology, the most common is varicose veins.Let us pay attention to the heading of the article: the most common material is considered in this material - in turn, the localization of “varicose”, namely the expansion of veins on the legs.Other options are relatively less common, however, in the field of view of specialized and related specialists, they also constantly fall;These are, for example, the expansion of the veins of the esophagus, the seed, the small pelvis, etc. In other words, to associate the term "varicose expansion" only and exclusively with the lower limbs, which is practiced in everyday speech, would be incorrect.However, in the professional environment, a certain terminological variety is still observed: in some sources, the “varicose veins” is used in some sources, in others the “varicose expansion” is separated from the “varicose disease”, etc.
Varicose veins of the lower extremities are a very unpleasant polysimptomatic disease, accompanied by noticeable external manifestations.The cosmetic defect on the legs usually progresses over the years, and many patients (primarily female) are much more worried than hemodynamic disorders and organic changes in the venous walls.Such patients, or rather, patients tend to resort to a variety of intramedician methods and methods of "eliminating varicose veins", at best harmless, and sometimes significantly aggravating the situation.Meanwhile, the untreated, neglected forms of venous pathology are fraught with the most serious consequences, and at the first symptoms (see below), consult a doctor should be consulted if possible: like the vast majority of other diseases, varicose veins are much better to treat the initial stages.
Returning to the question of prevalence, a wide range of published epidemiological assessments should be noted.This is partly due to regional differences and age-related trends (the older the examination, the more the share of clinically significant cases in it), partly the difference in diagnostic approaches, but the main reason for statistical ambiguity is, apparently, the design of the conducted studies: in some cases, reporting medical documentation is analyzed (which is reflected, in essence, not reflected, not in essence, notThe prevalence, and the frequency of calls for help with this disease), in others, certain categories of the population are specially examined, during which characteristic symptoms are recorded and then the real frequency of their occurrence in the general population is evaluated.Even if you discard extreme assessments, the situation with the varicose veins of the lower extremities is very depressing: to one degree or another, at least 55-65% of women and 15-25% of men of mature age suffer.Such a deep imbalance between the floors is due to anatomical and hormonal differences, as well as the reproductive function of a woman (pregnancy, childbirth), which in many cases becomes a direct prerequisite for the development of venous disorders.
The tendency to “rejuvenate” of such pathologies cannot but be disturbed by the average age of the onset of the disease, most sources call the interval of 20 to 30 years, however, cases of varicose veins on the feet of schoolchildren, including young men, are increasing from year to year: growing changes in lifestyle (reduction of physical activity) and food diets, chips, hiss and others are affectedLittle gray substances).
Reasons
First of all, it should be noted that the varicose expansion is not diagnosed with respect to arteries: this "curse" lies on the veins.The arteries, of course, are also vulnerable and predisposed to various pathological changes, but in this case, aneurysms (local sculsions), atherosclerosis, various kinds of obstruction (narrowing of the lumen), thromboembolism (blockages), etc. are more often observed.Compared to arterial, the venous walls are less durable and elastic, less resistant to stretching deformations under load or internal pressure;They are easier to become thinner and become partially permeable, as a result of which the sealing of blood or its individual fractions through the venous wall may begin.The fact that varicose veins are most often observed in the lower extremities, many researchers consider one of the side effects of the evolutionary transition to straightforwardness (the other severe "tribute" that humanity paysFor the release of hands, is the pathology of the spinal column).The whole body weight is based on the legs, which creates an abnormally high load on the joints and the circulatory system.It is reliably known that people suffered from varicose veins already in ancient times;Then the dominant cause was, apparently, the constant carrying of weights.This factor is relevant today (some types of sports and labor activity), however, as civilization has developed, especially in the last hundred or two years, the loads have increased many times with the advent of "sitting" and "standing" professions: any stagnant phenomena for vein are fatal.Direct risk factors include obesity, plant food deficiency in the diet, injuries (including surgical, e.g., consequences of an orthopedic operation), congenital vascular anomalies, hereditary predisposition and gender (see above).Thrombosis of deep veins and the concomitant inflammation (thrombophlebitis) lead to severe changes in the venous system of the legs;So, as a separate form of varicose vegetable expansion in Western literature, posttrombophlebitical syndrome is considered.A large group of provoking factors is made up of diseases and conditions that determines increased intra -abdominal pressure: tendency to constipation, chronic cough, etc.;In such cases, varicose expansion is detected, as a rule, not only in the limbs.
Separately, it should be said about tobacco -course, which is rightly called the "killer of the veins."The connection is so obvious and cramped that many experts strongly set the condition for a complete rejection of smoking before starting any treatment.The ethical aspects of such a medical position can be argued (recently, the demagogic term "chauvinism of non -smoking" has even appeared), but in the fact that if this condition is not observed, the treatment automatically becomes meaningless and useless, there is no doubt.An avid smoker, which in this case requires the exercise of the right to medical assistance, is similar to a drug addict, who expects to eliminate dependence and withdrawal syndrome, but is going to continue to take drugs.
At the organic, anatomical level, the main cause of varicose veins is the failure of the venous valves, which should exclude reflux (blood flow in a direction opposite normal, which creates excessive pressure in the veins).Actually, with the study of the causes and mechanisms of the development of venous-valve dysfunction, with the development of the first methods of its surgical correction at the end of the 19th century, modern phlebology began as a medical science of diseases of the veins, methods of their treatment and prevention.
In general, it is necessary to admit that the abundance of the reasons described above - the significance of each of which is repeatedly and reliably confirmed by large -scale studies - still does not form a single system.So, under almost equal conditions, under absolutely the same, seemingly combinations of risk factors, in one person, the varicose veins of the lower extremities develop and quickly progress, and in the other vein for decades remain intact.This suggests that today the etiopathogenesis has not been clarified to the end, and any, even the most effective of modern therapeutic strategies, remains, in fact, palliative.However, phlebology is developing extremely dynamically today, and the “missing links” in our knowledge of varicose veins will, in all likelihood, are identified and studied in the foreseeable future.
Symptoms
Often the harbingers or the first symptoms of venous blood circulation disorders are subcutaneous stars or mesh of the small blood vessels of the extended and visible and visible.Then, swelling nodes, winding or located at clusters, are formed on the calves.The legs with varicose veins swell and get tired, many patients complain of frequent painful convulsions in the legs (including at night), sensation of itching, heat, crawling "goosebumps", etc.In the absence of treatment, varicose veins can be complicated by acute thrombophlebitis and perforation of nodes (sometimes sufficiently the slightest mechanical exposure so that the stretched and thinned wall of the vein burst out);Bleeding in this case can be very strong and lead to massive blood loss.
Diagnostics
An experienced phlebologist recognizes varicose veins from the first cursory glance.However, an additional examination, of course, is as necessary as collecting a detailed history and complaints.There are a number of special functional samples, and from the instrumental methods the most important is X-ray-contract angiography and ultrasound in the mode of Duplex Doppler scanning.
Treatment
In the previous decades, the specialty "phlebology" was usually interpreted as a synonym for vascular surgery.Thus, it was implicitly implied that there can be no non -surgical treatment of venous pathology.However, to date, the situation has changed dramatically, and the main shifts relate to the last 15-20 years.The course for use - wherever possible and shown - are few high -tech - and microinvasive methods are withstanding in all surgical specializations, and the treatment of varicose veins on the legs today does not necessarily implies a "large" operation.As a rule, therapy is comprehensive and begins with conservative measures - according to indications, drugs -enotonics, anticoagulants and anti -agents, and anti -inflammatory drugs are prescribed.You can use an elastic bandage or compression knitwear only after consulting a doctor (in particular, the bandaging technique should be explained in detail - starting from the fingers, with the mandatory capture of the heel and the gradual weakening of the compression closer to the knee).Therapeutic physical education, water procedures, diet (it is also necessary to normalize body weight), and hirudotherapy are effective.
However, varicose veins still remains a surgical disease, i.e.The radical effect can only be achieved by surgery.There are many specific phlebectomy techniques - vein removal, the residual functional viability of which does not reach 10% of the norm.At the same time, minimally invasive methods mentioned above are more widespread, which have several advantages (less traumatic, the possibility of outpatient treatment "one day", the absence of crooked cosmetic defects, etc.).The most promising and effective of these methods include sclerotherapy (artificial sprinkling, “gluing” venous walls with a special solution, which is administered by microeds), laser therapy (including intravenous), radio frequency ablation (a thin probe is introduced into the vein, as the walls are “sealed”).
It should be understood that the effectiveness of any treatment in this case directly depends on what stage the patient turns for help.It is not necessary to bring the matter to the “big” surgery: the varicose veins of the lower extremities are completely cured today, but this disease itself does not pass.