Scientific editor: Strokina OA, therapist, doctor of functional diagnostics. Practical experience since 2015.
October, 2018.
Varicose veins - a persistent and irreversible enlargement and elongation of veins occurring in by gross changes in their walls, as well as the failure of the valve apparatus due to a genetic defect.
Predisposition women explained cyclical increase extensibility of the walls of veins and loosening valves at magnifications hormone concentration progesterone .
Causes
The primary factors for varicose veins - a hereditary weakness of the vascular wall.
In addition, of great importance in the pathogenesis of a human life:
- long work standing or sitting;
- lack of regular exercise;
- weight lifting;
- reception estrogensoderzhaschih drugs.
The risk of varicose veins increases with age. But more and more patients appear younger than 30 years.
Manifestations of varicose veins
Most often, patients with varicose veins are concerned a feeling of heaviness, bloating, fever, itching of the skin, "anxiety" in the legs and aching, throbbing pain in the calf muscles. A characteristic feature of these features is their appearance after prolonged standing. Typically, discomfort fully tested or their intensity is significantly reduced if walking, lying down, after a night of rest, or when using medical compression products.
An important feature of the disease are cramps in the calf muscles, usually occurring at night.
Saphenous veins dilate as convoluted cyanotic conglomerates of the lower leg and thigh. Unfortunately, there is a perception that spider veins are a manifestation of varicose veins. But it is worth noting this is not an absolute sign of disease and is largely a purely cosmetic problem. Such signs may be on the skin with varicose veins, but for the most part found in healthy people.
With the development of varicose veins, shin skin disorders develop power. Initially, there are areas of excess dye, a little later the subcutaneous tissue and skin are sealed, the latter acquires the characteristic "painted" look. In the center of the colored area of the skin in response to a minimal injury exposes a small portion whitish, resembling incrustation stearin. This so-called white skin atrophy, followed by open trophic ulcer.
Eating disorders of the skin is a sign of chronic venous insufficiency, which also include symmetrical swelling in the legs.
Diagnostics
Ultrasound angioscanning (color duplex scanning; triplex scanning) - the "gold standard" in the diagnosis of varicose veins. Sonogram technician must inspect the vessels of the legs on both sides. It assesses their diameter, compressibility, flow characteristics and size reflux (backward flow of blood). Evaluation of the venous valves is performed not only in the position of the patient lying down, but standing.
Radionuclide and a radiopaque venography once considered the main methods of instrumental diagnosis of varicose veins, but they are now left far in the past.
Treatment of varicose veins
Current treatment of varicose veins include surgery, sclerotherapy, compression therapy, and use of various medicaments.
Operation
Surgical treatment - the only method to significantly improve quality of life, reduce the risks of complications and the likelihood of disease recurrence. It consists in the removal of varicose veins and eliminate pathological reflux. There are 2 types of interventions:
- Thermal obliteration - maloinvazivnyj (without cuts) treatment method that is "soldering" inside veins using a laser or radio frequency sensor.
- Traditional surgery involves excision of varicose saphenous veins. Currently, the technique of these interventions are sufficiently worked out and provides a good functional and cosmetic results.
Separately considered sclerotherapy as the method of surgical treatment. She successfully completes, and in some cases (the initial stage of varicose veins) replaces surgery. The procedure consists in the introduction of a special preparation in a varicose vein, which glues its inside.
Compression treatment of varicose veins
Bandages: pros and cons
Compression therapy is mandatory component of any method for treating varicose veins and most effective method for its prevention.
For the treatment of compression is most commonly used elastic bandages which, depending on the degree of stretching is divided into 3 classes:
- short (elongation of the bandage is not more than 70% of the original size)
- mean (range increase of the original length under tension in the range 70-140%),
- long (140% or higher) elongation.
Classes necessarily indicate on the packaging of the bandage, and they are a necessary feature for the correct choice of product.
Bandages long elongation should be used in the immediate postoperative period with the aim krovoostanovki and reliable fixation of the dressing. To ensure optimal therapeutic compression mode best suited bandages short and medium extensibility.
When elastic bandaging legs should stick to the following rules:
- The dressing is applied, the maximum pre-stretching foot "over", to prevent the formation of folds in the area of the ankle, which can damage the skin when moving.
- Bandaging always start from the joints of the toes and heel grip.
- Pressure bandage should gradually weaken from the ankle to the thigh.
- A roll of bandage unwind outside, while it is in close proximity to the skin.
- Modeling cylindrical profile limb is achieved by placing foam or latex pads.
The majority of patients with varicose veins should use elastic bandage during the day by placing it in the morning before getting up out of bed and taking off in the evening before night's sleep. For the treatment of venous ulcers multilayer compression bandages may be applied not removed for a long period, with directly to the affected portion of the skin contact tibia bandages impregnated with drug substances (zinc gelatin, zinc oxide and etc. bandages). Compression bandages additional fixing is performed by means of special adhesive bandages, which is particularly necessary when bandaging thigh.
Despite the high efficiency compression therapy elastic bandage it has obvious disadvantages - causing physical and aesthetic nuisance, besides the elderly is very difficult to self-bandaging himself, observing all regulations.
compression knitwear
The widespread popularity of becoming a special compression stockings. He is represented by courses, stockings to the lower, middle and upper thirds of the thigh, as well as tights (including special tights for pregnant women), four compression classes.
Such knitted fabrics made of cotton, natural rubber - elastane or synthetic rubber - elastodena. Products of natural fibers are optimal for a sensitive and diseased (varicose eczema, dermatitis, trophic disorders) skin. With respect to synthetic fibers, their advantages - a small diameter and a variety of colors, allowing to make medical knitwear with high aesthetic properties.
Drug therapy of varicose veins
The main goals of drug therapy are the elimination of subjective symptoms of venous deficiency, as well as prevention and reduction of severity of side effects after surgery interventions.
The main treatments for varicose veins are fleboprotektory (synonyms: venotoniki, venoaktivnye drugs). They should be taken only under the supervision of the attending physician. According to research safety of such medicines proved only for short courses of therapy. In the case of a longer terms may receive non-severe but annoying adverse effects such as gastrointestinal disorders.
One of the most commonly prescribed drugs are drugs with active ingredient Diosmin. Typically, a week after the start of the reception there is a positive trend: nightly cramps, pain, feeling of heaviness, swelling decreases. It is believed that the minimum duration of the course must be at least 2 months. In severe forms of varicose the drug can be extended up to six months or more.
Ointments and gels
Ease of use and relative cheapness of ointments and gels make them highly popular among patients and physicians. A serious drawback of uncontrolled use of topical preparations is the high frequency of complications in the form of skin peeling, dermatitis and eczema, Cause sensitization with prolonged use of the same means.
Therefore, it is not recommended to use topical drugs (ointments, gels, lotions) as the prevention and in the absence of symptoms of chronic venous disease.
Funds on the basis of heparin - one of the most popular drugs. Apply 3-4 times a day. At the beginning of the use of possible mild skin irritation and flaking phenomena in the field of application of the drug.
Adjunctive therapy
In Russia, widespread physical therapy treatments. To combat these symptoms varicose veins, the pain and cramps in the calf muscles, you can use the method of electrical stimulation of leg muscles1. Other methods of physical therapy do not have any evidence of the effectiveness of treatment of this disease.
Prevention of varicose veins
The rational organization of work and rest is necessary for all patients with varicose veins. This category of patients is not recommended to work associated with prolonged stay standing or sitting, heavy lifting, exposure to high temperature. At work and at home, they need periodic rest with their angle of 15-20 degrees feet (during sleep is recommended lift the foot end of the bed above the level of the heart), a balanced diet that excludes the consumption of spicy and salty foods, as well as alcohol. It should strictly control body weight as obesity It leads to the progression of the disease.
In the context of elastic compression permitted activity moving sports (skiing, riding bike), but the optimal conditions for venous drainage and exercise the muscles of the lower extremities are provided swimming.
sources:
- 1. LA Laberko, VE Banirov. Hemodynamic efficacy of electrical stimulation of leg muscles. - Physiotherapy, Balneology and Rehabilitation, 6/2012.
- 2. Varicose veins without chronic venous insufficiency. - Clinical Guidelines, 2017.