Бесплатный фрагмент - VARICOSE VEINS AND VEIN DISEASES

Preface

The book is intended for a wide range of readers and is devoted to diseases of the venous system. Varicosity and other venous diseases are common pathologies of the lower extremities. Currently, there is no more pervasive vascular disease than varicose veins, which occurs nearly a quarter of the adult population of the world. And this is not surprising, because the legs take on the weight of the body and they are in motion every day. The main reason for the development of varicosity is heritable disease of the venous wall. And if the relatives had varicose veins, then one way or another it will most likely show itself. You can get rid of varicose veins quickly enough, especially if the disease is not started and precautionary measures are taken on time. The book presents modern views not only on varicose veins of the lower extremities, but also diseases such as thrombosis of superficial and deep veins, trophic ulcers, chronic venous insufficiency. Quite effective and modern methods for the treatment of cosmetic defects, such as spider veins and asterisks, have been proposed. Some chapters are devoted to compression garment and sport, as not all of its types are a contraindication to training with varicose veins and it can help to improve the general condition.

Chapter I

The history of the issue

“… varix should be punctured in many places where circumstances indicate”

Hippocrates / Ιπποκράτης

The first pictire of varicose veins was found west of the Acropolis, dating back to the 4th century BC. A bearded man was depicted with a varicose vein on his left leg. In his work Comparative Biographies, Plutarch describes one of the first surgery for varicose veins. The Greeks were looking for new ways to treat and study the circulatory system. Diogenes of Apollonia and Euryphon of Cnidus in the 5th — 4th centuries were the first who described blood vessels and divided them into arteries and veins. Ideas that laid down in ancient Greece, such as miniflebectomy, vein ligation, compression therapy, are still used today. There are known cave paintings that indicate the use of a compression bandage in the earliest era of human development. Hippocrates believed that ulcers of the lower extremities are associated with varicose veins. In the treatment of ulcers, Hippocrates pointed the veins and bandaged the lower extremities. About the treatment of varicose veins, Hippocrates wrote: “… varix should be punctured in many places, where circumstances indicate.” The surgeons of the Hellenistic era were the first who dared to remove varicose veins. In earlier times, these operations were unknown. Byzantine doctors believed that the most common areas of varicose veins were the lower extremities, the abdomen (abdominal cavity “medusa’s head”), and the temporal lobe. The methods of vein surgery of the Byzantine doctors are based on the methods of the famous Greek doctors of the Hellenistic period, which moved into medieval surgery, influencing and inspiring even modern surgeons. For example, the modern “vein engaging technique” described in 1975 dates back to the Byzantine period. For its part, after a while, Friedrich Trendelenburg (1844—1924), conducting operations, refers to the operation described by the doctors of Byzantium and other ancient surgeons. The revolutionary method of surgical treatment of varicose veins was proposed in 1908 by the American physician W.W. Babcock, which consisted of the removal of the subcuticular veins. The next stage in the development of phlebology is associated with the emergence of X-ray diagnostic methods in the 1920s. The appearance of color-imaging ultrasound angioscanning and Doppler imaging was a breakthrough in the diagnosis and treatment of varicose veins. Sclerotherapy — the injection of chemicals (special foam) into the varicose vein appeared in the 1970s. The method of laser coagulation of varicose vessels, whichwas proposed by K. Bone in 1998—1999,remains one of the main methods in modern phlebology. This method became an important point in the treatment of varicosity.

Chapter II

General Issues

“Part of the disease comes only from the way of life”

Hippocrates / Ιπποκράτης

Chronic venous disease (CVD) of the lower extremities is a very common pathology, affecting up to 50% of the adult population; among CVD, varicose veins of the lower extremities is the most common.

Incidence of venous disease

According to various sources, up to 88% of women and up to 66% of men from among the inhabitants of developed countries have signs of venous diseases. Among the adult population, the prevalence ranges from 24% to 50%. According to the WHO, every third adult on the planet suffers from varicosity. Studies over the past few years indicate that different degrees of the venous system damage of the lower extremities occur and reduce the quality of life in 80% of people of working age. One of the largest studies that describe cases of chronic venous diseases was the Vein Consult Program, which included 91,545 people from 20 countries. Diseases of the veins were found in 83%. Among patients with CVD, women (68.4%) prevailed over men (31.6%). The average age of those who surveyed with CVD was 53.3 years. Age dependence of the prevalence of venous diseases. The prevalence of varicosity in people aged 18 to 24 years is from 11%, men in the age group from 30 to 40 years is about 3%, and men over 70 years old is 40%. For women: from 30 to 40 years old is about 20%, and for women over 70 years old, more than 50%. From 55 to 64 years old is about 55.7%. The prevalence of skin changes in chronic venous unsufficiency (CVI) for women from 30 to 39 years old is 1.8%, while at the age of over 70 they are already found in 20.7% of those who surveyed. The increase in the prevalence of CVD with age is also confirmed by a study conducted in 2010 in Germany, in which molecular genetic methods were used for the first time.

Geography of chronic venous diseases

There is a well-defined dependence on the level of development of the country and diseases of the veins, therefore WHO classifies these diseases as diseases of civilization, in other words, to pathologies associated with urbanization and scientific and technological development.

Russia: the detection rate between men and women is 2 to 1, 38—40% for women and 18—20% for men;

USA: varicose veins among men in the age group 30—40 years old — 22%, 50 years old — 42% of cases, among women — in the age group 30—40 years old — 45%, 50 years old — 64% of cases.

England: about 11 — 18%

Europe: women and men — 2: 1;

In the countries of Central Europe, the prevalence of varicose veins in women is 30%, in men — 15%;

Mediterranean countries 18—19%;

China, Japan, India, the incidence rates in these countries are low, about 9%;

Africa 5—6%;

Arab countries approximately 11.5%;

New Zealand — about 33—40%.

In developing countries, varicose veins of the lower extremities are much less common than in economically developed countries, however, such indices may indicate a low quality of diagnosis, in contrast to countries where diagnostic rates are much higher, as well as the number of visits to a doctor with these kind of problems.

What is the circulatory system?

The circulatory system performs one of the most important functions in the body — it delivers to organs and tissues oxygen and nutrients what are necessary for the body’s vital activity, while simultaneously removing carbon dioxide and waste products from them. The blood vessels through which blood moves from the heart are called arteries, and the vessels through which blood returns to the heart are called veins. Small vessels that permeate all organs are capillaries.

What are the veins in our legs?

The veins of the lower extremities are divided into several groups depending on the depth of their location: cutaneous veins (the most superficial), superficial (located under the skin), deep, and also connecting the superficial veins and deep veins — perforant.

Cutaneous veins (small, their diameter is up to 3—4mm),while expanding, they form vascular “asterisks” and reticules which is a cosmetic defect. They do not cause health problems.

— Superficial veins (saphenous).

Superficial veins develop varicose veins. It can develop as an independent disease, and this condition is called varicose veins of the lower extremities. Perhaps as a secondary, when there is a pathology in the deep veins of the leg, which for its part causes overload and secondary expansion of the saphenous veins (superficial). In addition to varicose veins, they may have thrombosis, the so-called thrombophlebitis.

— Deep veins.

Deep veins do not develop varicose veins, they may have congenital defects and local expansion of deep veins (aneurysm) which is rather rare occurrence.

— Perforant.

Perforating veins are veins that connect superficial veins to deep veins.

What diseases are attributed to diseases of the veins?

Spider veins, varicose veins, thrombosis, chronic venous insufficiency, trophic ulcers.

Which doctor should you contact due to vein diseases and what is “phlebology”?

The treatment of blood vessels is done by “cardiovascular surgeons”, “general” surgeons, but specifically by venous diseases — phlebologists. Phlebology comes from the Greek phlebos (φλεβός) — “vein” and logos (λόγος) — “doctrine”, “science”) — a branch of medicine that studies the structure, functions of veins, and also develops methods of diagnosis, treatment and prevention of diseases. A phlebologist is a doctor specializing in vein diseases. Ideally, you need to contact him. Generally, phlebologists are proficient in ultrasound methods and all modern minimally invasive technologies, laser or radiofrequency ablation, sclerotherapy, and others.

What are the symptoms of venous diseases and when to consult a phlebologist?

When the following symptoms appear: spider veins and meshes, the appearance of varicose veins, ooedema, sudden one-sided ooedema (urgently), redness of the skin along the veins, heaviness or pain in the legs, the appearance of pigmentation on the skin of the legs, trophic changes, ulcers, during pregnancy for the prevention or treatment (varicose veins, thrombosis) and others.

What are the diagnoses for venous diseases, what is written in the doctor’s conclusion?

Chronic venous disease is diagnosed according to the CEAP classification.

CEAP is a clinical, etiological, anatomopathophysiological classification that takes into account: clinical manifestations (C — clinic), etiology (E — etiology), anatomical localization (A — anatomy) and pathogenesis (P — pathogenesis) of the disease. The reason for attributing a patient to a particular class is the presence of the most pronounced objective symptom of chronic venous diseases.

Examples of diagnoses:

CEAP: C2, S, Ep, As, p, Pr, 2.18 denotes: Symptomatic varicose veins, primary disease. Reflux along the great saphenous vein in the thigh and the perforating vein of the lower leg.

CEAP: C 3, S, Es, Ad, Po, 11,13,14,15 means: Post-thrombotic disease of the lower limb veins with oedema. Deep vein obstruction of the femoral-popliteal segment and tibial veins of the lower leg.

Interesting fact.

In 400 BC, Hippocrates first described varicose veins and how to treat it.

Chapter III

Vein Diseases

“Everything that the doctor does, let him do it right and beautifully”

Hippocrates / Ιπποκράτης

This chapter details common vein diseases and their complications.

Spider veins and meshes

Varicose veins

Thrombosis

Chronic venous insufficiency

Trophik disorders

Spider veins and meshes

Telangiectasia is a persistent expansion of small vessels of the skin (arterioles, venules, capillaries) of a non-inflammatory nature, showing by spider veins or reticules. The word comes from the Greek “expansion of the final part of the vessel”, telos (τέλος) — end, segment, and ectasia — expansion. Spider veins develop in the skin veins and give only a cosmetic defect when they are dilated and not harmful to health and this is not varicosity, but they can also be combined with varicose veins. “Meshes” and “spider veins” in medical terminology are called reticular veins and telangiectasias which is a very common pathology.

What are the reasons?

There are no proven reasons for their occurrence. There are several theories, for example, changes in hormonal levels (during pregnancy) or taking contraceptives, but all of them have not been proven.

Spider veins are varicose veins?

They do not cause a health hazard, complications and varicosity.

How to find out if there are meshes and spider veins or not?

One of the main reasons for seeking medical attention is cosmetic. This phenomenon is common to all ages. Eventually, the number of meshes increases. In older age, they form on the skin of the legs and legs but they do not go into varicosity.

Which doctor you need to contact?

Phlebologists and cosmetologists deal with the treatment of meshes and spider veins. However, it is best to contact a phlebologist, since doctor has experience in treatment and diagnosis, phlebologist can diagnose concomitant pathology if it is present, for example, varicose veins, and start treatment at an early stage, and as the third argument is that if a cosmetologists detects a disease, you go again to the phlebologist.

The treatment

This pathology is treated to remove unwanted cosmetic defects from the skin.

There are several treatments, the most popular of which are microsclerotherapy, laser percutaneous coagulation, radiofrequency coagulation and the ClaCS method. These methods are practically uncomplicated.

Microsclerotherapy is the introduction into a vessel of a special substance (sclerosant), which leads to the “sticking” of small vessels.

Laser percutaneous coagulation is a laser of a certain wavelength on the vessels, which allows them to be hardened without damaging the skin.

Radiofrequency coagulation — electrocoagulation.

However, in practice, microsclerotherapy and laser percutaneous coagulation are mainly used.

ClaCS method is a combined method of phlebologist Kazu Miyaki.

CLaCS is a method for the treatment of spider veins and asterisks. It combines the techniques of sclerotherapy (concentrated 70% glucose) and laser percutaneous removal with cooling during the procedure. The procedure is outpatient and takes about an hour. There are no advantages of some methods over others in the treatment of nets and asterisks.

Complications of the treatment

Complications are possible after any of the treatment methods for this pathology. Skin pigmentation, skin necrosis, relapse and allergic reactions.

— Hyperpigmentation and depigmentation

After the procedures, brown spots are formed. Hyperpigmentation will go away within a few months or years but depigmentation is rareand the causes of these complications are unknown.

— Skin necrosis

It is not common complication. The complication is associated with the wrong technique of performing the procedure. As a result, either heals completely, or leaves a small scar.

— Relapse

The appearance of new telangiectasias, most of which later go away on their own.

— Allergic reactions

As with the vast majority of drugs, the body may react to sclerosants. Modern sclerotherapy drugs are not strong allergens, and allergic reactions are rare.

Prevention

Phlebotropic drugs, dietary supplements, vitamins, folk methods do not prevent the development of spider veins and nets.

Interesting fact

The use of high-heeled shoes increases muscle load while walking and decreases venous pressure in the legs compared to walking barefoot, which is a positive factor in the treatment of varicose veins.

Varicose veins

“Of the constitutions of the year, the dry, upon the whole, are more healthy than the rainy, and attended with less mortality”

Hippocrates / Ιπποκράτης

Varicose veins of the lower extremities (from the Latin varix — “knot”) — one of the most common diseases of the vessels of the lower extremities, according to various sources, 20% — 40% of the adult population of developed countries suffer from varicose. Only superficial veins (saphenous) are subject to varicose veins, deep veins do not suffer from varicose veins. Diseases of veins are very multiple, it has different clinical symptoms and prognosis. For example, spider veins cause cosmetic problems for young women. Blood clots in deep veins can be asymptomatic and when they rupture, a very serious complication can occur — pulmonary embolism. One of the main symptoms of the disease is the appearance of varicose veins, the formation of varicose nodes — nodular extensions, which gave the name of this disease (varix — “knot”) and the thinning of the venous wall and it loses its elasticity as a result of the vessels stretch, which leads to the appearance of valvular insufficiency veins and the development of the symptoms of chronic venous insufficiency (CVI). CVI is occured by such symptoms as heaviness in the legs, ooedema, fatigue, burning sensation, cramps at night, violation of the trophism of the skin and soft tissues. Eventually, venous insufficiency develops in all patients with varicose veins.

How does varicose veins occur?

The circulatory system consists of a large number of large and small blood vessels. The blood fluid flows to the tissues and organs through the arteries, and back through the veins. The veins of the lower extremities have the largest number of valves. Blood normally flows upward through the veins — to the heart and lungs — because muscle contractions help it. With any movement, the contracting muscles act as a kind of pump, squeezing blood out of the veins and pushing it towards the heart. But according to the laws of physics, the liquid tends to go down. To prevent this from happening, there are valves in the veins. They open in the direction of the blood flow and close to keep it out. If the valves do not work properly, they do not close completely, and blood flows down the veins — a reverse flow (reflux) is formed. The vessels do not contain all this blood, they stretch, become longer and visible above the skin and acquire a tortuous shape. And there is a situation of varicose veins (varicose veins).

Etiology — causes of the disease?

Varicose veins are a person’s reward for walking upright. Compared to the blood vessels of four-legged animals that never suffer from varicose veins, the venous system of the lower extremities of a bipedal person is not in the best position.

Unproven reasons in the development of the disease from the point of view of science

An inactive lifestyle, wearing high-heeled shoes, working while sitting or standing, thermal procedures, sitting “cross-legged”, hormonal contraceptives or drugs do not lead to varicose veins. Some contraceptives be a risk factor for venous thrombosis.

Proven causes of varicose veins

— Family history — heredity

During of various and long-term studies of this pathology, it was noted that varicose veins is a hereditary disease and is the main factor in the development of varicose veins. When both parents have varicose veins, the offspring has a 90% chance of having varicose veins. By inheritance, a predisposition to the occurrence of the disease is transmitted and evidence of this is cases when young people or athletes develop an ailment. Inheritance usually occurs from mother to daughter. In patients, there is a congenital weakness of the venous wall and valves, due to a violation of the structure of the connective tissue, which ensures the strength of the venous vessels. It is interesting to note that varicose veins in these patients are combined with hemorrhoids, hernias, flat feet, varicocele (enlargement of the veins of the spermatic cord). If one of the parents has varicose veins, then the children inherit this disease in 60% of cases, if both, then in 90% of cases. Varicose veins can be not only in relatives, but also in several family members. Although varicose veins are “heredity”, it does not mean that it will show itself in 100% of cases. It develops under the influence of negative factors, lifestyle and work.

— Pregnancy and tendency to varicose veins in women

Pregnancy and childbirth can cause illness. Progesterone lowers the tone of the veins and develops an inferiority of the venous valves.In addition, the pregnant uterus compresses the veins of the abdominal cavity, disrupting the venous outflow and increasing the pressure in the veins of the legs, which increase in volume.

— Obesity

Visceral fat increases intra-abdominal pressure. It is transmitted to the veins of the lower extremities, which expand and valvular insufficiency appears. Although the factor with “being overweight” is controversial, it is only known for certain that obesity aggravates varicose veins and obese people with varicose veins have a higher percentage of complications.

How to find out if there are varicose veins or other vein diseases?

Veins are twisted and dilated, nodes are visually visible — this is varicose veins. In case of problems in deep veins, the elasticity of the skin in the lower parts of the legs changes and the skin becomes darker in color. For venous diseases, pain and discomfort in the lying position, disorders of skin sensitivity, tingling sensation are not characteristic. Pain disturbs in the evening. Varicose veins are most often seen in the lower leg and thigh area. In order to make a diagnosis, you need to find out the patient’s complaints, the history of the disease, conduct an examination, palpation, perform laboratory and instrumental studies.

There are no special tests (blood and others) for making a diagnosis.

On examination, varicose veins are revealed. Clinical evaluation should focus on visible signs of venous disease. The results of the physical examination such as the size, location and distribution of the dilated veins should be documented. Only the presence of varicose veins — gives the right to diagnose “varicose veins of the lower extremities.”

For a complete assessment of the disease, an objective examination should be supplemented with instrumental methods for diagnosing the lower extremities.

These include ultrasound, MRI and phlebography. Ultrasound is the most common research method and is the gold standard for the diagnosis of varicose veins. The most informative ultrasound method for venous pathology is duplex ultrasound in a special mode (B-mode). This method is most often used to diagnose, plan, conduct and evaluate the results of treatment of chronic venous diseases. Ultrasound should, if possible, be carried out in a standing position. The horizontal position is not suitable for detecting reflux and measuring vein diameters. Other tests (MRI, tomography, phlebography / venography) can be used in exceptional cases (for example, in case of congenital anomalies).

When there is no reason to worry?

— Unpleasant sensations in the legs, but outwardly the vessels are not changed, there is no ooedema — venous disease is unlikely;

— On the skin, “meshes” and “spider veins” are cosmetic defects.

When to see a doctor?

With the appearance of bulging, convoluted veins, formations similar to varicose veins. For any unilateral oedema. If the ooedema is bilateral and symmetrical, then they are not venous, but other reasons for the appearance, such as cardiovascular failure or etc.

Visit a doctor urgently!

The sudden, rapid appearance of unilateral ooedema is suspiciously similar to acute deep vein thrombosis, and it is this condition that should always be ruled out in the first place for unilateral ooedema. It is necessary to urgently call an ambulance, even if you feel normal, in extreme cases — to independently consult a doctor as a matter of urgency.

Which doctor do you need?

Varicose veins are treated by “cardiovascular surgeons”, “general” surgeons, but more specialized still “phlebologists”. The best option is to get to him. As a rule, a phlebologist himself conducts an ultrasound examination and owns all modern minimally invasive technologies for treating veins (laser ablation, sclerotherapy, etc.)

At the doctor’s appointment and after it.

The doctor finds out complaints, examines the limbs, discusses the treatment with you. The doctor performs ultrasound in standing position. In the lying position, the pelvic veins and the veins in the abdominal cavity are examined. The drug can be prescribed in tablet form, topical ointment and compression garment. But this appointment is more suitable for the treatment of chronic venous insufficiency. At the end, a conclusion is issued with the diagnosis, treatment, ultrasound protocol and a recommendation to be observed by a phlebologist to control the development of the disease in order to adjust the treatment at the right time.

Will varicose veins develop if it is not treated?

If you do not receive treatment for varicose veins, the condition can be worse and progress to the next stage of the disease. Several complications may occur, one of which is thrombophlebitis, trophic changes, and others. In addition, by delaying the treatment period, it will become more and more expensive.

The goals of varicose veins treatment

Depending on your symptoms, your doctor may recommend lifestyle changes, a procedure to remove or close varicose veins, compression therapy, or medication. The goal of treatment is to relieve symptoms, improve appearance, and prevent complications such as trophic ulcers, thrombosis and bleeding.

What are methods of treatment?

— Folk remedies

To treat varicose veins with folk remedies is not only ineffective, but sometimes not safe. When patients are treated with questionable methods, the result is many complications. For example, the use of leeches (hirudotherapy) can be harmful, after the procedure, scars form at the bite sites, infectious complications, and erysipelas. The use of various herbs inside, ointments based on them is absolutely useless and who can cause an allergic reaction.

— Local treatment