Contents
The blood flowing through the veins is not easy. It even has to rush to reach the heart for oxygen and nutrients in the allotted time. The worse the condition of the veins, the more delayed the blood reaches the target. And when the life does not want to support her on this path – the blood stops. Varicose veins appear where the blood makes a compulsory stop.
When in 1628 William Harvey – professor at the Royal School of Medicine in London, an anatomist, physiologist and iatrochemist (advocate of the idea that the main task of chemistry is to discover new drugs) – published a theory about the structure and functioning of the human bloodstream, neither he nor his contemporaries they did not think it would be one of the most important discoveries in the history of medicine. After many experiments, Harvey showed that the heart acts as a pump that pumps blood into the blood vessels. These in turn distribute it throughout the body, supplying every system, organ, and the smallest cell with nutrients and oxygen, and transport it back to the heart.
It was Harvey who discovered that since the bloodstream is a closed system (blood does not spill over the body) and dynamic (blood does not stop circulating), it is possible not only to reduce and enlarge the amount of blood in the bloodstream, but also to administer drugs to it. It was Harvey who contributed to the popularization of phlebotomy, i.e. bloodletting, known from the Middle Ages and used until the end of the 1901th century (its effectiveness has not been confirmed). At Harvey’s initiative, the first transfusions were also performed. Although they were not successful, because blood groups and the theory of their compatibility were discovered only in XNUMX, the eminent Austrian doctor, scientist and Nobel laureate, Dr. Karl Landsteiner, Harvey’s trials gave rise to subsequent research on methods of replenishing the “life-giving” fluid.
Human plumbing
Today we know more about the anatomy and principles of the circulatory system. We also call it cardiovascular because it is made of the heart, blood vessels and blood. The heart is a precise device with special durability and the ability to adapt to the organism’s requirements. “It beats” with a frequency of 60-80 times a minute, which gives 100 thousand. strokes in one day and over 2,5 billion in 70 years. The heart is the “motor” of the entire circulatory system, which holds an average of about 5 liters of blood. With each heartbeat, approx. 70 cm3 of blood flows through this system, which is 300 liters of pumped blood per hour. The heart pumps blood into the small (pulmonary) circuit, where the blood is oxygenated and at the same time carbon dioxide is removed from it, and the large (peripheral) circuit, which distributes blood, the so-called fresh, i.e. oxygenated and nourished throughout the body.
Without oxygen and the nutrients in our blood, our cells simply die. Hence the important role of blood vessels forming the so-called vascular system – a kind of system of “pipes and tubes” transporting blood, with a smaller or larger cross-section, different structure and function. These “tubes” are nothing but arteries, veins and capillaries (capillaries, capillaries). The blood vessel network is so dense that each cell in the body is only 0,000025 mm away from the nearest vessel. If all the vessels were placed in one line, their length would be approx. 100 meters. km – more than twice the circumference of the globe.
From the vein …
It would be difficult to settle the dispute over which blood vessels are more important. After all, the task of the arteries (marked in red in anatomical figures, see p. 14) is to transport “fresh” blood from the heart and lungs to the tissues. Thin capillaries, about 0,1 mm in diameter, connect the arteries with the veins. Capillary walls have a high permeability, which means that these vessels are directly involved in the exchange of respiratory gases, nutrients and various metabolic products between blood and body cells. But the role of the veins (marked in blue in the figures) is no less important, as they carry blood from the tissues to the heart and lungs in order to re-oxygenate and nourish it.
The veins that occur in our body can be of various sizes – from microscopic to those whose width exceeds the thickness of two fingers of an adult human. The latter are called the main veins. The most important of them are: the superior vena cava that collects blood from the upper body, the inferior vena cava that drains blood from the lower parts, the jugular veins – internal (collects blood from the cavity of the skull, neck and face) and external (collects blood from the scalp and around the face) and the hepatic vein that drains blood from the liver. We also divide all veins into two types: deep, which accompany the arteries, and superficial – independent of the arteries.
The blood that flows through the venous vessels is usually deprived of oxygen and rich in metabolic products, therefore it takes on a dark cherry color. However, there are exceptions – blood flowing in the pulmonary and umbilical veins is bright red, which means it is highly oxygenated.
… for varicose veins
Veins differ from arteries not only in function but also in structure. Their walls consist of three layers: the outer – the so-called adventitia, i.e. a flexible membrane made of connective tissue fibers, the middle tissue – the so-called an intermediate membrane made up of elastic and partially muscular fibers, and an inner membrane – the so-called intima, consisting of connective tissue. Compared to the walls of the arteries, the walls of the veins are thinner and less contractile. Interestingly – if we cut the vein, it would turn out that in the cross-section it has the shape of an oval, not a circle. This is because the flowing blood only partially fills the vein.
The second characteristic of the veins are the so-called valves, or pocket-like folds of the inner membrane of the vein. It is the valves that allow the blood to flow to the heart and keep it from flowing back. There are numerous valves in the veins of the lower extremities, where the blood pressure is the weakest, and therefore the greatest possibility of its withdrawal.
The importance of the proper functioning of the valves was discovered by those who one day noticed disturbing changes – extensions, twists, and twists in superficial veins (visible through the skin) on the thighs and lower legs. These changes are commonly called varicose veins. In people who have weak muscles, weakened vein walls, or damaged, leaky valves, blood flowing through the venous arteries is more likely to divert its course upwards towards the heart. If it is not stopped by a closing valve, it begins to press against the walls of the veins with increasing force. These in turn expand and fill with hypoxic blood. The residual blood initially only slightly shows through the skin, but over time forms a thick, dark blue bulge.
The first word for “varicose” is “leg”. And no wonder – chronic venous insufficiency, the symptoms of which are disfiguring small “spider veins” or thick “ropes” of sick veins, most often affects the legs. We rarely equate varicose veins with hemorrhoids, and we know the least about varicose veins located in the esophagus or other lower parts of the body – the urinary bladder, uterus, vagina in women and seminal cord of the penis in men.
Troubles tumbling around
Both women and men suffer from chronic venous leg insufficiency, but the first four times (!) More often. This is because the walls of the veins in women are thinner and more delicate due to the action of female hormones. It is estimated that about 47% of Polish women struggle with the problem of varicose veins.
Women who often experience pain, swelling and cramping of the calves, swelling of the legs during menstruation (a symptom of hormonal disorders), have been pregnant several times or are undergoing menopause and taking hormonal drugs are at risk of varicose veins. It is also known that people whose work requires prolonged standing (e.g. hairdressers) or sitting (e.g. office workers, drivers), who lead a less active lifestyle, and who are overweight and obese (move less, and cholesterol obstructs blood flow) and joint diseases (e.g., degenerative or rheumatoid arthritis) or those that have had phlebitis. The formation of varicose veins is also a genetic condition. If one of the parents had them, the probability of inheriting the disease is 40%, and if both – it is even 90%. The legs should be especially taken care of by people in advanced age (their valves do not work very well anymore), as well as those who have had cases of venous thrombosis or pulmonary embolism in their family, and finally those who were immobilized for a long time due to the disease.
The first symptoms of varicose disease are usually not disturbing. Depending on the season, “heavy legs”, swelling, tingling and cramps, the feeling of cold or hot legs can be explained by heat, heavy shoes, standing or sitting for too long, and dry, flaky skin – with a badly matched body lotion. It is only when “blue threads” appear on the surface veins visible through the skin – usually on the calves, thighs and under the knees – that we panic. If you do not consult your doctor within this time, these bluish lines will become more convex over time and you will feel distinct lumps by touching them. In the next stages, our legs may become disfigured by the twisted “ropes” of the veins, then brown discoloration of the skin, and finally, difficult to heal and unfortunately recurring leg ulcers may develop.
Another serious complication is the thrombophlebitis of varicose veins, which can affect not only superficial but also deep veins, and lead to pulmonary embolism, i.e. blood blockage that leads to death. Pulmonary embolism is caused by blood clots which, broken from the wall of the venous vessel, reach the lungs with the blood. It is precisely because of the risk of pulmonary embolism that all people who are planning an operation are recommended by surgeons to remove varicose veins first.
The arsenal of a phlebologist
Before making a diagnosis of the stage of chronic venous insufficiency of the legs and determining the method of its treatment, it is preceded by a detailed diagnosis. The phlebologist (specialist in venous diseases) will first assess the skin tone (whether it is red or pale, but with discoloration), check the body temperature around the venous lesions by touch, as well as the course of the veins and the size of “spider veins” or larger varicose veins, as well as swelling and induration venous. Then he orders a standard Vein Doppler ultrasound (Duplex-Scanner), which helps to determine the way blood flows, observe narrowing and obstruction of the veins, and assess the degree of valve functionality. Other tests, equally often used in the diagnosis of varicose veins of the legs, are: varicography – a contrast agent is injected into the veins to create a kind of map of malfunctioning vessels, and liquid crystal thermography – the patient first changes the position of the foot several times, putting it on the heel, then on the fingers, and then a liquid crystal plate is placed on the foot, and diseased veins can be seen on it as “hot spots”. The third additional test may be venography, which assesses the condition of the deep veins. A contrast agent is injected into a vein on the back of the foot, and then a tourniquet is applied to the ankle. Under pressure, the center goes directly to the deep veins.
Telenagiectasia, or varicose “spider veins”, and simple varicose veins are usually treated conservatively (eg by wearing special, certified anti-varicose stockings or knee-length socks, massages, baths in cool water with the addition of alum or baking soda, which help shrink venous vessels). Pharmacology is also used (e.g. the use of ointments, creams, oral preparations with the addition of horsetail, rue, arnica and horse chestnut extract, which reduce swelling, stimulate circulation and strengthen the walls of blood vessels). With this type of varicose veins, the doctor may also decide to perform minimally invasive procedures to remove venous changes, e.g. laser therapy, sclerotherapy or photoderm surgery. Large varicose changes go under the surgeon’s scalpel, who can choose between three methods of removing varicose veins – miniphlebectomy, cryostripping and stripping.
Varicose veins at the end
Hemorrhoidal disease, i.e. inflammation of haemorrhoids (professionally called haemorrhoids, colloquially haemorrhoids), is a disease as common as varicose veins of the lower extremities, but much more embarrassing. Malfunctioning hemorrhoids occur in about 30% of adults, but since most patients do not admit to having this disease, these are only estimates. The shame is caused mainly by the location of the venous changes. Hemorrhoids are small vascular plexuses filled with blood that tightly surround the upper part of the anal canal, like a ring. Together with the sphincter they control the process of defecation. When they become inflamed, the vessels fill with blood excessively and do not empty completely when passing stools. As a result, they are constantly irritated and lose their elasticity.
Hemorrhoids are sometimes referred to as “taxi driver’s disease” because their formation is favored by sitting in one place for many hours. Other risk factors include age (people over 50 complain about it most often) because with it the connective tissue that fixes the venous vessels begins to weaken, which can cause varicose veins to fall out, as well as a tendency inherited from parents, liver diseases, hypertension, obesity, frequent constipation and diarrhea, and a diet low in fiber. People who have undergone operations on the gastrointestinal tract also admit to having problems with hemorrhoids – for example, who have undergone surgical treatment of obesity and have a gastric bypass. These patients digest their food faster and need to use the toilet more often.
In the initial stage, hemorrhoidal disease may not be felt at all. Its first symptom is usually slight bleeding during defecation. Only the development of the disease brings other, much more troublesome ailments – itching, burning, a feeling of pressure, swelling, irritation of the epidermis around the anus, a feeling of constant humidity and stool incontinence, leaving stool marks on the underwear and pain – sometimes severe and long-lasting, which appears, when the blood in the varicose vein clots. Proctologists (specialists in diseases of the large intestine and rectum) distinguish four stages of hemorrhoidal disease. In the first, small varicose veins appear that do not cause any problems. In the second – the nodules enlarge, causing pain (when sitting and standing), they fall out when passing stools, but then return to the anal canal on their own. In the third – varicose veins protrude outside, but they can be put back in the anal canal. In the fourth, the hemorrhoids fall out and do not return to their place.
Treatment of hemorrhoids is preceded by tests that exclude other diseases that give similar symptoms – e.g. colorectal cancer. The diagnosis is made after proctological examinations – anoscopy (with local anesthesia, insertion of a speculum through the rectum to check the condition of the hemorrhoids and anal canal) and colonoscopy (after administration of relaxing agents and anesthetics or under general anesthesia, the doctor introduces an endoscope through the rectum, i.e. a very flexible optical apparatus). electronic to view the entire length of the large intestine). During the second examination, it is possible to take sections of the changed tissue for histopathological tests and perform certain surgical procedures.
Malfunctioning hemorrhoids in the first phase of the disease are completely curable. The therapy is facilitated by exercise and the introduction of more fiber into the diet, which regulates the metabolism. Until recently, hemorrhoids that fall out were placed directly under the surgeon’s scalpel. Today, however, they are subjected to inoperable therapies – e.g. electrocoagulation (electrosurgery method consisting in cutting protein in the tissue using an electric arc), cryotherapy (cold treatment) or ligature with the Barron method. The latter procedure involves placing a tight rubber band around the base of the hemorrhoidal nodule, which inhibits the blood supply and causes necrosis of the nodule.
… And at the beginning of the alimentary path
Varicose veins can also be located in the esophagus – they are in the form of dilated veins located in its lower part. Their appearance is associated with liver failure – usually cirrhosis caused by alcoholism, chronic hepatitis B and type C. If the liver is not functioning properly, blood pressure increases in its vessels, which, unable to flow through the organ itself, looks for another expensive. The blood flows into the esophagus veins and produces the so-called collateral circulation. And because the veins in the esophagus are not naturally adapted to collecting this amount of blood, they begin to swell and stretch, become brittle, and prone to bursting and bleeding. And it is the profuse hemorrhage that is the first symptom of esophageal varices. It does not have to take the form of a fresh blood stream, but it can be, for example, vomiting stained with blood or with clots, or vomiting with blood already slightly digested. Interestingly, esophageal bleeding can also be seen in the so-called tarry, that is, dark red or black stools. The large loss of blood during hemorrhage leads to weakness, lowered blood pressure, increased heart rate, and even shock and death.
Esophageal varices are diagnosed only after the first bleeding – most often during endoscopic examination, which is performed under local or general anesthesia. It consists in inserting a soft probe with a camera into the patient’s esophagus and examining its walls. The advantage of this examination is the possibility of simultaneous treatment of varicose veins – e.g. the already known sclerotherapy (repeated at first 3-4-day and then several-week intervals) or putting a rubber band on the varicose veins in order to lead to its necrosis. Pharmacological agents (e.g. vasopressin, somatostatin) are also used to treat esophageal varices. If no methods help to stop the bleeding, a so-called tamponade using a special probe inserted into the esophagus through the nose or the so-called TIPS, i.e. transvenous intrahepatic systemic anastomosis, which involves the insertion of a special stent in the venous vessels of the liver, which improves the circulation in this organ and the resulting collateral circulation through the esophageal veins is less stressed. The most effective method of treating esophageal varices is to eliminate their immediate cause, i.e. liver cirrhosis. This, however, is only possible through a transplant.
Intimate – not only feminine
Pregnancy is a period of special changes in a woman’s venous vessels. Then the blood volume in her body increases by approx. 50% – from approx. 4 to approx. 6 liters. Its role is not only to nourish the fetus. It is also a “reserve” for the “bloody” time of labor. In order to cope with such a large amount of blood, veins in pregnant women grow larger, but under the influence of a high dose of progesterone, they simultaneously lose their elasticity and hardness. This is why one of the common ailments during pregnancy are varicose veins of the lower extremities. In addition, the pressure of the still-enlarging uterus on the veins of the pelvis can also lead to the formation of varicose veins in the uterus, but also in the vagina and bladder. The problem of varicose veins in these intimate places is usually solved after … resolving.
More effort is required in the treatment of men – varicose veins of the penis’ spermatic cord. They appear in the veins that collect blood from the testicles and scrotum as a result of congenital or acquired insufficiency of the valves in the veins. The blood then withdraws, remains in the vessels, its pressure increases, and under its pressure, the veins expand. This type of varicose veins can also be caused by kidney cancer or thrombosis of the kidney vessels. In most cases, the presence of varicocele does not manifest itself in any obvious ailments. Sometimes patients complain of heaviness, dull pain or discomfort in the scrotum. It happens that they report to the doctor themselves when they feel small, lumpy formations above one of the testicles. Varicose veins of the spermatic cord are treated with three methods – surgical, reaching the venous vessels collecting blood from the testicle, laparoscopic and the already described sclerotherapy – in this case the nuclear vein.
WORTH KNOWING
Methods of removing varicose veins of the legs
– Laser therapy – the area around varicose lesions is anesthetized with a special preparation, and then the laser illuminates several places on the “spider veins”. The laser beam evaporates the blood from the vessel, creates a vacuum bubble, the walls of the vein collapse and stick together, and the varicose veins close. Sometimes a variable frequency RF current is used along with the laser beam, which helps the diseased vessel to close.
– Photoderm (using pulsed IPL light sources) – the skin over the varicose vein is lubricated with an anesthetic cream and then with a cooling gel. The crystal tip of the device generating the pulsed light beam is placed on the marked fragment of the varicose veins. This light passes through the crystal, heats the tissue to a high temperature and destroys it.
– Sclerotherapy (obliteration) – a special preparation is injected into the varicose veins, which causes the vein to simply overgrow. The procedure lasts from 10 to 30 minutes, it is performed in a treatment room, does not require anesthesia, but it happens that the injections have to be repeated several times, and after a series of treatments, anti-varicose stockings with increased pressure should be worn for about 3-4 weeks.
– Miniphlebectomy – the doctor makes a 1-3-mm incision over the diseased vein, and then uses a crochet-like instrument to pull out the pieces of the main stem of the changed vessel, and then its branches. The wounds are taped over with patches, and once they have healed, there is a slight trace of the incisions. The procedure is also performed under local anesthesia and then does not require hospitalization.
– Cryostripping (cryoavulsion) – along the veins, the surgeon makes several 1,2-3 mm incisions through which he inserts a probe with a 24-carat gold-plated tip. The probe is connected to a device containing nitrous oxide, which cools the tip to a temperature of -80 to -100oC. A fragment of the vein sticks to the cold tip and is pulled out. In this way, the entire diseased venous vessel is removed piece by piece. The procedure is performed under local anesthesia.
– Stripping – the procedure is performed under full or lumbar anesthesia (blocks the feeling from the waist down). The surgeon makes two 1-2- or 5-cm incisions in specific places of the leg – in the groin or under the knee and at the ankle of the foot. He introduces a soft, metal or plastic, disposable rope into the diseased vein, i.e. stripper to which he attaches the cut vein and removes it. This is how it “gets rid” of other varicose veins. Varicose veins outside the major basins are removed using miniphlebectomy or cryostripping. At the end of the treatment, sutures, skin staplers (i.e. metal staples) or special plasters are removed after 8-10 days. The operated leg may hurt for a few days, postoperative hematomas are visible for about 2-4 weeks, and small scars remain after the incisions.
IMPORTANT!
How to care for the veins
Sick, broken veins do not hurt. Usually, we do not realize that there is something wrong with them. Clear symptoms such as disfiguring venous changes visible through the epidermis, pain or hemorrhage are prompting us to consult a phlebologist. Here’s what we can do for the veins to improve their circulation so that they serve us as long as possible:
– enrich the diet with fiber that accelerates the metabolism;
– move! – exercise, walk, climb stairs every day, do not take the elevator;
– do sports – jogging, cycling, Nordic walking, swimming;
– give up wearing high-heeled shoes on a daily basis;
– do not wear tight-fitting clothes (e.g. pants, underwear) and self-supporting stockings;
– do not cross your legs – while sitting, place your legs next to each other, bent at right angles and joined at the knees;
– place your legs above the level of your heart as often as possible – preferably in the “sheriff” position, ie on a table (stool);
– take frequent breaks for a short walk while working that requires long sitting or standing;
– minimize the use of the solarium and sauna – especially when varicose veins have already appeared;
– replace hot baths that make the blood circulate through the veins more lazily with a cool shower.
Text: Magdalena Gajda