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Varicose veins can be a signal of chronic venous insufficiency – a condition in which, due to damage to the venous valves, the retreating blood causes swelling on the lower limbs, and over time also leads to skin lesions and ulcerations. Varicose veins are also prone to thrombosis, and ruptured veins can cause bleeding.
Mechanism of chronic venous insufficiency
Veins are the blood vessels through which blood flows to the heart. The flow of venous blood in the limbs takes place thanks to the work of the muscles pressing the veins, and the valves present in the veins cause that the blood pumped in this way flows only in one direction. Valve failure causes that the regurgitating blood causes the so-called venous hypertension. Increased pressure in the venous system leads to widening of the veins and the formation of varicose veins. Serum fluid passes beyond the veins, causing swelling in the limbs. Red blood cells also come out of the vessels, which in turn is manifested by the presence of rusty discoloration on the skin. White blood cells leaving the vessels lead to fibrosis of the skin and subcutaneous tissue. Additionally, the depletion of the venous outflow reduces the oxygen saturation of the blood and surrounding tissues, which results in the formation of skin ulcers.
Varicose veins – risk factors
Abnormalities in the structure or function of the veins are found in 50% of people. Varicose veins occur in 30% of the population, more often in women and in old age. The presence of varicose veins in parents is one of the risk factors for chronic venous insufficiency. If both parents are affected, children are 90% likely to have them. When they are present in one of the parents, the risk of their occurrence in the daughter is 62% and in the son – 25%. If neither parent has varicose veins, the risk in children is 20%. A strong risk factor is smoking, pregnancy, obesity, and the presence of a hernia. The weaker risk factors include a sedentary lifestyle and prolonged standing. Such a factor is also … flat feet. Chronic venous insufficiency can also be caused by a history of deep vein thrombosis (post-thrombotic syndrome).
Symptoms of varicose veins
Venous system disorders can manifest themselves on the lower extremities as telangiectasias, i.e. veins up to 1 mm in diameter visible on the skin, reticular veins (1-3 mm in diameter) and varicose veins (dilated veins> 3 mm), often twisted along their course. These abnormalities may be asymptomatic, and if symptoms are present, the most common symptoms are tingling, burning, fatigue, heaviness and fullness in the legs. Calf and foot cramps occur at night. There is swelling on the legs – initially in the evening, then it persists throughout the day. As the disease progresses, point-like rusty-brown discolorations merge on the skin of the lower half of the legs. In very advanced venous insufficiency, allergic dermatitis and subcutaneous tissue inflammation and painful ulcerations develop, which are typically located in the lower part of the shin, most often above the medial ankle.
Varicose veins – When to examine?
Color Doppler ultrasound is the test that allows you to confirm the diagnosis and plan the treatment. It should be performed in those people who have diagnostic doubts, if there is swelling of the limbs resistant to conservative treatment, or if surgical treatment of varicose veins is planned.
Varicose veins – When to treat?
Indications for the treatment of chronic venous insufficiency are symptoms such as a feeling of heaviness in the lower limbs, swelling, pain and cramps in the legs, the presence of typical skin lesions on the lower limbs (rusty brown discoloration, contact dermatitis) or venous ulcers. Treatment of chronic venous insufficiency begins with conservative therapy and only when it fails, invasive methods are used.
Conservative treatment of varicose veins
Conservative treatment consists mainly of changing the lifestyle and compression therapy. People with chronic venous insufficiency should avoid prolonged standing or sitting with legs bent. They should walk more and tighten their calves from time to time while sitting. It is recommended that at least 3 times a day, while sitting or lying down, place the lower limbs above the level of the heart for 30 minutes, preferably supported along their entire length. The second element of conservative treatment is compression therapy, i.e. pressure treatment, which is used in the presence of edema, contact dermatitis (associated with chronic venous insufficiency) or venous ulceration. For this purpose, special, available in pharmacies, elastic stockings with graded compression and appropriate compression class or elastic bandages are used. Kompresjoterapia is the only method of treating chronic venous insufficiency that effectively slows down its progression. Contraindication to its use is chronic lower limb ischemia, poorly controlled arterial hypertension, and severe heart failure. Pharmacological treatment is recommended only for people who are not able to apply the above methods or for whom these methods have proved ineffective. Drugs that reduce swelling and subjective ailments related to chronic venous insufficiency are preparations containing escin, which should be taken in an appropriate dose.
Varicose veins – Surgical treatment
Invasive treatment is used when the venous valves are inadequate and conservative treatment after 6 months of use does not bring any effect, as well as for cosmetic reasons and after superficial vein thrombosis or varicose rupture. Contraindication to surgical treatment is the deep venous obstruction found in ultrasound, pregnancy, chronic ischemia of the lower limbs, advanced systemic disease and joint diseases limiting the mobility of the limbs. There are many treatment methods for treating varicose veins. Among them, the least invasive is scletrotherapy, which consists in injecting a substance that causes it to grow into a broadened vein or vein. In the thermal method, laser light or radioablation is used for this purpose. The methods of mechanical treatment of varicose veins include ligation of veins, plastic surgery of venous valves and stripping (removal of varicose veins through small cuts on the skin). These methods are not perfect, as recurrences occur in up to 50% of people undergoing these procedures, and in the case of sclerotherapy, in 10% of people undergoing this least invasive method, permanent skin discoloration develops.
Varicose veins and contact dermatitis
One of the manifestations of advanced chronic venous insufficiency is contact dermatitis, which manifests itself in the skin with redness, itching, and vesicles. It develops in response to allergenic ingredients such as lanolin, silver or washing agents contained in skincare preparations, dressings or compression materials. It becomes then necessary to avoid factors causing allergic changes, moisturize the skin with petroleum jelly, use topical steroid ointments, and in cases of very severe reactions also oral steroids. Compression therapy is also indispensable in this case.
Venous ulcers
Venous ulcers require special attention. In order to heal them, they should be mechanically cleaned of necrotic tissue and fibrin. They require frequent changes of sterile dressings. Currently, silver, hydrocolloid and hydrogel dressings are available on the market. In the case of ulcers, compression therapy is necessary – during the treatment of ulcers, elastic bandages, and after healing, compression socks, which effectively prevent ulcer recurrence. When the ulcer is larger than 6 cm in diameter, the best way to heal it is to transplant healthy skin into the site.
When varicose veins are accompanied by typical symptoms, you should consider visiting a doctor who can make the correct diagnosis. If the suspicion of chronic venous insufficiency is confirmed, he / she will help to choose a treatment method appropriate to the stage of the disease. Proper therapy can bring relief from ailments and prevent further development of venous insufficiency, and thus protect against difficult-to-treat, poorly aesthetic complications.