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Varicose veins: Where do “veins in the legs” come from and how to deal with them

IF JACK WHITE VENINS ON THE SKIN ENCHANGE and even inspire the creation of songs, then too noticeable vessels can cause psychological and sometimes physical discomfort for many of us. Often in such cases, varicose veins are diagnosed – a common disease that up to 35% of the population face in the United States alone , and in Russia, according to recent data , 34% of 703 study participants (both men and women) are concerned about it. The same statistics show that over 69% of the surveyed Russians live with chronic venous insufficiency, which sometimes leads to varicose syndrome.   

Together with a phlebologist surgeon, a member of the Association of Phlebologists of Russia and Reaclinic doctor Oleg Shonov, we understand how varicose veins change our veins, whether the disease can seriously harm our health and which treatment works more effectively.

Why do veins swell

Varicose veins (from the Latin varicis – “swelling”) is the first thing that comes to mind when it comes to diseases of the legs. The lower limbs really suffer from it much more often, but under certain circumstances, the veins can increase in diameter not only in the legs. Experts talk, for example, about the varicose veins of the pelvis, which occurs during pregnancy, about the expansion of the bowel vessels or varicocele – varicose veins of the testicle. But, according to Oleg Shonov, such phenomena, as a rule, turn out to be only a symptom of another condition or disease.  

By itself, varicose veins leads to the fact that the vessel not only grows in diameter, but really swells, as it were, acquiring a tortuous shape. The cause is malfunctioning of the venous valves, which regulate blood flow. The thing is that in healthy legs the blood moves through the vessels from the bottom up (towards the heart and contrary to the law of gravitation), which is exactly what the valves are responsible for; in addition, muscles also help, for example, when we walk. They work on the principle of a pump, and each muscle contraction “pushes” blood upward. At this time, the valve opens, allowing the flow, after which the flaps close tightly, not allowing blood to drain in the opposite direction. When something goes wrong, a gap appears between the flaps, and, as a result, the valves stop coping with their function: blood is thrown in the opposite direction, that is, down from the heart, and the tissues receive less oxygen. As a result, the pressure increases so much that the walls of the veins cannot withstand, which is why they spread out in breadth.

In this case, varicose changes affect only the saphenous, superficial veins, which are easy to see. The deep ones, through which up to 90% of the blood passes, remain unharmed due to their powerful, thick walls and more developed valves. Nevertheless, both are connected like twigs, and although the deep veins are not afraid of varicose syndrome, it is much more dangerous for them to develop blood clots, which can provoke advanced varicose veins.

Are all visible veins dangerous?

If for some time the vessels under the skin have become more noticeable and it has become easy to feel them, this does not mean that varicose veins have appeared. Many are inclined to think that its initial stage is manifested in the form of “spider veins” or “nets” (in the Western tradition – spider veins); large saphenous veins from nature, which are often clearly visible in people with thin, fair skin, can also scare. A fundamental difference from unhealthy enlarged veins in diameter – the veins of the spider veins reach no more than 1 mm, and the width of large subcutaneous veins can be within 1-3 mm, but neither one nor the other is dangerous in itself.

According to Oleg Shonov, about 80% of women encounter vascular networks. At first, they appear as small, almost imperceptible veins, but they can increase in size and occupy an ever larger area. This may be due to severe physical exertion, pregnancy, general changes in the hormonal background, including when taking contraceptives, injuries or congenital diseases. It is not at all difficult to distinguish stars from varicose veins: the former can be not only blue, but also red, and also not felt when held by hand, while the latter are more textured, they rise above the surface of the skin, often resemble a nodule or tubercle.  

In most cases, the phlebologist determines the expansion of the veins visually, and ultrasound examinations are needed rather to find the source of varicose veins, to understand which vein triggered the process, and to determine the treatment tactics. Nevertheless, if patients notice specific symptoms, such as swelling, itching, and pulling pain along the inner side of the leg, and there are no visible manifestations, an ultrasound scan will help to exclude non-obvious abnormalities. In this case, the doctor will prescribe a duplex scan ( Doppler ultrasound), and sometimes angiography , which will show how the vessels look, how the valves in the veins work, how the blood flow moves.  

Who is at risk 

Researchers and specialists still cannot give an unambiguous answer why some of us develop varicose veins, while others, even with strong loads on the veins (professional sports, multiple pregnancies, etc.), he bypasses. There is a theory about congenital weakness of the venous wall, as well as the idea that a characteristic inflammation can occur inside the vessels, which will then lead to varicose veins, but there is still no sufficient evidence.

Today, doctors agree that there are factors due to which the risks of manifestation of varicose syndrome are growing. It is believed that much depends on heredity, and if at least one of the parents had varicose veins, the chances of children to face the same problem increase to 40-50%. Pregnancy, strenuous physical activity (for example, work where you need to stand for a long time), lack of moderate sports activity and heavy weight can also affect. But frequent and prolonged walking in heels, in which advertising usually sees the culprit of varicose veins, is unlikely to provoke the disease. “On the contrary,” says Oleg Shonov, “a high heel makes the lower leg muscles work actively, stimulates a more powerful release of blood, there will be no stagnation. For veins, in my opinion, the height of the heel does not matter. You just need to periodically change it, do not go constantly on high heels. Choose not only high heels, but also medium and low. Then different muscles are involved in the work, which is good for the foot, and the muscle pump of the lower leg will be used one hundred percent. ” 

It is no coincidence that advertising of drugs for veins is targeted at women: as a recent study of a part of the Russian population shows , varicose veins are recorded in 63% of women and 37% of men. Shonov explains this distribution by the fact that the tone of the veins is regulated, including at the hormonal level, and pregnancy in this sense is a powerful trigger, so that most patients note the appearance of noticeable veins during this period. Firstly, in the veins of the pelvis, in the ovarian and uterine veins, the volume of blood increases greatly, which can lead to their expansion through the perineal vessels, for example, to respond with varicose veins in the legs. Secondly, the uterus increases in volume and can press its weight on nearby veins, which also increases venous pressure and leads to varicose veins.  

What does it threaten

Due to impaired blood flow in the varicose veins, blood clots can form and the so-called thrombophlebitis begins . The worst thing is when blood clots spread to deep veins: the consequences of such complications ( thrombosis , thromboembolism), if the necessary measures are not taken in time, can be very serious and even life-threatening. Untreated varicose veins can result in trophic skin disorders of varying degrees: pigmentation and hyperpigmentation, venous ulcers. If the pressure on the vessels only increases, metabolic processes begin to suffer and, as a result, the skin. Trophic ulcers are the last stage of such changes: they heal for a long time and can reopen repeatedly until the source of the disease is eliminated. 

Will ointments from advertising help?

Today, you can get rid of varicose veins in different ways, and often you have to choose not one method, but several complementary ones. In the treatment of venous problems, specialists can combine both conservative agents (compression hosiery, tablets), and surgical intervention (laser and radiotherapy, mechanical vein removal), sclerotherapy. It all depends not only on the financial capabilities and wishes of the patient, but also on the availability of the necessary equipment and drugs in the clinic.

If you do not want to carry out the operation, and the scale of the damage is not so strong, you can limit yourself to conservative treatment. At the same time, Shonov recommends focusing on the use of compression hosiery, since in reality this is the only means that slows down the progression of the disease without surgery. Knee-highs and stockings create a dense frame for the veins, compensating for the lack of natural tone of the vascular walls. Ointments and tablets can help, but not as advertised: ointments are useful for self-massage – the cooling components included in the composition will reduce the unpleasant signs of varicose veins – and the tablets will close the symptoms and relieve heaviness in the legs. The above will not work at all on the spider veins, it is better to use sclerotherapy – a method in which a drug is injected into the vessel to glue the veins, which makes them stop expanding. With varicose veins, this method can work only if the lesion is small and isolated; otherwise, relapses may begin. 

Surgical treatment of varicose veins is still the leader in efficiency. At the same time, the classic phlebectomy – the surgical removal of varicose veins, when they are pulled through a small incision in the skin – is almost never used today. In addition to the fact that the procedure itself is very traumatic, it cannot be carried out without anesthesia, and after the operation, a recovery period is inevitable. Laser and radiofrequency surgery are also surgical methods of treatment that, unlike traditional surgery, do not require incisions, are performed under local anesthesia and have no physical limitations: immediately after the procedure, the patient can get up and go about his business. Moreover, after the operation, even a thirty-minute active walk is recommended.

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