Varicose veins are veins that have been subjected to prolonged compression by abnormal blood flow, resulting in impairment of the normal function of the valves in the vessels, causing excess blood to accumulate in the vessels, resulting in thinning of the vessel walls and protrusion of the vessels. The external manifestations are usually protruding veins, edema and ulceration, and the internal manifestations are thrombosis. It has a considerable relationship with lifestyle habits and is more common in women than men, with a tendency to be younger. The consultation falls under the category of vascular surgery treatment. Because the initial symptoms of varicose veins are not obvious, they are often overlooked, and people usually find varicose veins starting from “bruises”, but this often does not attract the attention of patients, so that they miss the time for treatment, which eventually leads to “old rotten legs” and even amputation. And varicose veins caused by the venous thrombosis may also lead to sudden heart, brain and lung embolism, 5 minutes can cause death, so we must follow the principle of early detection and early treatment.
Varicose veins are mainly caused by damage to the valves of the veins in the lower extremities, and are one of the four most common surgical diseases, and experts point out that the main feature is that the blood vessels protrude from the surface of the skin, like earthworms, curved and lumpy. Early varicose veins of lower limbs are asymptomatic, so it is easy to be ignored and not taken seriously. Generally after experiencing the disease for more than 10 years, as the backflow of venous blood and bruising worsens, it gradually causes lower limb edema, darkening of calf skin color (hyperpigmentation), bruising dermatitis, painful venous thrombosis, and even ulcers. In the past, the knowledge of varicose veins often stays in the fact that standing for a long period of time leads to elevated venous pressure and varicose veins.
According to the expert group’s clinical findings over the years, varicose veins have a certain relationship with prolonged sitting and estrogen, in addition to prolonged standing. Unlike men, varicose veins in women mostly occur in urban office population. According to statistics, about 25-40% of women and 20% of men in Taiwan suffer from varicose veins. Teachers, surgeons, nurses, hair stylists, counter girls, chefs, restaurant waiters and other occupations that require long hours of standing are all high risk groups.
Varicose veins are an irreversible process, so once you are confirmed to have varicose veins, you should go to the vascular surgery department of a regular hospital as soon as possible to avoid missing the best treatment period.
Varicose veins clinical performance
1.Surface blood vessels are like earthworms, obviously protruding from the skin, and the varicose veins are in the shape of masses or nodules;
2.Soreness and swelling in the legs, heavy at night, light in the morning, skin pigmentation, dark color, skin flaking, itching, edema in the ankles;
3, there is ascites, hepatosplenomegaly, vomiting blood, black stool, extensive edema of both lower extremities pain in the affected extremities, aggravated by movement, sometimes pain at rest, aggravated at night;
4, the limbs have different sensations, limb chills, limb hot flashes, thinning of the affected limbs, thickening of the skin with pins and needles, itching, numbness, burning sensation;
5, the epidermis temperature increases, there is pain and pressure pain;
6.Toe (finger) nail thickening, deformation, slow growth or stop;
7. Gangrene and ulcers are produced.
Varicose veins symptoms causes
Varicose veins are mainly caused by damage to the valves of the veins in the lower extremities, which is one of the four most common surgical diseases, and experts point out that the main feature is that the blood vessels protrude from the surface of the skin, like earthworms, curved and lumpy. Early varicose veins of lower limbs are asymptomatic, so it is easy to be ignored and not taken seriously. Generally after experiencing the disease for more than 10 years, as the backflow of venous blood and bruising worsens, it gradually causes lower limb edema, darkening of calf skin color (hyperpigmentation), bruising dermatitis, painful venous thrombosis, and even ulcers. In the past, the knowledge of varicose veins often stays in the fact that standing for a long period of time leads to elevated venous pressure and varicose veins.
According to the expert group’s clinical findings over the years, varicose veins have a certain relationship with prolonged sitting and estrogen, in addition to prolonged standing. Unlike men, varicose veins in women mostly occur in urban office population. According to statistics, about 25-40% of women and 20% of men in Taiwan suffer from varicose veins. Teachers, surgeons, nurses, hair stylists, counter girls, chefs, restaurant waiters and other occupations that require long hours of standing are all high risk groups.
Varicose veins are an irreversible process, and once confirmed, varicose veins should be seen by a vascular surgeon at a regular hospital as soon as possible to avoid missing the best treatment period (see the term “early treatment implications”).
Superficial varicose veins start in the calf and extend to the thigh, while deep varicose veins can appear anywhere in the lower extremities.
However, experts point out that the appearance of a long, straight “bruise” in the calf is not necessarily a varicose vein, which is common in the calves of athletes, whose feet are often under pressure, and whose veins are normal.
Varicose veins are a vicious cycle, when one of the valves breaks down and loses its function of transporting blood back to the heart, the blood accumulates in the vein, the vein expands under pressure and implicates the next valve, which is unable to cover the overexpanded vein and loses its piston function, which then affects the third and fourth valves. With the gradual improvement of people’s living conditions, more and more people are paying attention to the early treatment or good.
After a long investigation and research, several key causes have been summarized.
1) Congenital causes: Patients may be born with some small problems with their valves, and with the acquired pressure, varicose veins are formed;
(2) Vascular problems: People who have suffered from venous embolism may have impaired valve function as a result;
(3) Perforation failure: The perforated veins, which connect the superficial veins to the deep veins, also have valves that prevent blood from flowing from the deep veins to the superficial veins, however, when the perforated veins have valve function problems, blood flows at will and puts pressure on the superficial veins, which dilate;
(4) Drug addicts: People who use syringes to take drugs are prone to damage to the valves of the deep veins;
(5) Pregnant women: Female hormones can cause the veins to dilate and the valves cannot cover the veins to stop the backflow of blood;
(6) Obese people: Because the lower extremities need to support the huge body, the venous pressure increases.
The occurrence of primary lower extremity deep vein valve insufficiency leading to varicose veins is a major contributing factor to the disease, in addition to the underlying causes such as weak vein walls and poorly developed vein valves, and the long-term increase in reverse pressure in the proximal segment of the veins and acting on the distal deep vein valves. Increased pressure in the proximal segment of the deep veins of the lower extremities, i.e., the continuous enhancement and impact of reverse gravity, firstly, causes the free edge of the valve to relax, elongate, sag and incomplete, and eventually loses the one-way opening function, leading to backflow of blood, and then results in venous hypertensive lesions, causing venous stasis and dilatation.
Venous dilatation is the result of valve damage; the first pair of valves in the superficial femoral vein is damaged by gravity of the vertical blood column, and the valves in the distal superficial femoral vein are damaged sequentially according to the “domino” effect. At the beginning of the lesion, the venous blood can still return to the heart quickly without any symptoms due to the compensatory function of the body, especially the effective pumping action of the gastrocnemius muscle.
When the valve destruction once crosses the N vein plane, on the one hand, the calf vein wall and valve bear higher pressure because of centrifugal farther; on the other hand, when the calf deep vein valve is destroyed, the deep vein blood flows backward to the distal side, due to the contraction effect of gastrocnemius muscle pump, the distal deep vein valve and traffic vein valve can be destroyed, the so-called “broken wind box “When the gastrocnemius muscle contracts, some of the blood in the deep vein flows backward into the supra-ankle venous network through the traffic vein, causing the local venous system to be in a state of stasis and high pressure, thus causing a series of pathological changes of skin dystrophy in the foot and shoe area.
Varicose vein disease classification
Varicose veins stage I. The surface blood vessels are varicose like earthworms, protruding out of the skin obviously, and the varicose veins are in the shape of masses or nodules, with capillary dilation, reticular veins, and flushing of the ankle.
Varicose veins stage II The curved and thickened superficial veins can be seen in the legs when standing, higher than the skin, and can disappear after the legs are raised or lying down, often with discomfort such as sore and swollen calves, easy fatigue, etc. This stage is the best time for treatment.
Varicose veins stage III The varicose blood vessels increase and edema begins to appear in the lower leg, which is more obvious after standing for a long time or after exertion, and the edema can subside in the morning. The affected limb is often thicker than the opposite leg, and some people also have itchy skin, and in severe cases, skin lesions such as eczema and stasis dermatitis.
Varicose veins stage IV Excessive blood stagnation in the blood vessels and a significant increase in venous pressure cause part of the blood components to penetrate into the skin and subcutaneous tissue outside the blood vessels, resulting in localized skin reddening, turning purple, until black (iron deposits in the blood), and loss of elasticity and hardening.
Varicose veins stage V has developed into an acute ulcer stage, the blackened and hardened skin breaks down under the action of external forces, which is difficult to cure by ordinary methods and seriously affects work and life.
Varicose veins stage VI The late stage of varicose veins, or recurrent venous ulcers without proper treatment, forming polycarbonate legs, commonly found near the ankle joint and the lower part of the calf, commonly known as “old rotten legs”.
Diagnosis of varicose veins and susceptible groups
Diagnosis and susceptible groups
Several diagnostic bases.
A. A history of prolonged standing and elevated abdominal pressure, or a family history of varicose veins.
Second, the veins of the lower extremities of the patient are obviously tortuous and dilated, which is more obvious when standing.
Third, the deep vein is patent, the saphenous vein valve is incompetent, and there may be traffic branch vein valve incompetence.
Ultrasound Doppler or venography shows tortuous dilatation of saphenous vein and valve insufficiency.
V. It may be accompanied by complications such as hyperpigmentation, ulceration, thrombotic superficial phlebitis, bleeding, and ulceration.
Sixth, varicose veins of the spermatic cord are mainly caused by sedentary, standing, long-term masturbation, unrestrained sexual life, smoking and drinking, etc.
Hazards of varicose veins
Hazards of varicose veins of lower limbs
(1) Affect the beauty of legs: varicose veins affect the beauty of legs, besides, at the early stage of the disease, patients have more soreness and pain; at the later stage, the damaged veins bulge and expand, and the saphenous vein of calf is heavy.
(2) Vein damage. Long-term varicose veins in patients with weak vein walls, high venous pressure, coupled with the local blood supply is insufficient to cause muscle, fat tissue atrophy, varicose veins protrude under the skin, mild injury will cause ulcers, and easy to damage the vein wall.
(3) Edema combined with eczema. Due to the increased edema of the tissue caused by venous stasis, eczematous changes in the skin occur.
(4) Ulcers. Itching of the skin makes the patient scratch uncontrollably, aggravating the eczema and causing erosions and ulcers. In long-standing cases, there is often skin atrophy, desquamation, itching, hyperpigmentation, hardening of the skin and subcutaneous tissue, and even the formation of eczema and ulcers, which may sometimes be complicated by bleeding and thrombophlebitis.
(5) Necrosis. This ulcer mostly occurs in the upper part of the inner ankle and the lower 1/3 of the inner calf. Due to insufficient blood supply to the tissues, the ulcers become thin around the tissues, the skin becomes black and hard, and the ulcers do not heal for a long time and are prone to recurrence after healing.
Hazards of varicose spermatocele
(1) Lower body discomfort, affecting life and work
Patients with varicocele will have uncomfortable feeling in scrotum and other parts of the body, mainly manifested by the feeling of swelling in scrotum and testicles, wet and cold, swelling and pain in scrotum and hidden pain, which will affect normal life and work.
(2) Affect sperm quality
Varicocele causes local temperature increase, lack of oxygen, pH change, and retention of toxic substances, which leads to the decrease of sperm count.
(3) Severe cases can lead to infertility
Varicocele, which leads to stagnation of spermatozoal blood, leads to elevated temperature of the testes, and also affects testicular metabolism, causing local hypoxia and stagnation of metabolic waste, which poisons the spermatogenic cells and spermatozoa of the testes. The combined consequences of the two factors cause the patient to have a lower sperm count, lower motility, and increased malformed sperm, thus can lead to infertility.
(4) Other hazards
A few people also have signs of neurasthenia such as emotional instability, insomnia and dreaminess, mental depression and fatigue. Others may even experience sexual dysfunction such as decreased libido, decreased sexual pleasure, painful intercourse, erectile dysfunction and premature ejaculation.
Varicocele can sometimes affect fertility. 9% of people with varicocele have infertility and 39% of male infertility is caused by varicocele. Severe cases can cause testicular atrophy. The danger of varicocele can affect fertility and can cause testicular atrophy in severe cases. The reason is that the temperature in the affected scrotum increases and reflects to the opposite side, causing degeneration of spermatogonia, atrophy and reduction of sperm count; or the left adrenal gland secretes pentraxin or steroids through the left internal spermatic vein into the testis, causing a reduction of sperm count.
Although it has not been medically proven that body size is related to varicose veins, it may be because the spermatic vein returns to the left renal vein in a right-angle shape, which affects the return of blood.
Varicose veins health care methods
A foot bath: soaking feet with hot water, especially with ginger or chili decoction, can expand the capillary network of human respiratory mucosa faster and speed up blood circulation, so that the white blood cells in the blood within the respiratory mucosa can destroy the bacteria and viruses that attack the human body in time, so that the human body is protected from infection. Often standing people, prone to “lower limb varicose veins” disease, and foot bath can speed up the leg blood circulation, so that the leg veins blood back to the right heart in time, is conducive to reducing the leg veins stasis, prevention of varicose veins in the lower limbs. In addition, before going to bed with hot water bubble feet, but also help to calm the mind to annoy, hypnotic sleep, so that sleep more deep and sweet.
Second, massage feet: after washing feet, hands rubbed hot, lightly rub the relevant parts or acupuncture points, can be full foot massage, can also be local massage, more Mo Chung Quan points (foot) or Tai Chong points (one, two toe joints after) or Tai Xi points (between the high point of the inner ankle and Achilles tendon depression). Dizziness, insomnia, anorexia, dullness, fatigue, hypertension, constipation, etc. have a preventive effect.
Third, high lift your feet: 2-3 times a day will be feet up, flat or higher than the heart, when the feet, legs blood circulation is strong, the lower extremity blood flow back to the lungs and heart speed up, get full circulation, the head can get enough and fresh blood and oxygen, while the foot acupuncture points, reflex zones is also a benign stimulation.
Fourth, rub the leg belly: the palms of both hands tightly clamped side of the calf belly, while turning rubbing, each side rubbing about 20 times, and then the same method to rub the other leg. This method can enhance the leg force.
Five, wrenching feet: take a sitting position, both legs straight, head down, body bent forward, with two hands wrenching toes and ankle joints 20-30 times each, can exercise foot force, prevent legs and feet weakness.
Six, twist the knee: two feet parallel together, bend the knee slightly downward squatting, hands on the knee, knee back and forth in a circle, first to the left, then to the right, about 20 times each. Can smelt lower limb weakness, knee pain.
Seven, shake the leg: a hand to hold things or hold the wall, first forward shake the calf, so that the leg tip upward, and then shake backward, so that the toe force backward, the foot surface taut, the leg is also as straight as possible. When shaking the leg, the upper body is straight, the two legs exchanged dozens of times each. This method can prevent hemiplegia, atrophy and weakness of the lower limbs and leg numbness, calf cramps, etc.
Preventive care
(1) Avoid prolonged standing or sitting posture, walking can use the pumping action of calf muscles to promote venous return;
(2) Elevating the lower limbs can relieve edema and other symptoms;
(3) Wearing a compression gradient can slow down the progression of the disease;
Varicose veins, commonly known as “fried legs”, occur mostly in the lower extremities. Varicose veins in the lower extremities refer to the impaired blood flow in the venous system of the lower extremities, and the pressure in the veins increases, resulting in the gradual expansion and elongation of the superficial veins, which are restricted by the surrounding tissues and thus become earthworm-like and tortuous, and the veins are particularly thin and expand in a cystic manner. It occurs mostly in people who work permanently on their feet or in heavy physical labor, such as salesmen, teachers and porters, soldiers, etc. It is also more common in women who have had many children and in those who are significantly obese.
Prevention of varicose veins.
Women (especially women in labor), people who stand for long periods of time (>6 hours per day), and obese people are more likely to develop varicose veins. Prevention of varicose veins can be done in the following ways.
1.Lift your legs. Varicose veins are caused by the inability of the veins to send blood back to the heart, so lifting the legs can help slow the disease.
2. Elevate the end of the bed to help blood return during sleep.
3. Do not wear high heels.
4. Maintain ideal weight.
5. Be careful with birth control pills. Certain birth control pills may cause this problem.
Varicose Vein Care
1, more consumption of vitamin E; why should we eat more of this nutrient, because vitamin E has the effect of improving the limb, blood circulation, but also can effectively slow down the heaviness of the limb, relieve the pressure of the veins, prevent varicose vein disease, containing vitamin E rich food: cabbage, spinach, kale, malt, nuts, soy, whole wheat, coarse grains, eggs, etc.. All are the varicose veins diet, usually pay attention to the.
2, pay attention to the consumption of vegetables and fruits; some fresh vegetables, fruits, most of them will be rich in vitamins, minerals nutrition, so that can better improve the oxidation of body tissues, enhance the body’s blood circulation, improve the immunity of the body. For example, fresh fruits contain a lot of vitamin C, which can improve blood circulation, promote recovery and prevent bruises by reducing the tendency of blood clotting. Therefore, varicose veins diet, need to eat more vegetables and fruits.
3, supplement sufficient protein; most varicose veins diet, need to supplement some protein nutrition, such as beef, fish, etc., and some, plant protein rich food, like some soybean need to eat more. Adequate protein can maintain the balance of all nutrients in the body, enhance immunity, protect cells, and also emulsify fat and promote blood circulation, which should be noted in the diet of varicose veins.
Varicose veins prevention
1, before going to bed, you can do special vein exercises, lift the lower limbs, keep the palms of the feet parallel to the body, and then let the legs and feet shake gently. When sleeping, it is best to take the left side of the bed, because lying on the left side can avoid compression to the abdominal vena cava, reduce the pressure on the veins of the legs, it is recommended that you can use a pillow to lean against, the varicose lower limbs, raised 30D40 degrees angle.
2, pick the weight or long-term standing workers, available elastic bandage leg binding, leg binding when the first leg and foot cushion, with elastic bandage will be tied to the lower leg, can prevent the lower limb vein stasis expansion. When tying, should be tied from the ankle upwards, and try to tie a little tighter. If you have conditions, you can wear varicose veins special, health care elastic socks.
3, simple squatting exercise can not only exercise the muscles, but also very good for the joints. Both can effectively prevent varicose veins, and calf cramps and other symptoms, but also can promote blood circulation, enhance physical fitness. Don’t look at the squatting action is very simple, but there is a certain amount of attention to do, otherwise it will be the opposite.
4, often leg massage, two hands on each side of the calf, from the ankle to the knee, rubbing the calf muscles to help venous blood flow back.
5, adhere to fast walking four times a day, 15 minutes each time, you can effectively relieve the symptoms. Because in the rapid walking, the gastrocnemius muscle movement increases, the activity is constantly, the veins are like pumping, like the blood accumulated in the varicose state, the veins in the heart to provide. At the same time, due to the accelerated local microcirculation, the metabolism of varicose veins is also accelerated, and the veins can be restored to normal sooner.
Varicose Vein Treatment
Medication
The basic principle of drug therapy is to enhance venous tone, improve venous permeability and reduce exudation. The effect of medication can significantly relieve the symptoms caused by venous stasis and prevent complications to some extent, but it does not improve the venous stasis itself. Although medication is an adjunctive treatment for varicose veins and cannot be expected to make varicose veins disappear, it is still an important treatment for patients with existing complications (such as swelling, pigmentation, dermatitis, thrombophlebitis and ulcers).
Surgical treatment
Surgery is also the main treatment for varicose veins. The basic principle of varicose vein surgery is to remove, or close, the diseased veins, because the valves in these veins are destroyed and the blood flows backwards, not only failing to return the blood normally, but also causing the blood to flow backwards, or to form a dead circulation locally. The classical method of surgical treatment is a high ligation of the saphenous vein (which is the main point of reflux) and a main trunk tap with stripping of the varicose branch veins.
Physical therapy
Physiotherapy is the treatment for varicose veins. The most fundamental reason for the occurrence of varicose veins is the increase in venous pressure in the lower extremities due to the effect of gravity when humans walk upright, which is essentially a physical problem, so physical therapy is the most basic and effective treatment for venous disease in the lower extremities. The specific methods include: elevation of the limb, elastic bandages, elastic stockings and pneumatic compression pumps.
The significance of early treatment of varicose veins
Early treatment implications
In the past, the idea was that asymptomatic varicose veins or elderly patients could be treated first with conservative treatment, including medication or compression stockings. This view has some prevalence and is based on the consideration of high surgical trauma, economic burden, and the risk of surgery at the patient’s advanced age.
However, medical development today, the answer to the question of whether “early surgery or first conservative treatment is better for varicose veins?” The answer to this question has undergone a subtle change. More and more varicose vein patients are opting for early and minimally invasive surgical treatment.
First of all, drugs and compression stockings, as the main means of conservative treatment for varicose veins, can only delay the progression of the disease but not treat the root cause of varicose veins. Therefore, drugs can only be used as an adjunctive treatment after varicose vein surgery in the lower extremities. Although the effect of elastic stockings is exact, they need to be worn for life, and they are troublesome and expensive to use. At present, the vast majority of patients who initially wear compression stockings eventually choose surgery. Since surgery is required in the end, the time and effort spent on conservative treatment is wasted.
Medical advances have also made surgery for varicose veins in the lower extremities increasingly minimally invasive. The adoption of minimally invasive surgery has shortened the hospital stay from a week in the past to within two days, and large incisions with multiple incisions have become microincisions with fewer incisions. However, minimally invasive surgery is only suitable for early varicose veins.
One of the consequences of the development of varicose veins is that as the blood from the deep veins flows back into the opening of the diseased saphenous vein, it flows backwards into the superficial venous system, creating an ineffective circulation that aggravates the burden on the deep veins and, over time, causes or aggravates the degree of deep venous valvulopathy. The severity of the lesions in the deep veins is an important factor in the chances of recurrence after varicose vein surgery.
Once the condition reaches edema, hyperpigmentation, bruising dermatitis or ulcers, the effectiveness of the surgery is greatly reduced. For example, surgery does not eliminate the darkening of the skin, surgery is very ineffective for edema, and surgery is less than 80% effective for bruising dermatitis. The general condition of elderly patients decreases with age. If they do not undergo minimally invasive surgery in the early stages and develop varicose vein complications later, they often cannot be treated because they cannot tolerate surgery.
Therefore, in order to avoid these complications, the best option is to have early surgery to resolve varicose veins before complications arise.
In summary, the drawbacks of conservative treatment of varicose veins are: (1) the side effects of medications; (2) the use of compression stockings diminishes the quality of life (e.g., too hot in summer, hard to wear, having to buy new stockings every 6 months) (3) the possibility of progression of the disease and loss of the opportunity to choose minimally invasive surgery. (4) Significant increase in surgical recurrence and failure rates once complications arise. (5) Loss of the purpose of post-surgical leg aesthetics.
Although varicose vein surgery has some recurrence rate, even if recurrence occurs, it is much better than complications that occur without surgery. However, most recurrences are related to the clinical experience and skill of the surgeon.
So, it is a prerequisite to choose an experienced vascular surgeon to perform the surgery. Because, a surgeon who lacks experience in varicose vein surgery or if traditional open surgery is used, post-operative complications can occur quite a lot.