In daily life, we can often see some people have worm-like protrusions on their legs, winding and varicose, higher than the skin, which is varicose veins in the lower limbs, commonly known as “tendon bumps”; serious cases can lead to swelling, soreness and discomfort, purple skin and ulcers in the lower legs, commonly known as “polycarbonate legs “or “old rotten leg”. This disease is a common disease with a high incidence in the population, mostly occurring in people who are engaged in long-term standing work or manual labor, and often forms persistent ulcers (polyposis) at a later stage, which not only aggravates the patient’s pain, but also seriously weakens the labor force. Therefore, the early diagnosis and treatment of this disease is very important, and the situation of varicose veins of lower limbs is introduced as follows.
I. What is meant by varicose veins of lower extremities
The composition of lower limb veins. The veins of lower limbs are generally divided into three layers: superficial veins located under the skin, deep veins and traffic branch veins between deep and superficial veins, and varicose veins of lower limbs generally occur in superficial veins of lower limbs. The superficial vein system is divided into saphenous vein and small saphenous vein. The saphenous vein starts from the inner side of the dorsum of the foot and is distributed in the front of the inner side of the lower limb up to the groin; the small saphenous vein starts from the outer side of the dorsum of the foot and is distributed in the back of the outer side of the lower leg up to the N fossa.
Therefore, varicose veins of the lower extremities refer to the formation of tortuous and sinuous venous masses in the dilated veins of the lower extremities in the standing position, causing the skin to bulge, including saphenous varicose veins and small saphenous varicose veins, with saphenous varicose veins occurring in the medial side of the lower extremities being the most common. The incidence of this disease is very high in all countries of the world, and the medical epidemiological method of investigating the incidence of the disease is described by a few hundred thousand, while the incidence of varicose veins in the lower extremities is expressed by a percentage, which shows the high incidence of the disease. In our country, the incidence of this disease is about 10%, according to this estimate, excluding teenagers and children under 15 years old, there are about 80 million to 100 million patients with varicose veins of lower limbs in China. Among various limb vascular diseases, varicose veins of lower extremities can account for 96.19%, so it is a veritable common disease and multi-morbidity.
Second, those factors can cause varicose veins of lower limbs
There are many reasons for the formation of varicose veins in the lower extremities, but the root causes are the weakness of the superficial vein wall itself, the poor function of the valves in the veins, the increase of pressure in the veins, the blockage of the veins and the pressure on the veins. Specifically, there are the following.
1, genetic factors: patients suffering from primary varicose veins of lower extremities, with a family history of almost 70%. This is mainly related to the weakness of the superficial vein wall itself in the family and the defective valves in the veins. Therefore, family members who have a history of varicose veins in the lower extremities should pay special attention to protect their lower extremity veins.
2, long time engaged in standing work: such as weavers, clampers, teachers, salesmen and so on, because of the long standing, resulting in the superficial veins within the pressure persistently rise, destroy the valves in the veins, so that the lower limb veins of blood backflow and the formation of the disease.
3, long-term heavy physical labor: such as loading and unloading, handling and tricycle delivery workers and farmers, etc., the incidence is higher. Mainly due to the weight bearing when the abdominal cavity pressure rises, the lower limb venous reflux is blocked, venous pressure also increases, and the poor function of the intravenous valves for a long time to form this disease.
4.Pregnancy: the abdominal pressure increases during pregnancy, and the venous reflux of lower limbs is obstructed to form this disease, especially in multiple pregnancies and multiple pregnancies.
5.Deep vein thrombosis of lower extremity: As the thrombus blocks the deep vein of lower extremity, the blood return of lower extremity vein is obstructed, which increases the burden of superficial vein and makes the superficial vein dilate gradually, and this disease is formed after a long time.
6, primary lower limb deep vein valve insufficiency, so that the venous blood backflow: this is also a common cause of the formation of this disease.
7, pelvic tumor compression, congenital vascular development abnormalities: this can also cause varicose veins of the lower limbs.
Third, the varicose veins of lower limbs have those symptoms and hazards
After the varicose veins of lower extremities occur, the following changes can occur according to the sequence of clinical symptoms.
1, appearance change: that is, the expansion, meandering and tortuous of the superficial veins of lower limbs, the degree of which gradually increases and involves more and more veins, there can be no obvious discomfort at this stage, mainly affecting the beauty, especially for young women with cosmetic requirements.
2, lower limb soreness and pain: often occur after a long day of standing or exertion, early light, gradually aggravated, can be relieved after walking or lying down. People with sensory allergy can be accompanied by pain. At this stage, the patient obviously feels discomfort and prefers to flatten or elevate the lower limbs, and the labor force is somewhat affected.
3. Swelling: The cause of occurrence is related to the increase of local pressure in the veins of lower limbs, blood stagnation and extravasation of fluid components within the blood. The swelling is usually aggravated after a day of labor and reduced or disappeared after a night of rest. The labor force is affected.
4, thrombotic superficial phlebitis: local varicose veins of lower limbs may suddenly appear red, swollen, feverish and painful, and lines of hard cords may be found, with pressure pain. Larger extent can be accompanied by elevated body temperature. In a few cases, the thrombus can extend from superficial veins to deep veins and cause deep vein thrombosis, which has serious consequences.
5.Nutritional changes of calf skin: including atrophy and hardening of skin, purple color, itching, flaking and subcutaneous hard nodes, which are caused by slow blood return of lower limbs after varicose veins, coupled with incompetent valves of traffic branch veins, backflow of blood, lower limbs stasis, lower oxygen content of blood, and degenerative changes of skin. It seriously affects the labor force.
6, ulcers and bleeding: late can be due to scratch or trauma and the formation of ulcers or bleeding, ulcers mostly occur in the inner and outer ankle joint, once formed that is difficult to heal, the scope is often gradually expanded, and does not heal over the years, more exudate, smells foul, the patient suffering abnormal. Bleeding is mostly caused by trauma or scratching, and it happens suddenly with large amount of bleeding, which is a danger signal and needs emergency treatment, otherwise it can be life-threatening.
Fourth, the traditional treatment of varicose veins of lower limbs
There are three kinds of treatment for varicose veins of lower limbs: non-surgical therapy, injection therapy and surgical therapy.
1.Non-surgical therapy: It is mainly to tie elastic bandage or wear medical sequential decompression elastic stockings. It is only applicable to the lighter superficial varicose veins, so that the progress of the lesion is suspended and the symptoms are reduced, but it cannot cure the varicose veins; it is also used for the auxiliary treatment after varicose vein surgery.
2.Injection therapy: It is injected into varicose veins with various sclerosing agents to make them inflamed and thrombosed, and finally lead to fibrosis and blockage of the lumen by adhesion with the lining of the vessel wall. It is mainly used for limited small varicose veins with sound valve function or as an adjuvant therapy to surgical treatment. This therapy has tended to be eliminated due to poor efficacy and more complications.
3.Surgical therapy: surgical treatment is the fundamental method to deal with varicose veins. It mainly includes high ligation and stripping of saphenous vein and small saphenous vein, and ligation of incompetent traffic branch vein. The advantage is that the treatment is complete and it is the cure; the disadvantage is that the surgery is very traumatic and leaves more surgical scars on the lower limbs after the surgery, which affects the beauty. At present, it is also gradually replaced by new methods.
V. Modern treatment of lower limb varicose veins DD endovenous laser therapy (EVLT)
Endovenous laser treatment of varicose veins in lower extremities is one of the latest minimally invasive surgical methods that have been developed in recent years. The earliest laser was applied to treat capillary dilation. The principle is to use the properties of the laser to denature, carbonize and vaporize the proteins in the lining of the blood vessels, ultimately leading to occlusion of the varicose veins, achieving the same effect as surgical excision. This is accomplished by making a small 2-3 cm incision in the groin and inserting a laser fiber into the varicose vein to excite the laser.
The biggest advantages of EVLT over traditional surgical treatment are.
1.Safety: The patient’s time on the operating table is shortened due to fewer incisions, which reduces surgical complications and provides a high level of safety.
2.Effectiveness: like surgical treatment, the treatment is complete and is a cure.
3. Minimally invasive: Except for a small incision in the groin, all other parts are performed by laser puncture, which is minimally invasive, and the patient recovers quickly and can get out of bed in 6 hours after surgery and be discharged in 2-3 days.
4., Cosmetic: Traditional surgery leaves more surgical scars on the lower limbs after surgery, while this treatment has no or less incisions on other parts except for a small incision at the groin, which is beautiful. It is especially suitable for young women with cosmetic requirements.
Therefore, endovenous laser treatment of varicose veins in lower limbs has expanded a broad prospect for the treatment of varicose veins in lower limbs, and it has been welcomed by most of the patients in a short time once it was carried out.