Simple superficial varicose veins of the lower extremities refer to those whose lesions are limited to the superficial veins of the lower extremities, whose lesions include the saphenous vein, the small saphenous vein and its branches, and the majority of patients occur in the saphenous vein, which is clinically diagnosed as saphenous varicose vein.
The superficial veins are elongated, dilated and flexed, and they are mostly found in people who are permanently engaged in standing work and physical labor. Simple superficial varicose veins of the lower extremities are usually mild and surgical treatment often provides good results.
Etiology
Most superficial varicose veins are caused by regurgitation of superficial venous blood flow due to incomplete closure of the first pair of valves in the superficial veins (saphenous valves), which increases venous pressure in the lower extremities. Secondly, congenital weakness of the vein wall is also an important cause. Patients often have a combination of circumferential or restricted vein wall defects, which produce venous tortuosity and dilatation under increased venous pressure. Finally, factors such as prolonged standing, obesity and abdominal pressure can increase venous pressure and increase the likelihood of varicose vein development.
Clinical manifestations
In the early stage of the disease, most of the lower limbs are sore, swollen and dull painful, and there is a feeling of heaviness and weakness. These sensations are aggravated after standing for a long time, and can be relieved by lying down and elevating the limb. In the middle and late stage of the disease, the vein wall is damaged and the vein is bulging, dilated and tortuous, with earthworm-like appearance, which is obvious in the saphenous vein travel area on the inner side of the calf. In long duration of the disease, the skin of the limb shows nutritional changes, such as flaking, itching, pigmentation, etc., and even eczema and ulcers are formed. As the disease evolves, it can be accompanied by painful vascular travel, lower limb swelling, bruising dermatitis, superficial vein thrombosis and other symptoms.
Diagnosis
Superficial varicose veins of the lower extremities have obvious morphological features and can be clearly diagnosed by general physical examination. The protrusion of superficial veins in the lower extremities upon standing is indicative of the possibility of varicose veins. For further comprehensive understanding of the condition, further detailed physical examination is needed to understand the venous valve function and deep vein patency, and venous ultrasound or angiography is needed if necessary. The focus should be differentiated from varicose veins caused by the sequelae of deep vein thrombosis, which have a history of deep vein thrombosis and tend to show significant swelling of the lower extremities. If the lower extremity has ulcers in the boot area and severe dermatitis, attention needs to be paid to any involvement of the traffic veins.
Treatment
1.The treatment of saphenous varicose vein is based on high ligation and stripping.
2.If the saphenous vein is incompetent but the traffic branch and deep vein are normal, high ligation can be done to cut off the saphenous vein and its branches.
3.Incompetent saphenous vein valve and incompetent traffic branch valve, in addition to the above surgery, the abnormal traffic branch should be ligated and cut off respectively, or saphenous vein stripping.
4.If the small saphenous vein enters the N vein with reflux phenomenon, the entrance section can be ligated and excised, and the distal section can be stripped or injected with sclerosing agent.
5.Limited varicose veins with small scope, or only the traffic branch valve insufficiency, or part of the varicose veins left after surgery, or local recurrence after surgery, sclerotherapy is applicable.
6.The following cases are not suitable for injection or surgical therapy, but can be treated by wearing elastic stockings:
(1) Systemic diseases, such as active hepatitis, progressive tuberculosis, uncontrolled diabetes, severe heart or kidney disease, etc.
(2) Local diseases, such as arterial circulation disorders, deep venous obstruction, intrapelvic or intra-abdominal tumors, acute phlebitis, and calf ulcers complicated by cellulitis.
(3) Patients within pregnancy, over age, secondary to arteriovenous fistula, etc.
7.Injection therapy:
5% sodium cod liver oil acid, 5% sodium oleate – ethanol, 1% to 3% sodium tetradecyl sulfate. Patients stand, so that the varicose vein is filled, in the intended injection site, with a needle beveled short injection needle into the blood vessels, then ask the patient to lie down, the affected limb slowly elevated, pay attention to fix the needle does not move, wait for the varicose vein blood completely driven out, with fingers tight pressure on the upper and lower end of the section of the vein, and then slowly inject sclerosing agent, followed by massage with gauze at the injection site, and then from the toes to the knee wrapped with then wrapped with an elastic bandage from the toe to the knee for 2~3 weeks. After the injection, the patient was asked to walk as usual.
Prevention
1, this disease has a genetic tendency, generally in the 30 years of age onset, so in childhood and adolescence should be diligent exercise, enhance physical fitness, to help prevent.
2, obese people should lose weight, obesity is not the direct cause, but the excessive weight pressed on the legs may cause poor venous reflux in the legs, so that the venous dilatation aggravated.
3, long-term heavy physical labor and long-term standing work, it is best to wear elastic socks cover.
4, women during menstruation and pregnancy and other special periods to give special care to the legs, more rest, to often massage the legs to help blood circulation, to avoid varicose veins.
5, quit smoking, because smoking can make the blood viscosity change, blood becomes sticky and easy to stagnate. Oral contraceptives also have a similar effect, should try to take less.
6, elevate the legs and wear elastic stockings: elevate the legs so that the body position changes to help the venous blood flow back. Choose elastic socks (medical) with high elasticity and slowly put your legs up before getting out of bed each day. The pressure of the elastic socks can improve and prevent varicose veins in the lower limbs.
7, every day adhere to a certain time walking, walking can play the calf muscle “muscle pump” role, to prevent the pressure of blood backflow.