I. What is saphenous vein?
The saphenous vein starts from the dorsal vein of the foot and goes up along the inner calf to the root of the thigh. The varicose vein mostly occurs in the inner calf, but in serious cases, it can extend upward to the inner thigh, and even the varicose vein can be seen in the whole lower extremity as a tortuous mass. In these patients, varicose veins of the lower limbs mainly occur in the saphenous vein and its branches, hence the name saphenous varicose vein.
Saphenous varicose veins are mainly manifested as the tortuous expansion of the superficial veins of the lower limbs, and in serious cases, they are “earthworm-shaped”, and in the early stage, there can be only cosmetic changes or soreness and swelling of the lower legs after standing for a long time, but in the late stage, various complications will appear, such as calf edema, pigmentation, lipid scleroderma, chronic eczema, chronic ulcers that do not heal (commonly known as “old rotten feet”) and even varicose vein rupture and bleeding.
Second, the etiology
Saphenous varicose vein is a common disease in life. Long-term standing work, especially heavy physical work, is the causative factor of the disease. Long-term stimulation causes aneurysmal expansion of the saphenous vein valve, which makes the valve lose its role as a “one-way valve” and impairs blood return to the lower extremities, resulting in stasis of blood in the saphenous vein, making the vein tortuous and dilated.
Symptoms
Early stage: after standing or walking for a long time, the calves are sore and swollen, just like lead, easily fatigued and weak; generally speaking, the symptoms are lighter when waking up in the morning, and the symptoms are aggravated at night after a busy day; some patients have numbness and mild pain in the inner side of the ankle; there are blue vein masses similar to “earthworm-like” protrusions in both calves.
Later stage: soreness and swelling are gradually heavier, even affecting work; both calves are covered with varicose vein masses; skin atrophy, desquamation, itching, pigmentation, skin and subcutaneous tissue hard knots, even eczema and ulcer formation due to poor blood circulation.
IV. Diagnosis
With the development of ultrasound technology, the diagnosis is completely clear by lower limb vascular ultrasound. Some patients may be combined with deep vein valve insufficiency or need
I. What is saphenous varicose vein?
The saphenous vein starts from the dorsal vein of the foot and travels up the inner calf to the root of the thigh. The varicose vein mostly occurs in the inner calf, but in serious cases, it can extend upward to the inner thigh, and even the varicose vein can be seen in the whole lower extremity as a tortuous mass. In this part of patients, varicose veins in the lower limbs mainly occur in the saphenous vein and its branches, so it is called saphenous varicose vein. Li Zeshu, Department of Thoracic and Cardiovascular Surgery, Peking University Medical Center Lu Zhong Hospital
Saphenous varicose vein is mainly manifested as tortuous expansion of superficial veins in the lower limbs, and in serious cases, it is “earthworm-like”, and in the early stage, there can be only cosmetic changes or soreness and swelling in the lower legs after standing for a long time, but in the late stage, various complications will appear, such as calf edema, pigmentation, lipid scleroderma, chronic eczema, chronic ulcers that do not heal (commonly known as “old rotten feet”) and even varicose vein rupture and bleeding.
Second, the etiology
Saphenous varicose vein is a common disease in life. Long-term standing work, especially heavy physical work, is the causative factor of the disease. Long-term stimulation causes aneurysmal expansion of the saphenous vein valve, which makes the valve lose its role as a “one-way valve” and impairs blood return to the lower extremities, resulting in stasis of blood in the saphenous vein, making the vein tortuous and dilated.
Symptoms
Early stage: after standing or walking for a long time, the calves are sore and swollen, just like lead, easily fatigued and weak; generally speaking, the symptoms are lighter when waking up in the morning, and the symptoms are aggravated at night after a busy day; some patients have numbness and mild pain in the inner side of the ankle; there are blue vein masses similar to “earthworm-like” protrusions in both calves.
Later stage: soreness and swelling are gradually heavier, even affecting work; both calves are covered with varicose vein masses; skin atrophy, desquamation, itching, pigmentation, skin and subcutaneous tissue hard knots, even eczema and ulcer formation due to poor blood circulation.
IV. Diagnosis
With the development of ultrasound technology, the diagnosis is completely clear by vascular ultrasound of lower limbs. Some patients may be combined with deep vein valve insufficiency or need to exclude the sequelae of deep vein thrombosis, etc., and need to do deep venography.
V. Treatment
1.Physical treatment
The increase of venous pressure in the lower limbs due to gravity is an important cause of varicose veins, so physical therapy is also one of the most basic treatment measures for venous diseases in the lower limbs. The specific methods include: elevating the limb, elastic bandage wrapping, wearing elastic stockings and air pressure pump, etc. Note to avoid using elastic sleeve which can only wrap tightly around the calf to treat the vein disease, it can aggravate the ankle vein stasis and form ulcer more easily.
2.Medication
The basic principle of medication is to enhance venous tone, improve venous permeability and reduce exudation. The effect of medication can partially relieve the symptoms caused by venous stasis, prevent complications and improve venous stasis.
3.Surgical treatment
Surgery is the main method of treating varicose veins. The basic principle of surgery is to remove or close the diseased vein. The classic method is high ligation of saphenous vein + main stem extraction + varicose branch vein stripping. In recent years, a number of new methods have emerged, including laser, radiofrequency, microwave, etc. The basic principle is to close the veins that would otherwise require surgical stripping by physical or chemical means to block venous backflow and dead circulation. However, surgery is risky, costly and prone to recurrence.
Currently, our hospital uses a combination of traditional and minimally invasive approaches. High ligation and trunk stripping are retained, and minimally invasive electrocoagulation is used for varicose vein clusters, which is less invasive, more effective and less expensive.
4.Sclerotherapy
It refers to the local injection of sclerosing agent and closure of blood vessels in varicose veins. However, the recurrence rate is high and there are many complications. It is a technology that is gradually phased out.
Six, complication treatment
1. Thrombotic superficial phlebitis: hot compresses, etc. Surgical treatment after the symptoms subside.
2. Eczema and ulcers: control infection, wet dressing, elevation of the affected limb, local drug change, and surgical treatment as soon as possible after infection control.
3. Bleeding from varicose vein rupture: elevate the affected limb, apply pressure bandage, and suture to stop bleeding if necessary.
1.Physical treatment
The gravitational effect leads to the increase of venous pressure in the lower extremity is the important cause of varicose veins, so physical therapy is also one of the most basic treatment measures for venous disease in the lower extremity. The specific methods include: elevating the limb, elastic bandage wrapping, wearing elastic stockings and air pressure pump, etc. Note to avoid the use of elastic sleeve that can only wrap the calf belly to treat venous disease, it can aggravate the ankle vein stasis and more likely to form ulcers.
2.Medication
The basic principle of medication is to enhance venous tone, improve venous permeability and reduce exudation. The effect of medication can partially relieve the symptoms caused by venous stasis, prevent complications and improve venous stasis.
3.Surgical treatment
Surgery is the main method of treating varicose veins. The basic principle of surgery is to remove or close the diseased vein. The classic method is high ligation of saphenous vein + main stem extraction + varicose branch vein stripping. In recent years, a number of new methods have emerged, including laser, radiofrequency, microwave, etc. The basic principle is to close the veins that would otherwise require surgical stripping by physical or chemical means to block venous backflow and dead circulation. However, surgery is risky, costly and prone to recurrence.
Currently, our hospital uses a combination of traditional and minimally invasive approaches. High ligation and trunk stripping are retained, and minimally invasive electrocoagulation is used for varicose vein clusters, which is less invasive, more effective and less expensive.
4.Sclerotherapy
It refers to the local injection of sclerosing agent and closure of blood vessels in varicose veins. However, the recurrence rate is high and there are many complications. It is a technology that is gradually phased out.
Six, complication treatment
1. Thrombotic superficial phlebitis: hot compresses, etc. Surgical treatment after the symptoms subside.
2. Eczema and ulcers: control infection, wet dressing, elevation of the affected limb, local drug change, and surgical treatment as soon as possible after infection control.
3. Bleeding from varicose vein rupture: elevate the affected limb, apply pressure bandage, and suture to stop bleeding if necessary.