What are varicose veins in the lower extremities?
In the standing position, the dilated veins of the lower extremities form a tortuous, bulging, and sinuous mass of veins, which is called varicose veins of the lower extremities. Most varicose veins in the lower extremities occur in the saphenous vein and its branches, i.e., in the inner calf, or in severe cases, they may extend upward to the upper inner thigh, or even to the entire lower extremity, where the varicose veins may be seen to migrate into clusters. In most patients, varicose veins occur mainly in the medial calf.
Incidence of varicose veins in the lower extremities
Varicose veins in the lower extremities are a very common condition. The prevalence is as high as 20-40% in European and American countries. There is no systematic and extensive epidemiological survey in China, and about one in ten people suffer from varicose veins in the lower extremities. It is projected that there are about 80 to 100 million patients with varicose veins in lower extremities in China.
How are varicose veins in the lower extremities formed?
The veins of the lower extremities are divided into two groups: deep veins and superficial veins, and there are also traffic veins connecting the deep veins and superficial veins, and the superficial veins eventually converge to the main saphenous vein, which is injected into the deep veins at the root of the thigh. Both the deep and superficial veins and the traffic veins have many venous valves, which act as a one-way valve to stop the backflow of blood back to the heart.
Anomalies in the superficial veins themselves, poor functioning of the venous valves, etc., can affect the function of the valves, resulting in the valves not closing tightly and blood backflowing downward, increasing the venous pressure and causing the veins to dilate. Venous blockage, venous pressure, etc. cause venous reflux obstruction, which also increases venous pressure and dilates the veins. Over time, the superficial veins become tortuous and varicose veins are formed.
Depending on the cause, varicose veins of the lower extremities can be simply divided into simple varicose veins and secondary varicose veins of the lower extremities. Simple varicose veins are caused by the superficial veins themselves, while superficial varicose veins caused by abnormal function of deep vein valves, blockage or compression of deep veins are called secondary varicose veins.
What is the meaning of lower extremity deep vein valve insufficiency?
Deep vein insufficiency in the lower extremities can cause varicose veins in the lower extremities. The increased pressure in the deep veins of the lower extremities and the dilatation of the veins will cause the valves in the veins to fail to close and the valves to become incompetent, and the veins of the lower extremities will lose their unidirectional centripetal reflux and blood will flow backwards, causing blood to pool in the veins of the lower extremities and further increasing the pressure in the deep veins of the lower extremities. The pressure will be transmitted to the traffic veins and superficial veins, and the latter two are much less able to withstand the pressure than the deep veins, and varicose veins will appear or aggravate the existing varicose veins.
The treatment of varicose veins caused by deep vein insufficiency in the lower extremities may differ from simple varicose veins depending on the condition.
Who is at risk for varicose veins in the lower extremities?
Varicose veins can be triggered by factors that increase the pressure in the veins of the lower extremities. The incidence of varicose veins is higher among heavy workers and those who stand for long periods of time, such as workers, farmers, teachers, nurses, and traffic police. People with chronic cough and chronic constipation are also prone to develop varicose veins in the lower limbs.
The occurrence of varicose veins has a certain relationship with heredity. Foreign data show that the occurrence of varicose veins in lower limbs is related to heredity. Domestic data are not yet available, but it is often found in clinical practice that several generations of a family have lower extremity varicose veins.
There is also a relationship between the onset of varicose veins and gender, with women presenting with varicose veins at twice the rate of men.
Can pregnancy trigger varicose veins in the lower extremities?
When pregnant, the enlarged uterus compresses the blood vessels and impedes blood return, which increases the venous pressure in the lower extremities and can cause varicose veins in the lower extremities. In addition, changes in progesterone and estrogen during pregnancy can lead to relaxation of the vein walls and valves, which can also increase blood reflux. Therefore, taking certain precautions during pregnancy such as wearing compression stockings can help prevent varicose veins in the lower extremities.
What are the symptoms of varicose veins in the lower extremities?
In the early stages of varicose veins, there are no symptoms and pain other than affecting the appearance, but if treatment is not given early, the condition will worsen and symptoms such as swelling, pain and itchiness in the lower limbs will appear. At this time, the veins are like earthworms crawling all over the legs and even swelling and protruding, which cannot even be covered by socks. The varicose decreases when lying down, but becomes obvious when standing up. In severe varicose, eczema, ulcers, inflammation of veins and even bleeding from ruptured veins may occur.
Why do varicose veins in the lower extremities cause skin pigmentation?
The stagnant blood in the varicose veins will cause local skin hypoxia and skin degeneration, and the tiny blood vessels in the skin will become brittle and easily rupture, which will cause pigmentation and darkening of the skin. The pigmented skin tends to harden and its resistance is reduced, and it also tends to develop secondary skin diseases, such as eczema, dermatitis, and dermatitis.
What is thrombophlebitis?
Thrombophlebitis is a sterile inflammation caused by thrombotic irritation of the blood flow in the vein that forms a thrombus. Thrombophlebitis is a common complication of varicose veins in the lower extremities. The thinning and degeneration of the vessel walls of varicose veins increases the brittleness, the blood in the veins stagnates and flows slowly, and minor trauma can damage the vessels and stimulate thrombosis, leading to thrombophlebitis.
Thrombophlebitis manifests as localized redness, swelling, heat, and pain, and a painful mass of streaks of pressure can be felt at the site of phlebitis. The inflammation persists for 1 to 2 weeks and gradually subsides, the redness is replaced by hyperpigmentation, the mass hardens like a cord, and the pressure pain usually takes 2 to 4 weeks to disappear. Thrombophlebitis is recurrent in patients with varicose veins.
Can varicose veins in the lower extremities cause skin ulcers?
The skin of varicose veins is degenerated and its ability to resist trauma, healing, and infection is significantly diminished. Minor trauma can easily lead to bacterial infection, which increases the breakage and delays healing, resulting in skin ulcers.
What kind of examination is required for patients with varicose veins in lower limbs?
In addition to careful physical examination by the doctor, patients with varicose veins in the lower extremities may also need to undergo lower extremity venous ultrasound, lower extremity venography, and in rare cases, CT or MRI to find out whether there are tumors or other factors compressing the veins in the pelvis or abdominal cavity causing varicose veins in the lower extremities, depending on their condition. Patients who are ready to undergo surgery also need to complete routine preoperative examinations.
Is an ultrasound of the veins in the lower extremities necessary?
The most common and valuable of all ancillary tests is the lower extremity venous Doppler ultrasound. The ultrasound can determine the location and extent of venous reflux, as well as the patency of the deep veins and the presence of deep vein thrombosis. It is important for how to choose the procedure.
When is a lower extremity venogram performed?
In some cases, a lower extremity venogram is required to more accurately determine the deep vein reflux and to understand the cause of varicose veins in the lower extremities. This is the “gold standard” for evaluating the patency of the deep veins and helps in the development of surgical plans. It is used to determine the location of valve insufficiency and to evaluate the function of deep vein valves, and can be graded according to the degree of regurgitation.
What are the treatment options for varicose veins in the lower extremities?
Treatment options include general supportive therapy, sclerotherapy, and surgery.
How can varicose veins in the lower extremities be prevented?
Get into the habit of exercising your legs properly every day, such as walking, brisk walking, cycling, running, etc. Avoid standing and sitting for a long time and avoid carrying heavy loads. Lying down and resting with legs padded higher than the chest and knees slightly bent can promote leg vein circulation. These are important measures to prevent varicose veins in the legs. Wearing elastic stockings or elastic bandages to promote blood evacuation in superficial veins, improve blood stagnation and help blood return to the lower limbs can also prevent varicose veins, and elastic stockings are generally available in medical stores.
For patients with mild symptoms, the above preventive measures can also be used as general supportive treatment, but they can only reduce the symptoms and delay the course of the disease, but not achieve the purpose of cure.