Varicose veins of the lower extremities are the most common of the peripheral vascular diseases. With the development of diagnostic tools and clinical research, there is a new understanding of the morphology and function of the lower extremity venous valves. Lower extremity varicose veins are common clinical manifestations of lower extremity venous diseases. In addition to simple lower extremity varicose veins, there are also diseases such as lower extremity deep vein valve insufficiency and lower extremity deep vein thrombosis.
I. Etiology of varicose veins of lower extremities
1.Weakness of vein wall and valve defect
Whether it is simple varicose veins of the lower extremities, or the valve insufficiency of the deep veins of the lower extremities, the pathogenic factors are: congenital weakness of the vein wall and valve defects, resulting in a lasting increase in intravenous pressure
2.Increased intravenous pressure
Usually the causes of increased venous pressure are more, such as long-term standing work, in addition, any factors that can make the intra-abdominal pressure increase can lead to increased intravenous pressure. Such as heavy physical labor or strenuous sports activities, chronic cough, constipation, etc., the pressure generated by closed-air force and abdominal muscle contraction can affect the venous blood return, thus damaging the valve function of the upper end of the saphenous vein.
Second, the clinical manifestations of varicose veins of lower limbs
(A) Superficial varicose veins of lower limbs
Superficial varicose veins mostly occur in bilateral lower limbs, but also in unilateral lower limbs, among which the left side is more common because the left iliac vein is compressed by the right iliac artery
(B) Soreness and pain in the affected limbs
Patients mostly have soreness or swelling of the affected limbs and are easily fatigued, which mostly occurs when standing for a long time. When the limb is elevated lying down, the soreness and swelling disappears rapidly.
(C) Swelling of the affected limb
The poorer the function of deep vein valve, the more obvious the swelling of the affected limb. If the lymphatic vessels are involved and lymphedema is concurrent, the swelling of the affected limb will be more obvious.
(D) Complications
1, thrombotic superficial phlebitis: the varicose veins of the lower limbs appear red, swollen, burning and painful, and hard nodules or cords can be palpated along the varicose veins with pressure pain. If it is complicated by perivenous inflammation, there is redness, swelling and heat around the superficial veins. After the acute inflammation subsides, local hard nodules or cords remain.
2.Hemorrhage of superficial vein
3.Stasis dermatitis ： Skin atrophy, dryness, flaking, pigmentation, oozing, itching.
4.Secondary infection
5.Stasis ulcer (old rotten leg): long time not healed
Clinical diagnosis of varicose veins of lower limbs
1.Age It can occur in people of any age, but it is more common in middle and old age.
2.Occupation Long-term standing workers, such as store salesmen, textile workers, teachers, hairdressers, nurses and surgeons, etc. have a higher incidence.
3.Past history Chronic bronchitis, habitual constipation, abdominal tumor and pregnancy patients, etc.
4.Family history: varicose veins of the lower extremities are related to heredity, often more than one parent or sibling in a family suffers from this disease.
5.Onset: if varicose veins of lower limbs occur after trauma, acquired arteriovenous fistula should be excluded; if varicose vein masses are present in lower limbs since childhood and accompanied by claudication, congenital vascular malformation or congenital arteriovenous fistula should be considered; if swelling of lower limbs occurs first and then varicose vein masses appear, post-thrombosis syndrome of deep veins in lower limbs should be excluded.
Fourth, the diagnosis of varicose veins of lower limbs
1.History of prolonged standing and diseases that can lead to increase of abdominal pressure (pregnancy and pelvic tumor history, chronic bronchitis, habitual constipation, etc.) mostly have family history of varicose veins of lower extremities.
2.The veins of lower limbs are obviously tortuous and dilated, which are more obvious when standing; often accompanied by thrombotic superficial phlebitis, and skin pigmentation, fibrosis and ulceration in the foot and boot area can occur in the late stage.
3.Deep vein patency test shows: deep vein patency
4.Ultrasound Doppler examination shows: saphenous vein valve insufficiency, or at the same time with deep vein valve insufficiency
5.. Venogram shows: saphenous vein tortuous dilatation, valve insufficiency, or deep vein valve insufficiency at the same time
6.Exclude other venous diseases.
V. Clinical treatment of varicose veins of lower limbs
The treatment principles of varicose veins of lower extremities are
1.Promote blood reflux in lower limbs and eliminate stasis of blood
2.Clear heat and anti-inflammation, control limb infection
3.Protect the affected limb and prevent trauma
Many patients are afraid of surgical treatment, so they believe in some exaggerated propaganda, such as the treatment of varicose veins without surgery or injections. In fact, the best treatment for severe varicose veins is surgery. Generally, we use high saphenous vein ligation + stripping surgery, using the patented stripping device made in France, the surgery can be completed in 40-60 minutes, the surgical wound is only 2 centimeters, the patient can get out of bed the next day after the surgery, and can be discharged home in 5-6 days after the surgery. Therefore, there is no need to worry too much about the trauma and risk of the surgery.
For patients whose symptoms are not very serious, we suggest that patients should avoid standing for a long time, rest properly and elevate the affected limb to promote blood flow back to the affected limb, which can reduce the swelling of the affected limb and prevent calf ulceration. In addition, it is necessary to wear suitable elastic stockings or elastic bandages, which can promote blood return to the affected limb and reduce or eliminate the feeling of heaviness and fatigue of the affected limb.