Varicose veins are a common venous disease of the lower extremities in the population. The main reason for the formation of varicose veins is that the blood accumulates in the lower extremities due to the congenital weakness of the vascular wall membrane or because the same posture is maintained for a long time with few changes, and over time the venous valves are destroyed and the venous pressure becomes too high, which is a symptom of protruding blood vessels on the skin surface. Varicose veins mostly occur in the lower extremities.
Causes
1, weak vein wall and valve defects: the vein wall is relatively weak and can expand under the action of venous pressure, and the expansion at the valve sinus leads to no tight closure of the original venous valve, and the valve function becomes relatively incomplete and blood flows backwards. Valve dysplasia or absence, also can not play an effective role in preventing backflow, leading to the onset.
2, venous pressure persistently elevated: venous blood itself due to the role of gravity, a certain pressure on the valve, under normal circumstances will not cause damage, but when the venous pressure continues to rise, the valve will withstand excessive pressure, gradually relaxation, prolapse, so that the closure is incomplete. This is mostly seen in long-term standing work, heavy physical labor, pregnancy, chronic cough, long-term constipation, etc.
3, followed by age, gender: because the limb venous pressure only in the body length up to the highest when the highest pressure, the body before puberty is not high, so the caliber of veins is small, all can prevent venous dilation, so although there are suffering from serious varicose veins before 30 years old, but most of them are with age, the vein walls and valves gradually lose their tension, the symptoms increase forcing patients to seek medical attention.
Varicose veins are more common in women, probably because pregnancy can trigger or exacerbate them. However, in women without pregnancy, the incidence is higher than in men (male:female=1:3), probably because of the wider pelvis, the excessive curvature of the vascular structures and the increased congestion of the veins in the pelvis during menstruation, pregnancy and menopause. Another reason why varicose veins are prone to occur during pregnancy is because the tension of the superficial veins of the extremities is reduced during pregnancy, making them prone to dilatation, a condition that can be restored after delivery.
Pathogenesis and pathology
Under normal conditions, venous reflux in the lower extremities depends on the synergistic effect of the diastolic force generated by the pounding of the heart, the pumping action of the muscles surrounding the deep veins within the deep fascia, and the negative pressure attraction within the thoracic cavity during respiratory movements. The venous valves act as a one-way restriction in blood return. If there is a valve defect, the unidirectional restriction is lost and causes additional impact on the next level of venous valves by backflow of blood, which in time leads to the destruction of the next level of venous valves. The destruction of the valves in the vein makes the backflow of blood to the vein wall to produce huge pressure, which can cause dropsy in the relatively weak part of the vein. Long-term standing, heavy physical labor, pregnancy, chronic cough, long-term constipation, etc. can increase the pressure in the veins, which further intensifies the impact of the blood on the valves and the pressure on the vein walls, leading to varicose veins. Prolonged varicose veins and blood stagnation eventually produce stasis dermatitis, hyperpigmentation and chronic sclerosing cellulitis or ulcer formation.
The pathological changes in varicose veins occur mainly in the middle layer of the vein wall. In the early stages, both the elastic and muscular tissues of the middle layer thicken, a change that can be considered a compensatory response to increased venous pressure. In the late stage, both muscle and elastic tissues atrophy and disappear and are replaced by fibrous tissues, and the vein wall thins and loses elasticity and dilates. The venous valves also become atrophied and sclerotic. The microcirculation of the tissues surrounding the diseased vein is also impaired by the increase in venous pressure, causing malnutrition and fibroblast proliferation. The subcutaneous tissue of the lesion is diffusely fibrous and edematous, and the edematous fluid contains a large amount of proteins, which in turn can cause fibroblastic proliferation. The lymphatic reflux is blocked by venous stasis, and the large amount of proteins in the lymphatic fluid aggravates the tissue fibrosis. The result of this vicious circle is local tissue hypoxia and reduced resistance to injury, thus making it prone to infection and ulceration.
Chinese medicine etiology
According to Chinese medicine, this disease is caused by the weakness of the tendons and veins due to the lack of innate endowment, coupled with prolonged walking and prolonged standing and excessive strain, which further damages the tendons and veins, resulting in the incompatibility of the meridians and veins, the poor flow of qi and blood, the congestion of blood in the lower part of the veins and veins, and the expansion and filling of silt and blood obstruction, which becomes intertwined and coiled over time. It resembles the shape of a tumor over time. It may also be caused by long distance travel, after exertion, wading through water and rain, suffering from cold and dampness, cold clotting the blood vessels, stagnating the tendons and veins and channels and becoming sick. If the silt does not dissipate for a long time, damp heat is generated and flows into the meridians of the lower extremities, and is triggered by scratching or insect bites, the sores become rotten and difficult to converge over time.
Clinical manifestations
Patients with primary varicose veins have no local symptoms in the early stage, but the following clinical manifestations may appear in the gradual development.
1.The affected limbs often feel soreness, dullness, swelling and pain, easy fatigue and weakness.
2.The superficial veins of the affected limbs are bulging, dilated, varicose, or even tortuous or lumpy, which is more obvious when standing.
3.Swelling: slight edema may appear in the ankle and dorsum of the foot, and mild edema may also appear in the lower part of the calf in severe cases.
4.Complications.
(1) Nutritional changes of the skin: thinning of the skin, flaking, itching, pigmentation, eczema-like dermatitis and ulcer formation.
(2) Thrombotic superficial phlebitis: pain at varicose veins, presenting red, hard nodules and striae with pressure pain.
(3) Bleeding: acute bleeding due to trauma or spontaneous rupture of varicose veins or small veins.
(4) Secondary infection: secondary infection is easy to occur because of the patient’s weakened resistance. The common ones are thrombotic superficial phlebitis, dermatitis, acute cellulitis, elephantiasis, etc.
Treatment methods
There are four types of treatment methods for varicose veins in lower limbs, including: compression therapy, drug therapy, varicose vein sclerotherapy and surgical procedures.
1.Compression therapy is suitable for those who have mild symptoms, do not require high aesthetics, are older, have combined deep vein thrombosis, or have moderate to severe deep vein reflux that is not suitable for surgery
The use of sequential compression stockings, sequential compression stockings establish the highest support pressure at the ankle, and gradually decrease up the leg. The pressure is reduced to 70%-90% of the maximum pressure in the calf and 25%-45% of the maximum pressure in the thigh. This decreasing change in pressure allows blood to flow back into the veins of the lower extremities, effectively relieving or improving the pressure on the veins and valves of the lower extremities. It is best to wear compression stockings in the early morning before getting up and take them off at night after going to bed.
2.Drug therapy is suitable for all conservative treatment and short-term post-operative recovery patients.
Medication for varicose veins cannot eradicate the disease, but can only relieve itching, dermatitis, lower limb edema, swelling and discomfort caused by varicose veins.
Common drugs are.
1.MaiZhiLing is a kind of medicine with European horse chestnut seed extract as the main ingredient, whose effects are: reducing vascular permeability, increasing venous reflux, reducing venous stasis symptoms, increasing vascular elasticity, increasing vascular tone, and anti-oxidant free radical effects.
2, Xiliotuo (mucopolysaccharide polysulfate cream), indications for superficial phlebitis, varicose phlebitis, adjuvant treatment after varicose surgery and sclerosis, hematoma, contusion, swelling and edema, thrombophlebitis, exudation caused by intravenous infusion and injection, inhibition of scar formation and softening of scars.
3.Calcium hydroxybenzene sulfonate capsule: This product regulates microcirculation function by regulating the physiological function of microvascular walls, reducing plasma viscosity, reducing platelet aggregation and other mechanisms, thus playing a role in the treatment of bruising dermatitis skin capillary microcirculation lesions caused by varicose veins of lower limbs.
4.Danshen and other related herbal medicines: it has the function of improving the capillary microcirculation lesions of the skin capillaries of varicose veins caused by stasis dermatitis of lower limbs.
3, varicose vein sclerotherapy Suitable for relatively mild condition, young female patients with high demand for cosmetic effect, with the advantages of small surgical trauma, good cosmetic effect, no bleeding, fast recovery, and can be repeatedly treated for many times.
Sclerotherapy for varicose veins in the lower limbs has become the first-line treatment program in Europe and the United States, and varicose veins are generally heavy in our population, and there is a possibility of recurrence after sclerotherapy alone. The recurrence rate is reduced.
4.Surgical treatment is suitable for patients with severe disease, combined with skin ulcers, venous rupture and bleeding, and no contraindications to surgery
The current surgical methods are
1.Traditional high saphenous vein ligation + segmental stripping This is a classic surgical procedure, the advantage is that it is effective, but the disadvantage is that it is traumatic, bleeding and slow recovery.
2.Laser treatment of varicose veins This method is inserted into the saphenous vein by laser guidewire, which burns the vein and closes the vein due to the high capacity of laser guidewire to achieve the treatment purpose, the advantage of this method is minimally invasive, the disadvantage is that some patients have a cord-like vein residue under the skin obviously after the operation, and some patients have numb skin after the saphenous nerve is damaged. But the overall patient satisfaction is high.
3.venefit endovenous targeted treatment technology was approved by FDA in 2006 and entered China in June 2015, similar to laser technology, through the guide wire inserted into the saphenous vein, under the monitoring of ultrasound probe directly acting on the vein wall to release radiofrequency energy to make the vein fibrosis and vascular closure, the advantage is minimally invasive, the disadvantage is expensive, more than 5 times the cost of ordinary varicose vein surgery
In short, according to the patient’s condition and social condition, it is very crucial to choose the right treatment method, and the most important point is that varicose veins are not a small problem, and this disease needs to be treated in the regular hospital vascular surgery, many patients go to the dermatology department, the Chinese medicine department for treatment, spending unjust money, taking the wrong path, and finally delaying the disease. If you need to consult with the quality appointment service, you will be provided with the best treatment plan.