When it comes to varicose veins in the lower limbs, people immediately think of superficial veins in the lower limbs, especially in the calves, which are dilated, twisted and higher than the skin, like an earthworm lying on the legs, and sometimes also dilated into a venous ball. Patients often feel sore and swollen calves, heavy and weak, and swelling in the ankle after standing for a long time, which not only affects the beauty, but also brings a lot of inconvenience to work and life. With the development of the disease, varicose veins become more and more serious, resulting in stagnant blood flow, increased venous pressure, metabolic products seeping into the subcutaneous, skin itching and pigmentation. The skin will be malnourished because of poor local blood circulation and tissue hypoxia, and the resistance will be reduced, which will easily complicate skin eczema, ulcers and repeated lower limb infections. Once the ulcers occur, they often do not heal for a long time, which is commonly known as “old rotten feet”. Sometimes the varicose veins also rupture due to ulcer erosion or trauma, causing acute hemorrhage. So we should not underestimate the varicose veins.
What are the causes of varicose veins?
The causes of simple varicose veins in the lower extremities are venous valve insufficiency, weakness of the vein wall and persistent increase in venous pressure. The first two are a manifestation of systemic tissue weakness and are associated with genetic factors. The important causes of persistent increase in venous pressure in the lower extremities are prolonged standing and increased intra-abdominal pressure.
When standing for a long time (in fact, when sitting for a long time as well), the venous blood flows backwards due to gravity, causing excessive pressure in the leg veins, while the calf gastrocnemius muscle is in a relaxed state and cannot pump the blood back to the heart, and the pressure is transmitted to the superficial veins through the traffic branches between the deep and superficial veins, causing superficial varicose veins.
Increased pressure in the abdominal cavity can also affect the return of blood, causing increased venous pressure in the lower limbs, resulting in varicose veins. For example, prolonged heavy physical labor, chronic cough, habitual constipation, etc.
Pregnant women can have varicose veins due to increased venous pressure in the lower extremities as a result of pressure on the returning veins from the pregnant uterus.
Other causes such as patients with deep vein thrombosis, patients with Bu-ga syndrome, patients with retroperitoneal tumors, etc., can cause varicose veins in the lower extremities because of obstruction of venous return.
The diagnosis of varicose veins is not difficult and can be made by the patient himself based on the symptoms and manifestations, but some tests are still needed to determine the cause of varicose veins and whether the deep veins are patent, such as valve function test, deep vein patency test, deep vein ultrasound, venography, etc.
What are the options to treat varicose veins?
Surgery is the most fundamental way to treat varicose veins in the lower extremities. In the past, high ligation of the saphenous vein and segmental stripping of the varicose veins were often used. This surgery is not only traumatic and leaves a lot of scars on the legs, which affects the beauty, but also the saphenous vein is destroyed by the surgery. As you know, with the continuous development of medical science and technology, many medical diseases can be treated by surgical methods, such as coronary artery bypass for coronary heart disease and renal artery bypass for hypertension. The best graft needed for these procedures is the saphenous vein. Therefore, high ligation of the saphenous vein is not generally advocated at this time, but rather ligation of the saphenous vein below the knee, unless there are also significant varicose veins in the thigh. Here is a new approach to varicose vein surgery.
Minimally invasive hook removal method Aesthetically pleasing without scarring
Minimally invasive surgery is popular among varicose vein patients for its small incision, quick recovery and aesthetic appearance after surgery. Based on this, the Department of Vascular Surgery at Shanghai Changhai Hospital has developed a “hook removal” procedure for varicose veins that leaves no scars after surgery. This procedure uses a special hook-like instrument to hook out the patient’s varicose veins one by one. The procedure is short, does not require stitches, and leaves no scars. For patients with mild varicose veins, the procedure can be done under local anesthesia. This procedure is mainly suitable for medium and early varicose veins because the lesions are rarely complicated by thrombosis and perivenous inflammation, the vessels are not yet brittle and the adhesions to the surrounding tissues are not serious. If the patient has already developed pigmentation or even ulcers on the legs, this method cannot be used, so early treatment is recommended.
Pre-operative preparation: the patient is made to stand so that all the varicose veins are filled and the surgeon draws a “map” with a marker along the varicose veins as an intraoperative marker.
The advantages of this procedure are
1.Simple operation, easy to master, short operation time, and less bleeding during the operation.
2.Small trauma and quick recovery. The incision is only 2-3mm, which can be healed in 2-3 days, and no scars are left, which ensures the beauty of the leg.
3.Shortened hospitalization time. The general hospitalization can be discharged in 4-5 days, and outpatient surgery is also available for patients with mild disease, which greatly reduces the cost of treatment.
4.Less complications. After the operation, you can move around on the ground without being bedridden for a long time, which reduces the chance of deep vein thrombosis and postoperative infection.
In addition, Shanghai Ninth People’s Hospital adopts ultrasound positioning and introduces laser fiber into the varicose mass of the saphenous vein to destroy the inner lining of the saphenous vein, causing the varicose vein to contract and occlude, and eventually fibrosis to achieve the treatment purpose. This procedure is also only suitable for patients with early or mid-stage varicose veins that are not severe. Recently, Rush-Copley Medical Center has developed a method of aspiration of varicose veins using a powered venous aspiration device under the illumination of a subcutaneous light source. Successful treatment of varicose veins using interventional catheter electrocoagulation has also been reported.
Compression therapy with compression stockings
Medical compression stockings for the lower leg have good elasticity and pressure gradient, which can make the varicose veins located in the lower leg, especially the superficial veins in the boot area, inner and outer ankle, to be compressed evenly and effectively, and play a role in controlling the development of the disease. It is mainly used for those who have small, mild and asymptomatic varicose veins; women during pregnancy; and those who are in poor general condition and cannot tolerate surgery.
Prevention of varicose veins in lower limbs
The only way to avoid varicose veins in the lower extremities is to do a really good job of preventive care. Most of those who have a family history of varicose veins develop them soon after puberty, so during childhood and adolescence, proper physical exercise should be carried out to strengthen the whole body and enhance the elasticity of the vein walls.
The measures to protect the superficial veins are
1.For those who are engaged in standing work or strong physical labor for a long time, it is advisable to wear elastic stockings for protection, so that the superficial veins are in the state of atrophy.
2.Sedentary people should pay attention to interval exercise, the flexion and extension movement of ankle and knee joint can make gastrocnemius muscle play the role of pump effectively and promote blood return, so as to reduce the pressure of superficial vein.
3, often elevate the lower limbs to reduce the pressure of the calf veins. Wash your feet with warm water before going to bed to promote blood circulation in the lower extremities, and never wash your lower extremities with cold water.
4, Quit smoking, light diet to reduce the damage of irritating metabolites to the vein wall.
For those who already suffer from varicose veins
Attention should be paid to.
1.Protect the affected limb and avoid touching the skin. When the skin itches, do not scratch hard to prevent scratching the skin to cause ulcers.
2.Avoid standing and sitting for a long time, wear elastic stockings, and elevate the affected limb at every opportunity to slow down the process of the disease.
3.For those who have lower limb swelling, take medication to reduce edema. Take small doses of enteric aspirin frequently to prevent the formation of deep vein thrombosis.
4, in any case, once the varicose veins of the lower limbs occur, it is advisable to operate as soon as possible to prevent acute bleeding, chronic ulcers and other serious complications.