How varicose veins of the lower extremities are formed
Varicose veins in the lower extremities are caused by a variety of factors such as genetics, valve dysplasia, obesity, standing, and low activity, resulting in venous blood backflow → superficial venous hypertension → superficial venous dilatation → superficial venous tortuosity → venous lengthening, thus forming varicose veins.
The venous blood of the lower limbs flows from the bottom to the heart, and in order to overcome the effect of gravity, many valves grow in the veins of the lower limbs from the bottom to the top, whose function is similar to the one-way “valve”, which only allows the blood to flow from the bottom to the top and does not allow the blood to flow backwards, and once these “valves” are not closed properly, the blood will flow backwards. If these “valves” are not closed properly, there will be a backflow of blood.
Usually the first pair of valves of the saphenous vein located at the root of the thigh is the strongest to resist the reverse pressure, once this valve is not fully closed, the backflow of blood from the saphenous vein will occur, and the valves below it will gradually become incomplete due to their weak resistance to pressure, causing the backflow of the whole vein. Since the veins in the lower leg are shallow, thin-walled and located at a low position, they are under the most pressure, so that high pressure → expansion → tortuosity occurs, which results in varicose veins. Most of the varicose veins are branches of the saphenous vein.
What are the negative consequences of varicose veins in the lower limbs?
After the formation of varicose veins in the lower extremities, the veins of the lower extremities become dilated, high-pressure, and stasis due to the backflow of blood in the standing position, and the lower extremities become swollen and painful due to the greater sensitivity of the vessels to dilation, and heavy due to stasis. Since the venous blood of the lower limbs is blood that has been used by the tissues, it lacks oxygen and other nutrients and contains a large number of metabolic products. The long-term stasis of this blood in the legs causes skin nutrition to become impaired, and the skin loses its luster and thickens, resulting in stasis dermatitis and itchiness. Because of the slow blood flow in the tortuous veins, it is easy to form thrombosis and form thrombophlebitis.
Due to the high pressure of the veins, the tiny veins expand, the distance between the cells of the capillary wall increases, and the red blood cells enter the capillaries from inside the capillaries, and the red blood cells contain pigments, which are not easily absorbed, forming skin pigmentation, with the aggravation of the disease, the scope of pigmentation gradually expands, from dotted to lamellar, and even the entire lower and middle legs appear pigmentation, the color gradually deepens, and finally The color gradually deepens, and finally forms a “black pan” like skin. At this time, the skin nutrition is extremely poor, once scratched or touched, ulcers will be formed, and it will not heal for a long time, forming the so-called “old rotten leg”.
What are the treatments for varicose veins in lower limbs
Varicose veins of lower extremities are common and multi-morbidity, the incidence rate accounts for about 20% of adults, and there are various treatment methods, the treatment methods are developing towards the direction from massively invasive to minimally invasive.
The traditional treatment method is: saphenous vein high ligation + stripping, which is commonly known as “cramping and peeling”, and most people are afraid of the surgery because of the large trauma, incision, bleeding, easy infection and unattractive appearance.
At present, minimally invasive methods are commonly used at home and abroad to treat varicose veins in the lower extremities. The methods used for the saphenous vein trunk are: radiofrequency endovenous closure, laser endovenous closure, microwave endovenous closure, which are used instead of high ligation + stripping of the saphenous vein trunk, i.e. instead of “tamponade”. The methods used for varicose veins in the lower leg segment are: punctal stripping, continuous subcutaneous circular suturing of superficial percutaneous veins, spinotomy, electrocoagulation, and laser closure, which are used instead of “stripping”. The methods used for the reversal of the traffic veins in the lower legs are: lumpectomy of the traffic veins, which is also used instead of “peeling”.
What are the types of varicose veins in the lower extremities?
There are three main groups of veins in the lower extremities: superficial veins (including large and small saphenous veins), traffic veins, and deep veins, all of which can develop varicose veins in the lower extremities due to incomplete valve closure. Varicose veins of lower extremities can be divided into the following types: I. Simple superficial varicose veins: including saphenous varicose veins and small saphenous varicose veins. Second, the traffic vein valve function
Insufficiency: It causes the superficial veins connected with it to be tortuous and dilated, mostly in the form of clusters. Primary deep vein valve insufficiency: deep vein backflow → causes high pressure, dilatation and backflow of the traffic vein → causes high pressure, dilatation and tortuosity of the superficial vein connected with it → causes high pressure, dilatation and backflow of the saphenous vein → aggravates the superficial varicose vein, and this type mostly shows hyperpigmentation, stasis dermatitis, edema and ulceration. Fourth, post-deep vein thrombosis syndrome: deep vein has valve destruction due to thrombosis → deep vein blood backflow → traffic vein high pressure, dilation, backflow → superficial vein high pressure, dilation, tortuosity → saphenous vein high pressure, dilation, backflow → superficial vein tortuosity aggravated. This type is accompanied by severe hyperpigmentation, dermatitis, edema, hard and inelastic skin, and often ulcers. The first three types can interact with each other. Clinically, 50% of varicose veins in the lower extremities are caused by deep venous valve insufficiency.
Radiofrequency treatment of varicose veins of the lower extremities
Radiofrequency treatment of varicose veins of lower extremities is a high-tech treatment technology originated from the United States, which has more than 100,000 cases of surgical experience in the United States, with mature technology, exact efficacy, small trauma, fast recovery and safe treatment. This technology was introduced to China in 2004.
This technique is mainly used to close the main trunk of the large (small) saphenous vein. The treatment method is: inserting the radiofrequency closure catheter from below the knee upwards into the main trunk of the saphenous vein to below the proximal opening of the saphenous vein, releasing the electrode inside the catheter, spreading the electrode piece around and sticking to the vein wall, connecting the radiofrequency catheter to the radiofrequency closure instrument and turning on the instrument, the radiofrequency energy is transmitted to the catheter electrode and generates heat, under the action of heat the vein wall is contracted, thickened, denatured and occluded, the catheter is gradually withdrawn and the whole vein is closed. The catheter is gradually withdrawn and the entire vein is closed. Once the vein is closed, no more backflow occurs and the varicose vein is treated. The closed vein becomes fibrotic after a few months and the lumen disappears, so it will not reopen and will not recur.
In May 2006, the Department of Vascular Surgery of Taian Central Hospital introduced this equipment exclusively in the province, which is specially used for the treatment of varicose veins of lower limbs and has achieved good treatment effect. Nearly 300 cases of varicose veins of lower limbs have been treated in more than one year. Since the application of this technology, the number of mild and moderate patients has increased exponentially, and they are only hospitalized for 3 days and can be discharged the next day after the operation. Severe patients also need only 5-6 days. The development of this technology has realized the desire of painless treatment of varicose veins for patients with mild and moderate varicose veins in lower limbs. Radiofrequency closure is the preferred method for treating varicose veins in the lower extremities.
Varicose veins of lower extremities must be treated comprehensively
Varicose veins of lower extremities are divided into four types: first, varicose veins caused by simple superficial veins; second, varicose veins caused by simple traffic vein valve insufficiency; third, varicose veins caused by primary deep vein valve insufficiency; fourth, varicose veins caused by deep vein post-thrombotic syndrome. Fifty percent of patients in supervised beds are the third condition: that is, deep vein, traffic vein and superficial vein all backflow; followed by superficial vein and traffic vein backflow; the least number of simple superficial vein backflow. For simple superficial venous reflux: radiofrequency + electrocoagulation is used to close the trunk by radiofrequency and the varicose veins in the lower leg by electrocoagulation. For superficial and traffic vein reflux: radiofrequency + electrocoagulation + ligature of traffic vein by lumpectomy. For those with deep vein, superficial vein and traffic vein reflux: deep vein valve repair + radiofrequency + electrocoagulation + lumpectomy traffic vein ligation method. For varicose veins caused by post-deep vein thrombosis syndrome, under the premise of deep vein trunk recanalization: lumpectomy traffic vein ligation + electrocoagulation + radiofrequency + long-term compression stocking treatment.
How to treat deep vein thrombosis of lower limbs
The three major causes of lower limb deep vein thrombosis are: 1) slow blood flow (bed rest, braking) 2) blood hypercoagulation state (post-operative, pregnancy, medication) 3) endothelial damage.
Lower limb deep vein thrombosis (DVT) is divided into three types: 1, peripheral type (in the calf) 2, central type (located above the root of the thigh) 3, mixed type: involving the whole deep vein. Swelling is insignificant or mild if only the calf is involved, swelling of the calf if below the root of the thigh is involved, and swelling of the entire lower limb if the whole limb is involved.
The basic treatment of DVT is anticoagulation, and there are also thrombolytic therapy, embolization therapy and catheter interventional thrombolytic therapy. Thrombolytic therapy: Nowadays, local administration is advocated. This method uses small amount of thrombolytic drugs, reduces swelling quickly, is safe, low cost and basically free of complications, and the course of treatment is 7-14 days. There is no limit to the duration of the disease. Embolization therapy: The thrombus in the lower abdomen and thighs can be removed, and the thrombus in the lower leg is not completely removed, and the inferior vena cava filter must be placed in advance to prevent the thrombus from dislodging during the process of embolization and pulmonary embolism. This method can reduce swelling quickly and protect valve function, but it may cause incisional hematoma and recurrence. The cost of treatment is high, amounting to 30-40,000 yuan. The embolus must be removed within a week of the onset of the disease. Catheter interventional thrombolytic therapy: In the catheterization chamber, the catheter is inserted into the deep vein from the posterior side of the knee joint, and local thrombolysis is performed in segments. In this method, the thrombolytic drug comes into direct contact with the thrombus, and the thrombolysis is faster and the swelling is reduced quickly. However, the inferior vena cava filter must be placed in advance to prevent the thrombus from falling off during thrombolysis; the cost of treatment is high, amounting to 40,000-50,000 yuan; and the patient must be bedridden and cannot move on the ground during the treatment.