Varicose veins in the lower extremities are common and frequent diseases of peripheral vascular disease. The varicose veins are tortuous and dilated due to the increase of venous pressure caused by various reasons. As the lesion progresses, the affected limb may become sore and swollen after prolonged standing or walking, and may also have calf muscle spasms. When standing, the affected limbs appear bulging, tortuous, dilated veins, and in heavy cases, they are in the shape of masses, and those who have been ill for a long time may develop stagnant dermatitis, hyperpigmentation, hardening of the skin and chronic ulcers in the boot area (lower and middle front of the calf), and may also develop thrombophlebitis secondary to varicose veins.
Lower limb varicose veins pathogenesis.
Due to congenital weakness of the vein wall and venous valve dysplasia or absence, or due to acquired long-term work reasons, such as long-term standing, overexertion, cold stimulation by washing cold water, trauma, major surgery, pregnancy, etc., the valve cannot close normally, or the weakness of the vein wall cannot normally withstand the pressure in the vein and expand extremely, resulting in the relative incomplete closure of the deep vein valves of the lower extremities, and the incomplete closure of the vein The incomplete valves further increase the pressure in the distal veins, which over time leads to the expansion, extension and tortuosity of the distal veins, stagnation of venous blood (hemosiderosis), and destruction of the elastic fibers of the vein walls and the onset of the disease.
Diagnostic criteria for varicose veins of lower limbs:
(1) A history of prolonged standing and elevated abdominal pressure, or a family history of varicose veins in the lower extremities.
(2) The veins of the patient’s lower extremities are significantly tortuous and dilated, more pronounced when standing.
(3) The deep veins are patent, the saphenous valves are incompetent, and there may be venous valve insufficiency of the traffic branch.
(4) Ultrasound Doppler or venography shows tortuous dilatation of the saphenous vein with valvular insufficiency.
(5) There may be complications such as hyperpigmentation, ulceration, thrombotic superficial phlebitis, bleeding, and ulceration.
Complications of varicose veins of the lower extremities.
(1)Thrombotic superficial phlebitis;
(2) Superficial venous hemorrhage;
(3) bruising dermatitis;
(4) Secondary infection;
(5) bruised ulcers.
How to prevent varicose veins of lower extremities?
The main prevention of varicose veins in the lower extremities is to strengthen the venous walls and protect the superficial veins, and the specific measures are.
(1)Appropriate physical exercise should be carried out to strengthen the vein wall under the condition of enhancing the whole body.
(2)Those who are engaged in standing work or strong physical labor for a long time should wear elastic stockings for protection, so that the superficial veins can be atrophied;
(3)Those who are engaged in standing work for a long time should emphasize doing work gymnastics or can walk around frequently, at least do more ankle extension and flexion activities so that the gastrocnemius muscle can play the role of effective pump to promote the return flow of blood to the lower limbs to reduce the pressure within the superficial veins. If varicose veins in the lower extremities have occurred, you must consult a vascular surgeon as soon as possible and take reasonable treatment under the guidance of a doctor to avoid serious complications such as lower extremity ulcers.
How to treat varicose veins of lower extremities?
Regarding the treatment of varicose veins in lower limbs, different treatment methods should be formulated after the cause of the disease is clarified through effective examination means such as color ultrasound or venography.
(1) Non-surgical treatment: It mainly consists of wearing elastic stockings or using elastic bandages on the affected limbs. It is suitable for the following conditions.
(i) those with limited, mild and asymptomatic lesions;
(2) Pregnant women, since the symptoms tend to disappear on their own after delivery, non-surgical treatment can be performed temporarily;
(3) Those who are estimated to have very poor tolerance for surgery.
(2) Sclerotherapy and compression therapy: Intravascular injection with sclerosing agents such as 5% sodium cod liver oil acid can never be injected into the saphenous vein in the inguinal region due to the limitation of injection site, so it cannot treat varicose veins of lower limbs fundamentally, and the recurrence rate of simple application is high, so it is only applicable to simple lesions below the knee joint, and it can also be used as an adjuvant therapy for surgery to deal with the residual varicose veins which are not exhausted by stripping. varicose veins.
(3) Surgery: This is the fundamental approach to deal with varicose veins in the lower extremities. All symptomatic people should be treated surgically as long as there are no contraindications, such as very poor tolerance for surgery. The most commonly used surgical method is varicose saphenous vein stripping, which is basically divided into three steps.
①High ligation of the saphenous or small saphenous vein;
(2) Stripping the varicose saphenous vein or small saphenous vein;
The minimally invasive methods such as laser treatment of varicose veins, microwave treatment and venous planing and aspiration all have certain efficacy and indications, and the most suitable method is chosen by the doctor and the patient together depending on the condition.