Angiology: diseases — симптомы, диагностика и лечение

Varicose veins are persistent dilation of the saphenous veins of the legs due to incompetence of the venous valves. Blood that should move from bottom to top partially flows back and stretches the vein. Many people consider varicose veins to be a purely cosmetic problem and wait for years until they “get in the way.” In fact, this is a progressive disease: without treatment, it leads to swelling, darkening of the skin, trophic ulcers and thrombophlebitis. At the same time, at an early stage, treatment is simple and outpatient.

Atherosclerosis of the arteries of the lower extremities is a narrowing or complete closure of the vessels supplying the legs due to plaques in their walls. The muscles receive less blood than required during exercise, and the person begins to stop every few hundred meters due to pain in the calves. This pain, which goes away after a minute or two of rest, is called intermittent claudication and is almost always attributed to age, fatigue or the back - in fact, it is an early and very reliable sign of arterial disease. It is important to understand it not only because of the legs: a person with damage to the arteries of the legs has a much higher risk of heart attack and stroke, because the plaques are rarely found in only one place.

The aorta is the largest vessel in the body, and an aneurysm is a persistent dilation of more than one and a half times its normal diameter. The main feature of this disease is that it does not show itself for years: the aneurysm does not hurt, does not interfere, and is discovered by chance - on an ultrasound of the abdomen, done for a completely different reason. At the same time, a rupture of an abdominal aortic aneurysm kills most patients even before the operating table. Hence a simple practical conclusion: it makes sense not to look for symptoms, but to timely measure the aortic diameter in those who are at risk. One routine ultrasound examination, taking a few minutes, solves this issue.

Diabetic foot syndrome is damage to the tissues of the foot in a person with diabetes that occurs due to a combination of two processes: nerve damage and poor blood supply. The most insidious thing here is the absence of pain. With diabetic neuropathy, the foot loses sensation, and a callus, abrasion from a new shoe, a burn from a heating pad, or a pebble in a shoe goes unnoticed until an ulcer forms in its place. People are accustomed to trusting pain as an alarm signal, but with diabetes this signal is turned off - and that is why examining the feet with one’s own eyes every evening becomes not a hygienic habit, but a full-fledged medical procedure. The vast majority of amputations due to diabetes are preceded by an ulcer, which could be noticed in time.

Thrombophlebitis is an inflammation of the vein wall with the formation of a blood clot. It is fundamentally important to distinguish between two situations: thrombophlebitis of the superficial veins, which is visible and palpable as a painful dense cord under the skin, and deep vein thrombosis, which is almost invisible from the outside, but is what causes pulmonary embolism - a life-threatening condition. Therefore, if there is sudden unilateral swelling of the leg with pain, you should not warm or rub the leg, but urgently do an ultrasound of the veins.

Chronic venous insufficiency is a condition in which the veins in the legs cannot cope with the return of blood to the heart. The blood stagnates below, the pressure in the veins of the leg increases, fluid and proteins leak into the tissues, and the skin itself gradually changes: first, swelling in the evening, then itching and darkening, then a dense area fused with the underlying tissues, and the result is a trophic ulcer. It is important to separate two concepts that are confused in everyday life. Varicose veins are dilated subcutaneous veins, what is visible to the eye. Venous insufficiency is a dysfunction that can exist without a single visible vein, for example after deep vein thrombosis. Therefore, “the veins don’t protrude, that means everything is fine” is an incorrect reasoning.