How it works and why it progresses
The blood from the legs rises up against gravity thanks to the work of the lower leg muscles and a system of valves in the veins that prevent it from flowing back. When the valves stop closing, some of the blood is dumped down at each step - reflux occurs. The veins become overfilled, the pressure increases, the walls stretch, which damages the following valves. This completes the circle: the longer venous hypertension exists, the more the skin microcirculation suffers, and the closer the trophic changes are.
- Initial stage: almost no complaints, only spider veins and reticular veins are visible
- Next, varicose veins appear
- Then swelling occurs, first at the ankle and only in the evening
- The next stage is skin changes: darkening, thickening, eczema, whitish atrophic areas
- The outcome is a healed or open trophic ulcer in the lower third of the leg, usually above the inner ankle
Symptoms that are not taken seriously
Early manifestations are so common that almost no one associates them with vein disease: they are attributed to fatigue, weather, work and excess weight. Meanwhile, it is at this stage that treatment is the simplest and most effective - compression, movement and observation are enough, without any interventions.
- Heaviness and swelling in the legs, increasing in the evening and after standing or sedentary work
- Swelling, which goes away by the morning after sleep, is an early and very characteristic sign.
- Noticeable mark from the elastic of the sock on the shin
- Night cramps in the calf muscles
- Itching of the skin of the lower leg, especially above the ankle
- Restlessness in the legs, desire to move them in the evening and in bed
- Darkening of the skin above the ankle - brownish pigmentation that is often mistaken for a sunburn or bruise
The difference with arterial disease is fundamental: with venous insufficiency it becomes easier when the legs are raised and when the person walks, and worse when he stands or sits without moving. With atherosclerosis of the arteries, the opposite is true: pain occurs when walking and goes away with rest, and intensifies when lifting the leg. This simple check helps ensure that two conditions that require different treatments are not confused.
What increases the risk
Venous insufficiency develops over years, and the contribution of various circumstances adds up. Heredity cannot be changed, but most other factors can be corrected, and it is they who ultimately determine whether it will lead to skin changes and ulcers or whether the disease will stop at the stage of evening severity.
- Heredity is one of the most significant factors, especially in the female line
- Work involving prolonged standing or sitting: salespeople, hairdressers, surgeons, drivers, office workers
- Pregnancy and childbirth, especially repeated ones
- Overweight
- Previous deep vein thrombosis
- Age and decreased physical activity
- Regular heat exposure: hot baths, saunas, working near a heat source
- Chronic constipation and heavy lifting, which increases intra-abdominal pressure
Survey
The key question of the examination is: is this a venous problem at all? Leg swelling is a symptom that has at least a dozen causes, and prescribing compression without understanding the diagnosis is pointless and sometimes dangerous.
- Осмотр в положении стоя: только так видны истинные размеры вен и отёка.
- Дуплексное ультразвуковое сканирование вен нижних конечностей — main метод. Оно показывает состояние клапанов, наличие и протяжённость рефлюкса, проходимость глубоких вен, следы перенесённого тромбоза, и именно на нём строится план лечения.
- Исключение других причин отёка: сердечная недостаточность, diseases почек, щитовидной железы, лимфедема, приём некоторых препаратов. Двусторонний симметричный отёк чаще указывает не на вены.
- При наличии язвы — обязательное измерение лодыжечно-плечевого индекса до назначения компрессии: при сопутствующем поражении артерий сильная компрессия опасна.
- При рецидивирующих тромбозах в молодом возрасте — обследование на нарушения свёртывания по назначению врача.
Compression hosiery: how to choose and wear
- Класс подбирает врач. Первый класс применяется при начальных проявлениях, отёках и профилактике; второй — при выраженном варикозе, стойких отёках и после вмешательств; третий — при тяжёлых формах, посттромботическом синдроме и лимфовенозной недостаточности.
- Размер подбирают по замерам, а не по весу и росту: измеряют окружность лодыжки, голени, при чулках — бедра. Замеры делают утром, пока нет отёка.
- Надевать трикотаж нужно утром, лёжа в постели, до того как ноги опустились вниз. Надетый днём на отёчную ногу, он работает заметно хуже.
- Носить в течение дня, снимать на ночь. Исключения — только по отдельному указанию врача.
- Уровень изделия определяется зоной поражения: в большинстве случаев достаточно гольфов, так как основные проблемы сосредоточены ниже колена. Чулки и колготы нужны при поражении вен бедра.
- Менять изделия примерно каждые 6 месяцев: трикотаж растягивается и теряет лечебное давление, даже если выглядит целым.
The most common reason why knitwear is lying in the closet is that it is difficult to put on, especially the second and third grade, with back pain or excess weight. The problem can be solved: there are special devices-frames for putting on, silk socks-slides and textile gloves, which at the same time protect the knitwear from tightening. It is worth asking about this during selection, and not refusing treatment. The second most common reason to quit is the heat: in the summer months it is harder to wear compression, but it is then that venous congestion intensifies, and the doctor selects a product with a lighter weave.
Treatment and what you can do yourself
Separately, it is worth mentioning about pregnancy. Veins expand under the influence of hormones and increasing pressure in the abdominal cavity, and in some women varicose veins first appear then. It is not customary to operate during pregnancy: a significant part of the changes decrease on their own within a few months after birth. The correct tactics for this period are compression hosiery, selected by a doctor, movement and observation, and the issue of intervention is decided no earlier than six months after childbirth and completion of feeding.
- Endovasal laser or radiofrequency obliteration is the modern standard for eliminating reflux along the trunk of the saphenous vein: through a puncture, without incisions, with a return to normal life on the same or next day
- Sclerotherapy is the administration of a drug that glues a vein; used for tributaries, reticular veins and spider veins
- Miniphlebectomy - removal of varicose veins through micropunctures, often in addition to obliteration
- Classic surgery to remove the vein trunk - today used less often, with anatomy unsuitable for intravascular methods
- Venotonic drugs reduce heaviness, swelling and cramps, but do not eliminate reflux or eliminate compression - this is an addition, not a basis
- For an open ulcer - compression therapy and special bandages: healing is possible, but requires time and discipline, and without eliminating reflux, ulcers often open again
What helps in everyday life is what seems too simple: walking and working the calf muscles, raising your legs above heart level for 15–20 minutes several times a day, raising the foot of the bed 10–15 cm, losing weight, avoiding long hours of standing and sitting without breaks, cool showers on your shins instead of hot baths. The calf muscle pump is the second most important pump in the body, and its work depends only on whether a person walks or not.
