VARICOSE VEINS AND VEIN DISEASES
TextBefore taking any medication contact your doctor
© Nikos Aledzhanov, 2021
ISBN 978-5-0053-4518-9
Created with Ridero smart publishing system
Preface
The book is intended for a wide range of readers and is devoted to diseases of the venous system. Varicosity and other venous diseases are common pathologies of the lower extremities. Currently, there is no more pervasive vascular disease than varicose veins, which occurs nearly a quarter of the adult population of the world. And this is not surprising, because the legs take on the weight of the body and they are in motion every day. The main reason for the development of varicosity is heritable disease of the venous wall. And if the relatives had varicose veins, then one way or another it will most likely show itself. You can get rid of varicose veins quickly enough, especially if the disease is not started and precautionary measures are taken on time. The book presents modern views not only on varicose veins of the lower extremities, but also diseases such as thrombosis of superficial and deep veins, trophic ulcers, chronic venous insufficiency. Quite effective and modern methods for the treatment of cosmetic defects, such as spider veins and asterisks, have been proposed. Some chapters are devoted to compression garment and sport, as not all of its types are a contraindication to training with varicose veins and it can help to improve the general condition.
Chapter I
The history of the issue
“… varix should be punctured in many places where circumstances indicate”
Hippocrates / Ιπποκράτης
The first pictire of varicose veins was found west of the Acropolis, dating back to the 4th century BC. A bearded man was depicted with a varicose vein on his left leg. In his work Comparative Biographies, Plutarch describes one of the first surgery for varicose veins. The Greeks were looking for new ways to treat and study the circulatory system. Diogenes of Apollonia and Euryphon of Cnidus in the 5th – 4th centuries were the first who described blood vessels and divided them into arteries and veins. Ideas that laid down in ancient Greece, such as miniflebectomy, vein ligation, compression therapy, are still used today. There are known cave paintings that indicate the use of a compression bandage in the earliest era of human development. Hippocrates believed that ulcers of the lower extremities are associated with varicose veins. In the treatment of ulcers, Hippocrates pointed the veins and bandaged the lower extremities. About the treatment of varicose veins, Hippocrates wrote: “… varix should be punctured in many places, where circumstances indicate.” The surgeons of the Hellenistic era were the first who dared to remove varicose veins. In earlier times, these operations were unknown. Byzantine doctors believed that the most common areas of varicose veins were the lower extremities, the abdomen (abdominal cavity “medusa’s head”), and the temporal lobe. The methods of vein surgery of the Byzantine doctors are based on the methods of the famous Greek doctors of the Hellenistic period, which moved into medieval surgery, influencing and inspiring even modern surgeons. For example, the modern “vein engaging technique” described in 1975 dates back to the Byzantine period. For its part, after a while, Friedrich Trendelenburg (1844—1924), conducting operations, refers to the operation described by the doctors of Byzantium and other ancient surgeons. The revolutionary method of surgical treatment of varicose veins was proposed in 1908 by the American physician W.W. Babcock, which consisted of the removal of the subcuticular veins. The next stage in the development of phlebology is associated with the emergence of X-ray diagnostic methods in the 1920s. The appearance of color-imaging ultrasound angioscanning and Doppler imaging was a breakthrough in the diagnosis and treatment of varicose veins. Sclerotherapy – the injection of chemicals (special foam) into the varicose vein appeared in the 1970s. The method of laser coagulation of varicose vessels, whichwas proposed by K. Bone in 1998—1999,remains one of the main methods in modern phlebology. This method became an important point in the treatment of varicosity.
Chapter II
General Issues
“Part of the disease comes only from the way of life”
Hippocrates / Ιπποκράτης
Chronic venous disease (CVD) of the lower extremities is a very common pathology, affecting up to 50% of the adult population; among CVD, varicose veins of the lower extremities is the most common.
Incidence of venous disease
According to various sources, up to 88% of women and up to 66% of men from among the inhabitants of developed countries have signs of venous diseases. Among the adult population, the prevalence ranges from 24% to 50%. According to the WHO, every third adult on the planet suffers from varicosity. Studies over the past few years indicate that different degrees of the venous system damage of the lower extremities occur and reduce the quality of life in 80% of people of working age. One of the largest studies that describe cases of chronic venous diseases was the Vein Consult Program, which included 91,545 people from 20 countries. Diseases of the veins were found in 83%. Among patients with CVD, women (68.4%) prevailed over men (31.6%). The average age of those who surveyed with CVD was 53.3 years. Age dependence of the prevalence of venous diseases. The prevalence of varicosity in people aged 18 to 24 years is from 11%, men in the age group from 30 to 40 years is about 3%, and men over 70 years old is 40%. For women: from 30 to 40 years old is about 20%, and for women over 70 years old, more than 50%. From 55 to 64 years old is about 55.7%. The prevalence of skin changes in chronic venous unsufficiency (CVI) for women from 30 to 39 years old is 1.8%, while at the age of over 70 they are already found in 20.7% of those who surveyed. The increase in the prevalence of CVD with age is also confirmed by a study conducted in 2010 in Germany, in which molecular genetic methods were used for the first time.
Geography of chronic venous diseases
There is a well-defined dependence on the level of development of the country and diseases of the veins, therefore WHO classifies these diseases as diseases of civilization, in other words, to pathologies associated with urbanization and scientific and technological development.
Russia: the detection rate between men and women is 2 to 1, 38—40% for women and 18—20% for men;
USA: varicose veins among men in the age group 30—40 years old – 22%, 50 years old – 42% of cases, among women – in the age group 30—40 years old – 45%, 50 years old – 64% of cases.
England: about 11 – 18%
Europe: women and men – 2: 1;
In the countries of Central Europe, the prevalence of varicose veins in women is 30%, in men – 15%;
Mediterranean countries 18—19%;
China, Japan, India, the incidence rates in these countries are low, about 9%;
Africa 5—6%;
Arab countries approximately 11.5%;
New Zealand – about 33—40%.
In developing countries, varicose veins of the lower extremities are much less common than in economically developed countries, however, such indices may indicate a low quality of diagnosis, in contrast to countries where diagnostic rates are much higher, as well as the number of visits to a doctor with these kind of problems.
What is the circulatory system?
The circulatory system performs one of the most important functions in the body – it delivers to organs and tissues oxygen and nutrients what are necessary for the body’s vital activity, while simultaneously removing carbon dioxide and waste products from them. The blood vessels through which blood moves from the heart are called arteries, and the vessels through which blood returns to the heart are called veins. Small vessels that permeate all organs are capillaries.
What are the veins in our legs?
The veins of the lower extremities are divided into several groups depending on the depth of their location: cutaneous veins (the most superficial), superficial (located under the skin), deep, and also connecting the superficial veins and deep veins – perforant.
Cutaneous veins (small, their diameter is up to 3—4mm),while expanding, they form vascular “asterisks” and reticules which is a cosmetic defect. They do not cause health problems.
– Superficial veins (saphenous).
Superficial veins develop varicose veins. It can develop as an independent disease, and this condition is called varicose veins of the lower extremities. Perhaps as a secondary, when there is a pathology in the deep veins of the leg, which for its part causes overload and secondary expansion of the saphenous veins (superficial). In addition to varicose veins, they may have thrombosis, the so-called thrombophlebitis.
– Deep veins.
Deep veins do not develop varicose veins, they may have congenital defects and local expansion of deep veins (aneurysm) which is rather rare occurrence.
– Perforant.
Perforating veins are veins that connect superficial veins to deep veins.
What diseases are attributed to diseases of the veins?
Spider veins, varicose veins, thrombosis, chronic venous insufficiency, trophic ulcers.
Which doctor should you contact due to vein diseases and what is “phlebology”?
The treatment of blood vessels is done by “cardiovascular surgeons”, “general” surgeons, but specifically by venous diseases – phlebologists. Phlebology comes from the Greek phlebos (φλεβός) – “vein” and logos (λόγος) – “doctrine”, “science”) – a branch of medicine that studies the structure, functions of veins, and also develops methods of diagnosis, treatment and prevention of diseases. A phlebologist is a doctor specializing in vein diseases. Ideally, you need to contact him. Generally, phlebologists are proficient in ultrasound methods and all modern minimally invasive technologies, laser or radiofrequency ablation, sclerotherapy, and others.
What are the symptoms of venous diseases and when to consult a phlebologist?
When the following symptoms appear: spider veins and meshes, the appearance of varicose veins, ooedema, sudden one-sided ooedema (urgently), redness of the skin along the veins, heaviness or pain in the legs, the appearance of pigmentation on the skin of the legs, trophic changes, ulcers, during pregnancy for the prevention or treatment (varicose veins, thrombosis) and others.
What are the diagnoses for venous diseases, what is written in the doctor’s conclusion?
Chronic venous disease is diagnosed according to the CEAP classification.
CEAP is a clinical, etiological, anatomopathophysiological classification that takes into account: clinical manifestations (C – clinic), etiology (E – etiology), anatomical localization (A – anatomy) and pathogenesis (P – pathogenesis) of the disease. The reason for attributing a patient to a particular class is the presence of the most pronounced objective symptom of chronic venous diseases.
Examples of diagnoses:
CEAP: C2, S, Ep, As, p, Pr, 2.18 denotes: Symptomatic varicose veins, primary disease. Reflux along the great saphenous vein in the thigh and the perforating vein of the lower leg.
CEAP: C 3, S, Es, Ad, Po, 11,13,14,15 means: Post-thrombotic disease of the lower limb veins with oedema. Deep vein obstruction of the femoral-popliteal segment and tibial veins of the lower leg.
Interesting fact.
In 400 BC, Hippocrates first described varicose veins and how to treat it.
Chapter III
Vein Diseases
“Everything that the doctor does, let him do it right and beautifully”
Hippocrates / Ιπποκράτης
This chapter details common vein diseases and their complications.
Spider veins and meshes
Varicose veins
Thrombosis
Chronic venous insufficiency
Trophik disorders
Spider veins and meshes
Telangiectasia is a persistent expansion of small vessels of the skin (arterioles, venules, capillaries) of a non-inflammatory nature, showing by spider veins or reticules. The word comes from the Greek “expansion of the final part of the vessel”, telos (τέλος) – end, segment, and ectasia – expansion. Spider veins develop in the skin veins and give only a cosmetic defect when they are dilated and not harmful to health and this is not varicosity, but they can also be combined with varicose veins. “Meshes” and “spider veins” in medical terminology are called reticular veins and telangiectasias which is a very common pathology.
What are the reasons?
There are no proven reasons for their occurrence. There are several theories, for example, changes in hormonal levels (during pregnancy) or taking contraceptives, but all of them have not been proven.
Spider veins are varicose veins?
They do not cause a health hazard, complications and varicosity.
How to find out if there are meshes and spider veins or not?
One of the main reasons for seeking medical attention is cosmetic. This phenomenon is common to all ages. Eventually, the number of meshes increases. In older age, they form on the skin of the legs and legs but they do not go into varicosity.
Which doctor you need to contact?
Phlebologists and cosmetologists deal with the treatment of meshes and spider veins. However, it is best to contact a phlebologist, since doctor has experience in treatment and diagnosis, phlebologist can diagnose concomitant pathology if it is present, for example, varicose veins, and start treatment at an early stage, and as the third argument is that if a cosmetologists detects a disease, you go again to the phlebologist.
The treatment
This pathology is treated to remove unwanted cosmetic defects from the skin.
There are several treatments, the most popular of which are microsclerotherapy, laser percutaneous coagulation, radiofrequency coagulation and the ClaCS method. These methods are practically uncomplicated.
Microsclerotherapy is the introduction into a vessel of a special substance (sclerosant), which leads to the “sticking” of small vessels.
Laser percutaneous coagulation is a laser of a certain wavelength on the vessels, which allows them to be hardened without damaging the skin.
Radiofrequency coagulation – electrocoagulation.
However, in practice, microsclerotherapy and laser percutaneous coagulation are mainly used.
ClaCS method is a combined method of phlebologist Kazu Miyaki.
CLaCS is a method for the treatment of spider veins and asterisks. It combines the techniques of sclerotherapy (concentrated 70% glucose) and laser percutaneous removal with cooling during the procedure. The procedure is outpatient and takes about an hour. There are no advantages of some methods over others in the treatment of nets and asterisks.
Complications of the treatment
Complications are possible after any of the treatment methods for this pathology. Skin pigmentation, skin necrosis, relapse and allergic reactions.
– Hyperpigmentation and depigmentation
After the procedures, brown spots are formed. Hyperpigmentation will go away within a few months or years but depigmentation is rareand the causes of these complications are unknown.
– Skin necrosis
It is not common complication. The complication is associated with the wrong technique of performing the procedure. As a result, either heals completely, or leaves a small scar.
– Relapse
The appearance of new telangiectasias, most of which later go away on their own.
– Allergic reactions
As with the vast majority of drugs, the body may react to sclerosants. Modern sclerotherapy drugs are not strong allergens, and allergic reactions are rare.
Prevention
Phlebotropic drugs, dietary supplements, vitamins, folk methods do not prevent the development of spider veins and nets.
Interesting fact
The use of high-heeled shoes increases muscle load while walking and decreases venous pressure in the legs compared to walking barefoot, which is a positive factor in the treatment of varicose veins.