Varicose disease of the lower extremities: causes, symptoms, diagnosis, treatment

Varicose disease of the lower limbs - an expansion of the superficial veins of the lower extremities. Usually the obvious reason is missing. Varicose disease is usually asymptomatic, but there may be a feeling of overflow, pressure and pain or hyperesthesia in the legs. Diagnosis is established during a physical examination. Treatment of varicose disease of the lower extremities includes compression, injury prevention, sclerosing therapy and surgical intervention.

This disease occurs in isolation or in combination with chronic venous insufficiency.

Causes of varicose disease of lower extremities

The causes are usually unknown, but varicose dilatation may be a consequence of primary venous valve failure with reflux or primary expansion of the vein walls due to the weakness of the vascular wall. In some people, varicose veins are the result of chronic venous insufficiency and venous hypertension. Most people do not have any obvious risk factors. Varicose veins occur frequently in members of the same family, which implies a component of heredity. Varicose veins are more often found in women, because estrogens adversely affect the vascular wall, pregnancy increases venous pressure in the veins of the pelvis and lower limbs. Sometimes, varicose veins are part of the Klippel-Trenone-Weber syndrome, which includes congenital arteriovenous anastomoses and widespread cutaneous capillary angiomas.

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Symptoms of varicose disease of lower extremities

Varicose veins may initially be strained and palpable, but not necessarily visible. Later they are able to progressively increase, act and become visible. This condition can cause a feeling of overflow, fatigue, pressure and superficial pain or hyperesthesia in the legs. Varicose veins become better visible when the patient is standing. For unclear reasons, congestive dermatitis and venous varicose ulcers rarely develop. When skin changes occur (for example, induration, pigmentation, eczema), it typically localizes in the area of the medial malleolus. Ulcers can develop after minimal trauma, usually they are small, superficial and painful. Varicose veins are sometimes thrombosed, causing pain. Surface varicose veins can form thin venous bullae in the skin, capable of bursting and bleeding after a minimal injury. Very rarely, such bleeding, which occurred in a dream and not detected on time, becomes fatal.

Diagnosis of varicose disease of lower extremities

The diagnosis usually becomes apparent during a physical examination. Trendelenburg's test (comparison of venous filling before and after application of the tourniquet to the thigh) is partially no longer used to detect reverse blood flow through the imperfect valves of the saphenous vein of the leg, because the sensitivity, specificity, and variability of the results for this test have not been determined.

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Treatment of varicose disease of lower extremities

Treatment is aimed at reducing symptoms, improving the appearance of the foot and in some cases preventing complications. Treatment includes compression stockings and injury prevention.

Injection sclerosing therapy and surgical treatment are prescribed for the prevention of repeated thrombosis and skin changes. These procedures are also commonly used for cosmetic reasons. In sclerosing therapy, an irritant (eg sodium tetradecyl sulfate) is used to cause thrombophlebitis, leading to fibrosis and vein occlusion; but in many cases the patency of varicose veins is restored. Surgical treatment involves the ligation or removal of the large and (sometimes) small subcutaneous veins of the lower limb. These procedures provide for a while the disappearance of symptoms, but the long-term effectiveness is weak.

Regardless of the treatment, new varicose veins develop, and treatment is often done continuously.