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VARICOSE VEINS AND VEIN DISEASES
Nikos Aledzhanov


Vein diseases are very common phenomenon. Varicose is one of the most important problems of modern health care, and primarily because of its complications due to incorrect or late treatment. The book presents modern views on the causes of venous diseases. Recommendations are given for the treatment and prevention of varicose veins, thrombosis, trophic ulcers and chronic venous insufficiency. This book will be your guide to the issues of diseases of the venous system.





VARICOSE VEINS AND VEIN DISEASES



Nikos Aledzhanov



Before taking any medication contact your doctor



© Nikos Aledzhanov, 2021



ISBNВ 978-5-0053-4518-9

Created with Ridero smart publishing system




Preface


The book is intended for aВ wide range ofВ readers and is devoted toВ diseases ofВ the venous system. Varicosity and other venous diseases are common pathologies ofВ the lower extremities. Currently, there is no more pervasive vascular disease than varicose veins, which occurs nearly aВ quarter ofВ the adult population ofВ the world. And this is not surprising, because the legs take on the weight ofВ the body and they are inВ motion every day. The main reason for the development ofВ varicosity is heritable disease ofВ 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 ofВ 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 ofВ the lower extremities, but also diseases such as thrombosis ofВ superficial and deep veins, trophic ulcers, chronic venous insufficiency. Quite effective and modern methods for the treatment ofВ cosmetic defects, such as spider veins and asterisks, have been proposed. Some chapters are devoted toВ compression garment and sport, as not all ofВ its types are aВ contraindication toВ training with varicose veins and it can help toВ improve the general condition.




ChapterВ I





The history ofВ the issue




“… varix should be punctured in many places where circumstances indicate”

Hippocrates / О™ПЂПЂОїОєПЃО¬П„О·П‚


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.




ChapterВ II





General Issues




“Part of the disease comes only from the way of life”

Hippocrates / О™ПЂПЂОїОєПЃО¬П„О·П‚


Chronic venous disease (CVD) ofВ the lower extremities is aВ very common pathology, affecting up toВ 50% ofВ the adult population; among CVD, varicose veins ofВ the lower extremities is the most common.



Incidence ofВ venous disease



According toВ various sources, up toВ 88% ofВ women and up toВ 66% ofВ men from among the inhabitants ofВ developed countries have signs ofВ venous diseases. Among the adult population, the prevalence ranges from 24% toВ 50%. According toВ the WHO, every third adult on the planet suffers from varicosity. Studies over the past few years indicate that different degrees ofВ the venous system damage ofВ the lower extremities occur and reduce the quality ofВ life inВ 80% ofВ people ofВ working age. One ofВ the largest studies that describe cases ofВ chronic venous diseases was the Vein Consult Program, which included 91,545В people from 20В countries. Diseases ofВ the veins were found inВ 83%. Among patients with CVD, women (68.4%) prevailed over men (31.6%). The average age ofВ those who surveyed with CVD was 53.3В years. Age dependence ofВ the prevalence ofВ venous diseases. The prevalence ofВ varicosity inВ people aged 18В toВ 24В years is from 11%, men inВ the age group from 30В toВ 40В years is about 3%, and men over 70В years old is 40%. For women: from 30В toВ 40В years old is about 20%, and for women over 70В years old, more than 50%. From 55В toВ 64В years old is about 55.7%. The prevalence ofВ skin changes inВ chronic venous unsufficiency (CVI) for women from 30В toВ 39В years old is 1.8%, while at the age ofВ over 70В they are already found inВ 20.7% ofВ those who surveyed. The increase inВ the prevalence ofВ CVD with age is also confirmed byВ aВ study conducted inВ 2010В inВ Germany, inВ which molecular genetic methods were used for the first time.



Geography ofВ chronic venous diseases



There is aВ well-defined dependence on the level ofВ development ofВ the country and diseases ofВ the veins, therefore WHO classifies these diseases as diseases ofВ civilization, inВ other words, toВ 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 inВ these countries are low, aboutВ 9%;

Africa 5—6%;

Arab countries approximately 11.5%;

New Zealand – about 33—40%.

InВ developing countries, varicose veins ofВ the lower extremities are much less common than inВ economically developed countries, however, such indices may indicate aВ low quality ofВ diagnosis, inВ contrast toВ countries where diagnostic rates are much higher, as well as the number ofВ visits toВ aВ doctor with these kind ofВ 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 inВ 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 ofВ the lower extremities. Perhaps as aВ secondary, when there is aВ pathology inВ the deep veins ofВ the leg, which for its part causes overload and secondary expansion ofВ the saphenous veins (superficial). InВ addition toВ 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 ofВ deep veins (aneurysm) which is rather rare occurrence.

– Perforant.

Perforating veins are veins that connect superficial veins toВ deep veins.



What diseases are attributed toВ diseases ofВ 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 ofВ venous diseases and when toВ consult aВ phlebologist?



When the following symptoms appear: spider veins and meshes, the appearance ofВ varicose veins, ooedema, sudden one-sided ooedema (urgently), redness ofВ the skin along the veins, heaviness or pain inВ the legs, the appearance ofВ pigmentation on the skin ofВ 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 toВ 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 ofВ diagnoses:

CEAP: C2, S, Ep, As, p, Pr, 2.18В denotes: Symptomatic varicose veins, primary disease. Reflux along the great saphenous vein inВ the thigh and the perforating vein ofВ the lowerВ leg.



CEAP: C 3, S, Es, Ad, Po, 11,13,14,15В means: Post-thrombotic disease ofВ the lower limb veins with oedema. Deep vein obstruction ofВ the femoral-popliteal segment and tibial veins ofВ the lowerВ leg.



InterestingВ fact.

InВ 400В BC, Hippocrates first described varicose veins and how toВ treatВ it.




ChapterВ III





Vein Diseases




“Everything that the doctor does, let him do it right and beautifully”

Hippocrates / О™ПЂПЂОїОєПЃО¬П„О·П‚


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 inВ hormonal levels (during pregnancy) or taking contraceptives, but all ofВ them have not been proven.



Spider veins are varicose veins?



They do not cause aВ health hazard, complications and varicosity.



How toВ find out if there are meshes and spider veins orВ not?



One ofВ the main reasons for seeking medical attention is cosmetic. This phenomenon is common toВ all ages. Eventually, the number ofВ meshes increases. InВ older age, they form on the skin ofВ the legs and legs but they do not go into varicosity.



Which doctor you need toВ contact?



Phlebologists and cosmetologists deal with the treatment ofВ meshes and spider veins. However, it is best toВ contact aВ phlebologist, since doctor has experience inВ 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 aВ cosmetologists detects aВ disease, you go again toВ the phlebologist.



The treatment



This pathology is treated toВ remove unwanted cosmetic defects from the skin.

There are several treatments, the most popular ofВ 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 aВ laser ofВ aВ certain wavelength on the vessels, which allows them toВ be hardened without damaging the skin.

Radiofrequency coagulation – electrocoagulation.

However, inВ practice, microsclerotherapy and laser percutaneous coagulation are mainly used.

ClaCS method is aВ combined method ofВ phlebologist Kazu Miyaki.

CLaCS is aВ method for the treatment ofВ spider veins and asterisks. It combines the techniques ofВ 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 ofВ some methods over others inВ the treatment ofВ nets and asterisks.



Complications ofВ the treatment



Complications are possible after any ofВ 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 aВ few months or years but depigmentation is rareand the causes ofВ these complications are unknown.

– Skin necrosis

It is not common complication. The complication is associated with the wrong technique ofВ performing the procedure. As aВ result, either heals completely, or leaves aВ small scar.

– Relapse

The appearance ofВ new telangiectasias, most ofВ which later go away on theirВ own.

– Allergic reactions

As with the vast majority ofВ drugs, the body may react toВ 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 ofВ spider veins and nets.



InterestingВ fact

The use ofВ high-heeled shoes increases muscle load while walking and decreases venous pressure inВ the legs compared toВ walking barefoot, which is aВ positive factor inВ the treatment ofВ varicose veins.




Varicose veins




“Of the constitutions of the year, the dry, upon the whole, are more healthy than the rainy, and attended with less mortality”

Hippocrates / О™ПЂПЂОїОєПЃО¬П„О·П‚


Varicose veins of the lower extremities (from the Latin varix – “knot”) – one of the most common diseases of the vessels of the lower extremities, according to various sources, 20% – 40% of the adult population of developed countries suffer from varicose. Only superficial veins (saphenous) are subject to varicose veins, deep veins do not suffer from varicose veins. Diseases of veins are very multiple, it has different clinical symptoms and prognosis. For example, spider veins cause cosmetic problems for young women. Blood clots in deep veins can be asymptomatic and when they rupture, a very serious complication can occur – pulmonary embolism. One of the main symptoms of the disease is the appearance of varicose veins, the formation of varicose nodes – nodular extensions, which gave the name of this disease (varix – “knot”) and the thinning of the venous wall and it loses its elasticity as a result of the vessels stretch, which leads to the appearance of valvular insufficiency veins and the development of the symptoms of chronic venous insufficiency (CVI). CVI is occured by such symptoms as heaviness in the legs, ooedema, fatigue, burning sensation, cramps at night, violation of the trophism of the skin and soft tissues. Eventually, venous insufficiency develops in all patients with varicose veins.



How does varicose veins occur?



The circulatory system consists of a large number of large and small blood vessels. The blood fluid flows to the tissues and organs through the arteries, and back through the veins. The veins of the lower extremities have the largest number of valves. Blood normally flows upward through the veins – to the heart and lungs – because muscle contractions help it. With any movement, the contracting muscles act as a kind of pump, squeezing blood out of the veins and pushing it towards the heart. But according to the laws of physics, the liquid tends to go down. To prevent this from happening, there are valves in the veins. They open in the direction of the blood flow and close to keep it out. If the valves do not work properly, they do not close completely, and blood flows down the veins – a reverse flow (reflux) is formed. The vessels do not contain all this blood, they stretch, become longer and visible above the skin and acquire a tortuous shape. And there is a situation of varicose veins (varicose veins).



Etiology – causes of the disease?



Varicose veins are a person’s reward for walking upright. Compared to the blood vessels of four-legged animals that never suffer from varicose veins, the venous system of the lower extremities of a bipedal person is not in the best position.



Unproven reasons inВ the development ofВ the disease from the point ofВ view ofВ science



An inactive lifestyle, wearing high-heeled shoes, working while sitting or standing, thermal procedures, sitting “cross-legged”, hormonal contraceptives or drugs do not lead to varicose veins. Some contraceptives be a risk factor for venous thrombosis.



Proven causes ofВ varicose veins



– Family history – heredity

During of various and long-term studies of this pathology, it was noted that varicose veins is a hereditary disease and is the main factor in the development of varicose veins. When both parents have varicose veins, the offspring has a 90% chance of having varicose veins. By inheritance, a predisposition to the occurrence of the disease is transmitted and evidence of this is cases when young people or athletes develop an ailment. Inheritance usually occurs from mother to daughter. In patients, there is a congenital weakness of the venous wall and valves, due to a violation of the structure of the connective tissue, which ensures the strength of the venous vessels. It is interesting to note that varicose veins in these patients are combined with hemorrhoids, hernias, flat feet, varicocele (enlargement of the veins of the spermatic cord). If one of the parents has varicose veins, then the children inherit this disease in 60% of cases, if both, then in 90% of cases. Varicose veins can be not only in relatives, but also in several family members. Although varicose veins are “heredity”, it does not mean that it will show itself in 100% of cases. It develops under the influence of negative factors, lifestyle and work.

– Pregnancy and tendency to varicose veins in women

Pregnancy and childbirth can cause illness. Progesterone lowers the tone ofВ the veins and develops an inferiority ofВ the venous valves.In addition, the pregnant uterus compresses the veins ofВ the abdominal cavity, disrupting the venous outflow and increasing the pressure inВ the veins ofВ the legs, which increase inВ volume.

– Obesity

Visceral fat increases intra-abdominal pressure. It is transmitted to the veins of the lower extremities, which expand and valvular insufficiency appears. Although the factor with “being overweight” is controversial, it is only known for certain that obesity aggravates varicose veins and obese people with varicose veins have a higher percentage of complications.



How toВ find out if there are varicose veins or other vein diseases?



Veins are twisted and dilated, nodes are visually visible – this is varicose veins. In case of problems in deep veins, the elasticity of the skin in the lower parts of the legs changes and the skin becomes darker in color. For venous diseases, pain and discomfort in the lying position, disorders of skin sensitivity, tingling sensation are not characteristic. Pain disturbs in the evening. Varicose veins are most often seen in the lower leg and thigh area. In order to make a diagnosis, you need to find out the patient’s complaints, the history of the disease, conduct an examination, palpation, perform laboratory and instrumental studies.

There are no special tests (blood and others) for making aВ diagnosis.

On examination, varicose veins are revealed. Clinical evaluation should focus on visible signs of venous disease. The results of the physical examination such as the size, location and distribution of the dilated veins should be documented. Only the presence of varicose veins – gives the right to diagnose “varicose veins of the lower extremities.”

For aВ complete assessment ofВ the disease, an objective examination should be supplemented with instrumental methods for diagnosing the lower extremities.

These include ultrasound, MRI and phlebography. Ultrasound is the most common research method and is the gold standard for the diagnosis ofВ varicose veins. The most informative ultrasound method for venous pathology is duplex ultrasound inВ aВ special mode (B-mode). This method is most often used toВ diagnose, plan, conduct and evaluate the results ofВ treatment ofВ chronic venous diseases. Ultrasound should, if possible, be carried out inВ aВ standing position. The horizontal position is not suitable for detecting reflux and measuring vein diameters. Other tests (MRI, tomography, phlebography / venography) can be used inВ exceptional cases (for example, inВ case ofВ congenital anomalies).



When there is no reason toВ worry?



– Unpleasant sensations in the legs, but outwardly the vessels are not changed, there is no ooedema – venous disease is unlikely;

– On the skin, “meshes” and “spider veins” are cosmetic defects.



When toВ see aВ doctor?



With the appearance ofВ bulging, convoluted veins, formations similar toВ varicose veins. For any unilateral oedema. If the ooedema is bilateral and symmetrical, then they are not venous, but other reasons for the appearance, such as cardiovascular failure orВ etc.



Visit aВ doctor urgently!



The sudden, rapid appearance of unilateral ooedema is suspiciously similar to acute deep vein thrombosis, and it is this condition that should always be ruled out in the first place for unilateral ooedema. It is necessary to urgently call an ambulance, even if you feel normal, in extreme cases – to independently consult a doctor as a matter of urgency.



Which doctor do you need?



Varicose veins are treated by “cardiovascular surgeons”, “general” surgeons, but more specialized still “phlebologists”. The best option is to get to him. As a rule, a phlebologist himself conducts an ultrasound examination and owns all modern minimally invasive technologies for treating veins (laser ablation, sclerotherapy, etc.)



At the doctor’s appointment and after it.



The doctor finds out complaints, examines the limbs, discusses the treatment with you. The doctor performs ultrasound inВ standing position. InВ the lying position, the pelvic veins and the veins inВ the abdominal cavity are examined. The drug can be prescribed inВ tablet form, topical ointment and compression garment. But this appointment is more suitable for the treatment ofВ chronic venous insufficiency. At the end, aВ conclusion is issued with the diagnosis, treatment, ultrasound protocol and aВ recommendation toВ be observed byВ aВ phlebologist toВ control the development ofВ the disease inВ order toВ adjust the treatment at the right time.



Will varicose veins develop if it is not treated?



If you do not receive treatment for varicose veins, the condition can be worse and progress toВ the next stage ofВ the disease. Several complications may occur, one ofВ which is thrombophlebitis, trophic changes, and others. InВ addition, byВ delaying the treatment period, it will become more and more expensive.



The goals ofВ varicose veins treatment



Depending on your symptoms, your doctor may recommend lifestyle changes, aВ procedure toВ remove or close varicose veins, compression therapy, or medication. The goal ofВ treatment is toВ relieve symptoms, improve appearance, and prevent complications such as trophic ulcers, thrombosis and bleeding.




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