Журнал научных публикаций
«Наука через призму времени»
Февраль, 2018 / Международный научный журнал
«Наука через призму времени» №2 (11) 2018
Автор: Пахомова Алина Сергеевна, студентка
Рубрика: Медицинские науки
Название статьи: варикоз и способы его лечения
Дата публикации: 28.01.2018
К ВОПРОСУ О ВАРИКОЗЕ И СПОСОБАХ ЕГО ЛЕЧЕНИЯ
Пахомова Алина Сергеевна
Коваленко Виктория Сергеевна
преподаватель кафедры иностранных языков
Саратовский государственный медицинский университет им. В.И. Разумовского, г. Саратов
Аннотация. Данная статья посвящена анализу проблемы варикозных вен, причин появления данного заболевания и способов его лечения. В статье описан механизм появления варикоза, а также классификация его стадий, пользующаяся наибольшей популярностью у российских флебологов. Стоит отметить, что в статье описаны основные симптомы заболевания варикозных вен наряду с хирургическими и не хирургическими методами лечения. В заключение говорится о профилактических мерах и рекомендациях во избежание появления варикоза.
Ключевые слова: нижние конечности, варикоз, вена, внутривенный, лазерное лечение.
Nowadays, many people face the problem of varicose veins. Varicosity is a disease associated with a thinning of venous walls accompanied with an increase of permeability and a formation of extensions that are visible under the skin. People often mean varicose diseases of the lower extremities when they talk about varicose veins. In addition to varicose diseases of the lower extremities there may occur varicose veins of the esophagus, rectum, etc.
The problem of varicose veins of lower extremities is often experienced by women in their middle age (about 30% of population). However, 10-15% of men also have the disease .
Usually the causes of varicose veins are outlined as following:
1. Genetic predisposition. It is expressed by initial weakness of venous walls;
2. Obesity. In case of deviation of the body mass from the norm, the risk of varicose veins increases to 30%;
3. Pregnancy. During pregnancy women have the uterine enlargement, which compresses the inferior Vena cava. Also the circulating blood volume increases, which may cause the expansion of veins;
4. Hypodynamia. Prolonged sitting or standing position;
5. High physical loads.
For better understanding of this problem, one should consider the mechanism of occurrence of varicosity. The muscular layer of a venous wall is weak and cannot force the blood to move upwards. The flow of blood from the periphery to the center is accomplished by residual blood pressure and pressure of tendons located near the vessels. A crucial role is played by a so-called muscle pump. During any physical load muscles contract, and blood is pushed upwards, as the downward movement impeded by venous valves. The maintaining of normal blood circulation and a constant venous pressure are affected by venous tonus. The pressure in the veins is regulated by a vasomotor center located in the brain.
Valve insufficiency and weakness of a vascular wall lead to the fact that the blood under the influence of a muscle pump begins to flow not only upwards but also downwards, exerting excess pressure on the walls of blood vessels leading to varicose veins, formation of nodes and progression of valve insufficiency. The blood flow through the veins (that connect superficial and deep veins) is disturbed. Retrograde blood flow from deep to superficial vessels leads to a further increase of pressure in the superficial veins. Nerves located in the venous wall signal to a vasomotor center, which gives a command to increase venous tonus. The veins cannot cope with the increased load; gradually expanded, they elongate and become tortuous. High blood pressure leads to atrophy of muscle fibers of a venous wall and destruction of the nerves that are involved in the regulation of venous tonus.
Considering the disease of varicose veins, it is important to emphasize its stages. The most popular classification among Russian phlebologists is the classification of S.V. Saveliev. According to this classification there are the following stages of varicose veins:
1. The compensation. Most of the patients have no complaints, but there are varicose veins on the legs. Sometimes patients may complain of heaviness in the legs, fatigue and the absence of visual signs.
2. The subcompensation. The examination shows dilated veins in the lower extremities. Patients complain of feeling of fullness, paresthesia in the region of lower legs, night cramps; also they indicate the swelling of the feet and lower legs in the evening but in the morning the swelling usually disappears.
3. The decompensation. The symptoms increase dermatitis and eczema. The patient has itching. Appears hyperpigmentation .
In addition, among symptoms of each stage can be enlarged palpation of the veins, tense and fugolastic consistency. The walls of the affected veins become soldered with the skin. There is a hyperpigmentation of the skin with areas of cyanosis. Subcutaneous cellular tissue in areas of hyperpigmentation is sealed.
It is important to say that nowadays the diagnosis of varicose veins is not difficult. It can be done with the help of following methods: duplex angiography, ultrasonic doplerography (USDG) of the veins of the lower extremities etc.
Concerning one of the most important aspects of the diseases of varicose veins, namely methods of treatment, it can be outlined several ways of it. Conservative therapy is one of them. It includes general guidelines, exercise therapy, application of elastic bandages and compression hosiery, and venoactive drugs treatment. Conservative therapy does not give a complete cure and eliminates varicose veins. It is usually used before surgery or in case of impossibility of surgical intervention.
The next method of treatment is a compression sclerotherapy. This method is widely used in telangiectasia – it does not require anesthesia and it is performed on an outpatient basis. It has the best effect when it is used at early stages of varicose diseases. The method of sclerotherapy is about the intravenous injection of a medicinal product in the form of a liquid solution or microdisperse foam that glues the vein from the inside. The bloodstream stops, and over time veins are replaced by connective tissues and being absorbed.
The most popular ways of treatment are thought to be operative one. These methods include endovenous laser coagulation, radiofrequency obturation, EVLT, phlebotomy, etc. A bit more information should be given about these ways of treatment.
Endovenous Laser Coagulation and Radiofrequency Obturation have the same principles of work, namely instead of removing the varicose veins, a special catheter is injected in the lumen through a skin puncture, through which laser or radiofrequency radiation "seals" the vein without a removal. The operation is performed under local anesthesia. These techniques have an extremely small degree of trauma – virtually no pain in the process of manipulation and in the post-operative period. The injury is so small that the patient can be released home and even allowed to go to work on the day of the manipulation. The advantages of these techniques lie in their high efficiency. There are no changes in the everyday life of the patient exception of ban to prolonged physical load and high temperature treatments – steam baths, saunas, hot tubs, etc. Complications after such interventions happen extremely rare. Relapses do not occur in more cases than after a classic surgery. The cosmetic attractiveness of these interventions also should be mentioned. Manipulations are performed without incisions, that allows to eliminate varicose veins leaving no traces of the treatment on the skin. The only restrictions that may prevent the use of these methods are too large varicose veins and strongly twisted ones.
Another way or treatment is Endovenous Laser Treatment (EVLT), which is a method of treatment of varicose veins with a high efficiency and extremely low traumaticity. The essence of EVLT is in ultrasound guidance and local anesthesia, usage of paracentetic method or a mini incision in the vein when a special catheter is injected. During EVLT the laser light makes the vein sealed from inside. The bloodstream stops, and over the next 2-3 days there are bruises, dense threadlike strand (coagulated veins) that may be found in the area of the operation.
The last but not the least way of treatment that is mentioned in this article is phlebotomy. It is a classical method for surgical treatment of varicosity in which varicose veins are removed from individual cuts and paracentesis of the skin is performed using special surgical instruments .
To sum it up, it should be mentioned that to avoid varicose veins, it is necessary to follow preventive measures. If a person has to stay for a long time in a standing or sitting position, he or she needs to strain the muscles of the shins or to get legs in sublime or horizontal position. Also it is useful to be engaged in certain types of sports. During pregnancy or on the tough job, it is recommended to use elastic compression. When the first signs of varicose veins appear, a person should consult a phlebologist.
- Веденский А. Н. Варикозная болезнь.- Л.: Медицина, 1983.—207 с.
- Градусов Е. Г., Константинова Г. Д., Зубарев А. Р. и др. Склерооблитерация варикозных вен нижних конечностей под контролем ультразвуковых методов исследования // Ультразвуковая диагностика.— 2000.—№ 3.—С. 121—126.
- Кириенко А. И., Богачев В. Ю., Золотухин И. А. Компрессионная склеротерапия (практическое руководство для врачей / Под ред. акад. РАН и РАМН В. С. Савельева.— М.: Изд-во НЦССХ им. А. Н. Бакулева РАМН, 2004.— 40 с.
- Шевченко Ю. Л., Стойко Ю. М., Мазайшвили К. В. Лазерная хирургия варикозной болезни.— М., 2010.— 195 с.
- Шиманко А. И., Дибиров М. Д., Васильев А. Ю., Волков А. С. Примене ние лазера во флебологической практике //Материалы V конфе ренции ассоциации флебологов России.— М., 2004.—С. 348—349.