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Varicosity – the disease which is followed by thinning of a venous wall, increase in a gleam of veins and formation of anevrizmopodobny knotty expansions. Usually, speaking about a varicosity, mean an independent disease – varicose veins of the lower extremities. The varicose veins are shown by heavy feeling in legs and their fatigue, hypostases of feet and shins, night spasms in legs, visual hypodermic expansion of veins with formation of venous knots. The course of varicose veins can be complicated by phlebitis, thrombophlebitis, development of chronic venous insufficiency and formation of trophic ulcers. The main way of diagnosis of varicosity and its complications is UZDG.

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    Varicose veins (varicosity)

    Varicose veins (varicosity) – the pathology of veins which is shown in their expansion, an izvitiya, destruction of the valvate device. Initial manifestations are formation of vascular asterisks, swelling of hypodermic veins, formation of knots, morbidity of veins, weight in legs. When progressing a disease signs of chronic insufficiency of venous blood circulation join: hypostases of feet and a shin, a spasm in gastrocnemius muscles, trophic ulcers, thrombophlebitis, gaps varikozno the changed veins.

    Under certain conditions (some diseases, congenital pathology) not only veins of the lower extremities can extend. So, portal hypertensia can become the reason of expansion of veins of a gullet. At the varikotsel the varicosity of a seed kanatik comes to light, at hemorrhoids – expansion of veins in an anus and the lower part of a rectum. Irrespective of process localization, there is a hereditary predisposition to development of varicosity connected with congenital weakness of a vascular wall and insufficiency of venous valves.

    Separate articles are devoted to the diseases which are followed by a varicosity in various areas of a human body except for the lower extremities. In this article we will speak about an independent disease – a varicosity of the lower extremities.

    Varicosity – the disease which is followed by expansion of superficial veins, insolvency of venous valves, formation of hypodermic knots and violation of a blood-groove in the lower extremities. According to various researches in the field of a flebologiya from 30 to 40% of women and from 10 to 20% of men have varicosity 18 years are aged more senior.

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    Mechanism of development of varicosity

    Veins of the lower extremities form an extensive network which consists of the hypodermic and deep veins connected among themselves by perforantny (kommunikantny) veins. Through superficial veins there is an outflow of blood from hypodermic cellulose and skin, through deep – from other fabrics. Kommunikantny vessels serve for alignment of pressure between deep and superficial veins. Blood on them normal flows only in one party: from superficial veins to deep.

    The muscular layer of a venous wall is expressed poorly and cannot force blood to move up. Blood current from the periphery to the center is carried out at the expense of the residual arterial pressure and pressure of the sinews close to vessels. An important role is played by a so-called muscular pomp. At physical activity of a muscle are reduced, and blood is squeezed out up as down venous valves obstruct the traffic. Maintenance of normal blood circulation and constant venous pressure is influenced by a venous tone. Pressure in veins is regulated by the sosudodvigatelny center located in a brain.

    Insufficiency of valves and weakness of a vascular wall lead to the fact that blood under the influence of a muscular pomp begins to flow not only up, but also down, putting excessive pressure upon walls of vessels, leading to expansion of veins, formation of knots and progressing of valvate insufficiency. Blood current on kommunikantny veins is broken. The blood reflux from deep vessels in superficial leads to further increase of pressure in superficial veins. The nerves located in walls of veins give signals in the sosudodvigatelny center which gives the command to raise a venous tone. Veins do not cope with the raised loading, gradually extend, extended, become twisting. Elevated pressure leads to an atrophy of muscle fibers of a venous wall and death of the nerves participating in regulation of a venous tone.

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    Risk factors of varicosity

    Varicosity – a polietiologichesky disease. Allocate several factors increasing risk of development of varicosity:

    1. The genetic predisposition caused by weakness of a vascular wall owing to insufficiency of connecting fabric.
    2. Pregnancy. It is considered that varicosity at pregnancy develops because of increase in volume of the circulating blood and a sdavleniye of zabryushinny veins a pregnant uterus.
    3. Obesity - the proved risk factor of developing of varicosity. If the index of body weight increases to 27 kg/sq.m, the risk of development of a disease increases for 33%.
    4. Way of life. The risk of development of varicosity increases at long stay in a sitting position or standing, constant static loadings, especially – connected with heavy lifting. Adverse impact on the course of a disease is exerted by the corsets promoting increase in intra belly pressure and the close clothes squeezing the main veins in the field of inguinal folds.
    5. Features of food. The probability of development of varicosity increases at small contents in a diet of fruit and crude vegetables. Deficiency of rough cellulose leads to chronic locks, and a lack of some useful substances – to violation of restoration of structure of a venous wall.
    6. Violations of hormonal balance. A certain impact on prevalence of a disease is exerted by wide circulation of means of hormonal contraceptives and hormonal medicines which are applied at therapy of osteoporosis and a climacteric syndrome.
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    Classification of varicosity

    There are several classifications of a varicosity. Such variety is caused by a polietiologichnost of a disease and a set of options of a course of varicosity.

    Postadiyny classification

    The Russian phlebologists widely use postadiyny classification of a varicosity which option is V. S. Savelyev's classification:

    • Compensation stage (according to Savelyev – compensation And). Complaints are absent. At survey expanded veins on one or two legs are observed varikozno.
    • Subcompensation stage (according to Savelyev – compensation of B). At survey the expanded veins expressed varikozno are standing visible. Patients show complaints to feeling of a raspiraniye, paresteziya ("goosebumps") in shins, night spasms. Small puffiness of feet, anklebones and shins is noted in the evenings. In the morning hypostases disappear.
    • Decompensation stage. Dermatitis, eczema join the listed signs. Patients are disturbed by a skin itch. Skin becomes dry, brilliant, densely soldered to hypodermic cellulose. Small hemorrhages and the subsequent adjournment of a gemosiderin cause a hyperpegmentation.

    The modern Russian classification offered in 2000 reflects degree of chronic venous insufficiency, a form of a varicosity and complications caused by varicosity.

    Classification by forms

    Allocate the following forms of a varicosity:

    • Segmentary defeat of hypodermic and intracutaneous vessels without reflux.
    • Segmentary damage of veins with pathological dumping on superficial or communicative veins.
    • Widespread damage of veins with pathological dumping on superficial or communicative veins.
    • Widespread damage of veins with pathological dumping on deep veins.
    International classification

    There is a recognized international classification of a varicosity used by doctors of many countries of the world:

    • Class 0. Symptoms of varicosity are absent. Patients show complaints to weight in legs.
    • Class 1. Visually networks of veins and vascular asterisks (teleangioektaziya) are defined. Some patients have muscular spasms at night.
    • Class 2. At survey of the patient expanded veins are visible.
    • Class 3. There are hypostases of feet, anklebones and shins which are not disappearing after short-term rest.
    • Class 4. At survey signs of a lipodermatoskleroz (dermatitis, a hyperpegmentation of shins) come to light.
    • Class 5. Predjyazva are formed.
    • Class 6. Persistent trophic ulcers develop.
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    Varicosity symptoms

    Clinical displays of a disease depend on a varicosity stage. Some patients even before emergence of visual symptoms of a disease show complaints to weight in legs, increased fatigue, local pains in shins. Emergence of teleangioektaziya is possible. Signs of violation of venous outflow are absent. Quite often the disease in a stage of compensation proceeds asymptomatically, and patients do not address for the doctor. At fizikalny survey the local varicosity, most often – in the top third of a shin can come to light. Expanded veins soft, are well fallen down, skin over them is not changed.

    Patients with varicosity to stages of subcompensation complain of the passing pains, hypostases arising at long stay in vertical position and disappearing in a prone position. Fizikalno (especially in the second half of day) can come to light pastosity or insignificant hypostases in anklebones.

    Patients with varicosity in a stage of a decompensation show complaints to constant weight in legs, dull aches, increased fatigue, night spasms. The skin itch which was more expressed in the evening is a harbinger of trophic frustration. At external survey the expressed expansion of veins and global violation of venous haemo dynamics comes to light. Deposition of large volume of blood in the affected extremities in some cases can lead to dizzinesses and faints owing to falling of arterial pressure.

    Veins of a tugoelastichesky consistence are defined by Palpatorno expanded, intense. Walls of the affected veins are soldered to skin. Local deepenings in the field of solderings speak about the postponed periflebit. Visually the hyperpegmentation of integuments, the cyanosis centers comes to light. Hypodermic cellulose in areas of a hyperpegmentation is condensed. Skin is rough, dry, it cannot be taken pleated. Disgidroza are noted (more often – , is more rare – ). Trophic violations especially often appear on the forward-internal surface of a shin in the lower third. In the changed areas eczema against the background of which in the subsequent trophic ulcers are formed develops.

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    Diagnosis of varicosity

    Diagnosis does not represent difficulties. The duplex angioskanirovaniye, UZDG of veins of the lower extremities is applied to assessment of weight of violations of haemo dynamics. Radiological, radio nuclide methods of a research and a reovazografiya of the lower extremities can be used.

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    Treatment of varicosity

    In treatment of patients with varicosity three main techniques are used:

    • Conservative therapy of varicosity

    Conservative therapy includes the general recommendations (normalization of physical activity, reduction of static loading), physiotherapy exercises, application of means of an elastichesky compression (compression jersey, elastic bandage), treatment by flebotonik ( + , horse-chestnut extract). Conservative therapy cannot lead to full treatment and restore already expanded veins. It is applied as prophylactic, during preparation for operation and at impossibility of surgical treatment of varicosity.

    • Compression sclerotherapy of varicosity

    At this technique of treatment introduction to an expanded vein of special medicine is made. The doctor via the syringe enters elastic foam which fills the struck vessel into a vein and causes its spasm. Then to the patient put on the compression stocking holding a vein in the fallen-down state. In 3 days of a wall of a vein stick together. The patient wears a stocking within 1-1,5 months, dense solderings are not formed yet. Indications for compression sclerotherapy – the varicosity which is not complicated by a reflux from deep vessels in superficial through communicative veins. In the presence of similar pathological dumping efficiency of compression sclerotherapy sharply decreases.

    • Expeditious treatment of varicosity

    The main method of treatment of the varicosity complicated by a reflux through communicative veins is operation. The set of operating rooms the technician, including – with use of the microsurgical equipment, radio-frequency and laser coagulation of the affected veins is applied to treatment of varicosity.

    In an initial stage of varicosity make photocoagulation or removal of vascular asterisks the laser. At the expressed varicosity the flebektomiya - removal of the changed veins is shown. Now this operation is even more often performed with application of less invasive technique - miniflebektomiya. In cases when varicosity is complicated by a vein trombirovaniye on all its extent and accession of an infection, Troyanov-Trendelenburga operation is shown.

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    Prevention of varicosity

    An important preventive role is played by formation of the correct behavioural stereotypes (it is better to lie, than better to sit and go, than to stand). If it is necessary to be long in a standing position or sitting, it is necessary to strain periodically muscles of shins, to give to legs sublime or horizontal position. It is useful to do certain sports (swimming, bicycle walks). During pregnancy and at hard work it is recommended to apply means of an elastic compression. At emergence of the first symptoms of a varicosity it is necessary to address the phlebologist.

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    Varicose veins (varicosity) - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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