Varicose veins

Varicose veins - what are they, how to treat them?
Varicose veins affect 25-36% of the female population and 10-28% of men living in Europe.
And although it seems that they are only an aesthetic defect, it is a serious disease. If varicose veins are not treated, it can lead to serious health complications, such as thrombosis, and thus even death.

What are varicose veins?

Varicose veins are deformed and visibly dilated veins which indicate that the blood is not circulating properly. In healthy people, blood flows freely from the heart to e.g. the lower limbs and returns smoothly thanks to the muscle pump and venous valves placed in the veins. It is thanks to these valves that the phenomenon of reflux, i.e. the backflow of blood from deep to superficial veins, does not occur. In people with abnormal blood circulation, unfortunately, blood is withdrawn into the superficial veins, which results in their widening and deformation. The superficial veins affected by this disease very often resemble a sinuous cord with palpable protrusions and are known as varicose veins. They are usually accompanied by swelling of the legs and feet, tingling or burning, soreness or a feeling of heaviness in the legs, which very often disappears after, for example, resting with the legs raised up.

How do varicose veins arise?

The vascular system consists of deep veins and superficial veins (sometimes visible under the skin). These two systems are linked together by smaller veins, so-called piercing veins. They also connect directly at two places: in the groin and in the area below the knees.
Deep veins collect blood from the tissues of the lower extremities, as well as the blood that flows to them from the superficial veins through the piercing veins. These are veins without which the lower limb would not be able to function. Almost 90% of the blood flows through them. The deep veins include, among others: posterior tibial veins, anterior tibial veins, popliteal vein and femoral vein. They are located quite deep under the fascia, near the bone skeleton, and are surrounded by muscles. It is thanks to the compression of blood vessels during muscle contraction that, among others, to pump blood towards the heart. Although it is not the only "mechanism" that helps blood get up. For blood to return from the lower extremities, there must be an interaction between the heart pump and the pressure gradient, as well as the pump of the leg muscles and the efficiency of the venous valves.

The system of superficial veins is located under the skin or a little deeper in the fatty tissue. These veins are easily visible to the naked eye. It is in the superficial veins, which include: the saphenous vein (which begins at the end of the dorsal venous arch of the foot and extends through the entire limb along the groin) and the sagittal vein (starts at the lateral end of the venous arch of the back of the foot and ends under the knees, where connects to the deep popliteal vein), the most evident symptom of venous insufficiency, i.e. varicose veins, is formed.
The formation of varicose veins is associated with the phenomenon of reflux, i.e. the regurgitation of blood from deep veins to the superficial veins. The blood should normally flow from the superficial veins, through the piercing veins, into the deep veins and from there to the heart. The veins are fitted with valves to prevent the blood from regurgitating. However, if the valves fail to stop blood, blood collects in the superficial veins. Then, these veins are stretched and deformed, and then varicose veins form. The process of the formation of varicose veins is a cascade process. For when the first valve is under pressure and the returning blood pressing on it, pushes it to the next section, to the next valve, which also becomes damaged over time and causes another valve to break. This is why any surgical treatment must protect the highest valve that started the process. Otherwise, the mechanism of the formation of varicose veins will repeat itself.

The appearance of varicose veins is not only a consequence of poorly functioning valves, but also changes in the structure of the vessel walls. These pathological changes, both in the extracellular matrix and in cellular components, may be either primary or as a result of a disease process. When comparing healthy and diseased veins, one can notice, for example, a smaller amount of elastin in the latter and its altered structure. It can also be seen that there is an increased amount of type I collagen in them. This changes the proportions between type I collagen, which is responsible for tissue stiffness, and type III collagen, which is responsible for their extensibility. The result of this state of affairs is, inter alia, disruption of smooth muscle cell layers, change in the structure of the vein, which contributes to the development of venous insufficiency.

The causes of varicose veins

Family burden is considered one of the causes of varicose veins. Some people will therefore be more prone to varicose veins than others (the probability can be up to 80% if close relatives also had problems with deformation of the veins and valve insufficiency). This is due to the weakening of the connective tissue and its greater predisposition to stretch it. Of course, apart from hereditary tendencies, the lifestyle will also have an impact: e.g. prolonged work while sitting, improper eating or smoking. A factor that will also contribute to the appearance of varicose veins will also be all kinds of injuries to the veins or those resulting from pathological changes, e.g. diabetes. Also, all kinds of hormonal changes caused, for example, by pregnancy or taking birth control pills, can contribute to the occurrence of varicose veins.

How to cure varicose veins?

Compression method
Treatment with pressure, i.e. the so-called compression therapy, is used in those people who cannot or do not consent to undergo sclerotherapy or surgery, and in those people who are directly contraindicated in other types of treatments. Compression therapy mainly consists in applying uneven pressure with an elastic stocking or a special bandage. This compression is applied to e.g. the leg section from the foot to the groin. People who struggle with the problem of varicose veins should not choose stockings or tourniquets on their own. Compresses should be selected according to the individual needs of the patient by the attending physician. Improper, e.g. too strong pressure may cause further health complications, e.g. increase blood stasis in the leg, and thus cause a blood clot. Although stockings or bandages bring many benefits, such as: accelerating blood flow, improving valve efficiency, reducing swelling or reducing the diameter of the veins, not everyone can use them. The contraindications for compression therapy are: diseases of the arteries that cause limb ischemia; as well as fresh deep vein thrombosis or skin inflammation.
There are 4 compression classes used in clinical practice:
• Class I (below 25 mm Hg) - used to prevent varicose veins, mainly prophylactically, as well as in the initial stages of venous insufficiency;
• Class II (25-35 mm Hg) - used when varicose veins are already visible and large, and when there are already skin changes. Recommended mainly for pregnant women;
• Class III (35-45 mm Hg) - used in very advanced venous disease;
• Class IV (over 45 mm Hg) - used for large swelling causing pain.

Pharmacological treatment

Pharmacological treatment may be a form of support in treatment with other methods prescribed by a doctor, but it cannot replace them. So it cannot replace the method of pressure, movement, sclerotherapy or surgery. The administration of drugs can only help the patient to improve the circulation in the capillaries, to speed up the emptying of blood from the veins, or to strengthen and seal the walls of the veins. It is also important to have an anti-inflammatory effect. This helps to reduce leg swelling, relieve pain, reduce night cramps and eliminate venous stagnation. Most preparations used in the treatment of varicose veins contain substances obtained from plants or fruits, e.g. ginkgo biloba, arnica mountain, horse chestnut seeds, or extracts from grapes or citrus. They most effectively help to improve blood circulation and strengthen capillaries in the early stages of the development of venous disease, with the emergence of blood stagnation and swelling of the legs.

Surgical treatment

Surgical treatment cures varicose veins and removes the source of their formation. As long as blood continues to flow through the diseased veins, the problem of vein deformation will worsen. Only their removal will make the body return to normal. Surgical treatment has two main goals: to eliminate reflux from deep to superficial veins and to remove all places that are points of pathological leakage; as well as - the elimination of all superficial veins that are excessively dilated and have insufficient valves. Removal of superficial veins does not entail any threats to disrupting blood flow, because about 10% of venous blood flows through this type of veins, so the body can cope without them. Removal of connecting or piercing veins is also not a problem, because closing such a vein, e.g. during a laser treatment, will cause the blood to find a different path of flow. The most common methods of vein removal are: stripping, miniphlebectomy (called outpatient phlebectomy) or intravenous laser therapy. According to scientific reports, surgical treatment of varicose veins is the gold standard of care.

Source:
• H. Marona, A. Kornobis, Patofizjologia rozwoju żylaków oraz wybrane metody ich leczenia – aktualny stan wiedzy, „Postępy Farmakoterapii” 2009, tom 65, nr 2, s. 88-92.
• A.Jawień, A. Szotkiewicz, Anatomia u żylnego kończyny dolnej, „Przewodnik Lekarski” 2004, nr 8, s. 24-28.
• W. Noszczyk, Żylaki i inne choroby żył i kończyn dolnych, Warszawa 2007, s. 54-56, 61
• A.A. Ramelet, Ph. Kern, M. Perrin, Żylaki i teleangiektazje, Gdańsk 2004, s. 222