VARIATIONS IN THE LEGS - CAUSES, DEGREES AND TREATMENT
Varicose veins are tortuous and dilated veins that arise from the illness of the vessels. Contrary to what one might think, varicose veins in the legs are not just an aesthetic problem. The presence of the varix indicates a diseased vein, and is often the first sign of chronic venous insufficiency.
This text will address varicose veins in the legs (varicose veins of the lower limbs), emphasizing causes, symptoms, prevention and treatment.
To complement the information in this text, read also: VARIZES | Frequently Asked Questions.
WHAT ARE THE VARIETIES?
In order for us to understand what causes varicose veins and what their potential complications are, we need to understand how veins work.
Our blood is transported by two types of vessels: arteries and veins. The artery is the vessel that carries oxygen-rich blood away from the heart, toward the rest of the body, nourishing organs and tissues. The vein is the vessel that brings back the blood to the heart and lungs so it can receive oxygen again.
The blood gets to the legs through the arteries and rises back to the heart through the veins. As you may have already guessed, the veins of the legs work against gravity. We can say that varicose veins are a side effect of our evolutionary process that allowed us to walk standing under both legs. When we became bipeds, our heart began to stay away from our lower limbs, which made it much harder for the blood to return to it. But how then does this blood rise?
Only the work of pumping blood through the heart is not enough to overcome gravity. In fact, the veins have a mechanism that facilitates their work: the valves.
Valves are safety mechanisms that act as gates, preventing blood from flowing back. In this way, the blood always follows in a single direction.
varices Now imagine if these valves become incompetent. The blood that should just rise, begins to return down and to accumulate with the new blood that is rising. It is not difficult to see why veins dilate. This is the basic mechanism of varicose veins, diseased veins that become dilated and tortuous because of inability to flow blood toward the heart.
As the peripheral veins of the legs are very close to the skin, any tortuosity or dilatation becomes easily noticeable.
In addition to the valves, our lower limbs have two more tricks up their sleeves:1) Plant pump: every time we step on, the impact of the sole of the foot with the floor causes a mechanical pumping of the blood accumulated in the feet.
2) Calf pump: In addition to the plantar pump, when we step on, we use the calf musculature, popularly known as potato leg. Likewise, the contraction of these muscles pushes the venous blood upwards.
In summary, there are three mechanisms that facilitate the return of blood to the heart: the presence of valves in the veins, plantar pump and calf pump, the latter two are triggered when walking.
RISK FACTORS FOR VARIETIES
About 25% of women and 15% of men have varicose veins in their legs. As already explained, varicose veins arise when blood is dammed in the veins, usually by incompetence of the venous valves.
The main risk factors are:
Female: the presence of some hormones, such as progesterone, cause dilation of the veins and favor valvular incompetence.
Age: Varicose veins arise from the age of 30 and are becoming more common with aging. Older veins and subjected to dozens of years of work against gravity are more likely to get sick.
Family history: The presence of varicose veins tends to be a family tendency. There is a genetic component facilitating the appearance of the same in some people.
Obesity: the heavier we are, the greater the pressure on the veins (read: OBESITY AND METABOLIC SYNDROME).
Smoking: The cigarette hits the vessel wall, making them sick (read: HOW TO QUIT SMOKING).
Pregnancy: Increased hormones, associated with a greater volume of circulating blood and compression of the intra-abdominal veins by an increasing uterus, favor the appearance of varicose veins.
Sedentarism: As already explained, the act of walking facilitates the venous return, reducing the imprisonment of blood within the veins.
Trauma to the legs: any trauma that causes injury to the veins can make them weaker and susceptible to dilatation.
Standing standing for long periods: a person standing, not walking for several hours, is hindering the venous return and facilitating the appearance of varicose veins.
Stand several hours sitting with your legs bent: Sit and cross your legs as we all do normally. Imagine your vessels as a hose. If you keep your legs bent for several hours at a time, the blood still needs to overcome the gravity to rise, but in addition, the vessels are not rectified as in the standing position, but with a tortuous path.
Contraceptive Pills: Again, hormonal variation is a factor responsible for varicose veins (read: COLATERAL EFFECTS OF CONTRACEPTIVES).
SYMPTOMS OF VARIES
Varicose veins are usually tortuous and dilated veins that cause no major symptoms other than the aesthetic discomfort. They always appear in the most superficial veins, so they are so apparent.
When large, varicose veins may sag after trauma or small thrombi, a condition called thrombophlebitis.
Varicose veins, if multiple, may be one of the manifestations of so-called chronic venous insufficiency. When multiple veins become insufficient and varicose, blood begins to get trapped in the lower limbs, causing discomfort, feeling of heaviness, local pain, edema, darkening of the skin and, in advanced cases, onset of ulcers and skin infections.
In fact, varices should be considered as an intermediate stage of venous insufficiency, which can be divided into the following phases:
teleangiectasias
1) Teleangiectasias or spider veins
The teleangiectasias are small purple veins, very fine that appear in the initial phase of the venous insufficiency, as in the photo next door. These are signs of illness from the very small superficial veins that lie just below the skin. They are a species of microvarices.At this stage there are usually no other signs and symptoms except the onset of the own teleangiectasias.
2) Varicose veins
The onset of varicose veins indicates that difficulty in returning blood has already reached larger veins. The patient may have a single varix or, in later stages of the disease, present several varicose veins.
3) Edema
The more varicose veins there are, the more obvious is venous insufficiency. The blood that can not return to the rest of the body gets dammed in the legs, which causes the appearance of the edema (swelling).
In the early stages, the edema usually appears at the ankles and only at the end of the day, when the patient has spent several hours standing. As the disease progresses, the swelling may be persistent, and may affect the entire leg.
When there is edema, there may be other symptoms such as weight in the legs, nocturnal cramps (read: Cramps Causes and treatment), burning sensation, itching and pain in the path of the varicose veins.
4) Skin changes
In addition to edema, blood retention of the lower limbs can cause discoloration of the skin, making it darker and purplish.
The small veins and damaged capillaries of the legs allow the extravasation of red blood cells that, upon suffering destruction, release their red pigments that eventually deposit on the skin.
At this stage, the skin can undergo changes in its texture, becoming dry and inflamed, which is called stasis dermatitis. This dermatitis is characterized by a thickening of the skin associated with the scaling, erosion and loss of liquid by the pores.
At this stage the skin becomes vulnerable, facilitating its invasion by bacteria and the development of infections, such as erysipelas and cellulitis (read: ERISIPELA | CELULITE | Symptoms and Treatment).
5) Ulcers
The last stage of venous insufficiency is the appearance of ulcers on the skin. They may be single or multiple and are preferably located near the ankle, the site of major stasis.
Ulcers usually appear after minor trauma and form due to the fragility of the skin and vessels.
If left untreated, ulcers continue to grow circumferentially, and can become giant lesions and frequent sites susceptible to infections.
HOW TO AVOID VARIETIES
As already understood, the appearance of varicose veins and teleangiectasias is an early stage that may progress to chronic venous insufficiency. It is important for patients with these changes to notice that their lower limb veins begin to show signs of failure.
In the early stages, some changes in lifestyle are important. You should stop smoking and avoid long periods of sitting or standing, you should practice exercises often, especially walking to stimulate the plantar and calf pumps. If you are overweight, lose weight.
Exercises like bodybuilding, if performed correctly, do not cause varicose veins. Depilating the legs also has no influence. Climbing stairs does not hurt, on the contrary, the impact of the feet on the stairs favors the venous return.
In patients with a very strong genetic predisposition, the ideal is to look for contraceptive methods other than contraceptive pills.TREATMENT OF VARICES
Since there are already varicose veins, the tips described above are essential, but, in isolation, they may not be enough.
If signs of varicose veins or teleangiectasias already exist, the use of compression stockings helps a lot. The socks should be worn throughout the day, especially at times when you are standing for a long time. The socks should be tight, but not too tight. Ideally, you should seek advice from an angiologist or vascular surgeon when choosing the most appropriate stockings.
Lying down with your legs raised above your heart level for 30 minutes, three or four times a day, is also important.
Some medications, when used together with the above measures, help control varicose veins. The most commonly used are pentoxifylline (Trental®) and Daflon®.
Diuretics should be avoided. When used, they should be done briefly, as they may worsen edema (read: DIURETICS | Furosemide, Hydrochlorothiazide, Indapamide).
Often, however, the surgical treatment of varicose veins is necessary. The main modalities are:
- Sclerotherapy for varicose veins: it is a procedure used for small varicose veins, where the doctor injects substances that cause sclerosis (destruction and healing) of the vein selected. As this vein stops receiving blood, it becomes useless, and over time the body eliminates it. It is a technique that requires repetition, but it does not require anesthesia and can be performed in the office itself. However, to be effective it needs to be done by trained doctors.
- Laser surgery for varicose veins: also used in small varicose veins and teleangiectasias, consists in the destruction of these small vessels through the application of Laser. It is a procedure that does not need needles or incisions. It is not as good as sclerotherapy and it is not all skin types that can receive Laser pulses. It works best in teleangiectasias.
- Varicose vein catheter ablation: indicated in varicose veins of greater caliber. A small tube (catheter) is inserted into the vein, which can be destroyed by heat (intravenous laser) or radiofrequency.
- Surgery for varicose veins: consists of the surgical removal of the varicose vein. Currently, this type of surgery is done with minimal incisions and hospitalization usually does not last a day. When the varicose veins are very small, this procedure can be done until outpatient.
Regardless of technique, the destruction or withdrawal of the varicose vein does not pose any problem to the legs, since the treated vein no longer functions properly. Blood flow is automatically diverted to other collateral and deep veins. A varicose vein is not needed.
Treated varicose veins do not return. What may occur is the appearance of new varicose veins. It is important to understand that the treatments described above only eliminate existing varicose veins, but do not interfere with the process that causes them.
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