Varicose Veins – etiology, diagnosis, treatment
Secondary varices (occurring in certain occupations with prolonged orthostatism): waiters, barbers, security guards etc.
In terms of the incidence of varicose veins, it occur more frequently in women.
Conditions favoring venous stasis, thrombosis in the venous system or lesions of the vascular wall, are all potential causes of the occurrence of episodes of deep venous thrombosis. Of most times these cases are obvious, other times it requires a clinical investigation to leave no undiscovered major diseases.
In orthostatism blood stasis is followed by the reflux of blood from the deep venous system to the superficial with a continue growing of the venous pressure.
Diagnosis is clinical, history specifies when the disease started, mode of appearance (trauma, phlebitis, pregnancy), family history, working conditions (prolonged orthostatism), lifestyle (obesity, sedentary).
Symptoms: paresthesia, cramps, calf pain, exacerbated by prolonged orthostatism and warmth, feeling heavy legs after the edema. Physical examination reveals skin and the color of its, the existence of varicose (aspect of dilated veins packages located subcutaneously). Palpation is very important, we try to landmark those two saphenous, is seeking circulatory reflux at coughs.
Trendelenburg test for incontinent perforator accurate spot: the legs rises vertically to clear the venous network and fix a tourniquet to the base member; patient sits upright, remove the tourniquet and see the filling of the superficial veins;
Negative sample: tourniquet removal, veins slowly filled from the bottom to top -continence valve;
Positive sample: tourniquet removal, veins quickly filled from top to bottom, which express valvular incontinence. If you change the position tourniquet can locate the perforator incontinent.
Evolution: is the nature of the evolutionary progress of chronic venous cords.
Complications: chronic venous insufficiency, thrombophlebitis, varicose ulcer, dermatitis, pigmentosa.
Treatment: can be conservative or surgical nature
1. Conservative treatment: first should avoid prolonged standing.
venotropic medication: bioflavonoids (active substance: Diosminum);
ointments with heparin;
walking at least 25 minutes three times a day;
It is recommended position above the limb to be supine body, so lowering the local venous pressure;
hydrotherapy (cold compresses on the calf, simple baths followed by massage);
It is recommended practice of swimming, cycling;
Compression with elastic stockings, compression bandages may be helpful.
2. Surgical treatment:
Surgical treatment consists of micro-incisions pre-marked areas with maximum aesthetic effect (become virtually invisible in a few months). It can be completed in need of sclerotherapy of varicose veins crosslinking (small diameter) and spider veins (veins very fine, located in the dermis, visible through the transparent skin).
Sclerotherapy involves injecting a substance that “irritates” and destroys the vein on the inside, turning it at end in invisible cord fibrosis.
Endogenous laser treatment consists of exposing varicose veins to the energy light driven through an optical fiber that is inserted inside the vein. The result of this treatment consists in closing the vein under the skin that scars without leaving obvious traces its level.
The laser is used successfully in the treatment of superficial of varicose veins:
It allows the separate control of fluency (up to 300 J/cm2), pulse duration and repetition frequency, ideal for personalizing treatment;
Treats in maximum security conditions so superficial vessels, and thick veins, deep, from the level of the legs;
Required conductor for cooling the area is made of copper, leading to a high-efficiency, providing great comfort during the procedure;
The spot size and it can be easily adjusted (3-5-7 mm), reducing the duration of treatment and allowing to approach the vessels with different diameters;
The device is designed so as to allow viewing vessel during treatment, increasing efficiency and safety procedure.