Varicose veins – a real pathology

Varicose veins – a real pathology

It is mainly women over the age of 40 who have to deal with varicose veins, a problem that affects a total of at least three million Italians. Varicose veins are a network of veins that swell and emerge under the skin of the legs, usually blue or purplish in color, forming a kind of subway map on the lower limbs. Generally the problem is considered exclusively aesthetic and is hidden by covering the legs with body foundation or under opaque stockings. But varicose veins are not just a blemish: like cellulite they are a pathology which, if left untreated, can lead to unpleasant complications, such as vein inflammation (phlebitis), inflammation with thrombus (thrombophlebitis) and even skin ulceration of the lower limbs (phlebostatic ulcers). Varicose veins are the manifestation of a chronic venous disease caused, in most cases, by venous reflux: that is, when the valves stop working properly and increase the pressure and blood volume in the most extreme regions. This happens because the blood is unable to return to the heart, stagnates and begins to dilate the superficial veins.

What are the causes of varicose veins

While the arteries carry blood from the heart to the tissues, the task of the veins is to carry the so-called “return” blood from the tissues to the heart: the veins of the legs, therefore, must work against the force of gravity to allow the blood to go back to the heart. To push the blood upwards and at the same time avoid its flowing downwards, it is necessary that the walls of the veins are elastic and that the venous valves work properly: when this mechanism is not perfect, the veins do not they are able to make the blood go back towards the heart and blood stagnations are created in the veins, causing the appearance of varicose veins.

The main risk factors include:

– Familiarity

-Female sex

-Sedentary life

-Overweight or obesity

– Work activities that require standing for many hours a day.

-Age: over the years the walls of the veins tend to become less elastic and the valves tend to weaken.

-Pregnancy: Some pregnant women develop varicose veins. This happens on the one hand because the volume of maternal blood increases to support the growth of the fetus, and on the other because the uterus, especially in the last months of gestation, exerts significant pressure on the veins of the legs. Hormonal changes are also thought to play a role in the formation of varicose veins at this stage of a woman’s life. Varicose veins that develop during pregnancy usually improve without medical treatment within the first year after delivery.

What are the symptoms

The symptoms most commonly reported by those suffering from venous insufficiency include: pins and needles, itching, sensation of heat, pressing pain, unpleasant sensation of heaviness, burning, swelling and edema, especially in the ankle. The symptoms arise above all when one remains standing for a long time, they are more intense in the summer and tend to lessen with physical exercise. The clinical manifestations of venous insufficiency vary according to the stage of the disease: in the early stages there are only dilated capillaries, while in the more serious forms the circulation is so compromised as to lead to the formation of skin ulcers.

In order of severity we find the following clinical manifestations:

-Telangiectasias: groups of dilated and branching reddish or bluish capillaries. They are most often located on the lateral aspect of the thigh and on the inner and posterior surface of the knee. They are considered a preclinical expression of a chronic venous disease.

-Reticular varices: stage characterized by undetected subcutaneous venous dilatations.

-Varicose veins: permanent, raised and palpable superficial venous dilatations of variable dimensions. They are an expression of alterations of the wall of the main venous vessels of the superficial system, i.e. of the great and small saphenous veins. They express a state of chronic venous hypertension and constitute the vast majority of venous pathology of the lower limbs.

– Stasis dermatitis: blood stasis, i.e. the stagnation of blood in the tissues, determines the formation of a chronic inflammatory edema localized above all in the lower part of the leg, around the ankle. It manifests itself with itching and eczematous skin with the formation of skin discolorations due to the leakage of red blood cells from the compromised capillaries and consequent deposits of hemosiderin in the tissues, with swollen and dark legs.

-Lipodermatosclerosis: state of perivascular inflammation of the subcutaneous tissue which becomes thickened, adhesions form, the skin is reddened and dark and the process has a chronic evolutionary trend.

– Cutaneous ulcers: chronic lesions that do not tend to heal spontaneously except through treatments and health aids that can improve venous return. They tend to be located on the inside of the ankle and are caused by loco-regional hypoxia.

How to prevent varicose veins

Although there is no method that can prevent the appearance of varicose veins, however there are behaviors that, adopted at any age, help improve blood circulation in those suffering from varicose veins, as well as reduce the risk of loss of elasticity of the veins.

-Keep active and exercise regularly: walking, swimming, cycling are activities that help circulation and weight loss

-Control weight: avoid overweight and obesity

– Follow a healthy diet: summer can be an opportunity to increase the consumption of foods with a high fiber content such as vegetables and fruit, whole grains (spelt, barley, brown rice, millet). Better to avoid foods that are too salty

-Choose the right shoes: in the heat, it is best to avoid the prolonged use of high heels which contribute to increasing venous stasis

-Reduce or avoid cigarette smoking: smoking is a risk factor for diseases of the venous system

-Changing position often: sitting or standing for too many consecutive hours worsens the symptoms of varicose veins. When you are forced to stand up for a long time, for work but also when waiting for the bus to arrive in the summer sun, contracting and releasing your calf muscles while standing helps venous return from the legs to the heart, reducing venous stasis and leg swelling. Instead, if you are forced to sit for many hours, for example while traveling by plane, try to lift your limbs by placing your feet on a small booster or cushion.

The surgical techniques

Only in extreme cases is surgery performed. Minimally invasive techniques are used such as radiofrequency or laser thermal ablation aimed at the obliteration of pathological venous segments of large or small saphenous vein. The vessel is entered with a probe and, under local anesthesia, the vein is ablated with heat, which is thus closed and left inside the leg. Then there are the non-thermal techniques. Such as mechanochemical ablation: a rotating catheter causes mechanical damage to the wall and a sclerosing substance is administered inside the veins which occludes the vessel or ablation with cyanoacrylate glue, a painless, rapid and effective method, which obliterates the pathological veins occluding their lumen.