Simple lower extremity varicose veins
Introduction
Brief introduction of simple lower extremity varicose veins Simple lower extremity varicose veins only in the superficial veins of the lower extremities, due to valve insufficiency, weak vein wall, affecting blood return, causing vein extension, bending, dilatation, mostly in the saphenous vein, a small number of small saphenous veins or It occurs in the small saphenous vein alone. The superficial veins of the lesions are characterized by elongation, dilation, and flexion, which occur mostly in people who are persistently engaged in standing and physical labor. basic knowledge The proportion of illness: 0.004% Susceptible people: no specific population Mode of infection: non-infectious Complications: thrombophlebitis
Cause
Simple lower extremity varices
The vein wall is weak (29%):
Congenital weakness of the venous wall is also an important cause. Patients often have peripheral or localized venous wall defects. In the case of increased venous pressure, the veins are distorted and expanded.
Abnormal venous valve structure (28%):
Due to the superficial venous reflux caused by the incomplete closure of the first valve (the saphenous vein valve) of the superficial vein, the venous pressure of the lower extremity is increased.
Other factors (25%):
Finally, long-term standing, obesity, and abdominal pressure can increase the risk of varicose veins by increasing venous pressure.
Pathogenesis
The main hemodynamic changes of varicose veins occur during the systolic phase of the calf muscle. Due to the destruction of the venous valve that protects the blood from flowing in one direction, the deep vein blood reverses into the superficial venous system, and the deep venous pressure formed during muscle contraction is as high as 20 ~26.7kPa, due to the lack of muscle fascia around the superficial vein, but only the loose connective tissue under the skin, coupled with the weak vein wall itself, resulting in the growth of the vein, thickening, varicose veins.
Barnandl and Browse have shown that there is a large amount of capillary proliferation in the pigmentation and lipid-hardening areas of varicose veins of the lower extremities, and due to the increase in pore size between capillary endothelial cells, osmotic particles, especially fibrin The original large amount leaked, and at this time, the fibrinolytic ability of the vein decreased, so that a large amount of fibrin accumulated in the sheath around the capillary, which hindered the exchange of oxygen and nutrients between the capillaries and the surrounding normal tissues, and thus appeared in the skin and subcutaneous tissues. A nutritional change.
Prevention
Simple lower extremity varicose vein prevention
1. When standing, don't always support the whole body weight with two legs. You can focus on it and let the two legs rotate for a rest. You can pick up your feet, let the heels fall together, or do the calf kicks. These actions can cause strong contraction of the calf muscles and reduce venous blood accumulation.
2, Shaolang Erlang legs, because the sitting posture of Erlang legs will hinder blood flow to the lower limbs.
3, at noon and evening, the legs will be 15-20 cm high, which can promote blood circulation in the legs.
4, before going to bed every night, to develop the habit of washing feet with hot water, avoid washing feet with cold water. Washing your feet with hot water can eliminate fatigue, help sleep, and promote blood circulation.
Complication
Simple varicose veins of lower extremities Complications thrombophlebitis
Thrombophlebitis
The blood flow in the varicose vein is slow, and it is easy to form a thrombus with non-infectious inflammation. Sometimes it can cause infectious inflammation due to bacterial invasion of the foot. The patient's leg is red and swollen, and the fever is venous. The vein is in the shape of a cord. Rest in bed, raise the affected limb, pressurize the treatment during exercise, and apply anti-infective treatment such as penicillin and cephalosporin. The topical wet compress can be applied with 75% ethanol or 50% magnesium sulfate. After the inflammation is controlled, the operation is performed.
2. Ulcer
The upper foot boots area is a part with high venous pressure and has a constant penetrating vein. The skin is in poor nutritional condition. Once it is broken, it will cause refractory ulcers, often complicated by infection. Treatment includes bed rest, raising the affected limb, and when exercising. Compression therapy, anti-infective therapy, etc., because varicose ulcers are difficult to heal, so once the infection is controlled and the ulcer granulation tissue is fresh, surgery should be performed at the right time, and ulcer skin grafting is feasible if necessary.
3. Bleeding
The varicose vein wall is thin, slight trauma can cause rupture and bleeding and it is difficult to stop by itself. The affected limb should be raised and pressure bandaged with elastic bandage. If necessary, suture can be used to stop bleeding, and then surgery is performed.
Symptom
Simple varicose veins of the lower extremities Common symptoms Lower extremity swells lower extremity swelling and fatigue lower extremity superficial varicose lower extremity weight bearing disorder
1, more common in the physical workers engaged in standing, after a long standing, the limbs are heavy, sore, numb, sleepy.
2, standing position, saphenous vein and (or) small saphenous vein uplift, dilated, bent or twisted into a group, disappeared in the lying position, the lower part of the lower leg may have pigmentation, scaling, eczema and chronic ulcers.
3. In the early stage of the disease, due to the stimulation of the venous adventitia, the patient has a feeling of soreness and pain, and the pain is mostly dull and painful. At the same time, there is a heavy feeling of the limb, which is easy to fatigue and fatigue. The patient feels more in the long or afternoon. Aggravation, but in the supine, limb lift or wearing elastic stockings, it is significantly reduced, sometimes accompanied by calf muscle spasm, some patients have no obvious discomfort, the latter part of the disease with varicose veins and its complications Damaged veins are bulged, dilated, and distorted, especially in the calf and saphenous vein. The longer the course of the disease, the nutritional changes in the calves, especially the ankle skin, including skin atrophy, scaling, itching, Pigmentation, induration of skin and subcutaneous tissue, and even the formation of eczema and ulcers, sometimes with blood and thrombophlebitis, it is worth noting that simple superficial varicose veins are not accompanied by edema, even if present only in the ankle, foot back , relatively mild, such as combined with severe lower extremity edema, should consider other reasons, such as primary deep venous insufficiency or deep vein thrombosis, etc.
Examine
Simple lower extremity varicose vein examination
Lower extremity venous function tests should be performed:
(1) The function of the great saphenous vein valve and the valve between the great saphenous vein and the deep vein. The supine, the affected limb is raised, and the tourniquet is tied at 1/3 of the thigh. After standing, the tourniquet is not relaxed. Within seconds, see the vein filling below the tourniquet rapidly filling, indicating that there is traffic venous valve insufficiency below the tourniquet. If the tourniquet is relaxed, see the vein filling rapidly from top to bottom, which is the saphenous vein insufficiency.
(2) Small saphenous vein valve and small saphenous vein and deep vein communication valve function test, the results and significance are similar to the above test.
(3) Traffic branch positioning test of valve insufficiency, supine, limb elevation, tie the tourniquet at the base of the thigh, first wrap the first elastic bandage from the toe up to the armpit, and then the blood strip is downward. Put on the second elastic bandage, let the patient stand, and untie the first elastic bandage while continuing to entangle the second elastic bandage. If there is a varicose vein in the gap between the two bandages, Indicates that there is a traffic branch vein with valvular insufficiency.
(4) Deep vein patency test, if the varicose vein is aggravated, the deep vein occlusion is reduced or disappeared, indicating deep venous patency.
For suspected deep vein thrombosis syndrome, patients with primary deep venous insufficiency can be examined by vascular ultrasound, plethysmography and venography to determine the patency of the deep vein and the function of the valve.
Diagnosis
Diagnosis and diagnosis of simple lower extremity varices
Primary lower extremity superficial varices are distinguished from the following diseases.
Primary deep venous insufficiency
Primary deep venous insufficiency of the lower extremities is secondary to superficial varicose veins of the lower extremities, but its clinical manifestations are relatively serious. Patients have bulging pain and obvious swelling when standing for a long time. When the lower extremity is measured by superficial venous pressure, the pressure after standing activity The rate of decline is reduced, generally within 30%. The most reliable method of differential examination is lower extremity venography.
2. Lower extremity deep vein thrombosis syndrome
The superficial varicose veins of the lower extremities are mostly a compensatory symptom of the syndrome. In the early stage of the disease, the patient has uniform and uniform swelling of the limbs, and the pain is accompanied by fever. The examination shows that the trigone and the gastrocnemius muscles have obvious tenderness, and when bending to the dorsal side, That is, the pain in the gastrocnemius muscle (positive of Homans's sign), at this time, the deep vein of the lower extremity is blocked by the thrombus, forming a reflux disorder, and the Perthes test is positive. At the end of the course, the thrombus is recanalized, the venous valve is destroyed, and the flow is reversed. Lesions, patients with superficial varicose veins of lower extremities, edema of lower extremities, redness or cyanosis of the lower extremities when standing, and heavy swelling or soreness and nutritional changes of the limbs, secondary lymphedema of the affected limb, at this time and primary Deep venous insufficiency is difficult to identify, and deep venography can help to confirm the diagnosis.
3. Arteriovenous fistula
Most cases occur after trauma, especially after penetrating wounds. Occasionally, there are congenital ones. In the arteriovenous fistula, tremors and tremors can be heard and continuous vascular murmurs are heard. The proximal limbs are thickened and heated, and the hairs are easy to sweat. The distal limbs are When it is cold, it can cause edema. When the limb is raised, the blood in the lower extremity varicose vein is not easy to empty, and the venous pressure is obviously increased. When the vein is puncture, it is bright red oxygenated blood.
4. Venous malformation of bone hypertrophy syndrome (Klippel-Trénaunay syndrome)
The disease is caused by congenital arteriovenous communication or congenital venous malformation (deep vein compression, high stenosis or occlusion), varicose veins are more extensive, not limited to the trunk of the great or small saphenous vein, often on the outside of the thigh, the back side is also obvious Varicose veins, the affected limbs often increase the thickness of the healthy side of the hinge, there are still large patches of reddish-brown blood vessels, some people call it "wine spots", according to the above three signs, identification is easier.
