Great saphenous varicose veins
Introduction
Introduction to great saphenous vein The great saphenous vein is the longest subcutaneous superficial vein in the whole body. It starts from the dorsal vein of the foot and rises inside the lower limb until the groin. The varicose veins of the lower extremities occur mostly in the inner side of the calf, and can be extended upwards, directly to the inner side of the thigh, and even the entire lower extremity can see the varicose veins that are twisted into a group. The varicose veins of the lower extremities in this part of the patient mainly occur in the saphenous vein and its branches, so it is called saphenous vein. In the varicose veins of the lower extremities, the saphenous veins account for more than 90% of the varicose veins. People often refer to the varicose veins of the lower extremities as saphenous veins. basic knowledge The proportion of illness: 0.003% (long-term practice, such as traffic police, teachers with high incidence) Susceptible people: no special people Mode of infection: non-infectious Complications: thrombotic superficial phlebitis eczema
Cause
Causes of great saphenous varices
Genetic (45%):
Saphenous varicose veins are common diseases in life and are a type of varicose veins. The cause of saphenous varices is heredity. Congenital vein wall weakness and poor venous valve structure are the main causes of the disease.
Standing for a long time (35%):
Long-term standing work, especially heavy physical labor, is the cause of the disease. The valve can be subjected to excessive venous pressure, and in the case of poor valve structure, the valve may be incompletely closed, resulting in blood reflux. Due to the thin muscular layer of the superficial vein and the lack of connective tissue around it, blood reflux can cause the vein to grow thicker and varicose veins appear.
Pathogenesis
The pathogenesis of saphenous varicose veins is the tumor-like dilatation of the great saphenous vein valve, which causes the valve of the superficial vein of the lower extremity to lose the "one-way valve", the lower limb blood return disorder, the venous blood reflux, the great saphenous vein blood stasis. To make the veins distort and expand. The early manifestations of saphenous varicose veins showed that the superficial veins of the lower extremities showed a spasm-like dilation, and the patient developed discomfort and pain when standing, and disappeared when walking or lying down. As the disease progresses to the later stage, the lower extremity skin suffers from nutritional disorders due to poor blood circulation, skin atrophy, desquamation, itching, pigmentation, induration of skin and subcutaneous tissue, and even eczema and ulcer formation. Especially the back of the foot, the ankle, the lower part of the lower leg, the skin ulceration after severe or traumatic injury, long-term unhealed, commonly known as "old rotten feet."
Prevention
Great saphenous vein prevention
1. Lift the heel when going up the stairs and bear the weight with the legs. This can eliminate the fat on the inside of the thigh and the buttocks.
2. When you are sitting on the chair, cover the two calves together and exchange the legs from one to eight. Repeat this action and do not stop breathing. This will train the calf line.
Simply put, it is a vibrant walk. This way of walking should be a habit in peacetime. Standing and lifting the legs: Hold the table with both hands to help balance the body, legs naturally stand side by side, lift the heels, hold for two or three seconds, put down, do 5 to 6 times a day to tighten the calf, make the muscles more elastic The lines are more beautiful. Sitting and lifting the leg method: In the natural sitting position, put the legs flat at a 90-degree angle, try to lift the heel for ten seconds, then put it down and repeat the movement until the calf has a feeling of fatigue. This action tightens the buttocks and thighs, making the muscles elastic without thickening the hips and thighs and calves.
Complication
Complications of great saphenous vein Complications thrombotic superficial phlebitis eczema
Varicose veins, especially those with venous valve insufficiency of the lower extremities, have early symptoms of swelling, soreness, and fatigue of the lower extremities, affecting normal work and life, while the lower extremities are sickly protruding blood vessels, which also seriously affects the aesthetics of the lower limbs; When the hair is released to the middle and late stage, there are skin ulcers, exudation, bleeding, and infection in the calf. It has a great negative impact on the patient both psychologically and physiologically, which seriously affects the quality of life. And it is easy to cause complications:
(1) thrombotic superficial phlebitis: hot compresses, etc. Surgical treatment after symptoms subsided.
(2) Eczema and ulcers: control infection, wet wounds, elevated limbs, and local dressing changes.
(3) variceal bleeding: raise the affected limb, pressurize the dressing, and if necessary, suture and stop bleeding.
Symptom
Symptoms of saphenous varicose veins common symptoms calf swell varicose ulcer lower limb weight-bearing disorder long-standing edema lower extremity superficial varicose veins
The early symptoms are: after standing for a long time, the legs are sore and discomfort, easy to fatigue and fatigue; generally speaking, the symptoms are lighter when getting up in the morning, and the symptoms are aggravated at night after a busy day of work; some patients may have numbness on the inside of the ankle. Mild pain; the calf has a blue vein-like varicose vein.
The symptoms in the later stage are: the soreness of the legs is very heavy after standing for a long time, and even affects the work; the double calves are covered with varicose veins; the eczema and ulcers of the ankles appear, and the ulcers of the foot and ankle appear in the middle and late stages due to the varicose veins.
Examine
Inspection of great saphenous vein
1, blood, urine routine and anti-"O", erythrocyte sedimentation and mucin examination are normal.
2, superficial vein function test, traffic valvular function test and deep vein function test to determine the type of lesions, and correct treatment.
3, blood vessel B-ultrasound.
Diagnosis
Diagnosis and diagnosis of great saphenous vein
Need to distinguish from deep venous thrombosis, deep venous valve closure. It is mainly distinguished from clinical manifestations and test results.
(1) Clinical manifestations
The occurrence of simple varicose veins of the lower extremities is often related to occupational factors. It is often seen in textile workers, barbers, shop assistants, traffic police and security guards. Early mild varicose veins of the lower extremities may have no obvious symptoms. When the varicose veins are heavier, the patient has a soreness, numbness, sleepiness, heavy feeling, and fatigue after standing for a long time. The symptoms disappear after resting or raising the affected limb. When the patient is standing, the superficial veins of the diseased limbs are uplifted, dilated, distorted, and even curled into a group. Generally, the calf and ankle are obvious, and there is often no swelling. If complicated with thrombotic superficial phlebitis, local pain, skin redness, local tenderness, the same vein is a hard strip. After thrombosis and calcification, venous stones can form. If the course of disease is long and the varicose veins are heavier, the skin in the foot boots may have atrophy, desquamation, pigmentation, eczema and chronic ulcers. The varicose veins are ruptured due to ulcer erosion or trauma, and acute bleeding occurs.
(two) lower extremity venous function test
1. Large saphenous vein valve and large saphenous vein and deep vein communication valve function test (Trendelenburg test) patients supine, the limbs are raised, the varicose veins are emptied, a rubber tourniquet is placed on the upper third of the thigh, Prevent the blood flow from the saphenous vein. Then let the patient stand for 30 seconds, loosen the tourniquet, and closely observe the filling of the great saphenous vein: 1 Before the tourniquet is released, the saphenous vein is emptied. When the tourniquet is released, the saphenous vein is immediately filled from top to bottom, suggesting that the great saphenous vein is insufficiency, and the function of the valve between the saphenous vein and the deep vein is normal. 2 Before releasing the tourniquet, the saphenous vein was partially filled with varicose veins. After the tourniquet was released, the filling varicose was more obvious, indicating that the great saphenous vein valve and the traffic vein of the deep vein were incomplete. 3 Before the tourniquet was released, the saphenous vein was filled with varicose veins, and after the tourniquet was released, the varicose vein filling was not aggravated, indicating that the valve of the saphenous vein and the deep vein was incomplete, and the function of the saphenous vein valve was large. normal.
2. Small saphenous vein valve and small saphenous vein and deep vein between the traffic branch valve function test except the tourniquet is tied to the upper end of the calf, the test method is the same as the above test, the results and similar significance.
3. Deep venous patency test (Perthes test) patients stand, tying the tourniquet at the upper third of the thigh of the affected limb, blocking the return of the saphenous vein to the heart, and then squatting the patient to flex the knee joint 10 to 20 times to promote the lower limbs. The blood flows back from the deep venous system. If the superficial vein of the varicose vein is obviously relieved or disappears, it means that the deep vein is patency; if the varicose vein is not relieved or even aggravated, it indicates deep vein occlusion.
(C) venous angiography of the lower extremities has two angiographic methods, antegrade and retrograde, which are of great value for diagnosis and identification. Generally not necessary, when deep venous lesions are suspected, it is often used. Anterior angiography, simple lower extremity varicose veins, obvious superficial vein dilatation, traffic branch veins can be dilated and countercurrent, deep veins are normal; retrograde angiography, contrast agent can be seen to flow through the sacral femoral venous valve, and the proximal saphenous vein is displayed. The cystic dilatation, while the femoral vein valve has no countercurrent.
