Varicose veins of lower extremities
Introduction
Introduction to varicose veins Varicose veins of the lower extremities are a common disease, especially in people who are engaged in long-term manual labor or standing work. Mainly manifested as superficial vein expansion of the lower extremities, elongation, distortion, resulting in soreness, fatigue, heavy and other symptoms of the affected limbs, severe cases often accompanied by complications such as calf ulcer or superficial phlebitis. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: phlebitis, stasis, subcutaneous sclerosis
Cause
Cause of varicose veins of the lower extremities
(1) Causes of the disease
The weakness of the venous wall, the venous valve defect, and the persistent increase in superficial vein pressure are the main causes of superficial varices.
1. Congenital vein wall weakness or venous valve function defects, such as valve deficiency or hypoplasia, so the vein wall is easy to expand, the proximal venous valve insufficiency causes the blood to flow backward, further affecting its branch, and eventually causing varicose veins.
2. Long-term standing is an important factor causing varicose veins of the lower extremities. The vertical gravity of the blood column increases the venous pressure of the lower extremities, and the reflux can directly cause the destruction of the saphenous vein. Therefore, the saphenous veins are more common in workers who have stood for a long time.
3. Pregnant women or patients with pelvic tumors, due to increased intra-abdominal pressure, hindered venous return obstruction, can cause varicose veins of the lower extremities.
(two) pathogenesis
1. Intravenous factors
(1) Venous wall weakness and venous valve defects are part of the manifestation of systemic support tissue weakness, and are related to genetic factors. Because superficial veins are located in subcutaneous tissue, there is no strong support, when intravenous pressure increases (eg Weight-bearing, coughing and long-term standing, etc.), this situation is easy to cause vein dilatation, the proximal venous valve is incompletely closed, the blood is going backwards, the venous pressure is increased, and the distal valve is gradually destroyed, resulting in varicose veins. The condition is called "primary varicose veins".
(2) When the superficial vein wall and the valve are traumatized, if the healing is poor, it may affect the elasticity of the wall and the function of the valve, and varicose veins may occur at the injured site.
(3) In the elderly, the vein wall begins to degenerate, and varicose veins are also prone to occur.
2. Increased venous pressure
Although the vein itself has no lesions, the venous pressure is increased due to obstruction of blood flow, and varicose veins are prone to occur.
(1) Occupational factors such as long-term standing workers, the blood column acting on the vein wall of the lower limbs becomes straight, so that the intravenous pressure of the lower limbs is significantly increased; and because the straight steric position is often taken, the muscle contraction of the lower limbs is less, affecting the venous blood return, when When the blood volume exceeds the load of venous return, it causes an increase in intravenous pressure and occurs.
(2) uterine enlargement during pregnancy, pelvic tumors and enlarged lymph nodes can also cause superficial varices.
(3) Deep vein obstruction (such as femoral vein thrombosis), superficial vein compensatory dilatation.
The varicose veins caused by the weakness of the venous wall and the venous valve defects are secondary varices. Most of the varicose veins of the lower extremities occur in the saphenous vein. There are also large and small saphenous veins at the same time. The veins are less, the deep veins are protected between the muscle groups, and the muscles contract when the lower limbs move, which helps the blood circulation, so varicose veins do not occur; on the contrary, the superficial veins do not have the above protective conditions, so It is easy to cause varicose veins.
The main pathological changes occurred in the middle layer of the vein wall. Due to the slow or stagnant blood flow, the venous pressure increased, and the muscle fibers and elastic fibers were compensatory thickening at the early stage. At the later stage, the muscle fibers and elastic fibers atrophied or even disappeared, all of which were connective tissues. Instead, part of the vein wall expands due to thinning, and some vein walls become thicker due to connective tissue hyperplasia, resulting in uneven nodular appearance, while the venous valve atrophy and harden, affecting its function.
Prevention
Lower extremity varicose vein prevention
Primary prevention
For factories that are engaged in long-term standing work, enterprises should be protected by labor. For example, they should apply elastic stockings or elastic bandages during work, and organize work spaces during work.
2. Secondary prevention
Patients with mild varicose veins use elastic bandages or elastic stockings to raise the affected limb. For patients with symptoms without contraindications, patients with high saphenous vein can be ligated and all branches are cut off, and the main saphenous vein and branches are removed. Ligation and severing of incomplete traffic veins, local excision of varicose veins, small saphenous varicose veins should be done at the same time small saphenous vein and branch exfoliation, sclerotherapy injection compression therapy, especially suitable for postoperative residual varicose vein adjuvant treatment, commonly used The hardener is 5% cod liver oil sodium solution, oleic acid ethanolamine (ethamolin) solution, 3% sodium tetradecyl sulfate (sotradecol) solution and hypertonic syrup water and saline. The injection dose per dose is 5% sodium cod liver oil 1-2 ml. Multi-point injection can be done. After injection, it should be pressure-wrapped for at least 6 weeks to make the vein walls adhere to each other and closed. The short-term effect of injection compression therapy is satisfactory, but the recurrence rate is high, and repeated injections are needed. Some patients have allergies during injection. , hemolytic reaction, occasional pulmonary embolism, sclerosing agent leakage into the skin can cause subcutaneous necrosis, so special attention should be paid.
3. Three levels of prevention
(1) Ulcer: It is the most common complication of varicose veins of the lower extremities. It not only brings pain and inconvenience to the patient, but the ulcer that will not heal will cause malignant transformation. Therefore, it should be treated promptly. 1 Actively treat the primary disease, 2 bed Rest, raise the affected limb, strengthen nutrition, 3 parts can be used physiological saline, 1:5000 furancillin solution, 1% neomycin solution wet compress, external application of Oriental No. 1 ointment or zinc oxide tape application to promote ulcer healing, 4 ulcer surface Long-lasting unhealed can be cured by ulceration and local skin grafting.
(2) Acute bleeding: Many cases of venous rupture due to minor trauma, large amount of bleeding and difficult to stop by themselves, so it must be treated in time, when bleeding, raise the affected limb, pressure bandage, if necessary, suture the bleeding vein.
Complication
Lower extremity variceal complications Complications, phlebitis, stasis, subcutaneous sclerosis
1 variceal phlebitis: This is mainly caused by slow blood flow, but it can also be caused by trauma.
2 ulcer formation: due to long-term congestion of the vein, blood oxygen content decreased, capillary permeability increased, fluid extravasation, tissue edema, local resistance decreased, ulcers due to mild trauma, such ulcers often occur in the upper part of the iliac crest In the lower third of the lower leg, the surrounding tissue becomes thinner, pigmented, or has eczema-like changes, making it difficult to heal.
3 stasis subcutaneous sclerosis: due to insufficiency of the valve on the sacral traffic, increased blood flow, congestion of the lower extremities, connective tissue hyperplasia, stasis hardening in the subcutaneous tissue, or degenerative changes in the skin due to blood circulation disorders, performance For hair removal, the skin is thin and shiny, desquamation, pigmentation, etc., and hemoglobin can also be ruptured by capillary rupture.
4 Bleeding: thinning due to skin degenerative lesions, it is difficult to support the lower venous pressure to withstand intracavitary pressure, or due to trauma caused by massive bleeding, there are also subcutaneous hemorrhage caused by venous injury.
Symptom
Symptoms of varicose veins of the lower extremities Common symptoms Lower limb movements are heavy,... Lower extremity superficial varicose veins lower pigmentation of the lower leg... Lower extremity chilly calf swelling edema varicose veins hardening straight leg sputum test positive standing edema after a long time
The location and extent of primary varices are related to the local venous pressure and the thickness of the wall. Due to the gradual development of the lesion, the early clinical manifestations are mainly symptomatic, and later the varicose veins and complications. Mainly.
The lower limbs of the lesions often feel sore and discomfort, heavy or painful, easy to fatigue, when walking or lying down, due to the compression of the gastrocnemius contraction, the blood is easy to reflux, the intravenous pressure is reduced, and the symptoms are relieved.
The varicose veins first expand and bulge, and then bend, which causes the valve to be indiscriminate, and increases its severity. After a long time, the middle muscle is replaced by connective tissue, the wall is thinned, and the dilated vein can become nodular, saphenous varicose veins. It is mainly distributed on the inner side of the lower limbs and extends to the anterior and posterior muscles. Because the calf veins of the calf are smaller, the wall is thinner and the pressure is higher than the thigh pressure, so the degree and range are larger and the legs are heavier. Its branch is more serious than the trunk. When the thigh vein is obviously varicose, it often indicates that the main valve is insufficiency. If it occurs on the lateral side of the thigh, it shows the inferior femoral venous valve insufficiency; if it occurs in the posterior aspect of the thigh, it shows the shallow femoral Venous valve dysfunction, small saphenous veins are mainly distributed behind the lower leg and lower part, and extend to the outside and the back of the foot.
Simple primary varicose veins, no dysfunction of the sacral traffic branch valve, and no swelling; if there is traffic valvular insufficiency, mild swelling can also occur, which is characterized by one day after the event, and after a restful night Or disappear.
Examine
Examination of varicose veins of the lower extremities
Blood, urine routine and anti-"O", erythrocyte sedimentation rate and mucin examination were normal.
Superficial vein function test, traffic valvular function test and deep vein function test to determine the type of lesion, correct treatment, vascular B-ultrasound.
Diagnosis
Diagnosis and diagnosis of varicose veins
The morphology of varicose veins of the lower extremities has distinct features, and the diagnosis is not difficult, but sometimes the patient is mainly complication. At this time, further examination should be performed to make a diagnosis of varicose veins and complications, because the varicose veins of the lower extremities can be secondary to other Disease, therefore, after the diagnosis of varicose veins is established, the cause should be further traced to distinguish whether the varicose veins are primary or secondary. After the determination of primary superficial varices, it is still necessary to pass the examination, such as shallow The venous function test, the traffic valvular function test and the deep vein function test are used to determine the type of lesion and to perform correct treatment.
Need to distinguish from deep venous thrombosis, deep venous valve closure.
