Varicose veins
Introduction
Introduction to varicose veins Varicose veins, commonly known as "fried ribs," are the most common diseases of the venous system. The main reason for the formation is that the congenital vascular wall is weak or maintains the same posture for a long time. The blood accumulates the lower limbs and is destroyed in a long period of time. The venous valve produces a high venous pressure, which is a symptom of the blood vessels protruding from the surface of the skin. Varicose veins occur in the lower extremities, and other scrotal spermatic cords, abdominal veins, and gastric esophageal veins may also develop varicose veins. Some patients can form a thrombus in the superficial vein of varicose veins, which is characterized by local redness and swelling, hard block formation, and pain affecting walking. If left untreated, the thrombus may spread to the deep veins up or through the traffic vein, causing deep vein thrombosis, and the risk of life-threatening pulmonary embolism. In patients with chronic varices, the venous wall is weak, the venous pressure is high, and the local blood supply is insufficient to cause muscle and adipose tissue to shrink. The varicose veins are protruding under the skin. Mild damage will cause ulcers and easily damage the vein wall. basic knowledge The proportion of illness: 0.03% (long-term practice, such as traffic police, teachers with high incidence) Susceptible people: no special people Mode of infection: non-infectious Complications: stasis dermatitis thrombophlebitis erysipelas acute cellulitis
Cause
The cause of varicose veins
Perforation failure (20%):
Perforated veins connecting the superficial veins and deep veins also have valves to prevent blood from flowing from the deep veins to the superficial veins. However, when there is a problem with the function of the perforated venous valve and the blood flows arbitrarily, it will exert pressure on the superficial veins and expand the veins.
Innate cause (20%):
The patient's valve may be born with some minor problems, plus the acquired pressure, the formation of varicose veins; when one of the veins of the vein is broken, the function of transporting blood back to the heart is lost, the blood accumulates in the vein, the vein is compressed and expanded, and it is implicated In a valve, the valve does not cover the over-expanded vein and also loses the function of the piston, which in turn affects the third and fourth valves.
Vascular disease (20%):
In people who have had venous thromboembolism, valve function may be impaired.
Drug users (10%):
In patients who use syringes to take drugs, the valves of deep veins are easily damaged.
Pregnant women (15%):
The female hormone causes the vein to expand, the valve does not cover the vein, and does not prevent the blood from flowing backwards.
Obese people (15%):
Because the lower limbs need to support a large body, the venous pressure increases.
Prevention
Varicose vein prevention
Treatment of varicose veins:
(1) Avoid standing or sitting posture for a long time, walking can use the pumping effect of the calf muscle to promote venous return.
(2) Raising the lower limbs can alleviate symptoms such as edema.
(3) Wearing a pressure gradient can delay the development of the disease.
It occurs mostly in people who have long standing work or heavy physical labor, such as salesmen, teachers, porters, and military personnel. Women who have multiple births and are obviously obese are also more common.
Prevention of varicose veins:
Women (especially women), long-term standers (more than 6 hours a day), obese people are more likely to have varicose veins. To prevent varicose veins, you can start from the following aspects:
1, leg lift, varicose veins are due to the weakness of the veins to send blood back to the heart, so lifting the legs helps to slow down the disease.
2, padded bed tail, help blood return during sleep.
3. Do not wear high heels.
4. Maintain an ideal weight.
5, take the pill carefully, some contraceptives may cause this problem.
Complication
Varicose vein complications Complications, sclerosing dermatitis, thrombotic superficial phlebitis, erysipelas, acute cellulitis
Harm of varicose veins of lower extremities
1, stasis dermatitis: more than 1 / 3 under the calf or 2 / 3 under the calf, phenomenon skin dystrophies, skin atrophy, desquamation, dryness, pigmentation, exudation, itching.
2, superficial venous hemorrhage: due to high venous pressure, varicose veins have different thickness of the vein wall, a slight injury can cause venous rupture, and sometimes even small veins can spontaneously rupture and cause bleeding.
3, congestion ulcers: often occur in the lower and third of the lower leg of the inside and outside, a little trauma, can occur chronic calf ulcers (old rotten legs), it is difficult to heal.
4, secondary infection: due to weakened limb resistance, easily secondary infection. Usually there are thrombotic superficial phlebitis, erysipelas, acute cellulitis, etc., patients may have high fever, aversion to cold, yellow tongue coating, red tongue. Due to recurrent erysipelas, lymphatic obstruction, and finally a skin swelling.
5, thrombotic superficial phlebitis: the veins of the lower extremity varicose veins, burning, pain, along the varicose veins can touch hard nodules or strips, there is tenderness. If accompanied by venous peri-inflammation, red, swollen, hot, and painful symptoms occur on all sides of the superficial vein. After the acute inflammation subsides, the hard nodules or strips are left partially.
Harm of varicocele
(1) The lower body feels uncomfortable and affects life and work. Patients with varicocele will have uncomfortable feelings such as scrotum and other parts, mainly manifested by the feeling of scrotal testicular swelling, scrotum wet, cold, pain, and pain, which will affect normal life and work.
(2) The varicocele causes local temperature rise, hypoxia, pH change, toxic substance retention, etc., resulting in a decrease in sperm count.
(3) Serious can lead to infertility. Varicocele can cause the accumulation of spermatic vein blood, which leads to an increase in testicular temperature, which also affects testicular metabolism, local hypoxia, accumulation of metabolic waste, poisoning testicular spermatogenic cells and sperm. The common consequences of the two factors are that the patient's sperm count is reduced, the mobility is low, and the abnormal sperm is increased, which can lead to infertility.
(4) Other hazards. A few people also have emotional instability, insomnia, dreams, mental weakness, fatigue and other neurasthenia. Some people may even have sexual dysfunction such as decreased sexual desire, decreased sexual pleasure, sexual pain, erectile dysfunction, and premature ejaculation.
Symptom
Varicose vein symptoms Common symptoms Calf and ankle joint week... Skin freckle skin pigmentation and deep venous ulcer venous hemorrhage surrounding tissue perfusion varicose ulcer
1. Venous thrombosis: Some patients can form a thrombus in the superficial vein of varicose veins, which is characterized by local redness and swelling, hard block formation, and pain affecting walking. If left untreated, the thrombus may spread to the deep veins up or through the traffic vein, causing deep vein thrombosis, and the risk of life-threatening pulmonary embolism. In patients with chronic varices, the venous wall is weak, the venous pressure is high, and the local blood supply is insufficient to cause muscle and adipose tissue to shrink. The varicose veins are protruding under the skin. Mild damage will cause ulcers and easily damage the vein wall.
2, bleeding, ulcers: the skin of the region of the calf varicose veins is very fragile due to lack of nutrition, minor trauma, it is easy to cause rupture of varicose veins and cause massive bleeding. Because there are no other symptoms such as pain during bleeding, the patient is often unaware that if it occurs during sleep at night, it will have very serious consequences.
3, venous injury: patients with long-term varicose veins varicose veins weak, high venous pressure, combined with local blood supply caused by muscle and adipose tissue atrophy, varicose veins protruding under the skin, mild injury will occur ulcers, and Easy to damage the vein wall.
4, edema, skin pigmentation: due to venous reflux, patients often present early and late edema of the affected limb. Long-term venous hypertension leads to increased capillary permeability in the lower leg area, rupture of red blood cells after exudation, and deposition of erythropoietin under the skin, which causes the skin to darken and develop from point to sheet.
5, affecting the leg beauty: In addition to affecting the aesthetics of the leg, the varicose veins in the early stage of the disease, the patient has a lot of discomfort and pain; in the later stage, the damaged vein is bulged, the expansion is distorted, and the calf saphenous vein is the weight.
6, necrosis: this ulcer occurs more in the upper part of the inner iliac crest and the lower third of the calf. Due to insufficient blood supply to the tissue, the tissue around the ulcer becomes thinner, the skin becomes black and hard, and the ulcer wound is not cured for a long time.
Disease classification
1, varicose veins I: surface blood vessels like sputum varicose, clearly protruding skin, varicose lumps or nodules, telangiectasia, reticular veins, crotch flushing.
2, varicose veins II: in the leg when the leg can be seen curved thickened superficial venous blood vessels, higher than the skin, can be disappeared after the legs are raised or lying down, often have calf soreness, fatigue and other discomfort, This period is the best time for treatment.
3, varicose vein III: varicose blood vessels increased, edema began to appear in the calf, to stand too long or tired after the more obvious, edema can fade in the morning. The affected limb is often thicker than the lateral leg. Some people also have itchy skin. In severe cases, it has skin lesions such as eczema and hoarding dermatitis.
4, varicose vein IV: excessive blood stagnation in the blood vessels, venous pressure is significantly increased, so that a part of blood components penetrate into the skin and subcutaneous tissue outside the blood vessels, causing local skin redness, purple, until black (iron in the blood Deposition), and loses elasticity and hardens.
5, varicose veins V has developed into an acute ulcer period, black and hard skin under the action of external forces, it is difficult to cure by ordinary methods, seriously affecting work and life.
6, varicose veins in the sixth stage of varicose veins, or recurrent venous ulcers without correct treatment, the formation of hemorrhoids legs, common in the vicinity of the ankle joint and lower leg, commonly known as "old rotten legs."
Examine
Varicose vein examination
The deep vein is usually tested : the deep vein patency test is also called the kick test. It is a method for identifying signs of patency of the deep veins of the lower extremities. In particular, whether the varicose veins of the lower extremities can be an important sign of surgery. Let the patient stand first and stop the blood band in the upper third of the patient's thigh. At this time, the varicose veins of the lower extremity may be more obvious than before. The patient is then forced to flex the knee joint of the affected lower limb 10-20 times (also 10-20 times under the force).
Venous valve function test : the patient is supine, the affected limb is raised, the varicose vein is emptied, and a rubber tourniquet is placed on the upper third of the thigh to prevent the saphenous vein from flowing backward. 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 faint and empty. When the tourniquet is released, the saphenous vein is immediately Filling up and down, suggesting that the great saphenous vein valve is insufficiency, and the traffic stick between the great 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.
Traffic valvular function test : used to locate the traffic branch vein of valve insufficiency.
Diagnosis
Diagnostic differentiation of varicose veins
The diagnosis of simple varicose veins of the lower extremities is not difficult. The diagnostic criteria are summarized according to clinical practice as follows.
1. The patient's lower extremity vein is obviously distorted and expanded, and it is more obvious when standing.
2. Have a long history of standing and raising abdominal pressure, or a family history of varicose veins of the lower extremities.
3. Deep vein patency, saphenous vein dysfunction, may have venous valve insufficiency.
4. May be associated with pigmentation, ulcers, thrombotic superficial phlebitis, bleeding, ulcers and other complications.
5. Ultrasound Doppler or venography showed large saphenous vein tortuous expansion and valvular insufficiency.
Disease classification
1. Varicocele : Varicocele refers to the expansion of the veins in the spermatic cord due to obstruction of reflux. It is a common disease in young and middle-aged people. It refers to the vasodilatation, distortion and lengthening of the spermatic plexus (venous vascular plexus) caused by the accumulation of spermatic vein blood flow. The incidence rate is 10-15% for males and 15-20% for male infertility. This disease occurs mostly on the left side, but it is not uncommon for both sides to develop, which can be as high as 20%. Varicocele may be associated with testicular atrophy and spermatogenesis disorders, resulting in male infertility. Varicocele can also be caused by a kidney tumor or other retroperitoneal tumor. The varicocele caused by compression is called symptomatic or secondary varicocele.
2, varicose veins of the lower extremities : varicose veins of the lower extremities refers to the expansion, extension, and bending of the superficial veins of the lower extremities, and the lesions of chronic ulcers may be complicated in the late stage. This disease is more common in middle-aged men, or long-term load-bearing or standing workers. The disease has not broken the anterior smear Chinese medicine "fascial tumor" category, after the rupture of the "acne" category. Varicose veins of the lower extremities are the most important disease of the venous system and one of the most common diseases of the vascular diseases of the extremities. In the upper and lower extremity varicose veins, the superficial veins of the lower extremities are progressively aggravated, bulging and tortuous, especially in the inner side of the calf. Small saphenous vein lesions are mainly located outside the calf. In the early stage of the disease, the patient has a feeling of soreness and discomfort in the lower limbs. At the same time, he is accompanied by heavy and weak limbs and mild edema. It feels aggravated for a long time or in the afternoon, but it is obviously relieved after lying or limb treatment, sometimes accompanied by calf tendon. Some patients had no significant discomfort. Longer course, skin nutrient changes in the calf, especially sputum, including skin atrophy, desquamation, pigmentation, skin and subcutaneous tissue induration, eczema and refractory ulcers, sometimes complicated by thrombophlebitis and acute Lymphangiitis.
