Varicose veins (first part) بالانجليزية

 

Varicose veins are one of the most common venous problems around the world. It can affect both men and women of various ages. Varicose veins are defined as swollen, bulging, twisted superficial veins that may be felt beneath the skin and often measure more than 3mm in diameter. They are commonly found on the inside of the calf or thigh and develop as a result of vein wall weakening and valve dysfunction. Veins have one-way valves that open and close to allow blood to return to the heart. If the valves become weak or damaged, blood can back up and stagnate in the leg, causing increasing pressure in the vein. It causes the veins to expand causing varicose veins.

  

Varicose veins can be caused by a variety of factors including primary, secondary, or congenital causes. Primary varicose veins form due to an intrinsic weakening in the vein's wall. Varicose veins can be hereditary and frequently appear in multiple members of the same family. Secondary causes of varicose veins include trauma and deep vein thrombosis. Congenital varicose veins are caused by abnormalities in the natural development of the venous system and are typically associated with a vascular abnormality in the limb at birth.

The main risk factors for the development of varicose veins include a family history of venous illness, female sex, old age, heavy lifting, and chronically elevated intra-abdominal pressure owing to obesity, pregnancy, chronic constipation, or a tumour. Venous blockage caused by thrombosis or extrinsic pressure are also significant risk factors for varicose veins. Furthermore, any employment that requires extended standing or sitting is one of the variables that contribute to increased venous pressure on the veins. Less physical activity and higher blood pressure have also been associated to the development of varicose veins in women.

The clinical presentation of varicose veins varies, and some patients may be asymptomatic. Localized symptoms may be unilateral or bilateral including bulging, bluish veins, pain, burning, itching, tingling at the site of the varicose veins, as well as spider veins, which are tiny veins that resemble spider web. Generalized symptoms consist of aching, heaviness, cramping, throbbing, restlessness, and swelling in the legs. Symptoms are often worse at the end of the day, especially after prolonged standing, and usually resolve when patients sit and elevate their legs. Signs of a more serious underlying vascular insufficiency may include changes in skin pigmentation, eczema, infection, superficial thrombophlebitis, venous ulceration, loss of subcutaneous tissue, and lipodermatosclerosis  (a decrease in lower leg circumference due to chronic inflammation, fibrosis, and contraction of the skin and subcutaneous tissues). Although rare, hemodynamically significant external haemorrhage resulting from the perforation of a varicose vein has been reported

Weaker valves and veins are more susceptible to clotting and haemorrhaging, necessitating urgent treatment using various methods. The decision to proceed with treatment and the therapeutic options are determined by symptoms and patient preferences. The risk of complications, the existence or absence of profound venous insufficiency, and the features of the affected veins can all assist guide treatment. The treatment options for varicose veins include the following: phlebotonics which are oral and topical medicines that aim to reduce the symptoms of chronic venous insufficiency by increasing venous tone, improving capillary hyperpermeability, and decreasing blood viscosity. Compression has traditionally been advised as the initial treatment for varicose veins. However, there is little information to evaluate whether compression stockings are beneficial in the treatment of varicose veins in the absence of active or healed venous ulcers. Varicose veins also can be treated with interventional techniques such as thermal ablation, endovenous sclerotherapy, or surgery. Although surgery was formerly the basis of therapy, it has been largely replaced by endovenous thermal ablation, which can be performed under local anaesthesia and may produce better results with fewer difficulties than other treatments. Blockage of the pelvic veins may exacerbate the symptoms of varicose veins, necessitating separate treatment. 

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