The word varices derives from the Latin varus, that is, curved, because the
varicose veins are indeed ectasias, ie dilatations and deformations of the veins,
especially observable to the lower limbs, where they appear as cords or bluish sacciform
swellings, with great anxiety for the ladies who see
disfigured aesthetics and beauty of the legs and run considerable risks (embolism!).
They are defined as permanent dilatation of the vein wall of the lower limbs but
may involve other localizations (hemorrhoids of rectal plexus , nasal septum, esophagus,
pampiniform plexus of the testis, or varicocele).
The varices should not be confused with telangiectasias, substantially dilated capillaries.
Individuals who for reasons of work must stand up should be particularly susceptible to this type of alteration; women are still more affected (4: 1) for hormonal reasons (estrogens, oral contraception), for maternity with compression of the uterus on the system of the veins, the elderly, the obese and those who for meiopregia have the tendency. Also there is the danger of an inflammation (phlebitis) in pregnancy. The familiarity, the type of work (shop assistant, baker, hairdresser ...), the chronic constipation are other basic factors that favor the onset.
The vein system has valves, which, like pockets, when the blood presses to go back, fill and close the return circuit; however, it happens that the vase, for various reasons, it's getting larger, so that the blood flows downwards, instead of proceeding towards the femoral, iliac and hollow vein system and therefore the heart. This causes a further dilatation of the veins that become "varicose", ie tortuous, and the valves become insufficient and cause a very slow flow with a progressive expansion and stasis that gradually affect the downstream structures. Hence the edema, responsible for most of the symptoms and complications, with alterations involving the cutaneous microcirculation of the most sloping areas, with dilatation of the capillaries around the ankle, repeated blood microcircuits and chromatic alterations (ocher dermatitis), until true infections of the skin and ulcerations. The stasis inside the veins is also responsible for the ease with which blood tends to coagulate (phlebitis and thrombosis). Fearsome, therefore, are the complications: pulmonary embolism, hemorrhages, infections, stasis eczema and leg ulcers lead not only to a worsening of symptoms, but especially to risks that are not worth running.
Presence of dull pain or sense of compression in the lower limbs after prolonged
periods of standing, which recedes or is relieved with the lifting of the limbs.
Feeling of heavy legs and slight swelling of the ankles. Other symptoms are
cramps, itching or feeling of heaviness in the legs; pains can also occur and,
if the evil is neglected, local skin inflammation. Finally ulcers can occur,
especially to the ankles or other complications. Sometimes a symptomatology
prevails characterized by redness, swelling, pain, heat, and the appearance of a
sore cord in the region located along the course of the varice.
The treatment of varicose veins first is generally conservative, that is with drugs.
Not infrequently, in fact, the symptom regresses by holding the limbs
periodically raised, escaping the long standing up position and resorting
to the
use of elastic stockings, which allow to counteract the pressure existing in the
veins.
- Oral therapy for varicose veins and disparate drugs ranging from benzopyrones
(coumarin, flavonoids, diosmine, rutin, hesperidin);
- saponins (escin, ruscus, centella asiatica, other extracts from plants (anthocyanosides
of bilberry, ginkgo biloba - synthetic substances (dobesylated calcium ...) Some
of the products, for oral or topical use, present on the market in Italy are (in
order alphabetical):
ALVEN ARVENUM DAFLON DIOSVEN ESSAVEN FIBRASE FLEBORAL FLEBOSIDE FLEBS HIRUDOID
LIOTON TEGENS VENORUTON VENOSMINE
A plantar is useful to reduce edema, especially in cases where muscular pump
defects are associated. Advise to avoid the heat, especially at sea in summer,
and to prefer ablutions with iced water, lymphatic drainage and walking or
cycling, is a good choice to undertake a first treatment.The best method derives
from the combination of techniques, surgical and not , even in different times
and ways. Only by using all the methods available is it possible to resolve the
varicose disease
Elastic stockings and drugs are useful therapies in the treatment of disorders,
but do not eliminate the causes and complications.
In the benign forms, finally, by injection of a chemical solution, the affected
veins are sclerotized until they are closed; even in this case the blood reaches
the heart through other veins. The simplest cases are kept under control by
recommending the patient to avoid standing for long periods of time and to rest
frequently, keeping the legs slightly raised relative to the trunk. The elastic
stockings help to avoid swelling, while the march stimulates blood circulation
in the legs.In the presence of small symptomatic varices, sclerotherapy is
sometimes indicated, which consists in the injection into the varice of a
substance that causes its "closure" and then the disappearance, followed by the
application of a compressive bandage. Surgical therapy consists of ligation and
removal of saphenous (stripping) and should be reserved for patients with
important symptoms, with recurrent episodes of thrombophlebitis and / or skin
ulceration. Even in the absence of these veins the bloodstream of the limb,
after surgery, returns efficient. The diagnosis is very simple; a good
specialist visit; followed by an ecocolordoppler exam, which serves to exclude
major complications affecting the deep veins (especially thrombosis) and to
establish which therapeutic approach is best used among those available. With
this method it is in fact possible to evaluate with precision and reliability
some morphological characteristics (diameter, depth, seat) and functional
characteristics (entity, location, length of refluxes), able to influence the
choice of the best treatment method. surgery, especially minimally invasive
surgery, is indicated when the main venous axes (saphenous) are altered; they
range from the classic total stripping, to the short stripping, to the selective
binding methods (c.h.i.v.a.), to the endovascular laser. Sclerotherapy is
indicated when saphenous veins are still healthy (extrasaphenic varices), in
some cases saphenous varices with certain reflux characteristics and valves
involved, or when saphenous veins have been previously removed (varicose veins).
The laser and radiofrequency are excellent methodical, but they are few
applications;., but without forgetting that pathology, an expression of an
intrinsic weakness of the wall, is chronic and needs controls over time,
especially when deep circle problems coexist or when complications are already
established. A very frequent question on the part of patients regarding the
possibility of varicose vein recovery should be assessed individually from case
to case, based on the degree of valve compromise, the condition of the deep
circulation, constitutional and postural problems, and concomitant risk factors.
, after a correct clinical examination and a careful and targeted ecodoppler
examination.
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