Lower extremity varicose veins formation causes and treatment

Varicose veins of the lower extremities are the most common conditions in peripheral vascular diseases with the development of diagnostic means and clinical research, the morphology and function of the lower extremity venous valves have a new understanding. Varicose veins of the lower limbs are the ****same clinical manifestation of venous diseases of the lower limbs. In addition to simple varicose veins of the lower limbs, there are also diseases such as valvular insufficiency of the deep veins of the lower limbs and deep vein thrombosis of the lower limbs. The etiology of varicose veins of the lower limbs 1. Weakness of the vein wall and valve defects Whether it is simple varicose veins of the lower limbs or deep vein valve insufficiency of the lower limbs, the pathogenic factors are: congenital weakness of the vein wall and defects of the vein valves, which lead to a persistent rise in the internal pressure of the veins. 2. Elevated intraventricular pressure Usually, there are more reasons for increased venous pressure, such as people engaged in standing work for a long time, in addition to this, any factors that can make the intra-abdominal pressure increase can lead to increased intraventricular pressure. For example, heavy physical labor or strenuous physical activities, chronic cough, constipation, etc., the pressure generated by closed air exertion and abdominal muscle contraction can affect the venous blood reflux, thus damaging the valve function of the upper end of the saphenous vein and the onset of the disease. Clinical manifestations of varicose veins of lower limbs (1) superficial varicose veins of lower limbs, superficial varicose veins mostly occur in bilateral lower limbs, can also occur in unilateral lower limbs, in which the left side is more common, because the left iliac vein by the right iliac artery of the compression. (ii) Soreness and pain of the affected limbs Patients often have soreness or distension of the affected limbs and are easily fatigued, mostly when standing for a long time. When lying down and elevating the limb, the feeling of soreness and distension disappears rapidly. （Swelling of the affected limb The poorer the function of the deep vein valves, the more obvious the swelling of the affected limb. If lymphatic vessels are involved and lymphoedema occurs at the same time, the swelling of the affected limb will be more obvious. （Complications 1. Thrombophlebitis Characteristics: Redness, swelling, burning, pain in the varicose veins of the lower limbs, hard nodules or cords can be palpated along the varicose veins, and there is pressure pain. If complicated by periphlebitis, redness, swelling, heat and pain appear around the superficial veins. After the acute inflammation subsides, hard nodules or cords remain locally. 2. Hemorrhage of superficial veins 3. Stasis dermatitis Characteristics : Skin atrophy, dryness, desquamation, hyperpigmentation, oozing, itching. 4. secondary infection 5. stasis ulcer (old rotten leg) Characteristics: long time not healed 3. Clinical diagnosis of varicose veins of the lower limbs (a) Ask for history 1. 2. Occupation Long-term standing workers, such as store clerks, textile workers, teachers, hairdressers, nurses and surgeons, have a higher incidence of varicose veins. 3. Past history Chronic bronchitis, habitual constipation, abdominal tumors and pregnancy. 4. Family history Varicose veins of the lower extremities are genetically related, and often parents or siblings in a family suffer from the disease. 5. If varicose veins of the lower limbs occur after trauma, acquired arteriovenous fistula should be excluded; if varicose vein clumps are present in the lower limbs since childhood, accompanied by claudication, congenital vascular malformations or congenital arteriovenous fistula should be considered; if the lower limbs are swollen first and varicose vein clumps are present later, lower limb deep venous thrombosis post-syndrome should be excluded. 6. Complications Varicose veins of the lower limbs are often complicated by thrombosed superficial phlebitis, stasis dermatitis, ulceration, secondary infection and superficial venous hemorrhage. (II) Physical examination (1) General condition The patient's development, nutritional status, physical strength and weakness should be noted. 2. Physical examination (1) Skin condition of limbs ① Skin color and temperature: whether there is skin discoloration, hyperpigmentation, skin redness, swelling and hot pain, scattered red rash, accompanied by itching and oozing. ② Skin nutritional changes In the early stage of varicose veins of the lower limbs, there is no obvious nutritional disorder of the limb skin. With the aggravation of the disease, the main manifestations are thinning of the skin in the boot area, dryness, desquamation, hyperpigmentation and stasis dermatitis. (2) Superficial varicose veins of the affected limbs are bulging, expanding, bending, and even tortuous into a mass or earthworm shape, which is more obvious when standing. It may be accompanied by swelling of the calf. (3) Superficial thrombophlebitis: redness, swelling, hard nodules and cords at the varicose veins, painful pressure, and increased local skin temperature. (4) Lower limb ulcers In the advanced stage of lower limb varicose veins, stasis dermatitis and itching are often accompanied. Due to patient's scratching or trauma, skin breakage and secondary infection can cause long lasting ulcers. The ulcers mostly occur near the inner ankle, do not heal for a long time, and are prone to secondary infection. (5) Lower extremity venous function test ① Deep vein usual test (Perthes test) is not suitable for saphenous vein stripping surgery. ② saphenous vein valve function test (Trendelenburg test) ③ traffic vein valve function test (Prart test) (C) auxiliary examination 1. color ultrasonography: simple and convenient, preferred for the clinic. 2. 2. CT venous angiography: adapted to complex venous lesions. 3. Angiography: invasive, "gold standard" IV. Diagnosis and differential diagnosis of varicose veins of the lower limbs (a) Diagnosis 1. There is a history of prolonged standing and a history of increased abdominal pressure (history of pregnancy and pelvic tumors, chronic bronchitis, habitual constipation, etc.), and there is a family history of varicose veins of the lower limbs. 2. The veins of the lower limbs of the patients are obviously tortuous and dilated, which is more obvious when standing; it is often accompanied by thrombosed superficial phlebitis, and in the late stage, skin pigmentation, fibrosis and ulceration in the boot area can occur. 3. Deep vein patency test: deep vein patency. 4. Ultrasound Doppler examination shows: valvular insufficiency of the great saphenous vein, or concomitant deep vein valvular insufficiency. 5. Venography: tortuous dilatation of the great saphenous vein, valvular insufficiency, or concomitant deep vein valvular insufficiency. 6. Exclude other venous diseases. （Differential diagnosis 1. Post-deep vein thrombosis syndrome of the lower limbs The patient has a history of sudden swelling, distension and pain of the lower limbs. In the late stage of deep vein thrombosis, superficial varicose veins of the lower limbs appear, and the swelling of the affected limbs is obvious, which cannot be completely relieved after rest. 2. Lower extremity arteriovenous fistula This disease is divided into congenital and secondary. If there is no obvious reason for severe varicose veins in the limbs in youth and children, and vascular murmurs and tremors can be detected in the varicose veins, congenital arteriovenous fistula should be considered. If it is accompanied by thickening and growth of the affected limb, hairiness and excessive sweating, the diagnosis of the disease is more supported. If there is trauma first, and then the affected limb is thick and swollen, varicose veins, then secondary arteriovenous fistula should be considered. 3. venous malformation bone hypertrophy syndrome (Klippel-Trenaunay syndrome) This disease is characterized by limb growth, thickening, superficial veins abnormally large and varicose, skin hemangioma (wine-like spots) triad. 4. Budd-Chiari's syndrome (Budd-Chiari's syndrome) is characterized by hepatosplenomegaly, massive and persistent ascites, esophageal varices often combined with hemorrhage, varicose veins of the chest and abdominal wall, edema and varicose veins of the lower extremities, skin hyperpigmentation, and ulcers. V. Clinical treatment of varicose veins of the lower limbs The treatment principles of varicose veins of the lower limbs are: 1. promote blood return to the lower limbs to eliminate stasis 2. clear heat and anti-inflammatory, control limb infection 3. protect the affected limbs to prevent trauma (a) Surgical treatment Varicose veins of the lower limbs can be complicated with thrombosed superficial phlebitis, rupture of blood vessels and hemorrhage, petechial dermatitis, and ulcers of calves in the later stages if they are not treated in time. Therefore, timely surgical treatment should be performed to avoid complications. The following surgical methods are commonly used in clinical practice: 1. Saphenous vein high ligation and stripping + laser or electrocoagulation endoplasty This surgery is the most commonly used radical surgery for varicose vein diseases of the lower extremities. The key of the surgery is to ligate the trunk of saphenous vein or small saphenous vein in high position, strip out the trunk of large and small saphenous vein, ligate the high saphenous vein, and ligate the superficial and deep vein traffic branches. If accompanied by calf ulcers, ligation of the traffic branches should be performed on the basis of the above procedures, and percutaneous circumferential sutures should be applied around the ulcers. Elastic bandage should be tied after surgery, otherwise there is still a possibility of recurrence. Advantages: small incision, beautiful, good effect, no recurrence. 2. High ligation and stripping and percutaneous ligation are suitable for varicose veins and calf ulcers caused by incomplete function of both saphenous vein valves and traffic branch valves. Advantages: small incision, beautiful, good effect, not easy to recur Disadvantages: percutaneous ligation pain is obvious, affecting postoperative activities. 3. Lower extremity varicose veins point-type puncture extraction and stripping is suitable for patients with simple large and small saphenous varicose veins and recurrent varicose veins after surgery. Characteristics: small and beautiful wounds, fewer complications, faster wound healing after surgery. 4. Wound implantation Complicated large ulcers, difficult to heal by themselves, the affected limb blood circulation improvement, the affected part of the inflammation control, the wound surface is clean and the granulation is fresh, can be implemented stamp-like or point-like implantation. Promote wound healing, shorten the course of treatment. Attention: Make sure to grasp the timing of implantation, pay attention to the preoperative and postoperative treatment, and take the translucent thin skin slice during the operation, and the implantation can be successful. 5. Superficial femoral vein valve annuloplasty This procedure is also called superficial femoral vein valve banding. This operation is also known as superficial femoral vein valve banding. It is suitable for people with normal structure and shape of superficial femoral vein valve and incomplete valve closure caused by enlargement of the vein diameter. The operation is simple, with little damage and few complications. 6. Sclerotherapy Sclerotherapy alone is difficult to achieve results, but also brings serious complications and high recurrence rate of varicose veins. It is rarely used in clinical practice. (ii) Pharmacological treatment of varicose veins of the lower limbs, such as complications, can be clinically diagnosed and treated with effective prescriptions, combined with intravenous drip therapy, with lavage, external application, rubbing and other external treatments, the efficacy of the treatment is reliable. Swelling of the limbs: horse chestnut seed extract tablets, elimination of stop, diosmin tablets, hard knot pain: four wonderful pills, Wang Wang anti-inflammatory tablets, Heparin ointment, anti-inflammatory pain relief cream (C) auxiliary treatment 1. Elevation of the affected 1. Elevation of the affected 1. Lower extremity varicose vein patients with lower extremity superficial venous valves are not functioning well, the blood flows backward, therefore, should be avoided for a long time to stand, appropriate rest and elevation of the affected extremities, in order to promote the affected limbs of the blood back to the affected limbs, which can reduce the affected extremities of swelling and prevention of calf ulcers. Calf ulceration can be prevented. 2. Wearing elastic stockings or binding elastic bandage It is very necessary for patients with varicose veins of the lower limbs to wear suitable elastic stockings or binding elastic bandage, which can promote the blood return of the affected limbs and reduce or eliminate the feeling of heaviness and fatigue of the affected limbs. (D) wound dressing and treatment 1. ulcer purulent secretion more or local redness, swelling and pain, butter oil gauze dressing or 0.2% gentamicin wet dressing dressing, or with biological magnesium salts; 2. ulcer purulent secretion less, the wound sprinkle muscle pearl powder, covered with jade red cream oil gauze, collagen Menojia; 3. ulcers for a long time do not heal, the trauma of the granulation of the dark red and not fresh people applying the muscle cream or long skin paste, external spraying bei fuxing agent.