Varicose veins

　　The main cause of varicose veins is the long-term maintenance of the same posture with little change, causing blood to accumulate in the lower limbs. Over time, this can damage the venous valves, leading to high venous pressure and varicose veins. Varicose veins usually occur in the lower limbs, with the skin showing red or blue twisted veins like a spider web or earthworm, or hard nodules like tree tumors. The veins become abnormally enlarged, swollen, and tortuous.

　　Since the human body does not have a self-repairing valve mechanism, varicose veins are an irreversible phenomenon. However, they can still be prevented from spreading and their symptoms from worsening through conservative treatment (such as using elastic stockings, exercise, diet, and changes in lifestyle). Moderate exercise such as walking, swimming, and cycling can improve circulation and reduce the rate of new varicose veins.

　　In terms of diet, it is recommended to eat more high-fiber, low-fat foods and strengthen the intake of vitamins C and E. In daily life, it is important to control weight, avoid taking birth control pills, wearing tight clothing and high heels, crossing legs, and avoiding prolonged sitting or standing. Raise your legs for a period of time before going to bed, and sleep on your left side to reduce the pressure on the pelvic veins. Smoking can raise blood pressure and damage arteries and veins, so patients with varicose veins should quit smoking immediately.

　　There are many causes of varicose veins in the lower limbs, the most common being simple varicose veins in the lower limbs, whose main cause is the dysfunction of the femoral saphenous vein valve. Another important cause is primary deep vein valve insufficiency (PDVI) in the lower limbs, as it often combines with the dysfunction of the great saphenous vein valve, showing more superficial varicose veins. In addition, the post-thrombotic syndrome after deep vein thrombosis, due to poor venous return in the deep veins, causes compensatory tortuous expansion of superficial veins; varicose veins can also be present in lower limb arteriovenous fistulas and venous malformation osteohypertrophy syndrome; obstruction of inferior vena cava return, such as Budd-Chiari syndrome, can also lead to varicose veins in the lower limbs.

　　Complications of varicose veins:

　　1. Varicose vein phlebitis

　　Long-term varicose veins can lead to blood stasis, resulting in damage to the venous endothelium and the formation of thrombi. It quickly leads to inflammatory reactions in the entire superficial venous wall, even involving the surrounding venous tissue, with exudative fluid. Local manifestations include painful, swollen, and tender cord-like columns. The pathological characteristics are venous wall injury, changes in blood flow, and hypercoagulable state, leading to the formation of deep vein thrombosis.

　　2. Chronic subcutaneous sclerosis

　　Before the onset of the disease, there is varicose veins of the great saphenous vein in the lower leg, and there are incomplete valve functions of the superficial and deep venous communicating branches, as well as patients with no obvious varicose veins. There are also incomplete communicating branches between the superficial and deep veins, so incomplete communicating branch valve function may be the initiating factor for the disease.

　　3. Varicose vein eczema

　　Concave edema appears in the anterior tibial area, followed by macules, brown pigmentation, followed by papules, vesicles, erosion, and exudation, etc., similar to eczema. There is a sense of itching, and the local skin thickens and loses elasticity over time. Due to local blood circulation disorders, ulcers can form, leaving pigmentation after healing.

　　4. Edema

　　Due to venous reflux, patients often present with morning-mild and evening-severe edema of the affected limb.

　　5. Skin pigmentation

　　Long-term venous hypertension increases the permeability of capillaries in the lower leg, causing red blood cells to seep out and break, with hemosiderin deposited under the skin, making the skin dark. It develops from spots to patches.

　　6. Bleeding

　　The skin in the areas traversed by varicose veins is very fragile due to insufficient nutrition. Once not careful, it is easy to cause the rupture of varicose veins, leading to massive bleeding. Since bleeding is often not accompanied by pain or other symptoms, patients often do not realize it, and if it occurs during sleep at night, it can lead to very serious consequences.

　　7. Ulcers

　　The most common consequence of varicose veins is the occurrence of ulcers due to skin nutritional changes caused by varicose veins, which can be chronic and accompanied by local foul smell and pus discharge, severely affecting daily life.

　　8. Formation of venous thrombosis

　　Some patients may form thrombi in the varicose superficial veins, manifested as local redness, swelling, pain, and the formation of hard lumps, which can affect walking. If not treated promptly, the thrombus may spread upwards or through communicating veins to the deep veins, causing deep vein thrombosis and posing a risk of pulmonary embolism that can be life-threatening. Because of these complications, if varicose veins are judged to have the potential for development, early minimally invasive surgery can be considered. The benefits of early surgery are also evident: first, varicose vein surgery can be performed on the same day, second, postoperative recovery is fast and pain is minimal, third, the deep vein function is significantly improved, and the recurrence rate is reduced.

　　The symptoms of varicose veins can be divided into six stages:

　　1. The first stage of varicose veins is relatively mild. There is only a slight varicose of the small superficial veins. Generally, no treatment is required, and elastic socks can be worn.

　　2. The symptoms of the second stage of varicose veins can be seen as prominent varicose veins. At this time, laser minimally invasive treatment can be used to deal with it.

　　3. The third stage of varicose veins has more prominent symptoms, and clinical symptoms such as acid and swelling may also appear. At this time, it is necessary to treat actively. The skin in the third stage is basically unchanged, and laser minimally invasive treatment is appropriate.

　　4. The fourth stage of varicose veins, accompanied by edema, eczema, hyperpigmentation, or severe varicose veins of the great or small saphenous veins.

　　5. The fifth stage of varicose veins, accompanied by curable ulcerative varicose veins. The above pictures show the clinical symptoms of the fifth stage of varicose veins, which is a relatively serious condition of lower limb varicose veins. If the deep venous return is unobstructed, laser minimally invasive treatment can still be used for treatment.

　　6. The sixth stage of varicose veins, accompanied by recurrent ulcers that do not heal for a long time.

　　The symptoms of varicose veins are classified according to clinical manifestations as follows:

　　1. The superficial blood vessels may become varicose like earthworms, obviously protruding from the skin, and the varicose veins may appear in clusters or nodular shapes.

　　2. There may be a sensation of acid and swelling in the legs, which is more severe at night and less severe in the morning. The skin may have pigmentation, become darker, and there may be desquamation. The ankles may have edema.

　　3. There may be ascites, enlargement of the liver and spleen, hematemesis, black stools, widespread edema in the lower limbs, pain in the affected limb, sometimes pain at rest, and the pain may worsen at night.

　　4. There may be unusual sensations in the limbs, such as coldness, heat, thinning of the affected limb, an intense itching sensation, numbness, and a burning sensation.

　　5. The skin temperature may rise, and there may be pain and tenderness.

　　6. Toenails (fingers) may become thickened, deformed, grow slowly, or stop growing.

　　7. Gangrene and ulcers may occur.

　　The specific methods for preventing varicose veins are as follows:

　　1. Before going to bed, you can do special venous exercises, lift the lower limbs, keep the sole of the foot parallel to the body, and then let the legs and feet shake gently. It is best to sleep on your left side, as lying on the left can avoid compressing the inferior vena cava in the lower abdomen, reducing the pressure on the veins in the lower limbs. It is recommended to use a pillow to prop up the varicose lower limbs to an angle of 30-40 degrees.

　　2. Workers who bear heavy loads or stand for long periods can use elastic bandages to wrap their legs. When wrapping, first elevate the leg and ankle, then wrap the calf with an elastic bandage to prevent the expansion of varicose veins in the lower limbs. When wrapping, start from the ankle and wrap as tightly as possible. Those with conditions can wear special varicose vein elastic socks for health care.

　　3. Simple squatting exercises not only exercise the muscles but are also very good for the joints. They can effectively prevent varicose veins and cramps in the lower legs, promote blood circulation, and enhance physical fitness. Don't look down on the simple squatting movement, as it requires certain skills; otherwise, it may have the opposite effect.

　　4. Regular leg massage can help venous blood return. Place your hands on both sides of the lower calf, rub the calf muscles from the ankle to the knee joint.

　　5. Persisting in taking a brisk walk 4 times a day for 15 minutes each time can effectively alleviate the symptoms. Because when walking quickly, the movement of the gastrocnemius muscle increases, the activity is continuous, and the venous vessels act like a pump, providing the blood accumulated in the varicose veins to the heart. At the same time, due to the acceleration of local microcirculation, the metabolism of the varicose veins is also accelerated, and the veins can recover quickly.

　　6. If the work requires long-term sitting or standing, you can do leg stretching exercises for a while, such as raising the feet, then lowering them, or taking a short walk when possible. This is one of the preventive methods for varicose veins.

　　7. Patients can wear elastic stockings for one hour of leg exercise every day, which can not only prevent leg edema but also slim the legs. Activities such as walking, brisk walking, cycling, running, or running on a treadmill can be done to prevent the occurrence of varicose veins.

　　The traditional examination methods for varicose veins include the great saphenous vein valve function test, deep venous patency test, and communicating venous valve function test, etc. The commonly used clinical examinations also include ultrasound, volume description, venous pressure measurement, and venography, etc.

　　1. The deep venous test is an auxiliary examination method used to check whether the venous vessels are normal. It is used to determine the condition of deep venous return and check whether there is an obstruction in the deep veins of the lower limbs with varicose veins.

　　The specific operation is: use a tourniquet to block the main trunk of the superficial venous in the thigh, and let the patient kick their legs or perform downward蹬 movements continuously for 10 or more times. At this time, due to the contraction of the calf muscle pump, the venous blood is forced to return to the deep veins, causing the varicose veins to empty. If the varicose veins are more obvious and the tension increases after activity, or there is even a feeling of distension and pain, it indicates that the deep veins are not unobstructed.

　　2. The functional test of the communicating venous valve is also an auxiliary examination method used to check whether the venous vessels are normal. This examination is suitable for patients with great saphenous varicose veins undergoing surgical treatment, to judge the functional state of the deep and superficial venous communicating valves in the lower limbs. If the test is negative, it indicates that the communicating valve function is normal, and positive indicates incomplete valve function, and different surgical methods can be chosen according to the test results.

　　The specific operation is: the patient lies on their back, exposes their lower limbs, raises the patient, and allows the superficial venous blood to return until it is completely empty, and blocks the blood flow at the proximal end, then observe the filling status of the superficial veins to judge the functional state of the communicating valve.

　　Patients with varicose veins should eat more low-fat, low-calorie foods in their daily life, such as fresh vegetables, fruits, mixed grains, and eat moderate amounts of lean meat, skimmed milk, egg whites, etc. Green vegetables, seaweed, jellyfish, nori, mushrooms, soy products, and foods rich in vitamins B and C are particularly beneficial to the disease.

　　Patients with varicose veins can treat diseases through dietary therapy in their daily life. Patients with varicose veins can eat Angelica sinensis braised mutton, with 30 grams of Angelica sinensis and 10 grams of ginger. 200 grams of mutton are added with an appropriate amount of yellow wine and then cooked in a bamboo steamer. It is suitable for the initial stage of thromboangiitis obliterans. This is a good folk remedy for treating varicose veins.

　　In addition, patients with varicose veins should pay attention to avoid stimulative foods such as carbohydrates if they have diabetes and insufficient blood supply to the lower extremities, and patients with gangrene should avoid drinking alcohol. At the same time, it is advised to quit smoking for varicose vein patients to reduce the recurrence of the disease.

　　There are many dietary treatments for varicose veins, including 500 grams of white wine, 90 grams of radix salvia miltiorrhiza, soaked for a week, and then drinking 30 milliliters each time, 1-2 times a day. It is suitable for patients with cold limbs and numbness in the early stage of thrombophlebitis, which is very effective for treating varicose veins.

　　The general treatment methods for varicose veins mainly include wearing elastic stockings, which have a certain effect on mild varicose veins and can also have a good effect on alleviating the symptoms of varicose veins. However, it is impossible to cure varicose veins with this method alone, and other treatment methods are needed.

　　Another common method of treating varicose veins is sclerotherapy, which involves injecting high-tension solutions into the varicose veins to destroy the vascular intima, causing it to seal and disappear after healing. However, it can only treat small varicose veins, and there may be severe pain during treatment, and there are also many complications after treatment, so it is not recommended to use this method.

　　Surgical treatment is also a common method of treating varicose veins. High-tension solutions (such as high-concentration saline or sclerosing agents) are injected into the varicose veins to destroy the vascular intima, causing it to seal and disappear after healing. However, it can only treat small varicose veins, and there may be severe pain during treatment. But surgical treatment is a destructive surgery, causing significant harm to the patient, and the recurrence rate is also high. It is still recommended to use conservative methods to treat varicose veins.