Simple varicose veins in the lower extremities

　　1. Causes of the disease

　　Congenital weakness of the venous wall and malformation of the venous valve structure are the main causes of the disease. Heavy physical labor, long-term standing, and increased intra-abdominal pressure due to various reasons can all cause excessive venous pressure on the valves. In the case of malformation of the valve structure, it can lead to incomplete valve closure and blood reflux. Due to the thin muscle layer of the superficial venous wall and the lack of connective tissue around it, blood reflux can cause the veins to grow longer and thicker, leading to varicose veins. Due to the increased venous pressure in the lower extremities, a large number of capillaries can be produced and permeability increased in the area of the ankle boots, resulting in hyperpigmentation and lipid sclerosis. Due to the accumulation of a large amount of fibrinogen, it obstructs the exchange between the capillaries and the surrounding tissues, leading to nutritional changes in the skin and subcutaneous tissues.

　　13, Pathogenesis

　　The main hemodynamic changes of varicose veins occur during the contraction phase of the calf muscles. Due to the destruction of the venous valves that protect unidirectional blood flow, deep venous blood reverses into the superficial venous system. The pressure of the deep veins formed during muscle contraction can reach 20-26.7 kPa. Since the superficial veins lack muscle fascia support and are only surrounded by subcutaneous loose connective tissue, and in addition, the venous wall itself is weak, this leads to the enlargement and thickening of the veins, resulting in varicose veins.

　　Barnandl and Browse's research shows that in the areas of hyperpigmentation and lipohypodermosis in lower limb varicose veins, there is a large number of capillary hyperplasia. Due to the enlargement of the intercellular space between capillary endothelial cells, there is an increased permeability of particles, especially a large amount of fibrinogen leakage. At this time, the fibrinolytic ability of the veins decreases, resulting in a large amount of fibrin accumulating around the capillaries to form sheaths, obstructing the exchange of oxygen and nutrients between the capillaries and the surrounding normal tissues. As a result, nutritional changes appear in the skin and subcutaneous tissues.

　　What diseases can simple varicose veins of the lower extremities complicate?

　　7, Thrombophlebitis of varicose veins has slow blood flow in the varicose veins, which is prone to form thrombi and develop non-infectious inflammation. Sometimes, it can also cause infectious inflammation due to bacterial invasion of the foot. The patient's leg may appear red and swollen, fever, and the veins become cord-like, with pain upon palpation. It is advised that the patient rest in bed, elevate the affected limb, apply pressure treatment during activity, and use antibiotics such as penicillin and cephalosporins for anti-infection treatment. Local wet敷 with 75% ethanol or 50% magnesium sulfate can be applied, and surgical treatment can be performed after the inflammation is controlled.

　　6, The ulcer at the upper ankle and foot-shank area is a location with high venous pressure and a constant perforating vein. The skin nutrition status is poor, and once it breaks down, it can cause refractory ulcers. It often leads to concurrent infection. Treatment includes bed rest, elevation of the affected limb, pressure treatment during activity, and anti-infection treatment. Since varicose vein ulcers are difficult to heal spontaneously, timely surgery should be performed when the infection is controlled and the granulation tissue on the ulcer surface is fresh. If necessary, skin grafting of the ulcer can be performed.

　　5, The walls of the bleeding varicose veins are thin, and minor trauma can cause rupture and bleeding, which is difficult to stop spontaneously. The affected limb should be elevated and an elastic bandage should be applied with pressure. If necessary, suture ligation for hemostasis can be performed, and then surgical treatment can be carried out later.

　　1, Commonly seen in physical laborers who stand for long periods of time. After prolonged standing, the affected limb may feel heavy, sore, numb, and tired.

　　2, In the standing position, the great saphenous vein and/or the small saphenous vein become prominent, dilated, curved, or coiled into lumps, which disappear in the supine position. The lower part of the calf may have hyperpigmentation, desquamation, eczema, and chronic ulcers.

　　3. In the early stage of the disease, due to the stimulation of the venous outer membrane, patients often have a feeling of acid, swelling, discomfort, and pain, the nature of the pain is mostly dull pain, at the same time, there is a feeling of heaviness in the limbs, easy to fatigue and weakness. Patients often feel worse after standing for a long time or in the afternoon, while lying flat, raising the limbs, or wearing elastic stockings, the pain is significantly reduced. Sometimes, there may be phenomena of calf muscle cramps, and some patients have no obvious discomfort. In the late stage of the disease, the main manifestations are varicose veins and their complications. The damaged veins are prominent, dilated, and tortuous, especially in the course of the great saphenous vein in the lower leg. Patients with a longer course of disease often have nutritional changes in the skin of the lower leg, especially the ankle, including skin atrophy, desquamation, itching, hyperpigmentation, hardening of the skin and subcutaneous tissue, and even eczema and ulcer formation. Sometimes, hemorrhage and thrombophlebitis may occur, and it is worth noting that simple superficial varicose veins are often not accompanied by edema, even if it exists, it is only located at the ankle and the back of the foot, and it is relatively mild. If there is severe lower limb edema, other causes should be considered, such as primary incomplete deep vein valve function or deep vein thrombosis.

　　The prevention of this disease mainly includes the following aspects:

　　1, More common in people who have been engaged in standing work or physical labor for a long time;

　　2, Those with a family history of simple varicose veins usually develop the disease soon after puberty, so in the period of childhood and adolescence, appropriate physical exercise should be carried out to strengthen the overall physical fitness and enhance the venous wall;

　　3, Measures to protect superficial veins include

　　(1) For those who have been engaged in standing work or physically demanding labor for a long time, it is advisable to wear elastic sock sets for protection, so that the superficial veins can be in a collapsed state;

　　(2) For those who have been engaged in standing work for a long time, they should move around frequently and do more flexion and extension exercises of the ankle joints to reduce the pressure in the superficial veins;

　　(3) Improve working conditions and reduce labor intensity.

　　4. Postoperative attention should be paid to:

　　(1) Wear elastic stockings or use elastic bandages to wrap the limb during work or activity to prevent外伤.

　　(2) After 1 hour of work or activity, the affected limb should be elevated for a moment to promote venous return, reduce the pressure in the varicose veins, and prevent rupture and bleeding.

　　(3) After surgery, patients need to stay in bed for 7-10 days, with the affected limb elevated slightly above heart level.

　　(4) In cases of severe oozing at the incision, cover with dressing and apply local pressure.

　　(5) Bracing for 24 hours after surgery, using an elastic bandage to apply pressure, gradually relax the next day, while performing foot and toe activities.

　　(6) Keep the wound dressing clean and dry.

　　(7) Use antibiotics and hemostatic agents as prescribed by the doctor and observe their effects. Traditional Chinese medicine treatment for simple lower limb varicose veins

　　Lower limb venous function examination should be carried out:

　　1. Test for the function of the great saphenous vein valves and the valves between the great saphenous vein and the deep vein, lie on your back, raise the affected limb, tie a tourniquet one-third of the way up the thigh, after standing up, do not relax the tourniquet, if the veins below the tourniquet become rapidly engorged within 30 seconds, it indicates that there is incomplete valve function of the communicating veins below the tourniquet. If the veins become rapidly engorged from above to below after the tourniquet is released, it indicates incomplete valve function of the great saphenous vein.

　　2. Test for the function of the small saphenous vein valves and the valves between the small saphenous vein and the deep vein, the results and significance are similar to the above test.

　　3. Test for the location of incompetent perforating veins with incomplete valve function, lie on your back, raise the affected limb, tie a tourniquet at the root of the thigh, first wrap the first elastic bandage from the toes up to the popliteal fossa, then wrap the second elastic bandage down from the tourniquet, have the patient stand up, while loosening the first elastic bandage downwards, continue to wrap the second elastic bandage downwards, if varicose veins appear between the two bandages, it indicates that there are incompetent perforating veins at that location.

　　4. Deep vein patency test, if the varicose veins become more severe, it indicates that the deep veins are blocked, the superficial veins are reduced or disappear, indicating that the deep veins are patent.

　　For patients with suspected post-thrombotic syndrome after deep vein thrombosis and primary incomplete deep vein valve function, vascular ultrasound, plethysmography, and venography can be performed to clarify the patency of the deep veins and the function of the valves.

　　1. Boil Jinju root with pork stomach:Jinju root 30 grams, pork stomach 100-150 grams (cleaned and cut into pieces), add water to 4 bowls and boil to 1 and a half bowls, season with a little salt, drink the soup and eat the meat. Suitable for varicocele with liver qi stagnation.

　　2, Cimicifuga sesame fennel stewed pig large intestine:Cimicifuga 10 grams, black sesame 60 grams, fennel 10 grams, a section of pig large intestine (about 30 centimeters, cleaned). Put the above three drugs into the pig large intestine, tie both ends tightly, add an appropriate amount of water, cook until done, remove fennel, cimicifuga and sesame, season and drink the soup while eating the pig large intestine. For those with constipation, black sesame can be eaten continuously. It is suitable for Qi deficiency and blood stasis type varicocele.

　　3, Astragalus and Codonopsis Double Kernel Porridge:Astragalus 20 grams,

　　The prevention of this disease mainly includes the following aspects:

　　1, More common in people who have been engaged in standing work or physical labor for a long time;

　　2, Those with a family history of simple varicose veins usually develop the disease soon after puberty, so in the period of childhood and adolescence, appropriate physical exercise should be carried out to strengthen the overall physical fitness and enhance the venous wall;

　　3, Measures to protect superficial veins include

　　(1) For those who have been engaged in standing work or physically demanding labor for a long time, it is advisable to wear elastic sock sets for protection, so that the superficial veins can be in a collapsed state;

　　(2) For those who have been engaged in standing work for a long time, they should move around frequently and do more flexion and extension exercises of the ankle joints to reduce the pressure in the superficial veins;

　　(3) Improve working conditions and reduce labor intensity.

　　4, Notes after surgery

　　(1) Wear elastic stockings or use elastic bandages to wrap the limb during work or activity to prevent外伤.

　　(2) After 1 hour of work or activity, the affected limb should be elevated for a moment to promote venous return, reduce the pressure in the varicose veins, and prevent rupture and bleeding.

　　(3) After surgery, patients need to stay in bed for 7-10 days, with the affected limb elevated slightly above heart level.

　　(4) In cases of severe oozing at the incision, cover with dressing and apply local pressure.

　　(5) Bracing for 24 hours after surgery, using an elastic bandage to apply pressure, gradually relax the next day, while performing foot and toe activities.

　　(6) Keep the wound dressing clean and dry.

　　(7) Use antibiotics and hemostatic agents as prescribed by the doctor and observe their effects. Traditional Chinese medicine treatment for simple lower limb varicose veins