Lower limb varicose veins

　　There are many causes of varicose veins of the lower extremities, the most common being simple varicose veins of the lower extremities, with the main cause being incomplete function of the great saphenous vein valve. Another important cause is primary incomplete function of the deep venous valve of the lower extremities (PDVI), as it often occurs with incomplete function of the great saphenous vein valve, showing the tortuous dilation of superficial veins. Additionally, the post-thrombotic syndrome after deep venous thrombosis, due to poor deep venous return, leads to compensatory tortuous dilation of superficial veins; the lower extremity arteriovenous fistula, venous malformation, and hypertrophic osteoarthropathy syndrome can also have the manifestation of varicose veins of the lower extremities; the obstruction of inferior vena cava return, such as Budd-Chiari syndrome, can also lead to varicose veins of the lower extremities.

　　Thrombophlebitis of superficial veins, superficial venous hemorrhage, congestion dermatitis, secondary infection, and congestion ulcers.

　　Venous injury: Patients with long-term varicose veins of the lower extremities have thin venous walls, high venous pressure, and insufficient local blood supply, causing muscle and fatty tissue atrophy, the varicose veins protruding, and mild injury can lead to ulceration, and it is easy to damage the venous wall.

　　Edema and eczema: Due to venous reflux, patients often present with morning light and evening severe edema in the affected limb; while long-term venous hypertension increases the permeability of capillaries in the lower leg, with red blood cells leaking and breaking, hemosiderin depositing under the skin, making the skin black and eczematous, developing from spots to plaques.

　　Bleeding and ulceration: The skin in the area passed by the varicose veins of the lower legs is fragile due to insufficient nutrition, and minor injuries can easily lead to the rupture of varicose veins, causing massive bleeding; as there are no symptoms such as pain during bleeding, patients often do not notice it, and if it occurs during sleep at night, it can be a serious consequence.

　　Thrombosis: Some patients may form thrombi in the varicose superficial veins, presenting with local redness, swelling, and pain, the formation of hard lumps, and pain affecting walking; if not treated promptly, the thrombus may spread upwards or through communicating veins to the deep veins, causing deep vein thrombosis, with the risk of pulmonary embolism and life-threatening conditions.

　　The superficial veins are varicose like earthworms, obviously protruding from the skin, presenting in clumps or nodular shapes; there is a feeling of acid and swelling in the legs, with hyperpigmentation, desquamation, and itching of the skin, edema of the ankles; there is an unusual sensation in the limbs, such as pricking, intense itching, numbness, and burning sensation; the skin temperature rises, with pain and tenderness; local gangrene and ulcers may occur.

　　If it is a simple varicose vein of the lower extremities, the general clinical symptoms are usually mild, with slow progression, mostly表现为单纯曲张; in a few cases, there may be thrombophlebitis, venous ulcers, and other conditions; if there is incomplete function of the deep venous valve, or even obstruction of deep venous return, the condition is relatively severe, with a feeling of heaviness in the lower legs when standing, easy fatigue, and even swelling and bursting pain in the lower extremities. In the later stage, skin nutritional changes occur, with desquamation, atrophy, hyperpigmentation, and the formation of eczema and ulcers.

　　Obese people should lose weight. Although obesity is not a direct cause, excessive weight may put pressure on the legs, causing poor venous return and exacerbating varicose veins.

　　People who engage in heavy physical labor or standing work for a long time should wear elastic stockings to keep the superficial veins in a compressed state. Wearing properly sized medical elastic stockings can effectively prevent varicose veins of the lower limbs and control the progression of the disease. Female teachers who are pregnant should wear medical gradient elastic stockings to effectively prevent the occurrence of varicose veins of the lower limbs.

　　During special periods such as menstruation and pregnancy, special attention should be paid to the legs, more rest should be taken, and the legs should be massaged regularly to help blood circulation and prevent varicose veins of the lower limbs.

　　Avoid standing in place for long periods of time, and walk intermittently to get the leg muscles moving and return the venous blood, reducing leg pressure; when sitting for long periods of time, change sitting postures frequently or place the calves horizontally to facilitate blood return; appropriate kicking movements can promote the return of venous blood.

　　Avoid wearing clothes that are too tight around the waist and abdomen. Eat more fiber-rich foods and control excessive salt intake. In addition, doing leg care exercises and massaging the calf muscles regularly can alleviate lower limb fatigue and prevent the occurrence of varicose veins of the lower limbs.

　　Deep vein patency test: Also known as the kicking leg test. It is a method for identifying signs of patency of the deep veins of the lower limbs. It is particularly important for identifying whether the varicose veins of the lower limbs can be surgically treated. First, let the patient stand, tie a tourniquet around the upper third of the patient's thigh. At this time, the varicose veins of the lower limb may be more obvious than before.

　　Venous valve function test: The patient lies on their back, the affected limb is elevated to empty the varicose veins, a rubber tourniquet is tied around the upper third of the thigh to prevent the blood from the great saphenous vein from refluxing. Then, the patient stands for 30 seconds, the tourniquet is released, and the filling status of the great saphenous lower limb varicose veins is closely observed: ① Before releasing the tourniquet, the great saphenous vein is atrophic and empty. When the tourniquet is released, the great saphenous vein fills immediately from above to below, indicating incomplete valve function of the great saphenous vein, while the valve function of the tributary between the great saphenous vein and the deep vein is normal. ② Before releasing the tourniquet, the great saphenous vein is partially filled and varicose, and after releasing the tourniquet, the filling and varicose state is more obvious, indicating that both the great saphenous vein valves and the tributary valves between the great saphenous vein and the deep vein are insufficient. ③ Before releasing the tourniquet, the great saphenous vein is already filled and varicose, but after releasing the tourniquet, the filling of the varicose veins does not become more severe, indicating that the tributary valve between the great saphenous vein and the deep vein is insufficient, while the valve function of the great saphenous vein is normal.

　　Traffic branch valve function test: Used for locating the tributary veins with incomplete valve function.

　　Varicose veins are generally treated with light, easy-to-digest, and nutritious diets.

　　It is recommended to consume more low-fat, low-calorie foods, such as fresh vegetables, fruits, whole grains, and moderate amounts of lean meat, skimmed milk, egg whites, etc. Especially green vegetables, seaweed, jellyfish, nori, mushrooms, bean products, and foods rich in vitamin B and C are beneficial to the disease.

　　3. Eat more vegetables, fruits, beans, and other high-fiber foods. Also, eating a moderate amount of lean beef, chicken, etc., can warm the meridians and collaterals.

　　4. Eat more foods rich in vitamin E: Eating more foods rich in vitamin E can improve blood circulation and alleviate the feeling of leg heaviness. Foods rich in vitamin E include: cabbage, spinach, kale, malt, nuts, soybeans, whole wheat, coarse grains, eggs, etc.

　　What foods should be avoided for varicose veins of the lower extremities?

　　1. Patients should eat less high-fat, high-sugar, and salty foods to prevent constipation.

　　2. Avoid smoking and alcohol.

　　In 1999, laser was first introduced into the treatment of varicose veins of the lower extremities with success, thus opening a new era in the treatment of varicose veins of the lower extremities. Varicose veins of the lower extremities are a highly prevalent peripheral vascular disease, with a prevalence rate of over 9% in the general population.

　　The traditional treatment for varicose veins of the lower extremities is high ligation of the great saphenous vein and stripping surgery. This operation requires a surgical incision in the patient's inguinal area, cutting and ligating all branches, stripping the main trunk of the great saphenous vein along the entire lower limb, and making multiple incisions to strip all subcutaneous varicose veins. Traditional stripping surgery has a large wound surface, the incisions are not only long but also numerous, and patients need to lie in bed for several days to over a week after surgery. Postoperative complications often include large skin ecchymosis, skin sensory disturbances, and long scars. Efforts to minimize invasive treatment for varicose veins of the lower extremities have never ceased, but ideal methods have not been found for a long time. Hardening agent injection therapy was once popular, but its application was greatly restricted due to postoperative subcutaneous nodules, thrombophlebitis, skin necrosis, and high recurrence rates. The most fatal is that there is a high incidence of deep vein thrombosis and even pulmonary embolism after hardening agent injection, which directly threatens life. Therefore, at present, this method has been limited to the treatment of telangiectasia, recurrent, or limited varicose veins of the lower extremities in regular large medical institutions.