VARISCOSE VEINS

THE SUPERFICIAL CHRONIC VENOUS DESEASE

What is a vein?

t is a blood-vessel that ensures the return of blood from peripheral tissues to the heart. The vein has a role in thermo-regulation and is considered a “reservoir”.

In the lower limbs we have valves that act as anti-reflux valve.

Venous flow is carried out by the contraction of the calf muscles, the movement of the foot on the ground and the movement of the diaphragm in the deeper system.

Blood is driven upwards with every movement and cannot return downwards because of “anti-return” valves.

We have two venous systems in the legs:

A primary deep venous system, which drain 90% of the blood and do not carry varicose veins (fig.1).

An accessory superficial venous system, great and small saphenous veins where varicose veins can develop (fig.2).

What is a varicose vein?

The formation of a varicose vein is due to a chronic superficial venous insufficiency, a malfunctioning valve incontinent system : the blood does not go back toward the heart in varicose veins.

Approximately 60% of the population is afflicted. Varicose veins result in a permanent dilatation of one or more superficial veins becoming highlighted and unaesthetic at sight.

Medico-legal definitions:

The international classification CEAP1 2 (Clinical, Etiological, Anatomical, Physiopathological) evaluates chronic venous disease. The clinical stages are defined as follows:

C0 : no visible or palpable clinical signs of the disease
C1 : presence of telangiectasia or reticular varicose veins (‹ 3 mm)
C2 : varicose veins (> ou = à 3 mm),
C3 : venous edema,
C4 : trophic disorders of venous origin
- C4a : pigmentation, venous eczema
- C4b : lipodermatosclerosis or hypodermitis of venous origin, white atrophy
C5 : trophic disorders as defined in 4 with healed ulcer
C6 : trophic disorders as defined in 4 with active ulcer

The presence or absence of symptoms (pain, heavy legs, pruritus, impatience).

Summary:

Varicose veins: varicose vein apparent more than 3 mm in diameter.
Reticular network: veins apparent between 1 and 3 mm in diameter.
telangiectasia or spider veins: veins apparent less than 1 mm in diameter, it may take various forms: single, star, with an aspect of “broken vessels” or blue and red bruises.

SYMPTOMS

The functional signs:

They are numerous, they may be absent or associated with varying intensities, they may be due to “deep” varicose veins not seen to the naked eye (internal varicose veins):

Heaviness or weight of the legs or calves, accentuated at the end of the day, warm period of the year, standing up for a long period at a time and during the pre-menstrual period,
Edema at the end of the day disappearing at night,
Cramps while resting,
A certain impatience in the legs,
Eczema,
Pruritus, paresthesia in the lower third of the leg,
Hypodermite, dermite ocher, pigmentation,
Varicose ulcer.

The advice of a doctor is essential to distinguish the functional signs of the venous system from other factors not related to varicose veins.

Hereunder, images showing the evolution of the disease

FACTORS OF RISK AND PREVENTION

Risk factors:

The hereditary tendency is a most important factor, chronic venous disease is congenital, all the other factors only worsen or accelerate an existing fragility :• Static standing over a long period of time: hairdresser, surgeon:

Pregnancy by hormonal and mechanical mechanisms,
Obesity, sedentary life style,
Heat of the sun, certain heaters, furnaces,
Inadequate clothing or too tight,
Hormonal changes at different stages of life
Hormonal contraception

Prévention :

Physical activity is the best prevention and the best way to activate the supporting venous system : walking, bicycling, swimming, aqua-gymnastics.

An elastic restraint, support stocking, is very useful for all conditions at risk to compensate the venous deficiency such as an over exposure to heat, upright or motionless standing over a long period of time and pregnancy…