ETIOPATHOGENETIC MECHANISMS OF VARICOSE VEINS

ABSTRACT

The article under discussion depicts etiopathogenetic mechanisms of varicose veins. The author of the article considers that varicose vein disease of the lower extremities is one of the most common diseases that a wide range of surgeons have to deal with. Many methods of conservative and surgical treatment of this pathology have been proposed. At the same time we should note that, unfortunately, in spite of all efforts for the treatment of the current disease no convincing success has been achieved. Conservative methods do not allow to achieve a stable effect, and the performed surgery does not guarantee a cure at all.

АННОТАЦИЯ

В данной статье рассматриваются этиопатогенетические механизмы варикозной болезни. Автор статьи считает, что варикозная болезнь нижних конечностей является одним из самых распространенных заболеваний, с которым приходится сталкиваться широкому кругу хирургов. Было предложено множество методов консервативного и хирургического лечения данной патологии. В то же время следует отметить, что, к сожалению, несмотря на все усилия по лечению данного заболевания, убедительных успехов достичь не удалось. Консервативные методы не позволяют добиться стойкого эффекта, а проведенная операция вообще не гарантирует излечения.

Keywords: varicose vein disease, pathology, conservative methods, surgical treatment, connective tissue, progressive myopia, reproductive, obesity.

Ключевые слова: варикозная болезнь, патология, консервативные методы, хирургическое лечение, соединительная ткань, прогрессирующая близорукость, репродуктивная функция, ожирение.

Introduction

One of the leading causes of the disease is genetic predisposition, which appeared and evolved in the course of evolution on the background of upright walking due to the changing factors of technical progress, the nature and content of nutrition, changes in ecology, which led to the failure of connective tissue [1].

At the cellular level it is associated with the disturbance of physiological equilibrium between muscle cells, collagen and elastic fibers of the venous wall, which is confirmed by the frequent combination of varicose vein disease with hernias, hemorrhoids, flat feet, scoliosis, progressive myopia.

Discussion

Obesity is a proven risk factor for varicose veins in women of reproductive and menopausal age. The nature of life and work: low mobility, static loads of a permanent character, including professional ones - in standing position (surgeons, salespeople, hairdressers, lecturers, librarians) and sitting (office, scientific and other workers), contribute to the development of varicosity. Prolonged walking in high heels (over 4 cm), pregnancy can lead to dilation of the veins of the lower extremities in women.

Nutritional peculiarities: a reduction in the diet of raw vegetables and fruit leads to a deficiency of vegetable fibres, necessary for the remodeling of the venous wall, normal functioning of the intestines, leading to chronic constipation, which increases intra-abdominal pressure and complicates the outflow of blood from the veins of the lower extremities.

Congenital and acquired dyshormonal conditions, hormonal contraception and hormone therapy for various purposes can contribute to the development of varicose veins. Venous hypertension, which is the main cause of dilated veins, develops due to valve insufficiency and the occurrence of reverse blood flow – reflux [3].

This process can start simultaneously in both deep and superficial veins. Deficiency of deep vein valves leads to vertical blood reflux and venous hypertension not only in deep veins, but also damages the valves of perforating veins, which leads to their insufficiency. Blood from deep veins starts to flow under pressure into superficial veins. At the same time, the work of the muscular-venous pump, due to the incorrect function of the valves of perforating veins, promotes an increase in pressure in the superficial veins. There is a horizontal reflux, aggravating venous hypertension in superficial veins. Primary varicose veins develop - one of the main symptoms of varicose veins disease. At this point the muscular-venous pump loses its function - dynamic venous hypertension occurs. When the blood flow slows down, leukocytes are fixed on the venous endothelium, activating the process of inflammation. The same process proceeds intensively on the venous valves. Over time, this process spreads to the entire depth of the venous wall.

Significant drama unfolds at the level of the microcirculatory bed. Venous hypertension causes an increase in capillary permeability first for water. One of the early and main symptoms of venous insufficiency is edema.

It is easy to correct at first, either by walking or by raising the legs slightly above the level of the pelvis. With progressive venous hypertension, protein begins to leak into the matrix, which causes pericapillary infiltration with leukocytes (Schwartzman phenomenon). This protein hyalinizes, capillary bed becomes rigid, capillary blood flow is hindered, tissue ischemia increases, stimulating the formation of xanthine oxidase and the formation, in turn, of free radicals that destroy phospholipids of cell membranes. Appears clinical symptoms of trophic disorders in the form of dermatitis, paravenous eczema [2].

In the lower third of the tibia - in the area of the medial ankle, where the lower perforating veins are localized and venous hypertension is most pronounced, thickening of the cellular tissue (induration) appears. With the progression of these phenomena, hyperpigmentation appears in the same area due to increased permeability to erythrocytes and inflammation.

 This area will later develop into a chronic venous ulcer. Prevention of CVI (chronic venous insufficiency) and its complications begins with the prevention of varicose veins of the lower extremities. The risk factors are described above and allow primary prevention by distinguishing risk groups.

A healthy lifestyle since childhood: a proper diet, the use of products that do not contain preservatives, nitrates, the exclusion of genetically modified foods from the diet. Eating plenty of fruits and vegetables, rich in vitamins C and E, avoiding excessive weight and constantly monitoring the balance of calories consumed and used, timely detection and treatment of concomitant diseases (collagenosis, diabetes mellitus, hypertension, dyshormonal disorders, etc.), rational contraception prevent the varicose veins disease [5].

Elastic compression is considered today as the earliest prophylaxis, especially in the risk group. The rational choice of compression level and the wide variety of elastic stockings allow their use without disturbing the aesthetics and fashion. Many women, even without the manifestation of varicose veins, note the lightness in their legs when using them.

Modern achievements of civilization (long air travel with limited mobility, prolonged driving, especially with automatic transmission, which leads to turning off one leg) may be risk factors in the occurrence of thrombotic complications.

It is necessary to monitor the shape of the feet, to detect flatfoot as early as possible and to carry out its correction by special physical exercises (transfer of body weight from heel to toe and back without emphasis on the heel, circular movements of the feet), to wear rational shoes 3-4 cm heel, supinators for transverse flatfoot, and in risk groups also for longitudinal flatfoot, with a wide toe, walk correctly - from heel to toe on the outer surface of the foot and avoid flat-soled shoes and high heels.

Rational motor activity is an important component of lifestyle. Any dynamic exercise: walking, jogging, swimming - an important component of not only the primary prevention, but also the prevention of complications [6]. Loads should be alternated with rest, keeping them in an elevated position at pelvic level, if possible.

Conclusion

In conclusion, it should be noted that mankind, condemned to live under gravitation conditions and to be upright most of the time, exposed to negative influence of unfavorable ecological, biological and other factors, is a risk group for venous pathology, and therefore the problem should be of permanent interest for disease prevention.

References:

1. Vedenskii A.N. Varikoznaya bolezn'. L., Medicina. – 1983. - 207 s. [In Russian].
2. Lipnickii E.M., Sundukov I.V., Alekberzade A.V., Lagunov M.V. Endovenoznaya lazernaya fotokoagulyaciya v kompleksnom lechenii bol'nyh varikoznoi bolezn'yu // Annaly hirurgii. – 2009. - №1.- S.12-15 [In Russian].
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5. Tilyakhodjaeva, G. B. (2022). Varicose vein disease of the lower extremities as a topical problem in medical practice. // ISJ Theoretical & Applied Science, 02 (106), P.226-229. URL: https://www.researchgate.net/publication/358944404_VARICOSE_VEIN_DISEASE_OF_THE_LOWER_EXTREMITIES_AS_A_TOPICAL_PROBLEM_IN_MEDICAL_PRACTICE [In English].
6. Tishabaeva N.A. Infertility: Causes, methods of research and treatment.//Asian Journal Of Multidimensional Research. 2021, Volume : 10, Issue: 6. P.17-22 URL: https://indianjournals.com/ijor.aspx?target=ijor:ajmr&volume=10&issue=6&article=002