The majority of patients do not experience any symptoms until obvious intervene venous stasis and edema. The patients feel heaviness of the limb, especially in the evening and they notice a swelling that starts in the area around the ankle, especially in the inner ring. At the varicose vein there is a zone of increased sensation of heat (hyperthermia) sometimes accompanied by strong sense of itching. Related disorders are often due to complications of varicose veins. Initial skin changes are noticed with type of eczematus (redness and itching) ranging progressively worse until it reach the varicose ulcer (wound bleeding). in other cases, the patient may develop a superficial phlebitis or have bleeding from ruptured varicose, that looks bad, but fortunately it is always easily controllable.
Due to the alteration of circulation, tissues of the affected parties are particularly susceptible to injuries, so infections and wounds heal slowly and tend to turn into chronic varicose ulcers (not definitely treatable).
Particularly women are conditioned by the aesthetic problem connected not only to completely smooth of varicose veins that protrude visibly, but even the mere presence of small varicositi (reticular varicose veins) and spider veins (capillaries) that mark so flashy skin.
The varicose veins disease diagnosis is usually made on the basis of clinical examination only.The patient is standing and all the limb places are examined, both anteriorly and posteriorly. Particular attention must be paid to the internal malleolus region, initial centers of edema. The varicose vein is palpated throughout its extension. It has an elastic consistency different from the surrounding tissue, it is easily compressible and opposes a minimal resistance.
There are two simple tests that can be carried out at home to diagnose varicose veins:
1. Trendelenburg test
The patient is placed in the inclined (distended belly upwards) position and used to emptyng the limb by clearing the superficial venous circulation. And then arises a snare thigh root (by blocking the blood so it cannot get off), put in the upright position (upright position) and finally removes tourniqet. If the blood reflux downwards it means that there is a valve system incontinence of drilling for veins where the blood reflux from deep to shallow circle. If the varicose veins do not fill anymore, we are certainly faced with primitive varices by anatomical area of incontinence between Saphenous vein and the femoral at the root of the thigh.
2. Evidence of Perthes:
The patient in upright position with normal firmness of varicose veins, apply again a snare to the root and then patient need to walk. Walking causes squeezing of blood from superficial to deep system. If there is varicose veins draining, we are definitely facing a deep free venous circulation , because the blood from the superficial circle there flows smoothly. So we are facing a varicose primitive syndrome. If the varicose veins is not empty, we are facing a deep venous circle blocked and a varicose secondary syndrome to other causes.
If there are doubts about the presence of a valvular or incontinence on the primitiveness of varicose veins, it is good to perform a color doppler echo test, which is an instrumental examination with which you can reliably study the venous outbursts. It is then possible to visualise incontinence of superficial venous system, enhanced by manoeuvre such as Valsalva maneuvers (increased pressure within the abdomen) or compressive, which is sometimes required during the test to highlight the defect.
Varicose disease therapy requires appropriate treatment, especially to prevent painful and debilitating complications (varicophlebitis, dermatitis, varicose ulcer). It is important above all to implement a preventive policy. Varicose veins therapy involves the integration of various types of treatment:
hygiene norms and behavioural
elastic compression (compression bandages and stockings)
Unfortunately doesn’t exist the possibility to conduct a primary prevention that can prevent the onset of varices, since we still don’t know precisely the factors responsible for disease. It is possible to have preventive action on factors that may favor the appearance or aggravate varicose. This factors are are working and environmental conditions that involve standing (venous hypertension), almost motionless (deficiency of muscle pump), prolonged, hot environments (vasodilation). In other cases the overweight (obesity, pregnancy), while highly doubt is the role of other factors such as constant intake of oral contraceptives.
Pharmacological therapy is based on the use of substances to increase the tone of the venous wall in order to reduce the whitening, anti-edem (which reduce the edema), profibrinolytics (to prevent the formation of thrombi caused by blood stasis) and anty-inflammatory. However, there is no documentation on the serious fact that medicines are able to act on the causes of the appearance of varicose veins. Nevertheless, they are not entirely unnecessary because play a viable action on symptoms, reduces the sense of heaviness and swelling .
Relies on using elastic stockings graduate whitch descending compression from the foot to the thigh .Alternatively you can use elastic bandages with different mesh types and with different levels of elastic force. The compression level is related to the severity of varicose disease and must be able to move within the limits of normal venous hypertension.The elastic retainer, at any compression level, fails to regress the varicose manifestations, but certainly it eliminates noise and prevents complications.Keep in mind that there are some situations of intolerance to compression as in the case of arthritis for example, whereby these supports are preposterous.
Sclerotherapy involves the injection of chemicals into the vein that determine before the formation of a thrombus and the fibrous vein wall transformation. It finds its main application in the field of smaller varicose veins, but in the presence of varicose veins with nerve involvement of large and small veins Sclerotherapy is not effective. In this cases surgery is only care with the best clinical outcome. It consists in removing the venous tract affected by varicose vein and in reuniting the upstream portions and downstream removal.