Varicose veins. Attendance in primary health care

 

 

Author:  Daniel Ramon Gutierrez Rodriguez MD 

 

Translation: Sabrina Gisella Cordone. Más información en http://www.portalesmedicos.com/traductores-medicina/cordone/ 

 

Varicose veins are external manifestations of alterations in the circulatory system, caused by the effect of the erect position; that is to say, the fact that a man walks and stays erect during the day and throughout his life.  This posture forces the circulatory system to go the last mile to send the blood back to the heart, defeating the gravitation; furthermore, the return or venous circulation is particularly difficult in the legs.

If a person is exposed to long hours of working standing and in a reduced space, they will probably end up, in a 60% of the cases, by having any symptom of venous insufficiency in the lower extremities. This is the very common case of the women who iron clothes, for instance. Sedentarism and obesity, as well as lack of regular physical exercise make it difficult, obviously, the venous return of lower extremities. (1)

Classically, we recognize 3 venous systems in lower extremities: superficial, communicating and deep systems. (2) Patient may have evening malleolar edemas, stuffiness in lower extremities, pain in lower extremities. Additionally: deterioration during the day, getting deeper at dusk, and diminishing by means of repose and elevation of lower extremities.  It deteriorates with heat and improves with cold.

 

When you are a patient with dilative veins in lower extremities, along with an individual symptomatology, you do not have to settle for varicose veins diagnosis; instead, you have to shade and try to identify the affected veins, giving in each case a personalized diagnose.

 

Varicose veins.

 

Veins are in charge of send the blood back to the heart. To this end, veins have valves that, by means of exercising the muscles, compress the veins and send the blood up to the next stretch, in which the valve, by means of the blood force, opens and closes by means of gravitation. Sometimes, this game does not work properly and causes an alteration in the valve. It is a little bit open and part of the blood drains and falls to the inferior stretch, causing a hiperpressure dilatation in the superficial veins, known as varicose veins. As a rule, it usually happens in the most superficial veins of the organism. The WHO defines varicose veins as “vein dilatations that are frequently winding”.

Secondary varicose veins are caused by situations such as: tumors, traumatisms or valvular deficiency that prevent the normal venous return

 

According to their ethiopathogeny, they can be classified as:

 

·         By arteriovenous communication.

·         Essential, idiomatic or primitive.

·         Posphlebitic.

·         Post-operative.

·         By aplasia or agenesis.

 

Another classification is based on the varicose veins size:

 

·         Truncal varicose veins, which are particular of the inner or outer saphenous.

·         Reticulated varicose veins, which frequently begin in the popliteal hole.

·         Varicosities or varicose veins in broom filaments.

·         Telangiectasias and brush figures that affect the most external venous plexus.

·         Deep varicosis. It affects perforating veins.

 

The frequency of varicose veins appearance varies from one country to another. Even in the same country it can differ, depending on the data obtained from the corresponding health department or through an epidemiological study. Venous diseases are ten times more frequent that the arterial peripheric varicose veins. There are risk factors in which there is a higher predisposition of suffering from varicose veins, such as age and sex. As regards age, the elder the person, the most probable they can suffer from venous deficiency and to suffer from a most aggravated condition. Varicose veins are tour times more frequent and the chronical venous deficiency is seven times more frequent in the age group older than 60, if it is compared to the age groupolder than 20. Gender is also an important influence, since varicose veins have more incidence in women than men, being twice more frequent in the former than in the alter. Other factors that predispose the appearance of varicose veins are the kind of job, for situations in which people are required to spend long periods of time standing or sitting increase the possibilities of having varicose veins. (3) Tobbaco and other toxic factors or sedentarism specially redound in different vascular problems, are similarly responsable for the appearance of varicose veins.

(1)

 

Other risk factors are obesity, long sun exposure, wearing tight clothes, pregnancy and delivery, taking contraceptive pills, risk jobs (people who are exposed to a prolonged ortostatism) and diseases that carry along an increase of red blood cells or platelets. (3)

It is necessary to highlight two large types of complications that varicose veins produce: venous and  dermatological. Among the former, we can mention the bleeding veins phlebitis and the venous breaking.

The bleeding vein phlebitis is an obliterating thrombophlebitis of the superficial varicose cord. Its evolution is commonly benign, but the regressions are frequent. Symptoms begin roughly, with pain all throughout the indurated venous cord.

 

In the outer venous breaking, the skin is so thin that even a slight injury can cause a hemorrhage, and in the case of the inner breaking, the calf volume increases considerable, and at the same time, a sharp pain is experienced after carrying out any type of effort. The fuctional physical disability and the hematoma appear immediately. Dermatological complications are important due to its frequency and its fuctional, professional and social after-effects. They may affect all the tissues. The essential mechanic factor that determine varicose veins is stasis, due to a superficial venous hiperpressure. (1)  Vascular disorders may cause petechias purpura and equimosis, but in rare occassions they cause a severe bleeding. (4) Four dermatological complications may appear: dermatitis, capillaritis, dermohipodermic sclerosis and ulcer. (1)

 

There is no real and safe method to prevent varicose veins. The way of living undoubtely has an influence over their appearance and evolution. Playing sports, doing physical exercises, walking and massaging ease the return circulation and prevent blood stucking in legs. In this case, there are a few essential rules for preventing this disease: having the legs placed higher over the waist, in order to reverse the circulatory path and the return circulation goes downwards instead of upwards as usual, checking hormonal diseases, eating properly, avoiding tight clothes and particularly, a daily care of obesity and sedentarism. It is also advisable that patients suffering from venous disease in lower extremities try to sep with the legs slightly elevated, to daily bath with cold water for a few minutes in each leg and using compressive elastic stockings as a way of protection and support. It is a good thing to walk on bare feet ando n your toes a few minutes every day and to lie over your back and raise your legs, pedalling backwards and forwards a few minutes with the legs up. Lying over your back, raise alternately one leg and then the other and touch with your hand your toes. In a firm position, get up over your toes.(5)

 

 

Bibliographic references.

 

1. Sala Planell E. Patologias que tratamos. varices. [monografía en Internet]. Barcelona: Centro Médico Teknon; 2005 [citado 9 feb 2007]. Disponible en:

http://www.teknon.es/consultorio/sala-planell/varius.htm

2. Esperon Percovich A. Breves nociones de la anatomía y de la fisiología normales de los sistemas venosos de los miembros inferiores. Art Nac [revista en Internet],2001. [acceso 19 de octubre de 2005]; 11(21). Disponible en: http://www.sitiomedico.com.uy/artnac/2001/11/21.htm

3. Aguilar LC. Trastornos circulatorios de las extremidades inferiores (I). Clasificación, epidemiología, fisiopatología, clínica y complicaciones. OFFARM [revista en Internet],2003. [acceso 19 de octubre de 2005]; 22(09). Disponible en: http://external.doyma.es/pdf/4/4v22n09a13053132pdf001.pdf

4. Mark H, Beers MD, Berkow R. Trastornos vasculares hemorrágicos. En: Manual MERCK, 10ªed., edición del centenario. Madrid: Harcourt Internacional; 1999.

5. Salaplanell.com [sede Web]. La Coruña: Teknon.es; 2005 [actualizada el 3 de enero de 2006; acceso 8 de febrero de 2006]. Disponible en: http://www.salaplanell.com/contenido/asp/tipos_articulos.asp?CLV_FamiliasArticulo=5

 

 

Translation: Sabrina Gisella Cordone. Más información en    http://www.portalesmedicos.com/traductores-medicina/cordone/