ON THE PREVENTION OF VARICOSE VEINS OF THE LOWER EXTREMITIES

Full Text

relevance. Varicose veins is a disease of the venous system, expressed in an increase in the size of veins, a change in their shape and a decrease in elasticity. The superficial veins of the lower extremities, the venous plexuses of the rectum, the veins of the portal system and the spermatic cord are mainly affected. According to statistics, the disease is more common in older representatives of the weaker sex: 15% of men and 30% of women before 45 years, and after 45 years, 66% of men and 89% of women.
The development of varicose veins of the lower extremities is facilitated by difficulties with the outflow of blood through the venous system during prolonged and systematic standing (professional activity), lifting weights, heavy physical work. Compression of the pelvic veins occurs with systematic constipation, sedentary work, in the third trimester of pregnancy. Congenital weakness of the venous valves, obesity predisposes to the disease.

PURPOSE: to analyze the awareness of the population about the need to prevent varicose veins of the lower extremities, to recognize its symptoms and to present a set of measures to prevent a violation of venous circulation in the lower extremities.

MATERIALS AND METHODS. Printed sources and Internet resources, compiled questionnaire. Methods – questionnaire, search, analytical, descriptive, statistical processing of the results obtained.

results. Connective tissue dysplasia, hereditary predisposition, unfavorable external factors – disrupt the normal operation of venous valves. This is the trigger mechanism of varicose veins. Under the influence of gravity, the blood stagnates in the vessels, which leads to a gradual stretching of the veins, their thinning, an increase in the lumen, as well as reflux (reverse flow) of blood in the affected area. Over time, more and more new veins located below the original defect are involved in the process.
Clinical manifestations are associated with heaviness in the legs in the afternoon, their increased fatigue, non-localized aching pains in the calves. Complaints increase in the warm season, during menstruation, and decrease in the prone position, when walking, physical activity, when wearing compression knitwear.
Over time, when the muscular-venous pump is unable to compensate for the increased pressure in the venous system, chronic venous insufficiency develops, accompanied by edema of the distal parts of the lower extremities that do not pass after a night's rest.
Changes in the skin of the shins depend on the stage of development of the process: at first it is a venous mesh (telangiectomy), then local swelling of varicose veins in the form of nodes (cones), sinuous cords. Next – leg edema, trophic skin changes – hyperpigmentation, lipodermatosclerosis (skin compaction), venous ulcer. Trophic ulcers that do not heal for a long time, as a rule, are located above the inner ankle in the lower third of the lower leg.
Complications of varicose veins occur in several types: trophic (up to ulcers), thrombotic (thrombosis), inflammatory (phlebitis, thrombophlebitis), bleeding from varicose nodes.Phlebologists offer patients conservative and operative methods of treating varicose veins, considering radical invasive interventions. These are phlebectomy, sclerotherapy and obliteration of the problematic vessel.In this regard, prevention of varicose veins, especially primary, is of particular importance, based on a holistic approach to the functioning of the individual, and in persons with a predisposition, the influence of modifiable risk factors should be minimized.
First of all, an active lifestyle is necessary, ensuring the normal functioning of the entire cardiovascular system and the proper functioning of the musculoskeletal venous pump. Physical education and sports, physical therapy are suitable. Any exercises involving the legs are useful: swimming, jogging, skiing, cycling, jogging, walking, physical exercises for legs of a dynamic and static nature.
It is important to monitor your own weight, avoiding its increase. To do this, much attention should be paid to the rationality of nutrition. It is necessary to include in the diet bakery products made of coarse flour containing bran, cereals, especially buckwheat, raw vegetable products, primarily vegetables and fruits. In parallel, they limit the use of salty, spicy, fatty dishes. Unchanged vegetable oils (up to 50 ml per day) are very useful. Free fluid is an average amount (about 1.5 liters per day), since an increase in the volume of circulating blood leads to an additional load on the valvular venous apparatus, and dry eating leads to constipation accelerates the formation of chronic venous insufficiency.
It is necessary to give the legs a horizontal and / or elevated position more often to eliminate the resulting venous congestion in the lower extremities. At every opportunity, it is necessary to alternate standing, sitting, lying down, and also more often raise the feet above the knee and hip joints during the day.It is recommended to pay special attention to shoes: it should be comfortable, not having a narrow boot, with a low heel. It is extremely useful to walk barefoot.
First of all, smoking (active and passive) should be excluded from bad habits, leading to the development of early atherosclerosis, including lower extremities, accelerating trophic disorders and the development of complications.A good effect is given by wearing compression knitwear and / or regular bandaging of the legs with elastic bandages before getting out of bed in the direction from the bottom up, starting with the toes, leaving the heel open. The bandage is applied to the knee or the lower third of the thigh. These measures prevent venous stagnation and further expansion of the veins.

discussion. As part of this study, the population of Voronezh was surveyed for their awareness of varicose veins and the need for preventive measures. The questionnaire contained 10 questions compiled according to the principle of testing with the need to choose one of the options of the proposed answers.30 residents participated: 8 people (26.7%) male and 22 people (73.3%) female aged 18 to 76 years. The average age of the respondents was 39.8 years. The respondents had no medical education.To the first question of the questionnaire "Do you know what varicose veins are?" all participants answered in the affirmative (100%) – they know. In addition, 5 people (16.7%) indicated that they themselves suffer from this pathology.To the second question of the questionnaire, "Who is more likely to suffer from varicose veins, children or adults?" also, all respondents (100%) answered correctly – adults.To the third question of the questionnaire "The main clinical manifestations of the disease", all respondents (100%) chose the correct answer from the proposed one: "nodular dilation of subcutaneous veins, pain, heaviness in the legs, swelling of the foot and lower leg, fatigue in the legs at the end of the day." And not the second option – headaches, rash on the face and body, swelling, weakness, lethargy.On the fourth question of the questionnaire about complications of varicose veins, 27 people (90%) most often chose "blood clots, phlebitis, tropical leg ulcers". However, 3 people (10%) incorrectly noted that it was atherosclerosis, heart attack, arterial hypertension. The fifth question of the questionnaire "Is this disease contagious?" was answered as follows: 28 people (93.3%) are not contagious, 2 people (6.7%) can infect other people.To the sixth question of the questionnaire "Does rest with raised legs help prevent varicose veins?" 22 people answered in the affirmative (73.3%), on the contrary, 8 people (26.7%) spoke outOn the seventh question of the questionnaire on the prevention of this disease, all respondents (100%) chose the first proposed set of measures: to maintain the muscles of the lower leg in tone, avoid prolonged static loads on the legs, shoes without heels, avoid poses that impede the blood flow of the lower extremities. The second answer, obviously incorrect and unselected, included high–heeled shoes, moving less so as not to strain the muscles, taking baths, saunas. To the eighth question of the questionnaire "Is varicose veins inherited?", 20 participants answered affirmatively (66.7%), and 10 people (33.3%) answered negatively.On the ninth question of the questionnaire about the importance of choosing shoes, the overwhelming majority indicated that this choice is important – 26 people (86.7%). 4 people (13.3%) considered shoes an unimportant component in this context.To the tenth question of the questionnaire "Does body weight affect the occurrence of varicose veins?" 24 respondents (80%) answered that it does. and only 6 people (20%) indicated that body weight is not associated with the onset of the disease.Thus, the survey of the population as a whole showed good awareness of the prevention of varicose veins of the lower extremities, its clinical manifestations, complications. However, some of the questions related to lifestyle, work and leisure, nutrition, choice of shoes were incorrectly interpreted by individual respondents.

conclusion. Varicose veins is a modern civilizational disease associated primarily with the inactivity of modern people who spend too much time sitting or standing in a confined space. All types of preventive measures are relevant, especially primary ones in individuals with burdened heredity, as well as in middle-aged women.Purposeful, regular, enhanced by some components, maintaining a healthy lifestyle is the key to venous leg health for many years.

About the authors

Maria Aleksandrovna Cherkasova

Voronezh State Medical University named after N.N.Burdenko

Email: mariacerkasova586@gmail.com
ORCID iD: 0000-0002-8356-7226

Student

Russian Federation, Voronezh, Studentskaya str., 10

Nikita Evgenievich Litvinov

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: nikitalitvinov1998@mail.ru
ORCID iD: 0000-0003-4925-4637

Student

Russian Federation, Voronezh, Studentskaya str., 10

References