Varicose veins - A health problem that can lead to serious complications

Revista UP Pharma | 08/20/2018
Few people know, but varicose veins can appear at any age, even in adolescence, and are a health problem that can bring complications such as thrombosis or open sores. Most of the time, the biggest complaints are related to the aesthetic aspect, causing embarrassment in men and women, but the fact is that varicose veins can even cause hospitalizations.

In general, it is a problem that begins timidly and is therefore neglected by patients who, over time, feel difficulty sleeping due to leg pain. Not to mention unwanted sensations such as heaviness in the legs, cramps, paresthesia and edema.

Estimates indicate that 70% of adults have varicose veins, being a more prevalent disease in women, reaching 8 out of every 10. In general, the incidence of varicose veins is higher in those with a family history and sedentary life, besides high blood pressure, obesity and spend long periods standing.

Data from the Ministry of Health, collected in Brazil from September 2016 to August 2017, show that 73,720 people were hospitalized for varicose veins, of whom 17,700 were men and 56,020 women (source: Hospital Information System of the Sigle Health System (SUS) – SIH/SUS).

The good news is that there are several effective treatments for varicose veins. Today, it is possible to count on technologies and less invasive techniques and medicines with the hidrosmin molecule, that improves the circulation of blood in the legs, symptoms of pain, sensation of weight in the legs and swelling.

To discuss the matter, the UPpharma Magazine interviewed exclusively Dr. Ivan Benaduce Casella, PhD in Sciences from FMUSP and Physician of HC-FMUSP, which speaks of prevention and techniques for treatment. Check it out.

UPpharma Magazine - What exactly are varicose veins?
Dr. Ivan Benaduce Casella - The varicose veins of the lower limbs are dilated and tortuous veins in the legs. Varicose veins present a phenomenon called reflux, which is the flow of blood in an inverted direction (descending to the feet), becoming congested in the lower limbs.

What are the causes of this problem?
There is the hereditary factor, that is, genetic. But they are more common in women, obese patients, and certain professions, which require unfavorable posture positions (standing with little movement for long periods of time), such as teachers and security guards.

It is known that it is a problem that affects men and women, but what is the proportion?
Varicose veins are more prevalent in women, and in Brazil about 30% to 40% of people over the age of 40 have varicose veins of lower limbs in some degree. Varicose veins begin to appear early in adulthood. The speed of evolution and the intensity depend on several factors.

In women, can excessive exercise and intensive use of high heels cause varicose veins?
Only intense physical exercises related to bodybuilding can cause or aggravate varicose disease. Most physical exercises are not directly linked to the expressive increase of the disease. As for the high heel, it's use makes the woman's walk stray from the norm, because the woman decreases the functional use of the calf on the walk. The contraction of the calf muscles is very important to help the blood return from the leg to the heart. Therefore, the high heels when used too much hampers the return of blood, and may eventually aid in the formation of varicose veins.

How do you perceive the problem? What are the first symptoms?
The diagnosis of varicose veins is visual, that is, the person already perceives the dilated veins and arrives at the doctor with the perception of the diagnosis formed. The disease is confirmed by physical examination and then detailed with Doppler ultrasound examination, which will give information beyond the physician's physical examination perception. The most frequent symptoms are edema (swelling), pain in the legs, sensation of tiredness at the end of the day and cramps.

Is it a problem that develops into more serious diseases, such as thrombosis or other complications involving hospitalization? What are the consequences of this disease?
People with varicose veins present a slightly increased chance of presenting with venous thrombosis, but the main complication of varicose veins is phlebitis (inflammation of the superficial veins of the leg) and in extreme situations, varicose ulcer, a wound close to the ankle, difficult to heal.

How to prevent it? How to avoid them from appearing?
Attitudes such as weight control, moderate exercise and avoid standing and without moving for long periods help prevent varicose disease. But it must be clarified that certain people have a strong hereditary propensity to develop varicose disease, even with preventive measures. The definitive treatment is the eradication of the varicose veins. This is done through conventional varicose vein surgery and other similar techniques, such as the use of laser or radiofrequency surgery. There is another technique recently used, which is the treatment with foam, which consists of injecting foam into these veins, causing drying, the sclerosis of these veins. But there is no better technique, each patient needs an individualized indication.

Are there drugs that can also be used and are effective in prevention or treatment?
The medicamentous treatment of varicose veins is done with the so-called phlebotonic, which are adjunctive medications to ameliorate the symptoms of the disease. Among the most used are flavonoids, such as hidrosmin, a medication recently launched on the market with high solubility and low side effects. Many people say they have small spider veins.

Spider veins and varicose veins are basically the same thing?
There is a difference between varicose and spider veins. The "spider veins" (telangiectasias) are very thin and superficial veins, less than 1 millimeter thick. The most common treatment is called sclerotherapy, in which a liquid of high concentration is injected in the micro-spider veins, causing their dehydration and causing them to "dry".

What can we expect in the future in terms of treatment / medications for this type of disease? What are the trends in this area?
For the future, more and more so-called minimally invasive surgery techniques will predominate, making surgery less aggressive and apparent, and with better effect. The use of phlebotomics also plays an important role in controlling the symptoms of the disease. Elastic stockings are also important in treatment. Although they do not make the varicose veins regress, they are effective in controlling certain symptoms and can slow the progression of the disease.

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