VARICOSE VEINS - A HEALTH PROBLEM THAT CAN LEAD TO SERIOUS COMPLICATIONS

Few people know that varicose veins can appear at any age, even in adolescence, and are a health problem that can lead to complications such as thrombosis or open ulcers. Most of the time, the biggest complaints are related to the aesthetic aspect, causing embarrassment for both men and women, but the fact is that varicose veins can even cause hospitalizations.

It's usually a problem that starts off timidly and is therefore overlooked by patients who, over time, find it difficult to sleep because of the pain in their legs. Not to mention the undesirable sensations such as heaviness in the legs, cramps, paresthesia and edema.

Estimates suggest that 70% of adults have varicose veins, and the disease is more prevalent in women, affecting 8 out of 10. In general, the incidence of varicose veins is higher in those with a family history and a sedentary lifestyle, as well as those with high blood pressure, obesity and who 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 which 17,700 were men and 56,020 women (source: SUS Hospital Information System - SIH/SUS).

The good news is that there are several effective treatments for varicose veins. Today, it is possible to rely on less invasive technologies and techniques and medicines with the molecule Hydrosmin, which improve blood circulation in the legs, symptoms of pain, heaviness in the legs and swelling.

To discuss the subject, UPpharma Magazine exclusively interviewed Dr. Ivan Benaduce Casella, Doctor of Science at FMUSP and a physician at HC-FMUSP, who talks about prevention and treatment techniques. Check it out.

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

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

We know that this is a problem that affects both men and women, but what is the proportion?
Varicose veins are more prevalent in women and, in Brazil, around 30% to 40% of people over the age of 40 have lower limb varicose veins to some degree. Varicose veins start to appear in early adulthood. The speed at which they develop and their intensity depend on various factors.

Can excessive exercise and wearing high heels cause varicose veins in women?
Only intense physical exercise related to weight training can cause or aggravate varicose vein disease. Most physical exercise is not directly linked to a significant increase in the disease. As for high heels, wearing them causes a woman's gait to deviate from the normal pattern, as they reduce the functional use of the calf when walking. The contraction of the calf muscles is very important in helping the blood return from the leg to the heart. Therefore, when the heel is worn too much, it hinders the return of blood and can eventually help to form varicose veins.

How do you notice the problem? What are the first symptoms?
The diagnosis of varicose veins is visual, i.e. the person already notices the dilated veins and comes to the doctor with the diagnosis formed. The disease is confirmed with a physical examination and then detailed with a doppler ultrasound, which will provide information beyond the doctor's perception of the physical examination. The most common symptoms are edema (swelling), leg pain, feeling tired at the end of the day and cramps.

Is it a problem that can develop into more serious illnesses, for example, thrombosis or other complications that require hospitalization? What are the consequences of this disease?
People with varicose veins have a slightly increased chance of venous thrombosis, but the main complication of varicose veins is phlebitis (inflammation of the superficial veins of the leg) and, in extreme cases, varicose ulcers, a wound near the ankle that is difficult to heal.

How to prevent them? How to prevent them from appearing?
Attitudes such as weight control, moderate physical exercise and avoiding standing for long periods help prevent varicose vein disease. However, it must be made clear that certain people have a strong hereditary propensity to develop varicose vein disease, even with preventive measures. The definitive treatment is the eradication of varicose veins. This is done through conventional varicose vein surgery and other similar techniques, such as laser or radiofrequency surgery. Another recently used technique is foam treatment, which consists of injecting foam into the veins, causing them to dry out and become sclerotic. But there is no one best technique; each patient needs an individualized indication.

Are there medications that can also be taken and are effective in preventing or treating this?
Varicose veins are treated with so-called phlebotonics, which are adjunctive medications to ease the symptoms of the disease. Among the most commonly used are flavonoids, such as hydrosmin, a medication recently launched on the market with high solubility and low side effects. Many people say they have small spider veins on their legs.

Are spider veins and varicose veins basically the same thing?
There is a difference between varicose veins and spider veins. Spider veins (telangiectasias) are very thin and superficial veins, less than 1 millimeter thick. The most common treatment is called sclerotherapy, where a high-concentration liquid is injected into the microvessels, causing them to dehydrate and "dry out".

What can be expected in the future in terms of treatment/medicines 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 a better effect. The use of phlebotomists also plays an important role in controlling the symptoms of the disease. Elastic stockings are also important in the treatment. Although they don't make the varicose veins recede, they are effective in controlling certain symptoms and can slow down the progression of the disease.
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