Varicose veins

Japanese: 静脈瘤 - じょうみゃくりゅう（英語表記）Varicose veins

What is the disease?

Many of the veins on the surface of the legs (called superficial veins) expand, meandering ( Dako ) The venous valves are insufficient to function properly, and the veins are naturally dilated. Congenital venous ectasia ( Sentenced to the age of 18 ) They are divided into secondary varicose veins such as:

Most of the time, it is primary, and it is common in women who work standing up a lot, and it improves by elevating the legs. It is more noticeable in the evening, but it usually disappears by morning after a night's sleep.

Not only the superficial veins of the lower limbs, Spermatic cord ( Production ) It may also appear in the veins of the lower esophagus and anorectum.

What is the cause?

The veins in the legs are classified as the superficial venous system ( Great concealment ( Great food ) Veins and Small fossil ( Food ) venous system) and the deep venous system ( Femur ( The basics ) The blood vessels are divided into two parts, the venous system, and the arteries. Transportation branch ( Traffic ) The superficial venous system and communicating branches have anti-reflux valves that help venous blood return to the heart against gravity.

The most common cause of primary varicose veins is caused by dysfunction of the venous valves. In addition to the weakness of the original venous wall structure, other factors such as genetic factors, pregnancy, obesity, and standing work have also been pointed out.

How symptoms manifest

In the early stages, venous Eruption ( Docho ) However, as the condition progresses, symptoms such as fatigue, congestion, heaviness, pain, swelling, and muscle spasms in the lower limbs may appear when standing. Chronic eczema ( Full-time student ) Skin rashes similar to this may also appear.

In the chronic stage, symptoms include edema, bleeding, skin pigmentation, Refractory ulcers ( What kind of lifestyle do you have? ) Acute symptoms of thrombophlebitis, stasis dermatitis, etc. may appear, and sometimes intractable ulcers (varicose vein Leg ulcers ( Hard ulcer ) ) may also occur.

Testing and diagnosis

Primary varicose veins are diagnosed when varicose veins worsen due to sagging of the legs and improve with elevation. In other words, if varicose veins become more pronounced when standing and disappear when the legs are elevated, they are considered to be primary varicose veins, and surgery may be considered depending on the symptoms.

Recently, ultrasound tomography and venography have become possible to diagnose the location and extent of varicose veins in more detail.

Treatment methods

In early, mild cases, symptoms can be improved by avoiding standing for long periods of time, wearing compression stockings, and elevating the affected limb at night.

For patients with severe symptoms and large varicose veins, those with severe congestion that does not improve even by elevating the legs, those with chronic venous circulatory insufficiency, and those with recurrent thrombophlebitis, treatments include 1) subcutaneous stripping of the large and small saphenous veins, 2) high ligation and dissection of the vein, 3) removal of the varicose veins, and 4) injection of a sclerosing agent.

What to do if you notice an illness

Unfortunately, this disease cannot be cured completely. If the swelling disappears after a night's sleep, there is no need to wait and see, but if the swelling does not go away the next morning, it is necessary to see a doctor, including having the whole body checked for illnesses.

Yoshiaki Maruyama

Varicose veins
(Skin Disease)

Those with thick, prominent veins in the lower legs, especially in the lower third of the knee Varicose veins ( Kashijo Myakuryu ) In order for the blood in the veins that is pumped from the heart and flows to the legs to return to the heart against gravity, a check valve inside the vein is necessary. If this valve breaks down, blood will flow backwards, and blood will pool in the legs, causing the veins to expand, resulting in varicose veins.

Varicose veins are common in people who work standing up, and are more prevalent in women because childbirth can be a trigger, and there is also a genetic component. The frequency increases with age, and 10% of women over 40 have varicose veins.

The basis of treatment is to remove the blood that has accumulated in the veins. The first step is to compress the affected veins with elastic stockings or elastic bandages. Moving the muscles of the legs by bending and stretching, etc., will help blood flow by pumping. Sclerotherapy is a definitive treatment. Ligation ( Results ) Therapy, Intravenous Removal ( Extermination ) There are treatments such as laser therapy, and treatment can often be done on an outpatient basis, so please consult a dermatologist or vascular surgeon.

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　足の表面にあるたくさんの静脈（表在静脈という）が拡張し、蛇行(だこう)屈曲して浮き出た状態です。静脈弁の機能不全による一次性静脈瘤と、生まれつき静脈が拡張している先天性静脈拡張症(せんてんせいじょうみゃくかくちょうしょう)のような二次性静脈瘤に分けられます。

　ほとんどは一次性で、立ち仕事の多い女性に多く現れ、足を挙上する（高く上げておく）ことによって改善します。夕方に目立ちますが、一晩寝ると朝には消失していることがほとんどです。

　下肢の表在静脈だけでなく、精索(せいさく)、食道下部、直腸肛門部の静脈にも現れることがあります。

原因は何か

　足の静脈は、表面を走る表在静脈系（大伏在(だいふくざい)静脈や小伏在(しょうふくざい)静脈系など）と深部を走る深在静脈系（大腿骨(だいたいこつ)静脈など）に分けられ、両者の間は交通枝(こうつうし)という静脈でつながっています。表在静脈系と交通枝には逆流防止の弁があり、静脈血が重力に抗して心臓にもどってくるのを助けています。

　最も多くみられる、静脈弁の機能不全によって起こる一次性の静脈瘤の原因としては、もともとの静脈壁の構築の弱さだけでなく、遺伝的要因や妊娠、肥満、立ち仕事といった要素の関連も指摘されています。

症状の現れ方

　初期には静脈の怒張(どちょう)（ふくれあがる）だけですが、症状が進むと立位での下肢のだるさやうっ血感、重量感、疼痛、浮腫、筋肉のけいれんなどが出現し、静脈瘤部の知覚異常やかゆみ、かくことによる慢性湿疹(まんせいしっしん)様の皮膚炎なども現れてきます。

　慢性期になると、浮腫、出血、皮膚の色素沈着、難治性潰瘍(なんちせいかいよう)、血栓性静脈炎の急性症状、うっ滞性皮膚炎などが出現し、時に難治性潰瘍（静脈瘤性下腿潰瘍(かたいかいよう)）となることもあります。

検査と診断

　下肢の下垂による静脈瘤の悪化と挙上による改善で、一次性静脈瘤が診断されます。すなわち、静脈瘤が立位により著しくなり、足の挙上によって消える場合には一次性静脈瘤と考えられ、症状に応じて手術なども考慮します。

　最近では、超音波断層法や静脈造影によってより詳しい静脈瘤の部位と程度の診断が可能です。

治療の方法

　初期の軽度のものでは、長時間の立位を避け、弾性ストッキングを着用し、夜間に患肢を挙上する（高く上げておく）ことによって、症状は改善します。

　症状が強く大きな静脈瘤があるもの、うっ血が著しくて下肢の挙上でも改善しないもの、慢性の静脈血行不全があるもの、血栓性静脈炎を繰り返すものなどに対しては、①大小伏在静脈の皮下抜去（ストリッピング）、②静脈の高位結紮剥離、③静脈瘤の切除、④硬化薬注入による治療などが行われます。

病気に気づいたらどうする

　この病気は、残念ながら完治することはありません。一晩寝て翌日には消える程度のものならば様子をみてもかまいませんが、翌朝もむくみがとれない場合は、全身の病気のチェックも含めて、一度内科医の診察を受けることが必要です。

丸山　義明

静脈瘤
(皮膚の病気)

　下肢の、とくに膝下3分の1の静脈が太く浮き出ているものを下肢静脈瘤(かしじょうみゃくりゅう)といいます。心臓から送り出されて足まで流れてきた静脈内の血液が、重力にさからって再び心臓にもどるには、静脈の内側にある逆流防止弁が必要です。この弁が壊れると血液が逆流し、下肢に血液がたまって静脈が拡張し、静脈瘤ができます。

　静脈瘤は立ち仕事の人に多く、出産が誘因になることもあるため女性に多く、遺伝的要素もあります。年齢とともに頻度は増え、40歳以上の女性の1割に静脈瘤が認められます。

　治療の基本は静脈にたまった血液をとることです。弾性ストッキングや弾性包帯で患部の静脈を圧迫するのが第一です。屈伸運動などで下肢の筋肉を動かすとポンプ作用で血液が流れやすくなります。根治療法として硬化療法、結紮(けっさつ)療法、静脈抜去術(ばっきょじゅつ)、レーザー療法などがあり、日帰りで治療できることも多いので、皮膚科や血管外科で相談してください。

出典　法研「六訂版家庭医学大全科」六訂版家庭医学大全科について　情報

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