Differential diagnostic criteria for varicose veins. Ddvrvnkits differential diagnosis of varicose veins of the lower extremities and thrombophlebitis syndrome
The main reason for the development of varicose veins is considered to be a long stay in an upright position. Diagnosis of varicose veins is possible in several ways, which, if necessary, complement each other. Varicose veins can affect any vein, but most often affect the vascular system of the legs.
How to identify varicose veins in the legs?
In the early stages of the development of the disease, signs of varicose veins of the lower extremities are almost invisible. Symptoms are often overlooked and considered to be manifestations of other diseases or the result of physical overexertion.
To verify the diagnosis in the early stages, an additional examination is required to detect changes that are invisible during examination.
The characteristic symptoms of varicose veins of the lower extremities are:
- muscle cramps with increased night;
- aching pain in the bones, joints and muscles;
- feeling of heaviness and pressure;
- pain in the veins, aggravated by movement;
- puffiness;
- skin changes;
- tortuosity of large vessels with expansion of nodes;
- telangiectasia (spider veins).
Varicose veins are more often diagnosed in women, which is associated with the physiological characteristics of the body. First, varicose veins are manifested by the severity of the pattern of blood vessels. Most often, this symptom is accompanied by soreness and other discomfort in the lower extremities.
In the future, people suffering from varicose veins develop swelling of the legs in the evening, which almost completely disappears after sleep. You can determine how much the volume of the lower leg changes during the day, you can do it yourself. To do this, you need to measure the circumference of the leg in the morning and before going to bed. If the difference is more than 1 cm, then this is a sign of impaired venous blood flow, and a doctor's examination is required. At the initial stages of development, the symptoms of the disease disappear on their own after rest.
The progression of varicose veins is manifested in the expansion of veins that rise above the surface of the skin. Most often, pathological changes are localized in the lower leg and on the inner side of the thighs.
At this stage, people with varicose veins develop severe pain and a feeling of internal pressure in the legs when they stay in one position for a long time.
Hiking is accompanied by heaviness in the legs and fatigue. In the evening and at night, convulsions become more frequent with varicose veins.
Differential Diagnosis
Due to the fact that the symptoms of varicose veins occur in other pathologies, there is a need for differential diagnosis. The technique is based on the fact that during the examination, diseases that are unsuitable for one or another factor are excluded. Varicose veins are verified on the basis of hereditary predisposition, frequent fatigue and pain in the lower leg.
Similar symptoms are observed with osteochondrosis of the lumbar spine, flat feet and obliterating atherosclerosis. These diseases have a number of other characteristic features that make it possible to distinguish them from varicose veins. Dilated superficial veins in the legs are observed with angiodysplasia and post-thrombophlebitic syndrome. In the first case, the time of onset of the disease is taken into account. Angiodysplasia is characterized by development in childhood.
The difference between post-thrombophlebitic syndrome and varicose veins, especially in the later stages of development, is complicated and requires additional methods for examining the lower extremities. A change in the pigmentation of the skin is observed with injuries and dermatological disorders, but in this case there is no expansion of the veins. This characteristic feature allows you to confirm the pathology. With the formation of trophic ulcers, differential diagnosis helps to exclude complicated fractures, osteomyelitis, syphilis, and animal bites.
Phlebography
To assess the degree of damage to deep veins, doctors resort to x-ray examinations. An informative method is phlebography. The principle of this procedure is based on the introduction of a contrast agent and the study of the condition of the veins using x-rays.
In medical practice, there are 2 types of phlebography: direct and intraosseous. Both methods are used to detect their location and pathological disorders in the veins characteristic of varicose veins.
Straight
The procedure is carried out when the patient is standing. A contrast agent is injected into the lumen of the vessel. At this time, active contraction of the leg muscles is used or it is squeezed with an elastic bandage. Pictures are taken in frontal and lateral projections. The nature of the movement of the substance, the contours and diameter of the veins, their filling, and the release of contrast are assessed.
Intraosseous
The study is carried out by the method of puncture (puncture) of the spongy substance under local anesthesia. To fill the inferior vena cava and iliac veins, contrast is injected into the greater trochanter of the thigh, when examining the femoral veins, into the tuberosity of the tibia, and when diagnosing the vascular system of the lower leg, into the calcaneus.
Varicose disease. Diagnostics. Causes and treatment
dopplerography
As part of a comprehensive examination for varicose veins, the use of ultrasound diagnostics is widespread. The principle of dopplerography is based on measuring the speed and direction of blood flow using a special sensor.
Duplex and triplex scanning are highly informative in the diagnosis of varicose veins.
Both methods are based on the visualization of blood flow and its comparison with fixed segments. The difference between these methods from each other lies in the fact that the examination uses different modes.
Duplex vein scan
The duplex scanning method involves the use of both standard ultrasound and Doppler ultrasound. By combining these methods, the doctor can assess the state of the vascular system and measure blood flow. During the examination, the specialist receives a projection image, which allows you to reliably assess the condition of the vessels and the degree of violation. As part of the diagnosis, superficial and deep veins, arteries, tissue structures and surrounding vessels are examined.
Triplex scanning
There is little difference between duplex and triplex scanning. The difference lies in the fact that with triplex scanning, the examination is supplemented with color coding. This allows you to see the direction of blood flow inside the vessels in color. With the help of this type of diagnostics, the speed and direction of blood flow, the condition of the vessels, the presence of blood clots and congenital anomalies are assessed.
samples
To establish the cause of varicose veins, phlebologists conduct a comprehensive examination, which includes functional tests, instrumental methods and laboratory tests. When diagnosing varicose veins, the first method allows you to get reliable results, on the basis of which treatment is prescribed. Samples make it possible to assess the change in the performance of various body systems.
The data obtained make it possible to determine the stage of varicose veins, the degree of complications, the load, the body's response to external influences and the possibilities of compensatory processes. The purpose of functional tests is to study the response of various systems to external influences.
The examination begins with fixing the initial data of the venous system, which are compared with the values after the load.
Pratt-1
The test consists in measuring the circumference of the lower leg, after which the patient is asked to lie on his back. By stroking the veins, they are emptied. From below, an elastic bandage is applied to the limb affected by varicose veins. Within 10 minutes, the patient must walk. Varicose veins are confirmed if there is pain in the calves and an increase in the circumference of the lower leg.
Pratt-2
The technique of the test is that after emptying the veins, a rubber bandage is applied to the limb. At this point, the patient is lying down. A tourniquet is applied to the thigh in the groin area. Then the patient stands up, and under the tourniquet the limb is fixed with another bandage. Subsequently, the lower bandage is removed, and the upper bandage is wrapped around the leg 5-6 cm lower. The rapid filling of the knots in the free space from the bandage indicates the failure of the valves of the communicating veins.
The purpose of functional tests is to study the response of various systems to external influences.
Hackenbruch
During the examination for varicose veins, the doctor feels for a hole in the thigh, which is the site of entry of the great saphenous vein, and asks the patient to cough. With the failure of the ostial valve, a push of blood is felt under the fingers.
Talman test
To diagnose varicose veins, the affected limb is wrapped around a long rubber tourniquet in a spiral. The movement starts from below, while a gap of 5-6 cm is left between the turns. The filling of any of the sections indicates the failure of the valves in the communicating veins.
Delbe-Perthes
Based on the specifics of the conduct, the method is called a marching test. During the examination, the patient is in a vertical position, with the maximum fullness of the saphenous veins below the knee, a tourniquet is applied. The patient is then required to walk and march in place for 5 to 10 minutes. The collapse of the saphenous veins indicates the patency of the vessels.
If, after walking, desolation does not occur, the tension does not decrease and is felt when palpated, then this is a sign of obstruction of the veins.
Troyanov-Trendelenburg
Verification of varicose veins using this test is carried out when the patient lies on the couch. The patient is asked to raise the affected leg at a 45° angle. The doctor, by stroking from the foot to the inguinal region, empties the superficial veins. Then a soft tourniquet of rubber is applied to the upper third of the thigh. After this, the patient must take a vertical position.
In people who do not suffer from varicose veins, filling is not noted within 15 seconds. The rapid flow of blood from the bottom up is characteristic of insufficiency of the valves of the communicating veins. Then the tourniquet is sharply removed.
The rapid filling of the vessels of the thigh and lower leg from top to bottom indicates insufficiency of the ostial valve and valves of the trunk of the great saphenous vein. This reaction is typical for primary varicose veins.
Verification of varicose veins most often does not cause difficulties for doctors. Patients need to remember that the success of therapy largely depends on when the pathology is detected and treatment is started. Varicose veins in a neglected form can lead to disability, and in especially difficult cases - to death. With the appearance of symptoms characteristic of a violation of blood flow, it is not necessary to postpone a visit to the doctor. Timely diagnosis and treatment can completely stop the manifestations of varicose veins.
Post-thrombotic disease is characterized by: an increase in the volume of the limb due to diffuse edema; the skin of the limb has a cyanotic hue, especially in the distal sections; dilated saphenous veins have a loose appearance, and their pattern is more pronounced on the thigh, in the inguinal region and on the anterior abdominal wall.
Varicose veins of the superficial veins of the lower extremities
terisized by the formation of saccular dilatations of the walls of the veins, serpentine
tortuosity, increase in length, insufficiency of valves. It's on
observed in 17-25% of the population.
Post-thrombophlebitic syndrome - a symptom complex, developing
due to previous deep vein thrombosis of the lower extremities
stay. It is a typical type of chronic venous
insufficiency, manifested by secondary varicose veins
em veins, persistent edema, trophic changes in the skin and subcutaneous
leg tissue. According to statistics, in various countries
Differential diagnosis. First of all, there is a differentiation
distinguish primary varicose veins from secondary, observe
in post-thrombophlebitic syndrome. For post-thrombophlebitis
tic syndrome are characterized by: indications in the anamnesis of the transferred
deep vein thrombosis, "loose" type of varicose veins,
greater severity of trophic disorders, discomfort and pain during
trying to wear elastic bandages or stockings that compress the surface
veins.
The results of functional tests confirm the diagnosis (marching
Delbe-Perthes and Pratt-1), as well as the above instrumental
research.
Compensatory varicose veins should be ruled out
superficial veins, caused by compression of the iliac veins by tumors, is
going from the organs of the abdominal cavity and pelvis, tissues of the retroperitoneal
wanderings, congenital diseases - arteriovenous dysplasia
and phleboangiodysplasia of the lower extremities. Aneurysmal races
widening of the great saphenous vein in the area of the oval fossa can be
taken for a hernia (see "Hernias of the abdomen").
Edema of the affected limb in post-thrombophlebitic syndrome
must be differentiated from edema developing with disease
yakh heart or kidneys. "Cardiac" edema occurs on both legs, begins
from the feet, extend to the region of the sacrum and lateral surfaces
sti belly. With kidney damage, along with swelling in the legs, there is
puffiness of the face in the morning, increased creatinine, blood urea,
urine - increased protein content, erythrocytes, cylinders. And in that, and
in another case, there are no trophies inherent in post-thrombophlebitic syndrome
ic disorders.
Swelling of the limb may appear due to difficulty in the outflow of lymph
with lymphedema or blockade of inguinal lymph nodes by metastases
tumors of the abdominal cavity and retroperitoneal space. WHO difficulties
nicks in the differentiation of edema caused by post-thrombophlebitic
syndrome and lymphedema (elephantiasis) of the limb. Edema
primary lymphedema begins in the foot and slowly spreads to
shin. The edematous tissues are dense, the edema does not decrease after giving the leg
elevated position. In contrast to post-thrombophlebitis
droma skin color is not changed, ulcers and dilated subcutaneous
there are no veins, coarsening of skin folds in the ankle area is characteristic
joint, hyperkeratosis and papillomatosis of the skin of the foot.
clinical picture. Sick
complain about the presence
dilated veins,
Heaviness, sometimes pain in the legs, nocturnal
muscle cramps, trophic
changes in the legs. Extension
vein varies from small su
distal "asterisks" and intradermal
nyh (reticular) nodules up to
large tortuous trunks, nodes, protruding plexuses, clearly you
patients who are in an upright position. In 75-80% of cases it is time
the trunk and branches of the great saphenous vein are compressed, in 5-10% - the small vein
skin vein. Both veins are involved in the pathological process in 7-10%
observations.
On palpation, the veins have an elastic consistency, are easily compressible, the skin temperature above the varicose veins is higher than on the
tal areas, which can be explained by the discharge of arterial blood from arterial
teriovenous anastomoses and blood from deep veins through communicant
veins in varicose, superficially located nodes.
In the horizontal position of the patient, the tension of the veins and the size of the varicose veins decrease.
stagger. Sometimes it is possible to feel small defects in the fascia in places
connection of perforating veins with superficial ones.
As the disease progresses, fast fatigue joins.
lameness, feeling of heaviness and fullness in the legs, cramps in the calf
muscles, paresthesia, swelling of the legs and feet. Edema usually occurs in the evening and disappears completely by the morning after a night's rest.
Acute thrombus is a common complication of varicose veins.
bophlebitis of superficial veins, which is manifested by redness, cord-like
nym, painful compaction along the dilated vein, periflebi-
volume. Rupture of a varicose vein with subsequent bleeding can occur from the most insignificant damage to a thinned and soldered vein
skin. Blood pours out in a stream from a burst knot; blood loss sometimes
might be quite significant.
Diagnosis of varicose veins and associated chronic
venous insufficiency with the correct assessment of complaints, anamn
no statistical data and results of an objective study
there are no significant difficulties. Important for an accurate diagnosis is
determination of the state of the valves of the main and communicating veins,
evaluation of deep vein patency.
The state of the valvular apparatus of the superficial veins can be judged
Troyanov-Trendelenburg test and Hackenbruch test.
Troyanov-Trendelenburg test. The patient, being in a horizontal
position, raises the leg up at an angle of 45 °. doctor stroking the end
ness from the foot to the groin, empties varicose superficial
veins. After that, a soft rubber band is applied to the upper third of the thigh.
tourniquet or squeeze with fingers the great saphenous vein in the oval fossa -
at the place of its confluence with the femur. The patient is asked to stand up. Normally filled
venation of the leg veins does not occur within 15 s. Rapid filling of veins
lower leg from bottom to top indicates the flow of blood from the communicant
nyh veins due to insufficiency of their valves. Then quickly removed
tourniquet (or stop compressing the vein). Rapid filling of the veins of the thigh and
lower leg from top to bottom indicates insufficiency of the ostial valve
and valves of the trunk of the great saphenous vein, characteristic of the primary
varicose veins.
Hackenbruch test. The doctor gropes for an oval fossa on the thigh - a place
confluence of the great saphenous vein into the femoral and asks the patient to pokash
lyat. With insufficiency of the ostial valve, the fingers perceive tol
choked blood (positive symptom of a cough shock).
Differential diagnosis of varicose veins is primarily aimed at cutting off as a diagnosis of post-thrombophlebitic syndrome.
Despite the significant progress made in the diagnosis of lower extremity vein disease, and at present, many surgeons, after examining a patient with vein damage, often make a symptomatic diagnosis of saphenous varicose veins and, without finding out its cause, perform surgical treatment. Such treatment does not lead to recovery, and in a number of patients after an unreasonable operation, severe complications occur that aggravate the course of the disease. Removal of dilated saphenous veins in post-thrombophlebitic syndrome of the iliac-femoral segment deprives the surgeon of the opportunity to perform autovenous bypass bypass operations.
Varicose veins and post-thrombophlebitic syndrome have different pathogenesis. Comparison of causal factors allows to differentiate the triggers of diseases.
If in the occurrence of post-thrombophlebitic syndrome the leading pathogenetic factor is persistent venostasis with impaired function of all systems that provide venous hemodynamics, then with varicose veins, only the function of the saphenous vein system first suffers, and subsequently the communicating and deep veins are affected.
Based on a clinical examination of patients using additional methods, Russian doctors drew clinical parallels between varicose veins and post-thrombophlebitic syndrome of the lower extremities.
The main complaints of patients with post-thrombophlebitic syndrome are pain in the limb, fatigue, a feeling of heaviness and fullness, aggravated after long walking and standing and decreasing in a horizontal position or with an elevated position of the limb. Pain is usually localized in the lower leg and ankles. When the iliac-femoral segment is affected, it spreads to the thigh, and sometimes to the labia.
At the same time, only 34% of patients with primary varicose veins complain of pain in the affected limb. In most women, it occurs after a long stay in an upright position, is segmental in nature and is localized in the area of incompetent communicating veins. Pain quickly disappears in a horizontal position or after applying a compression bandage.
In 86.4% of women with post-thrombophlebitic syndrome, extensive edema of the limb is noted, the localization of which depends on the nature and extent of the thrombotic process. The more proximal the vascular occlusion is, the more massive the edema; they occupy the entire limb and pass to the shins in indurated edema. Usually, after the patient stays in a horizontal position, the edema decreases somewhat, but reappears when walking and never, unlike varicose veins, completely disappear.
Edema is observed only in 4.5% of women with varicose veins. They are usually minor and quickly pass in a horizontal position. In some patients with varicose veins, thickening of the limb is due to atonic dilatation of the saphenous veins, which is mistaken for edema. The circumference is measured in the elevated position of the limb, when the varicose veins subside, the tissues are released from the deposited blood and the limb takes its usual size.
In patients with post-thrombophlebitis syndrome, complaints are persistent and of the same type, while in patients with varicose veins they appear as the disease progresses and complications develop.
More than 70% of patients with post-thrombophlebitis syndrome indicate past deep vein thrombosis, and only in 27.6% it was latent.
Varicose veins usually occur in young women or after childbirth and gradually progresses; 62% of patients indicated the expansion of the saphenous veins in their parents. A carefully collected anamnesis in patients with venous lesions helps to resolve many issues of differential diagnosis of varicose veins and post-thrombophlebitic syndrome.
In 90.1% of patients with post-thrombophlebitic syndrome, saphenous vein dilation is observed with severe tortuosity of multiple anastomoses and small-caliber vessels, and when occlusion is localized in the iliac-femoral segment, varicose veins are also determined in the pubis, anterior abdominal wall and iliac wing.
With varicose veins, first of all, the main vessels of the system of the large and small saphenous veins expand.
Dystrophic changes in the skin and underlying tissues in post-thrombophlebitic syndrome are characterized by the appearance in the distal parts of the lower leg, more often from the medial surface, indurative edema, thickening of the skin and subcutaneous tissue with severe pigmentation and the appearance of a post-thrombophlebitic ulcer in the center.
Clinical observations show that post-thrombophlebitic ulcers often occur in the area of long-term skin pigmentation, even if there are no external signs of saphenous varicose veins. In post-thrombophlebitic disease, pigmented and indurated skin is often covered with crusts, hyperkeratosis, cellulitis, and dermatitis occur. Post-thrombophlebitic ulcer is initially small, 1-2 cm in diameter, deep, with flaccid granulations, purulent plaque, sharply painful on palpation. Such ulcers do not tend to epithelialize and are not amenable to conservative treatment. The occurrence of ulcers depends on the duration of the disease, the extent of the thrombotic process, the localization and degree of recanalization of the thrombosed vessel. Already 1-3 years after thrombosis, they occur in 32.5% of patients on the background of indurative edema, skin pigmentation and dermatitis, and after 10 years - in 73.2%.
With varicose veins, dystrophic changes in tissues are less pronounced. They occur late against the background of varicose saphenous veins in one or both lower extremities. Ulcers are observed in 24% of patients, pigmentation - in 15%, induration - in 19.4%. The degree of varicose veins does not significantly affect their occurrence. The development of an ulcer is preceded by thrombophlebitis, erysipelas, trauma, perivasal phlebosclerosis, edema and allergies. With varicose expansion of the system of the great saphenous vein, ulcers are more often localized at the medial malleolus, and with damage to the system of the small saphenous vein - at the lateral and posterior or lower third of the leg. Varicose ulcers usually occur along the course of an enlarged vein, more often in the area of its thrombosis or incompetent communicant. They are not painful, surrounded by unchanged tissues, and after a long stay of patients in a horizontal position, they usually heal.
It is often difficult to distinguish between complicated varicose veins and post-thrombophlebitic varicose veins, especially when the morphological signs of the disease characteristic of post-thrombophlebitic syndrome are superimposed. In this case, the anamnesis, phlebography and other research methods are of decisive importance.
The initial signs of varicose veins of the lower extremities are, as a rule, telangiectasias or varicose saphenous veins. In this case, the disease is often limited only to these symptoms and the progression of the process is to increase the number of telangiectasias and reticular veins. Only after a few years or even decades, varicose veins may appear in the basin of the large or small saphenous vein.
In cases where varicose veins begin with the appearance of typical venous nodes (varixes), two variants of the development of the disease can be distinguished. The appearance of varicose veins on the lower leg, more often on its medial surface, indicates a predominant lesion of the perforating veins, which can be detected by palpation or using instrumental examination methods. The predominance of low veno-venous discharge does not mean at all that the trunks of the main saphenous veins remain intact. Reflux can also be observed along them, but, as a rule, the lines are slightly dilated, varicose are not changed, and the discharge of blood through them is segmental.
The appearance of varicose veins initially outside the zone of the usual location of the perforating veins (femur, anteromedial surface of the leg, popliteal fossa and posterior surface of the upper third of the leg) indicates the leading role of the high veno-venous discharge in the development of the disease. Reflux in the great and/or small saphenous vein can be detected using functional tests or ultrasound. The main trunks themselves are dilated and well palpated throughout, especially in thin subjects. Often you can observe a typical varicose deformation of the subcutaneous highways. A high veno-venous shunt does not exclude the presence of incompetent perforating veins, but their pathogenetic role is small. Over time, the differences in the manifestations of varicose veins are leveled and doctors have to observe patients with both stem varicose veins and those with severe perforant shunt.
Identification of options for the development and course of varicose veins is important for solving practical problems, in particular, for determining the plan and volume of operational benefits.
The number and size of varicose veins that appear can increase over time, but sometimes the clinical picture is constant for many years. Irrespective of the type of discharge with which the disease proceeds, the addition of symptoms of CVI occurs in the same way. In most patients, after some time (on average 3-5 years) after the appearance of the first varicose veins, functional disorders are noted (complaints of a feeling of heaviness, pain in the leg, pastosity of the foot and lower leg that occur at the end of the working day).
In some cases, the disease begins precisely with these symptoms, and only later varicose veins are detected. This is commonly seen in overweight patients where the initial transformation of the superficial veins is "masked" by prominent subcutaneous adipose tissue.
The differential diagnosis of various diseases accompanied by the development of varicose syndrome is very important. At the stage of history taking and physical examination, significant difficulties are possible due to the commonality of many clinical manifestations of various pathological conditions, primarily varicose and post-thrombophlebitis diseases. In clinical practice, it is often necessary to make a differential diagnosis between these diseases and congenital venous dysplasia, since they are all accompanied by varicose transformation of the saphenous veins.
The correct determination of the type of pathology at the stage of examination of the patient allows you to optimize the diagnostic tactics and avoid the use of unnecessary examination methods. The main clinical differential diagnostic criteria for the causes of varicose syndrome are given in the table.
The presence of varicose veins is established on the basis of a comprehensive analysis of the data obtained during the examination and the results of functional and instrumental research methods.
Examination methods used for varicose veins:
- 1. Collection of anamnesis (history of life and illness). At this stage, find out:
- § complaints (pain, swelling, some external manifestations of varicose veins, etc.) and their nature;
- § anamnesis of life - from the moment of birth to the present day. This also includes a survey about concomitant chronic diseases, previous injuries;
- § anamnesis of the disease, i.e. the course of the disease. The onset of the disease, the course, the nature of exacerbations, the treatment carried out and its effectiveness are important;
- § living and working conditions, bad habits, regimen, nutrition.
- 2. Visual inspection for the presence of vascular "asterisks", nodes, dilated veins, ulcers, eczema, dermatitis, skin conditions and its color. Both limbs are examined, regardless of whether the process is unilateral or bilateral.
- 3. Palpation (feeling). Also performed on both legs. Changed veins, varicose nodes, lymph nodes are palpated (may be enlarged with thrombophlebitis).
- 4. Functional (harness) tests - to determine the state of the valve system and the patency of the veins. The most commonly used among them is the Troyanov-Trendelenburg test.
- 5. Laboratory research methods:
- § complete blood count - by the level of hemoglobin and the erythrocyte sedimentation rate, one can judge the rheological properties of the blood, and with an increase in the number of leukocytes, an inflammatory process (thrombophlebitis) can be suspected;
- § coagulogram (blood for clotting) - makes it possible to judge the coagulation system and the risk of thrombosis.
- 6. Instrumental research methods
- § Ultrasound examination methods are recognized worldwide as the most informative in the diagnosis of varicose veins. Modern devices, with the help of which ultrasonic angioscanning is performed, allow you to see not only the vessel, but also determine the direction and speed of blood flow, the presence of blood clots and their shape.
There are several types of ultrasound: dopplerography (blood flow, the condition of the walls and valves are assessed), duplex angioscanning (when several operating modes are combined, a black-and-white and color image of the vessel and the state of blood flow is obtained on the screen), triplex (a sound effect is added to the previous version).
- o X-ray methods can be used to examine deep veins. In this case, the contrast agent is administered intravenously. Then either pictures are taken (phlebography), or various parts of the veins are examined during the passage of a contrast agent (phleboscintigraphy). In severe cases, a CT scan may be needed.
- 2. Additional Methods research: phlebotonometry (measurement of pressure in the veins to determine the state of the valves), plethysmography (determination of blood filling of vessels at rest and under load).
Radionuclide phleboscintigraphy.
With varicose veins, all deep veins are visualized, the speed of blood movement through them is somewhat reduced - up to 5-7 cm / s (normally 8-9 cm / s). A characteristic scintigraphic sign of the disease is the contrasting of perforating veins with valvular insufficiency, through which superficial venous lines and their tributaries are filled. In addition, in conditions of complete valvular insufficiency of the great saphenous vein, its filling with a radiopharmaceutical from top to bottom is detected. Reflux through the dilated orifice of the small saphenous vein can also be registered using this method. The linear and volumetric blood flow velocity is reduced by 2 times or more compared to the norm.
Additional methods of instrumental examination. Occlusal plethysmography makes it possible to determine the tonoelastic properties of the venous wall based on changes in the evacuation volume of blood and the time of its evacuation.
Photoplethysmography and reflective rheography make it possible to estimate the time of recurrent blood filling, which indicates the degree of venous congestion. Repeated repetition of the procedure makes it possible to study the dynamics of changes in the tonoelastic properties of the venous wall and the parameters of venous circulation during treatment. This is especially true in cases of varicose veins with trophic disorders, i.e., when a course of conservative therapy is necessary before surgery.
Direct phlebotonometry with the measurement of venous pressure in one of the veins of the dorsal foot in a static position and during physical activity has long been considered the "gold standard" in assessing the function of the musculo-venous pump of the leg. The invasive nature of the study, as well as the emergence of methods for indirect assessment of functional parameters, led to the almost complete replacement of phlebotonometry from clinical practice.
X-ray contrast phlebography used to be considered the main method of instrumental diagnosis of varicose veins. Its data made it possible to judge the state of the deep venous system, trunks of the saphenous veins, as well as accurately localize incompetent perforating veins. Currently, X-ray phlebography for varicose veins is practically not used, since similar information can be obtained using ultrasound without the risk of any complications.
Differential diagnosis of varicose veins. First of all, it should be carried out with the syndrome of Parks-Weber - Rubashov and, Klippel - Trenaunay, femoral hernia, post-thrombophlebitic syndrome.