瞭解靜脈曲張：靜脈曲張的原因、症狀和現代治療方案

Varicose veins are a common vascular condition affecting approximately 23% of adults worldwide, with prevalence increasing with age. These enlarged, twisted veins—most commonly appearing in the legs—represent more than just a cosmetic concern; they can signal underlying venous insufficiency and lead to significant discomfort and complications if left untreated. This comprehensive guide explores the pathophysiology, risk factors, clinical presentation, and contemporary treatment modalities for varicose veins, providing valuable insights for both patients and healthcare professionals.

Pathophysiology of Varicose Veins

Varicose veins develop when the one-way valves within veins malfunction, disrupting normal blood flow. In healthy veins, these valves ensure blood travels upward toward the heart, counteracting gravitational forces. When valves become damaged or weakened, blood pools in the veins, causing increased venous pressure and eventual vein wall distension. This process, known as venous insufficiency, leads to the characteristic bulging and tortuous appearance of varicose veins.

The primary mechanism involves:

1. Valve Incompetence: Failure of venous valves to close properly, allowing retrograde blood flow
2. Venous Hypertension: Increased pressure within the venous system due to blood pooling
3. Vein Wall Remodeling: Structural changes in the vein wall, including weakening of elastin and collagen fibers
4. Inflammatory Processes: Release of inflammatory mediators contributing to further valve and vein wall damage

Research indicates that both macrovascular and microvascular changes occur in varicose vein development, with alterations in endothelial function, smooth muscle cell proliferation, and extracellular matrix composition.

Risk Factors for Varicose Vein Development

Multiple factors contribute to varicose vein formation, with both modifiable and non-modifiable elements:

Non-modifiable Risk Factors:

• Genetics: Family history accounts for approximately 70% of risk, with specific genetic polymorphisms identified
• Age: Prevalence increases significantly with advancing age due to natural vein wall weakening
• Female Gender: Women are affected more frequently than men (3:1 ratio), partly due to hormonal influences
• Previous Deep Vein Thrombosis: Post-thrombotic syndrome can damage valves and lead to venous insufficiency

Modifiable Risk Factors:

• Prolonged Standing/Sitting: Occupations requiring extended periods in one position increase risk by 1.5-2 times
• Obesity: BMI >30 doubles risk through increased intra-abdominal pressure
• 懷孕: Hormonal changes and increased blood volume contribute to vein dilation
• Lack of Physical Activity: Sedentary lifestyle reduces calf muscle pump effectiveness
• Constipation: Chronic straining increases abdominal pressure and impedes venous return

Clinical Presentation and Symptoms

Varicose veins present with varying degrees of severity and symptomatology:

Visual Appearance:

• Dilated, rope-like veins visible beneath the skin surface
• Blue or purple discoloration
• Tortuous, bulging venous segments
• Spider veins (telangiectasias) often accompanying larger varicosities

Common Symptoms:

• Aching or heaviness in legs (reported by 73% of patients)
• Swelling, particularly after prolonged standing
• Throbbing or burning sensations
• Nocturnal leg cramps
• Itching around affected veins
• Restless legs
• Skin changes, including dryness and discoloration

Symptom severity often does not correlate directly with the visual appearance of varicosities, with some patients having minimal visible veins yet significant discomfort, while others with prominent varicosities report few symptoms.

Complications of Untreated Varicose Veins

If left untreated, varicose veins can progress to more serious conditions:

1. Chronic Venous Insufficiency: Progressive deterioration of venous function leading to edema and skin changes
2. Venous Eczema: Inflammatory skin condition with itching, redness, and scaling
3. Lipodermatosclerosis: Hardening of subcutaneous tissues with skin discoloration
4. Venous Ulceration: Non-healing wounds affecting approximately 1% of adults with chronic venous disease
5. Superficial Thrombophlebitis: Inflammation and clotting in superficial veins
6. Bleeding: Spontaneous rupture of superficial varicosities, particularly with minor trauma

Diagnostic Approaches

Modern diagnosis of varicose veins relies on both clinical assessment and specialized imaging:

Clinical Evaluation:

• Comprehensive history focusing on symptoms, risk factors, and family history
• Physical examination including visual inspection and palpation
• Assessment of clinical severity using validated tools like CEAP classification (Clinical-Etiology-Anatomy-Pathophysiology)

Diagnostic Imaging:

• Duplex Ultrasound: Gold standard for evaluation, providing both anatomical and functional information with 95-98% accuracy
• Venous Reflux Testing: Quantifies valve incompetence and reflux duration
• Plethysmography: Measures volume changes in limbs to assess venous function
• Advanced Vascular Mapping: Used for complex cases or pre-procedural planning

Contemporary Treatment Options

Treatment approaches have evolved significantly, with minimally invasive procedures largely replacing traditional surgical techniques:

Conservative Management:

• Compression Therapy: Graduated compression stockings (20-30 mmHg or 30-40 mmHg) remain first-line therapy
• Lifestyle Modifications: Weight management, regular exercise, leg elevation, and avoiding prolonged standing/sitting
• Pharmacological Treatments: Venoactive drugs like micronized purified flavonoid fraction (MPFF) or horse chestnut seed extract

Minimally Invasive Interventions:

• Endovenous Thermal Ablation:
• Endovenous laser ablation (EVLA): Uses laser energy to seal veins with 95-98% success rates

• Radiofrequency ablation (RFA): Employs thermal energy with similar efficacy but potentially less post-procedure pain

• Non-thermal, Non-tumescent Techniques:

• Mechanochemical ablation (MOCA): Combines mechanical damage with sclerosant
• Cyanoacrylate adhesive closure: Medical-grade glue seals veins without thermal energy

• Endovenous foam sclerotherapy: Chemical irritant causes vein fibrosis

• 硬化療法:

• Liquid sclerotherapy: Ideal for smaller veins and telangiectasias
• Foam sclerotherapy: Enhanced contact with vein walls for improved efficacy in larger veins

Surgical Options:

• High ligation and stripping: Traditional approach with higher recurrence rates than modern techniques
• Ambulatory phlebectomy: Removal of varicosities through tiny incisions
• CHIVA method (Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire): Preserves veins while correcting hemodynamics

Post-Treatment Considerations

Following intervention, patients should be advised about:
– Expected recovery timeline (typically 1-2 weeks for most activities)
– Compression therapy requirements (usually 1-2 weeks post-procedure)
– Potential complications including bruising, hyperpigmentation, and paresthesia
– Follow-up protocols for assessment of treatment success
– Long-term maintenance strategies to prevent recurrence

醫療免責聲明

重要通知: This information is provided for educational purposes only and does not constitute medical advice. Varicose veins can be associated with underlying vascular conditions that require proper medical evaluation. The treatment options discussed should only be performed by qualified healthcare professionals after appropriate diagnostic assessment. Individual results may vary, and all procedures carry potential risks and benefits that should be thoroughly discussed with your healthcare provider. If you are experiencing symptoms of varicose veins or venous insufficiency, please consult with a vascular specialist for personalized evaluation and treatment recommendations.

總結

Varicose veins represent a common manifestation of chronic venous disease with significant impact on quality of life. Modern understanding of the pathophysiology has led to remarkable advances in treatment options, with minimally invasive techniques offering excellent outcomes with reduced recovery time. Early intervention can prevent progression to more serious complications, highlighting the importance of proper evaluation and management. With continued research and technological innovation, treatment approaches continue to evolve, providing increasingly effective and patient-friendly solutions for this prevalent condition.