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21
Zhang Xue Min
Vascular Surgery
About me
From 1988 to 1995, I studied at Beijing Medical University under the guidance of Professor Yan Zhongyu and Professor Li Tong, renowned experts in general surgery. I graduated with a master's degree in clinical surgery. From August 1995 to March 2001, I worked at the First Clinical Hospital of Beijing Medical University (Peking University First Hospital) in general surgery. In 2000, I studied peripheral vascular diseases under the mentorship of Professor Wu Qinghua, Professor Wang Weiliang, and Professor Huang Dexiang, renowned vascular surgery experts. From January to April 2001, I was responsible for vascular surgery at Peking University First Hospital. In April 2001, I transferred to Peking University People's Hospital and was one of the founding members of the vascular surgery department.
Proficient in diseases
Treatment of aortic and lower extremity artery intervention and surgery.
Voices
Will wearing compression stockings every day help with Grade 2 varicose veins?
In the grading of varicose veins, Grade II signifies that there are obvious superficial vein tortuosity and dilation, and some may even clump together, but without edema and pigmentation. For patients with such newly developed varicose veins, persisting in wearing compression stockings can possibly lead to improvement. The main principle here is that in patients with newly developed Grade II varicose veins, the damage to the venous valves may not be severe, but rather due to venous pressure causing vein dilation, resulting in the valves not closing tightly. In such cases, if we apply external force to ensure the valves close tightly, preventing further vascular dilation and reducing the force of damage to the valves, then there is a possibility of recovery to a certain extent. If the condition has been present for a longer time, and this valvular dilation has already resulted in long-term effects, wearing compression stockings might only help in reducing the potential for further progression, but it is unlikely to improve existing varicose veins significantly.
Late-stage complications of lower extremity varicose veins
In the advanced stages of lower extremity varicose veins, fixed ulcers can appear above the ankle in certain specific areas. These ulcers may improve or worsen intermittently and are long-lasting. The ulcers might gradually enlarge, and pigmentation can occur around them, with the skin gradually darkening, and even turning black. If these ulcers continue to remain unhealed for an extended period, there is a possibility of cancerous changes in some individuals. Therefore, it is essential to treat lower extremity varicose veins that have progressed to ulcers, with the primary treatments being compression therapy and medication, which can also be combined with surgical treatment.
The difference between thromboangiitis obliterans and varicose veins
Firstly, these are two completely different diseases. Thromboangiitis obliterans is an inflammatory vascular disease involving the medium and small veins and arteries, causing migratory superficial phlebitis and leading to the obstruction of the veins, as well as some obstructions in the lower limb arteries. Thus, thromboangiitis obliterans includes some obliterative diseases of both arteries and veins, the cause of which is an autoimmune inflammation. Varicose veins are one of the most common vascular surgical diseases. They primarily manifest as tortuous, clustered, and dilated superficial veins of the lower limbs. This condition does not involve arterial changes, but varicose veins can progressively worsen and may lead to pigmentation and ulceration, which at that time necessitates differentiation from arterial ulcers. Generally, the ulceration in varicose veins is located in the "gaiter area," which is the area covered by a boot when wearing one, including the lower one-half to one-third of the lower leg. Most of the ulcers from varicose veins primarily appear above the inner ankle. The ischemia caused by thromboangiitis obliterans leads to a dry-type ischemia, where the limbs can gradually become dry, shriveled, atrophied, and blackened, with ulcers typically beginning from the extremities.
Can people with varicose veins in the lower extremities drink alcohol?
The majority of patients with varicose veins in the lower limbs can drink alcohol in moderation, but should not drink excessively. However, there is one circumstance where it is advisable to check carefully before deciding whether to drink alcohol. This is the case if there are severe varicose veins in both lower limbs and even some clearly visible dilated veins on the abdomen. In such cases, it's recommended to check the liver first. This is because the veins from the lower limbs join to form a vein called the inferior vena cava, which passes through the liver to return to the heart. If there is a problem with the liver, it may compress the inferior vena cava, causing varicose veins on both sides. In this situation, drinking alcohol could further damage the liver, potentially worsening the varicose veins.
Will varicose veins recur and have sequelae after surgery?
After varicose vein surgery, there may be a recurrence, and there may also be sequelae. The main reason for recurrence is that we only close off the varicose veins, but the causes that lead to varicose veins are not removed, such as some people having a family history, some being involved in long-term physical labor, and some being excessively obese. If these factors are not eliminated, the patient is very likely to relapse. The recurring veins may be some other nearby superficial veins that some surgical methods did not remove but merely closed locally. These veins might also reopen, and sequelae are possible. The most common sequelae include nerve damage, such as saphenous nerve damage, which is quite common with an incidence rate of about 14%. The main symptom is numbness near the inner ankle, which might improve over time. Some people feel discomfort at the surgical site on rainy or cloudy days shortly after surgery, and if the deep veins are damaged during surgery, more severe consequences may occur, including poor reflux in the deep veins and deep vein thrombosis, etc.
Does varicose veins hurt when pressed?
In most cases, varicose veins are not painful on touch. However, if they are painful when pressed, there are several possibilities. One is that there is an obstruction at the proximal end of the varicose vein, which is closer to the heart. This results in high local tension in the varicose vein, and pressing on it can stimulate the nerves in the surrounding membrane, causing pain on touch. Another possibility is that a blood clot has formed inside the varicose vein. The formation of blood clots is often accompanied by some sterile inflammation. When there is inflammation, symptoms can include redness, warmth, pain, and localized heat. Pressing on such an area can intensify the pain. Additionally, it is particularly important to emphasize that if varicose veins are painful on touch, one must visit a hospital and not press on them themselves. If there is a blood clot, pressing it could dislodge the clot, causing it to travel to the lungs and lead to a pulmonary embolism.
What are the dangers of bruising due to varicose vein rupture?
When varicose veins rupture and cause bruising, if the area is small, it may be absorbed on its own. If the area is large, or if there is a certain degree of fluid accumulation, this fluid can potentially lead to infection, especially if the patient has diabetes or is using steroids, which may cause the accumulated blood to become infected. Additionally, after the absorption of a bruise, some patients may experience local pigmentation. This occurs because the iron-containing hemoglobin from metabolized red blood cells remains in the area, leading to a change in color. In severe cases, if the discoloration recurs, it may darken, and further development in some people might result in the skin becoming rougher and potentially ulcerating.
What is the cause of pain in varicose veins?
Varicose veins can sometimes cause localized pain, and there are several reasons for this pain. One reason is the formation of blood clots in the varicose veins, which can cause very obvious pain. Additionally, the affected area feels harder, not soft. When we say soft, it's like the softness of one’s lips; if it feels like the tip of the nose or the forehead, then it's considered very hard. In such cases, it indicates that the vein is not empty but contains a solid blood clot, which can cause pain. Another situation is if there is poor venous return in the proximal segment, causing the veins to fill significantly in a short time. This can also pull on the nerves outside the vein wall, leading to a sensation of pain.
Does Grade II varicose veins require surgery?
In our clinical staging, Grade 2 varicose veins are the most common type of varicose veins. Often, these do not have complications and are relatively early-stage. The decision to undergo surgery depends on the patient's personal treatment preference. Some individuals might be motivated by cosmetic reasons, such as wanting to wear skirts or shorts in the summer to show off their legs. In such cases, their desire for treatment might be stronger. For some older individuals, they might not care as much, so the choice of undergoing surgery or opting for conservative treatment for Grade 2 varicose veins really depends on the patient's own wishes.
Can you run if you have varicose veins in your lower legs?
Patients with simple varicose veins can run. The movement of muscles, especially during running when the calf muscles are active, can compress the deep veins, facilitating the emptying of these veins. This benefits the flow of blood in the superficial veins through the communicating veins back to the deep venous system, thus participating in the systemic circulation. Therefore, patients with varicose veins in the calves can still run in the majority of cases. However, there are exceptions. If a person experiences significant muscle pain, it is important to be cautious as there may be a thrombus in the muscle veins. If there is a thrombus in the muscle veins, and the return flow in the deep veins is obstructed, this may also cause varicose veins. In cases of fresh thrombosis, running might lead to the detachment of the thrombus. Thus, patients in such conditions are advised not to run until further evaluation is confirmed by an ultrasound examination.