Venous insufficiency is a condition in which the veins cannot transport blood from the extremities to the heart in sufficient volumes. Venous insufficiency of the lower extremities - its symptoms are familiar to men and women, and treatment causes difficulties even for specialists.
The most common symptom is Blunt pain in the legs, which by the end of the day becomes unbearable. The pain intensifies after prolonged standing. The symptoms are caused by stagnation of venous blood in the legs, which leads to swelling. This causes swelling, tingling and even cramps.
The skin becomes pale and then reddens and looks brownish-red. In the ankles, the limb increases in volume, and itching occurs. If venous insufficiency is associated with dilated veins, then they become noticeable as they turn blue and become bulging.
Then trophic disorders progress, the skin looks scaly and becomes covered with ulcers. The patient is accompanied by heaviness of the legs and noticeable swelling.
Venous insufficiency develops in the absence of proper blood circulation in the extremities. Circulation does not occur because blood flow is blocked by a blocked vein or valve insufficiency. As a result, blood begins to collect in the lower extremities. The venous valve apparatus serves to direct blood flow in the right direction (to the heart). If the valves are damaged, some of the blood remains in the lower extremities. Other reasons:
- Formation of blood clots in deep veins;
- Varicose veins of superficial veins;
- Blood clots that obstruct blood flow;
- Age over 50;
- Fluctuations in progesterone associated with pregnancy;
- Excess weight;
- Sedentary work;
- Muscle weakness;
- Oncological diseases;
- Injuries;
- Genetic abnormalities;
- Smoking.
Venous insufficiency is diagnosed by a doctor during a visual examination. An additional method is the use of Doppler ultrasound. The examination shows valve defects, blood clots, size and shape of the vessel. To clarify the diagnosis, MRI or tomography is used.
Treatment of venous insufficiency of the lower extremities
The most worrying symptoms are pain and swelling. Therefore, treatment primarily consists of relieving these symptoms.
Drug treatment - taking blood thinners. Anticoagulants dissolve blood clots and restore vessel patency. The drugs also prevent the formation of blood clots.
Medicines for the treatment of venous insufficiency:
- Avenue - the drug increases the tone of the vascular wall, increases lymphatic outflow, reduces fragility and capillary permeability.
- Detralex – protects the vascular wall from damage, tones the veins.
- Aescusan is a drug made from horse chestnut. Increases the production of catecholamines, protects veins from damage, increases the elasticity of the vascular wall.
- Venarus – improves circulation and venous outflow.
- Phlebodia – promotes venous blood flow, reduces swelling of the legs.
Laminin, bilobil, normoven have a similar effect.
Compression clothing - the mechanism of action is due to mechanical pressure on the vessels, which pushes blood in the right direction. They are in the pharmacy and are available to everyone. They differ in size, color and material. Compression stockings are characterized by a compression gradient.
Medical dressings for the treatment of trophic ulcers use antiseptics, ointments, and folk remedies. For treatment acute stage cold compresses are used - a chilled gauze swab is applied to the affected area for two minutes, then cooled again in a container with ice. The procedure is carried out for 40 minutes.
Non-surgical treatments
Endovenous thermal ablation is an effective and painless procedure for treating venous insufficiency. It is performed using a laser and high-frequency radio waves. This prevents the progression of the disease.
The method involves injecting a sclerosing solution into the vein, which fills the dilation and causes the vessel to stick together. This eliminates pain and swelling. The drug is eliminated from the body on its own. On early stages the technique gives positive results no worse than after surgery. In more advanced cases it is necessary combination treatment: surgical, medicinal and physical therapy.
Benefits of sclerotherapy:
- No scars are left;
- The integrity of the vein is preserved;
- Well tolerated psychologically;
- Convenient to use for chronic varicose veins;
- Can be prescribed in combination with other treatment methods.
Surgical treatment of venous insufficiency: venous bypass - eliminating the problem by transplanting a healthy section of the vessel.
Ligation and purification
The surgical procedure consists of stitching the affected area and clearing the varicose veins. Loops (ligatures) are placed through the skin using a special tool, and the sutures are tied from the outside. After contraction of the vessel, the thrombus is removed. The disadvantage of this method is that relapse is possible.
Phlebectomy – removal of blood clots and the affected area of the vein. Microinvasive intervention is performed through the skin on an outpatient basis. Modern methods: laser phlebectomy and radiofrequency obliteration.
Chronic venous insufficiency of the lower extremities
Long-term disruption of the venous outflow of blood and the development of venous obstruction leads to chronic venous insufficiency. Pathogenesis is associated with the destruction of valves by thrombosis, phlebitis, injuries and burns. The weakening of muscle strength, which is necessary to create sufficient blood pressure, is not the direct cause of chronic venous insufficiency, but contributes to the exacerbation of the disease.
Chronic venous insufficiency: clinical models
Symptoms of chronic venous insufficiency are grouped into the most common clinical variants:
- Uncomplicated venous varicose veins;
- Superficial thrombophlebitis;
- Varicose veins are generalized vascular lesions in combination with pain, swelling and skin changes. Often the cause is pathology of the superficial veins, treatment of which will help correct the situation;
- Venous hypertension syndrome – pain in the legs when standing. The pain goes away in a sitting position. Sometimes this is the only sign. The patients are young women. The cause is deep vein obstruction; surgical treatment relieves pain.
- Swelling of the extremities – occurs in older people who lead a sedentary lifestyle. More common in women.
- A complex of multisystem venous pathologies – a disorder in the system of superficial, deep and perforated veins.
Chronic venous insufficiency is diagnosed using anamnestic data and an external objective examination. Duplex ultrasonography allows you to establish the stage of the disease and confirm or refute the presence venous thrombosis. Other methods: venography, CT, MR angiography.
Minor vein injuries may cause no symptoms. On the other hand, the pathology of the deep veins, as well as the combination with a violation of the outflow from the superficial ones, leads to serious consequences. Another factor that causes peeling, impaired capillary circulation, lymph stagnation and decreased sensitivity is high blood pressure. Symptoms of chronic venous insufficiency are as follows:
Trophic venous ulcers are difficult to cure; they progress and recur. Risk factors for exacerbation of venous ulcers:
- Postthrombotic symptom;
- Blockage in the iliofemoral system;
- Deep vein insufficiency;
- Resistant venous hypertension.
The development of chronic failure depends on the rate of disease progression.
Chronic venous insufficiency: prevention
Active lifestyle physical exercise, aimed at strengthening the muscles of the leg - an excellent way to prevent venous insufficiency. Physical activity should not be only static, it should be alternated with dynamic (running, swimming). Walking for 40 minutes every day will strengthen the muscles and vein wall.
When lying down, your legs should be kept elevated. It must be taken into account that excess weight increases the load on the venous system and complicates the outflow from the limbs. High heels also prevent the venous system from moving blood freely in the vessels.
The use of oral contraceptives is a risk of developing venous insufficiency. In this case, you should regularly (twice a year) undergo ultrasound examination of the blood vessels of the legs. The same measures should be taken by pregnant women. If necessary, compression stockings should be used.
Chronic venous insufficiency (CVI) is a set of clinical manifestations resulting from impaired blood outflow in the venous system. CVI includes diseases such as varicose veins, postthrombotic disease, congenital and traumatic anomalies of the venous vessels.
CVI of the lower extremities is currently the most common vascular disease. CVI occurs three times more often in women than in men.
Video about chronic venous insufficiency
Causes of chronic venous insufficiency
Predisposing factors for the development of CVI include:
Heredity;
- female;
- repeated pregnancies;
- excess body weight;
- insufficient physical activity;
- heavy physical labor associated with lifting heavy objects, long periods of standing or sitting.
The main cause of the disease is considered to be a malfunction of the muscular-venous pump. Normally, the outflow of blood in the lower extremities is carried out through the system of deep (90%) and superficial veins (10%). To move blood towards the heart, the veins have valves that prevent the blood from moving downward due to gravity. Contractions of the muscles of the thigh and lower leg also play an important role, which prevents the reverse flow of blood.
The worst conditions for normal blood flow occur in vertical position body in the absence of active muscle contractions. Thus, blood stagnation occurs, pressure increases in the vein system and, as a result, their expansion. Insufficiency of the valve apparatus is formed, the valve flaps do not close completely, and abnormal blood flow occurs from top to bottom.
This leads to an even greater increase in pressure in the veins. As a result of increased pressure, the permeability of the venous wall increases, it swells, squeezing the surrounding tissues, disrupting their nutrition. Finally, a trophic ulcer forms in this place.
Symptoms of chronic venous insufficiency
Whenever the following signs it is necessary to contact a specialist in order to exclude CVI: slight heaviness in the legs, which occurs mainly in the evening or after static load; swelling of the ankles (the fingers are not affected). Swelling appears in the evening (can be determined by the presence of traces from the elastic of socks), the degree of severity depends on the duration of physical activity. It is important that swelling is not detected in the morning. You may have varicose veins or spider veins ( visible extension small wreath). All these signs indicate the presence of CVI of the first degree.
External manifestations of CVI.
Over time, intense, bursting pain in the legs and burning begin; cramps of the calf muscles, which usually appear at night. The swelling becomes persistent (detected at any time of the day), the skin is pale, cold to the touch, in addition, as a result of poor blood circulation, areas of hyperpigmentation (brownish discoloration), lipodermatosclerosis (inflamed area of red skin, painful when touched) and eczema appear on the skin ( thinning of the skin over the dilated vein, it becomes spotty and itches a lot). In this case, stage 2 CVI occurs.
The presence of an open or healed trophic ulcer, as well as complications of CVI (bleeding, deep vein thrombosis or thrombophlebitis) confirms stage 3 CVI.
The formation of ulcers during CVI occurs in several stages. Initially, an area of brownish discoloration of the skin appears. Over time, a compaction forms in the center, having a whitish, varnished appearance, reminiscent of paraffin deposits. In the future, even minimal trauma leads to the opening of an ulcerative defect. With delayed treatment, the size of the ulcer progressively increases, and infection may occur.
Also, grade 0 CVI is distinguished, when even pronounced varicose veins and spider veins are not accompanied by heaviness in the legs, pain and swelling. At this stage of the disease, treatment is also necessary.
CVI, if treated incorrectly or untimely, can lead to serious complications, such as deep vein thrombosis (complete or partial closure of the vein lumen by a blood clot) and thrombophlebitis (inflammation of the vein wall accompanying thrombosis). In this case, swelling suddenly occurs and quickly increases, which covers the entire lower limb, accompanied by intense bursting pain. The eyes may appear red or blue, painful thickening of the skin. There is no connection with previous physical activity, varicose veins, areas of brownish discoloration of the skin and ulcers may be absent. If a blood clot comes off, it can travel through the bloodstream to the lungs and cause a serious disease - pulmonary embolism (complete or partial closure of the artery lumen by a blood clot). This complication is often fatal. If you suspect deep vein thrombosis or thrombophlebitis, you must immediately lie down, elevate your leg, and call an ambulance medical care. It is strictly forbidden to stretch the muscles, apply any ointments, or step on the sore leg.
You should also be wary of injuries to the affected area, as they can lead to the development heavy bleeding. In case of bleeding, it is necessary to bandage the leg above the wound site with a tourniquet (medical or improvised), so tightly that the bleeding stops, and immediately call an ambulance team. Bleeding from varicose veins is also a life-threatening complication.
Symptoms of CVI, such as pain in the lower extremities and swelling, are also characteristic of a number of other diseases:
"Cardiac" edema. Presence of heart disease, hypertension. Edema of the lower extremities appears at any time of the day, most often permanent, always bilateral. There is no connection with physical activity. Pain in the lower extremities is usually absent, expressed only with significant swelling. The skin in the area of edema is warm and of normal color.
Swelling due to lymphedema (impaired lymph flow). Just like with CVI, swelling appears in the late afternoon and is associated with physical activity. The skin in the area of edema is of normal color and temperature. When the process is severe, swelling affects the thigh area. Pain of varying intensity. But there are no dilated veins or ulcers. It is possible to distinguish this disease from CVI by performing lymphography ( instrumental study lymphatic system).
With arthrosis, swelling and intense pain are detected only in the area of the affected joint. The mobility of the joint is sharply limited at the beginning of the movement, then, as the movement continues, the mobility improves somewhat and the pain becomes less intense. Ultrasound and radiography of the joint will allow differentiation between this disease and CVI.
With osteochondrosis of the lumbar spine, the greatest severity of pain is in the popliteal fossa. The pain is nagging, can “shoot” in the thigh and gluteal region. It usually occurs at night. The intensity decreases after a course of anti-inflammatory therapy. Swelling is not typical.
Only a qualified specialist can distinguish these diseases from CVI.
Diagnosis of chronic venous insufficiency
When you contact your doctor, you will be asked to undergo the following examination:
General blood analysis. The level of red blood cells and hemoglobin can be used to judge the degree of blood viscosity; the number of platelets assesses the state of the blood coagulation system; an increase in the number of leukocytes indicates the presence of inflammation.
Biochemical analysis of blood and urine. Changes in these indicators are not specific and depend on the presence and severity of concomitant diseases.
Most precise method diagnosis of venous pathology is Ultrasound of blood vessels of the lower extremities, during which areas of varicose veins, the presence of varicose nodes, and blood clots are determined. Ultrasound of the vessels of the lower extremities should be performed in the presence of any of the above signs of CVI.
If ultrasound data is questionable, surgical methods are resorted to, for example phlebography(intravenous administration of a contrast agent to assess the condition of the venous system).
Treatment of chronic venous insufficiency
Treatment of CVI is a complex process, the duration of which directly depends on the stage of the disease. Therapeutic measures are divided into surgical and conservative (non-surgical). Despite the high prevalence of the disease, surgical methods account for only 10%. Timely treatment will allow you to restore normal venous blood flow and avoid complications.
Conservative treatment of venous insufficiency includes reducing the severity of risk factors, recommendations for physical activity, elastic compression, medications and physical therapy. The use of these measures in combination provides the best result.
If possible, it is necessary to identify risk factors for disease progression, such as obesity, taking oral contraceptives, and improper physical activity, and try to correct them.
Also, for each stage of the disease, the doctor must give recommendations on physical activity.
Regardless of the stage, it is recommended to: elevate your legs as often as possible, place a pillow under them at night, and wear comfortable shoes. Among the sports recommended are walking, swimming, for CVI stages 0-2 - cycling, light running. Physical education (except swimming) is carried out using elastic compression. It is necessary to exclude participation in those sports that have an increased likelihood of limb injuries and require sharp (jerk) loads on the lower limbs: football, basketball, volleyball, tennis, skiing, various types of martial arts, exercises related to weight lifting. At home, regardless of the stage of the disease, the following set of exercises can be performed.
Elastic compression - the use of an elastic bandage or medical knitwear. At the same time, due to dosed compression of the muscles of the lower extremities, the outflow of blood through the veins improves, which prevents further expansion of the veins and the formation of blood clots. In addition, the skin is protected from mechanical damage and the risk of ulcers is reduced. The use of elastic compression is indicated at any stage of the disease.
Rules for using elastic bandages:
Elastic bandaging begins in the morning, before getting out of bed. The bandage is applied from bottom to top with the obligatory grip of the foot, heel to the thigh area. Each overlying turn of the bandage should cover the previous one by half. The compression should not be intense and should not cause pain. If the bandage “slips”, it must be bandaged.
Disadvantages when using elastic bandages:
Poorly fixed on the leg;
- it is difficult to achieve the desired muscle compression;
- stretches after several washes.
Medical care is free from these shortcomings compression hosiery(socks, stockings, tights). Depending on the stage of CVI, there are 3 classes of compression (compression), which must be taken into account when purchasing these products.
Compression hosiery is not used if you have:
Severe cardiopulmonary failure
- Severe disease of the arteries of the lower extremities
- Skin lesions of the lower extremities (dermatitis, eczema, acute erysipelas, infected ulcer). IN in this case elastic compression is carried out in a special way.
At stages 0-1 of the disease, the gold standard for the treatment of cosmetic defects is sclerotherapy - a method of treating dilated superficial veins and spider veins. A sclerosant (a special substance that leads to the cessation of blood flow through this vein) is injected into the vein. Finally, the vein collapses and the cosmetic defect disappears.
At stages 0-1 for prevention, at stages 2-3 for treatment, the use of medications is necessary. Most drugs are aimed at increasing the tone of the veins and improving the nutrition of surrounding tissues. The course of treatment is long, 6 or more months.
Currently used: Detralex, Cyclo 3 Fort, Ginkor-fort, Troxevasin, Anavenol, Aescusan, Asklezan, Antistax, Phlebodia 600. The use of a particular drug, as well as the treatment regimen, should be discussed with a specialist. The use of local treatment (ointments, gels) in the absence of complications (thrombophlebitis) is inappropriate.
Stage 3 of the disease is characterized by the presence of ulcers. Treatment of trophic ulcers is a complex process, including both general and local impact. Local treatment involves treating the wound area with antiseptics, using enzymes, and, if necessary, surgical removal of dead particles. Daily - two or three times cleaning the wound using the same standard medicines(dioxidine, dimexide, chlorhexidine), and prepared at home (a weak solution of potassium permanganate, a decoction of string or chamomile). After mechanical treatment, ointment (levomikol, levosin) is applied.
Physiotherapy is of auxiliary value in chronic venous insufficiency. They are used for any degree of severity of the process according to indications. For example, diadynamic currents, electrophoresis, laser, and magnetic field have a good effect.
With good results conservative treatment Further lifestyle correction, regular physical activity, and elastic compression are recommended. The decision to conduct a second course of treatment is necessary in case of relapse of the disease, the occurrence of complications or for prophylactic purposes.
If conservative treatment is ineffective, the issue of surgical treatment is decided. In addition, surgical treatment is necessary for:
Complications of CVI (thrombosis, thrombophlebitis, bleeding).
- The presence of long-term non-healing ulcers.
- Pronounced cosmetic defect.
Surgical treatment consists of removing the damaged veins. The extent of the operation depends on the severity of the process and complications.
Rehabilitation after surgery depends on its volume, but it is necessary to mention the general principles. The seams are finally formed after 6 months, therefore, to avoid their divergence and subsequent cosmetic defects, it is necessary to exclude strong mechanical impact on them (using a rough sponge, hard clothing). You only need to wash with warm, preferably cool, water. After surgery, it is recommended to wear elastic bandages for 3 months, followed by another 3 months of elastic therapeutic stockings. In the future, elastic compression is used in case of planned “harmful” physical activity (long journeys, flights, long periods of standing, hard work). Prophylactic use of drugs that improve venous tone may be necessary.
Prevention of chronic venous insufficiency
Currently, prevention of CVI is of great importance. Following simple measures can significantly reduce the occurrence of venous disease of the lower extremities:
Maintaining an active lifestyle, alternating static loads with walking, running, swimming.
- During rest, keep your legs elevated.
- Monitor your body weight
- Wear comfortable shoes with heels up to 4 cm, if necessary, use orthopedic insoles.
- When using estrogen drugs (oral contraceptives), during pregnancy, routinely perform an ultrasound scan of the veins of the lower extremities.
- If necessary, use elastic compression and medications.
General practitioner Sirotkina E.V.
Venous insufficiency is a pathology associated with venous outflow of blood (the blood, instead of moving up, begins to move down), is accompanied by vascular disorders lower extremities or brain. This disorder has both acute and chronic forms. Venous insufficiency is often confused with varicose veins.
This disease can be considered one of the most common in the world. In some regions, up to 40% of the population suffers from it. Such a large number of patients is due to a person’s upright posture - this increases the already considerable load on the vessels of the lower extremities, which increases even more with age.
In many cases, people do not notice the first symptoms appearing of this disease or associate them with normal fatigue. Great amount patients seek help from a doctor only after the disease reaches a progressive stage.
Forms of venous insufficiency
This disease can be divided into the following forms:
- AVI (acute venous insufficiency of the lower extremities)
The occurrence of acute leg failure occurs after prolonged closure (for example, due to strong compression) of the deep veins and the resulting disruption of blood outflow. Acute venous insufficiency of the legs is accompanied by pain in the area great vessels which disappears when a cold compress is applied to them.
This phenomenon can be explained by the fact that the volume of blood in the vessels decreases under the influence of cold. In addition to pain, swelling of the legs is also possible, as a result of which the skin sometimes takes on a bluish tint. Veins located superficially cannot be affected by ROV.
- CVI (chronic venous insufficiency of the lower extremities)
It is expressed by constant disturbance of blood circulation in the vascular area. The disease in this form may be accompanied by the development of pathological changes in the process of cellular nutrition ankle joint. CVI, depending on the degree of its course, can be divided into several stages. At the initial stage of the disease, patients notice pigmentation disorders in the form of pigment spots in the area where pathological changes have already begun to appear (in the area of impaired blood flow).
In the absence of treatment for venous insufficiency of this form dark spots will become more and more, and then they can grow into soft tissues and cause the appearance of trophic ulcers that are difficult to remove. The last stage of CVI is accompanied by the formation of blood clots, pyoderma - purulent skin lesions due to the contact of pyogenic cocci in any of its areas and other pathologies.
Causes
The acute form of this disease can often occur in both older and younger people. Among possible reasons The appearance of OVN distinguishes acute forms of thrombosis, as well as injuries that necessitate ligation of veins located in deep tissues.
The main causes of CVI include diseases such as varicose veins and postthrombophlebitis disease. In addition, people with low level mobility and overweight have an increased risk of developing CVI of the lower extremities. Lifting heavy objects or working for long periods of time in an uncomfortable sitting (or standing) position can also be reasons for the appearance of this pathology.
At risk are people with best chance occurrence of CVI, the following categories of the population can be attributed:
- Pregnant and lactating women;
- Patients taking hormonal medications (including women using oral hormonal contraceptives);
- Aged people;
- Adolescents (CVI at this age may appear due to hormonal changes in the body).
Symptoms
CVI is distinguished by different symptoms at different stages of the disease. At the initial stage of its course, symptoms of venous insufficiency may either be completely absent or appear to a minor extent. Patients in this case express the following complaints:
- a feeling of heaviness in the legs, which intensifies with prolonged standing;
- increased swelling;
- periodically short-term convulsions, usually occurring at night;
- increased pigmentation of the skin in the area remote from the lower leg.
In the first stages of this disease, varicose veins are the exception rather than the rule, but sometimes they can also appear. At deeper stages of CVI, such a disorder, on the contrary, occurs in almost all patients.
As the pathology develops, the following symptoms may be added to the above symptoms:
- impairment circulatory system deliver blood to tissues located in the lower
- limbs (in the affected area);
- the appearance of trophic ulcers;
- dizziness (sometimes accompanied by fainting) caused by excessive accumulation of blood in any of the vascular areas;
- the appearance of signs of heart failure.
Usually, with the disease “venous insufficiency,” the symptoms do not appear simultaneously, but complement each other gradually.
In patients with CVI of the lower extremities, the volume of circulating blood increases (in the vessels located in this area), so they usually have a hard time withstanding the increased volume of physical and mental stress.
Classification
In Russia, phlebologists – vein specialists – have adopted the following classification of CVI, structuring this disease depending on its stage:
- Grade 0. No symptoms of CVI;
- Degree 1. Patients complain of pain in the legs, a feeling of heaviness, periodic cramps and swelling;
- Degree 2. Edema becomes more pronounced and persistent, increased pigmentation is noticeable, changes in the subcutaneous tissue of a degenerative-dystrophic nature (lipodermatosclerosis or “indurative cellulite”), dry or weeping eczema may appear.
- Degree 3. Expressed by the appearance of an open or healed trophic ulcer in the patient.
The “zero” degree was designated by Russian specialists in order to correct definition treatment of symptoms of chronic venous insufficiency of the lower extremities, as well as the disease itself. In this case, it will differ from the therapy required for CVI of the 1st or 2nd degree.
International classification of venous diseases of the lower extremities
In medical practice Another structuring of venous diseases can be used, which is called CEAP and is international. It implies a “symptomatic” division of CVI according to the following criteria:
- There are no symptoms of the disease; upon palpation (feeling), CVI also does not make itself felt.
- Sustained dilation of small vessels is noticeable, but the inflammatory process is not started.
- Varicose veins are observed.
- Swelling is observed.
- Increased pigmentation of the skin is noticeable, eczema and degenerative-dystrophic changes in the subcutaneous tissue are possible.
- There are symptoms listed in the previous paragraph in the presence of a healed trophic ulcer.
- The requirements are similar to the previous paragraph, but subject to a fresh trophic ulcer.
Each of the listed signs in this classification is considered separately, and depending on the degree of manifestation, it is given the corresponding score - “0”, “1” or “2”.
Under the auspices of this classification, the degree of disability due to venous insufficiency is also established:
- Degree 0. The patient is fully able to work, there are no symptoms of the disease, the patient does not need special therapy;
- Grade 1. The patient has some symptoms of CVI, but does not have any disability. Such patients also do not require special treatment;
- Degree 2. The patient is able to perform work only if treated with prescribed medications;
- Degree 3. Complete loss of ability to work.
In addition, there are other criteria, based on which CVI was classified into 3 types:
- CVI is a congenital disorder (EC).
- primary CVI, the cause of which is unknown (EP).
- secondary CVI with an identified cause.
Valve insufficiency
Valvular venous insufficiency is one of the types of the disease. Venous valves play important role in the fight against gravity, in addition, they take an active part in blood circulation, preventing the reverse movement of blood.
Valvular insufficiency occurs in cases where the venous valves for some reason cease to perform their functions normally. If the quality of treatment for valvular insufficiency of the veins of the lower extremities is poor, the patient may experience a deterioration in general well-being, a decrease in the body’s endurance, and an increased risk of cardiovascular diseases.
Venous cerebrovascular insufficiency (VCI)
Venous insufficiency cerebral circulation– a pathology caused by difficulty in the outflow of venous blood from the cranial cavity. With a severe cough, playing wind instruments, loud screaming, neck compression and some other phenomena, this condition often occurs in an easily reversible form.
The disease of cerebral venous insufficiency is a consequence of another exposed and progressive this moment diagnosis. Its appearance is often observed with traumatic brain injuries, osteochondrosis, bronchial asthma, various tumors brain, some pathological changes in the liver, prolonged cessation of nasal breathing and other pathologies.
In many cases, IUD is asymptomatic. With increasing deterioration of the brain's ability to adapt to working conditions with difficult blood circulation, patients may complain of frequent dizziness, memory impairment, headaches (intensified when moving the head in any direction), darkening of the eyes, swelling of the eyelids and redness of the eyes. In some cases, this disease may cause convulsions, fainting and epileptic seizures.
Therapy for cerebrovascular insufficiency involves alleviating the symptoms of the underlying disease, but if it occurs, physiotherapy, oriental massage and some other methods will not be superfluous. drug therapy.
Diagnosis of the disease
Diagnose chronic failure veins is possible using ultrasound methods - Doppler ultrasound and duplex ultrasound scanning.
Doppler ultrasound allows you to study the flow of blood flow in a particular patient due to the ability of waves to change frequencies when interacting with the object being studied. In addition, with the help of this manipulation it is possible to determine due to the reflection of ultrasonic waves from red blood cells.
Duplex ultrasound scanning is a research method that also makes it possible to determine the presence of pathologies regarding the flow of blood, as well as to objectively assess the condition of the veins.
To determine the cause of CVI, radiopaque contrast films are used. diagnostic methods, for example, phlebography. Phlebography is carried out in the following way: a contrast agent is injected into the vein being examined, after which it is examined using radiography.
Treatment
Treatment of venous insufficiency of the lower extremities is carried out using both conservative (with the help of medications) and surgical methods. The use of medications without surgical intervention is effective in cases where the disease has not yet reached an advanced stage. In addition, the “therapeutic” approach will be rational in preparation for operations and during the recovery period after it.
Treatment of CVI is carried out with phlebotropic (venotonic) drugs related to pharmacological group angioprotectors.
Phlebotonics include the following drugs:
- Phlebodia. Available in tablet form. It is used to eliminate the symptoms of swelling, and is used to restore normal blood circulation in the vessels;
- Detralex. Tonic tablets for veins, reducing the distensibility of the walls of blood vessels;
- Angistax. The drug is available in the form of capsules, gel and cream. It has a herbal composition, including red grape leaf extract. It has a venotonic effect and normalizes blood movement through the vessels. To increase the effectiveness of therapy, it is advisable to use both oral and external shape drug;
- Troxevasin. A medicine available in the form of capsules and gel, which in most cases are preferably used simultaneously. The drug is able to relieve inflammatory syndrome and has an antioxidant effect;
- Aescusan. Drops for oral administration. The drug contains vitamin B1, which helps dilate veins, and horse chestnut extract, which has an analgesic effect caused by venous diseases.
Drugs for the treatment of venous insufficiency of the lower extremities must be taken under the supervision of the attending physician in order to prevent the development of the disease.
In addition to phlebotonics, if necessary, the doctor may prescribe non-steroidal anti-inflammatory drugs such as Meloxicam and Diclofenac, as well as blood thinners.
To treat severe forms of CVI, when trophic ulcers occur on the skin, antibiotics of the penicillin series and the cephalosporin group can be prescribed. Their use can protect the body from sepsis and other possible serious consequences.
Rules for applying compresses
A cold compress is prepared and applied as follows:
- Two pieces of gauze are folded several times and placed in a container with cold water or ice. 2 pieces are necessary for continuous therapy - while one piece of gauze is applied to the inflamed area in the form of a compress, the second is cooled at this time.
- After both compresses have cooled sufficiently, one of them is placed on the affected surface and held there for 2 to 3 minutes. After this time, the compress is changed, and the “spare” one is cooled for reuse.
- The above procedure must be repeated for at least 1 hour.
After eliminating the acute stage of inflammatory processes, the use of warming ointments that slow down blood clotting (for example, heparin) is allowed. The use of this ointment is permitted in the form of a warm compress. To apply such a compress correctly, you must adhere to the following procedure:
- Fold the gauze used for the compress into 3–4 layers.
- Soak the piece of gauze you are using with an ointment with a warming effect.
- Apply gauze to the affected area.
- Cover the soaked gauze with a plastic or compressor bag.
- A sufficient amount of cotton wool should be placed on top of the bag for insulation, or even better, the compress should be insulated with woolen cloth. Secure the finished compress with a bandage. Leave it overnight.
In the morning, the area of the leg subjected to compression therapy must be treated with alcohol.
Radical methods of treating venous insufficiency
In particularly severe cases, more radical approaches to treating the disease may be required, namely surgical intervention. IN modern medicine For these purposes the following manipulations are used:
- sclerotherapy. A procedure in which a special drug is injected into the lumen of the vessel, gluing its walls and causing subsequent resorption of the damaged vein. The manipulation is relatively painless, local anesthesia for its implementation it will be a completely sufficient method of pain relief. Used to remove veins of small diameter;
- laser surgery. A manipulation in which damaged veins are irradiated with laser light from the inside, after which they are glued and subsequently resorbed. The procedure does not require surgical incisions. With the help of laser surgery, it is possible to remove both large damaged veins and varicose veins on the legs;
- surgical removal of damaged veins. It involves the need to make incisions to gain access to the damaged vein, ligate it and then remove it. The operation is carried out only under general anesthesia. Surgical removal large diameter veins are exposed.
A timely visit to a doctor will avoid the need for the described manipulations, and, possibly, completely cure this pathology.
The term “venous insufficiency” is used in medicine to indicate the mechanism of pathological changes. Any disease associated with impaired venous blood flow to the right side of the heart is eligible. Statistics show that in different forms This disease affects up to 40% of the population.
You cannot “blame” only the structure of the veins. There may be a variety of factors underlying this. The division into venous insufficiency as a consequence of general circulatory failure and local stagnation in peripheral vessels. In this case, both the veins of the lower extremities and the brain are considered “equally extreme”.
Chronic or acute venous insufficiency is accompanied by stagnation and overflow of the venous bed, compression of adjacent tissues, and oxygen deficiency of organs and systems.
Main pathological changes
It is known that the venous vessels of most of the body are constantly working against the force of gravity. They push blood upward when a person is in an upright position. For this, the walls of the veins have sufficient muscle tone and elasticity.
Great importance attached to the valve apparatus, thanks to which the blood mass is kept from returning to the lower sections.
Local changes in the venous vessels most often occur in the legs. Due to loss of tone and sagging valves, the liquid and thick parts of the blood overflow. The portion of the reverse flow allowed by the valves is called the amount of reflux and determines the degree of venous dysfunction.
The international classification considers the signs of venous insufficiency according to the causes of occurrence:
- failure as a consequence of injury, thrombosis and other identified diseases;
- genetic predisposition;
- the specific reason has not been established.
According to the anatomical location of the affected vessels:
- a specific vein is called, for example, the inferior vena cava or the greater saphenous;
- the level and depth of the lesion are indicated (superficial, deep or internal anastomoses).
Clinical manifestations on the extremities
Depending on the clinical signs It is customary to distinguish 6 types or stages of the disease:
- there are no visible signs of vein pathology;
- there are dilated “spiders” in the superficial veins (telangiectasia);
- varicose veins on the legs are manifested by protruding strands;
- persistent tissue swelling occurs;
- changes in the trophism of the skin of the feet and legs in the form of peeling, non-healing cracks, dryness;
- characteristic scars from a healed ulcer;
- fresh ulcers on the skin, without scarring.
The acute form differs from the chronic form in the rapid increase in symptoms. Almost immediately the following appear:
- swelling of the legs;
- bursting pain along the vessels, which does not go away when changing body position or at rest;
- the subcutaneous pattern of veins clearly protrudes;
- cyanosis of the skin (cyanotic) - depends on the optical effect (flor contrast phenomenon), when longer light waves (red) are absorbed by the fibers of the dense connective tissue of the skin, and short-wave radiation (blue color) has greater penetrating ability, reaching the cells of our retina and “ show a bluish range of colors.
At acute form venous insufficiency, the leg swells and takes on a cherry tint
Diagnostic value
Help to confirm the doctor’s opinion:
- leukocytosis and accelerated ESR in a general blood test, as a reaction to nonspecific inflammation inside the vein and pain;
- changes in coagulogram parameters indicating increased coagulability;
- Ultrasound examination - allows you to determine the area of expansion and size, localization of a blood clot, varicose nodes;
- Phlebography is used only when the ultrasound conclusion is unclear; a contrast agent is injected intravenously, then a series of X-rays are taken.
Can venous insufficiency be detected in children?
Children have venous insufficiency cerebral vessels associated with:
- violation of maternal behavior and nutrition during pregnancy;
- birth injuries from the application of a vacuum extractor;
- traumatic brain injury after birth;
- prolonged screaming for any reason;
- cough.
The child notices:
- dizziness and unsteadiness when walking;
- frequent complaints of headaches;
- increased fatigue;
- inability to concentrate.
Aggression may be caused by cerebral venous insufficiency
At school age, in addition to headaches, the following appear:
- memory loss;
- inability to study with due diligence;
- tendency to faint;
- apathy;
- weakness and tremors of the hands;
- cyanosis of limbs, lips, ears.
IN childhood You can’t ignore the listed symptoms. The child undergoes the same types of examination as an adult. It is especially important to identify the cause of the deficiency and treat before serious complications develop.
Manifestations in pregnant women
In pregnant women, the main mechanism is usually the pressing action of the growing uterus on the inferior vena cava and iliac veins, increasing blood mass. This leads to slow blood flow and sagging saphenous veins. The pathology is called phlebopathy.
It differs from varicose veins in the legs by symmetrical lesions on both sides and variable swelling of the feet and legs. Goes away on its own after childbirth.
Pregnant women are at risk of developing varicose veins and venous insufficiency in the legs
Chronic form According to statistics, up to 35% of pregnant women suffer from venous insufficiency. For most women it appears for the first time. Vein dilatation is detected in 1/3 in the first trimester, in the rest - later.
All the signs characteristic of external varicose veins and stagnation appear: pain, swelling, weakness. At the same time, there is an expansion of the hemorrhoidal outer ring of blood vessels. Women often complain of constipation and painful bowel movements.
The disease leads pregnant women to gestosis, labor disturbances, chronic oxygen deficiency of the fetus, bleeding during childbirth and early pregnancy. postpartum periods.
It is important that venous insufficiency sharply increases the risk of thromboembolism in the brain and pulmonary artery.
Treatment
Treatment of venous insufficiency requires identifying the specific cause of the disease. It makes no sense to use only symptomatic drugs. They can only give a temporary effect.
For acute venous insufficiency of the legs therapeutic measures carried out in 2 stages:
- As first aid, apply a cold compress and change it every 2-3 minutes by dipping the cloth in a container of ice. These actions are repeated for about an hour.
- To subsequently relieve inflammation, it is recommended to use ointment preparations with anticoagulant components.
For chronic venous insufficiency of the extremities, it is recommended to wear compression garments and course medications. If the symptoms are caused by heart failure, medications are used that increase myocardial contractility (cardiac glycosides) and remove excess fluid (diuretics). At the same time, means are needed to restore energy balance.
Management of pregnant women (as some people call a management plan in a Western manner) provides for preventive measures in the form of compression stockings in the first trimester and special tights with thick pads in the lower abdomen - from the second trimester.
With increased intracranial pressure Eufillin and diuretics have a good effect. If the cause is a tumor process, specific treatment is prescribed (chemotherapy, radiation exposure). A consultation with a neurosurgeon determines the possibility of tumor removal.
In preparing hazelnut infusion, the bark, fruits and leaves are equally important.
The following are prescribed as drug therapy:
- venotonics - Diosmin, Detralex, Phlebodia, Vasoket;
- angioprotectors - Troxevasin, Rutoside, Aescusan drops, Venoruton;
- For local application recommended - heparin ointment, Lyoton gel, Troxevasin, Hepatrombin;
- disaggregants that prevent the formation of blood clots - Aspirin, Dipidamol, Pentoxifylline.
For sleep disturbances, herbal sedatives are prescribed. Mental changes require consultation with a psychiatrist and combination therapy.
Important attached to the elimination of risk factors. Some patients are recommended to change jobs, avoid strenuous sports, control weight, and engage in vigorous physical activity alternating with rest.
Alone folk remedies it is impossible to cope with venous insufficiency. But it is not forbidden to add herbal decoctions from the advice of healers to the main treatment:
- It is better to purchase horse chestnut extract at a pharmacy, since it is inconvenient to prepare it yourself;
- alcohol tincture of Kalanchoe is used for lotions and compresses in the treatment of trophic ulcers;
- Preparations from Sophora japonica have an anti-inflammatory, venotonic and healing effect.
All methods of therapy must be discussed with the attending physician. This is especially true for the treatment of children and pregnant women. You should not take risks and try untested products on yourself and cause harm.
For quotation: Klimova E.A. Chronic venous insufficiency and methods of its treatment // Breast cancer. 2009. No. 12. P. 828
Chronic venous insufficiency (CVI) of the lower extremities is a syndrome characterized by disturbances of venous outflow, which lead to disorganization of the regional microcirculation system. CVI is a common disease, occurring in 10-15% of the adult population. This is a syndrome that develops with a polyetiological disease - varicose veins of the lower extremities. Thus, a group of leading Russian phlebologists developed a capacious definition: “Varicose veins of the lower extremities is a polyetiological disease, in the genesis of which heredity, obesity, disorders hormonal status, lifestyle features, as well as pregnancy. The disease is manifested by varicose transformation of the saphenous veins with the development of CVI syndrome.” The disease is characterized by high prevalence. Thus, in the USA and Western European countries, about 25% of the population suffers from various forms of varicose veins.
Etiology
However, the etiology of CVI is currently still a debated issue. Modern studies of the functions of the endothelium indicate the dominant role of venules in this pathological syndrome. In the lower extremities, the surface area of the venules in contact with blood is greater than in all other venous vessels combined. Endothelial cells, due to their location at the interface between blood and other tissues, are responsible for maintaining vascular homeostasis. They regulate the passage of plasma and leukocyte contents from the bloodstream into the interstitium. These properties of the endothelium are associated with the presence of specific molecules - membrane receptors, adhesion molecules, intracellular enzymes and a special configuration of the cytoskeleton. Also, endothelial cells synthesize various substances that regulate platelet functions - platelet-activating factor, prostaglandins; leukocytes - interleukin-1, interleukin-8, granulocyte-macrophage colony-stimulating factor; smooth muscle cells - endothelin, growth factors. Inflammatory or other pathological processes in the inner wall of venules activate endothelial cells. The activated endothelium releases inflammatory mediators, which leads to the influx, adhesion and activation of polymorphonuclear neutrophils and platelets. If this process becomes chronic, T-lymphocytes and monocytes attach to the surface of the endothelium, which release highly reactive radicals, ultimately leading to the destruction of the endothelial barrier of the venules. Contact that occurs between plasma coagulation factors and tissue factor located in the extravascular space, and especially on the pericytes of adjacent capillaries, can trigger intravascular coagulation.
Until recently, in the domestic literature one could find various forms of classification of varicose veins of the lower extremities and CVI. In 2000, at a meeting of experts, “Standards for the diagnosis and treatment of varicose veins of the lower extremities” were adopted. Based on these standards, our country currently operates the classification presented in Table 1.
Pathogenesis
The leading place in the pathogenesis of CVI is occupied by the “valve” theory. Valvular insufficiency of various parts of the venous bed of the lower extremities leads to the appearance of pathological, retrograde blood flow, which is the main factor in damage to the microvasculature, which was proven using X-ray contrast venography, and then using non-invasive ultrasound methods. Indirect confirmation of the “valve” theory of CVI were the results of well-known epidemiological studies conducted in Germany and Switzerland, on the basis of which it was concluded that there is a primary need for correction of valvular insufficiency of the venous bed using elastic compression or surgically. However, the question remained about the cause of the development of valve insufficiency itself as a trigger for the development of CVI. Thus, a large number of patients were found with complaints characteristic of CVI in the absence of valve pathology. At the same time, the use of various variants of plethysmography recorded a violation of the tone of the venous wall of varying degrees of severity. Thanks to this, the hypothesis was put forward that CVI is not a valve disease, but a pathology of the vein wall.
It has now been proven that if there is various factors risk and under the influence of gravity in the venous knee of the capillary, the pressure increases, reducing the arteriovenular gradient necessary for normal perfusion of the microvasculature. The consequence is first periodic and then constant tissue hypoxia.
TO the most important factors The risk of developing CVI includes:
1) Pregnancy and childbirth.
2) Heredity.
3) Excess body weight.
4) Chronic constipation.
5) Hormonal contraception.
6) Systematic sports activities.
In addition, constant changes in body position and uneven load on various departments the venous bed of the lower extremities triggers another little-studied mechanism, called mechanotransduction, or shear force. This means that under the influence of pressure constantly changing in strength and direction, a gradual loosening of the connective tissue frame of the venule wall occurs. Disruption of the normal intercellular relationships of the endothelium of venous capillaries leads to the activation of genes encoding the synthesis of various adhesion molecules.
The main symptoms that occur with CVI are: heaviness in the legs, pain in the calf muscles, which is caused by a decrease in venous tone and hypoxemia; cramps, swelling of the lower extremities in the evening, which is caused by overload of the lymphatic system, increased capillary permeability and inflammatory reactions; constant skin itching. More often these symptoms are combined.
Treatment
Commonly accepted treatments for CVI include pharmacotherapy, compression therapy, and surgical treatments. The mechanical method of therapy, which is effective only during its application, does not affect the significantly increased permeability of the venule endothelium. This effect can only be achieved through pharmacotherapy, using a drug that binds to the endothelium of venules and has the ability to suppress or prevent inflammation, leading to a decrease in the permeability of small vessels and, as a consequence, a decrease in edema.
Compression therapy can improve the activity of the muscle-venous pump of the leg, reduce swelling and relieve heaviness and bursting pain in the legs. The greatest comfort for the patient and optimal physiological pressure distribution is achieved using special therapeutic knitwear.
Surgical treatment: the initial form of varicose veins (telangiectasia and reticular varicose veins) is only a cosmetic problem, and that’s all external manifestations can be completely eliminated using modern techniques such as sclerotherapy. The main goal of surgical treatment is to eliminate the mechanism of the disease, namely, pathological veno-venous discharges. This is achieved by crossing and ligating insufficient perforating veins, sapheno-femoral and sapheno-popliteal anastomosis. With the development of modern minimally invasive technologies, old ideas about venectomy as a voluminous and traumatic operation are a thing of the past.
Drug treatment
Among the main drugs used at all stages of the disease, the most widely used are venotonics, or phleboprotectors. These are a variety of pharmacological drugs that share a common property - stabilizing the structural components of the venous wall and increasing its tone. Of the main venotonics, the best studied are g-benzo-pyrones - flavonoids, preparations based on micronized diosmin. At severe forms CVI, accompanied by a violation of the hemostatic system with the development of hyperviscosity and hypercoagulation syndromes leading to thrombosis, anticoagulants are used as a means of basic therapy. Among anticoagulants, the most convenient to use is low-molecular-weight heparin, which causes a lower incidence of hemorrhagic complications, rare thrombocytopenia, has a longer action and does not require frequent laboratory monitoring compared to unfractionated heparin. Subsequently, indirect oral anticoagulants, represented by coumarin and phenidine derivatives, are used; their dose is individually selected depending on the value of the international normalized ratio. To specifically improve hemorheology and microcirculation, platelet disaggregants are used. The most commonly used are low molecular weight dextrans, dipyridamole and pentoxifylline. In recent years, the possibility of using clopidogrel has been studied, which appears to be more appropriate.
Also, auxiliary, symptomatic agents are used to treat CVI. For example, antibacterial and antifungal agents - for infected venous trophic ulcers or in case of development erysipelas. Anti-histamine drugs are prescribed for the treatment of such common complications of CVI as venous eczema and dermatitis. In cases of severe edematous syndrome, it is advisable to use potassium-sparing diuretics. NSAIDs are used for severe pain and convulsive syndromes, as well as for aseptic inflammation of the skin of the lower leg - acute indurative cellulite. Also, do not forget to use acetylsalicylic acid(ASA), which is perhaps the only representative of NSAIDs actively used in phlebological practice. Under the influence of ASA, the aggregation response of platelets to various thrombogenic stimuli is weakened. In addition, ASA suppresses the synthesis of vitamin K-dependent coagulation factors, stimulates fibrinolysis, and suppresses the lipoxygenase pathway of arachidonic metabolism in platelets and leukocytes. The usual dosage is 125 mg ASA per day. Corticosteroids are used in the most severe forms of CVI, accompanied by acute indurative cellulite, venous eczema, hemosiderosis, lamellar dermatitis, etc.
Topical medications (ointments and gels) occupy an important place in the treatment of CVI and are very popular among both doctors and patients. This is due to the fact that the cost of these drugs is relatively low, and their use is not associated with any difficulties. Ointments and gels based on venoactive drugs, along with some distracting effects, can have veno- and capillary-protective effects. An example of the highest quality drug presented on the Russian pharmaceutical market is Venitan gel or cream for external use. Active substance Venitana escin - active ingredient Chestnut fruit extract is a mixture of triterpene saponins. Escin has anti-inflammatory, angioprotective properties, improves microcirculation, reduces capillary permeability, prevents the activation of lysosomal enzymes that break down proteoglycan, reduces the “fragility” of capillaries and increases the tone of the venous wall, which helps reduce stagnation in the venous bed and fluid accumulation in the tissues, thereby preventing the appearance of edema (Fig. 1).
The most favorable effect of using this drug is achieved when using Venitan on initial stages development of chronic venous insufficiency.
Of particular note is the new form of the drug - Venitan Forte, which in addition to escin contains heparin; this combination acts not only on the venous wall, but also on the blood flow inside the vessel. Venitan Fotrte also contains dexpanthenol and allantoin, which improve the absorption of heparin and escin through the skin, promote tissue regeneration and improve skin condition. The drug is used not only for the initial stage of development of chronic venous insufficiency, but also for severe symptoms of venous insufficiency (stage II, III): swelling, a feeling of heaviness, fullness and pain in the legs, for the complex treatment of varicose veins and thrombophlebitis of the superficial veins. The mechanism of action of the drug Venitan Forte is presented in Table 2.
The doctor should not forget that the treatment of chronic venous insufficiency is complex measures aimed at both the pathogenetic mechanisms of the development of the disease and various etiological factors. For successful treatment it is necessary to rationally and balancedly use the existing arsenal of drugs, compression stockings and surgical methods of treatment.
Literature
1. Savelyeva V.S. Phlebology. Guide for doctors. M.: Medicine, 2001.
2. Kirienko A.I., Koshkina V.M., Bogacheva V.Yu. Outpatient angiology. Guide for doctors. M., 2001.
3. Becker C., Zijistra JA. New aspects of the pathogenesis of chronic venous insufficiency and the direction of action of oxyrutins. Consilium-Medicum Volume 3/N 11/2001.
4. Bogachev V.Yu. Initial forms chronic venous insufficiency of the lower extremities: epidemiology, pathogenesis, diagnosis, treatment and prevention. Consilium-Medicum Volume 06/N 4/2004.
5. Bogachev V.Yu. Chronic venous insufficiency of the lower extremities: modern principles treatment. Consilium-Medicum. Volume 05/N 5/2000.
