Chronic venous insufficiency (CVI) is a pathology which mainly affects the blood vessels (veins) of the lower extremities. In this syndrome of disturbed venous outflow, resulting in disruption of regional microcirculation (blood ow). CVI develops on the background of varicose disease, characterized by the transformation of the saphenous veins.
Please note:the main reasons for the development of varicose veins include genetic predisposition, hormonal imbalances (including pregnancy), metabolic disorders (obesity) and the specifics of the patient’s lifestyle (in particular physical inactivity or increased load on the legs).
According to the international classification for CVI include:
The prevalence of the syndrome in the population
According to statistics, chronic venous insufficiency is diagnosed in 10-15% of adults. According to the world health organization in the United States and several European States from this disease suffers almost every fourth.
Important:humans are the only creatures on the planet who have may develop CVI. The appearance of pathology is directly related to the movement in the vertical position.
In our country chronic diseases of the veins three times more often diagnosed in women (prevalence in the population reaches 62%). Until relatively recently, atherosclerosis was considered to be characteristic of patients 50 years and older. Now the early signs of venous reflux (abnormal backward blood flow) in some cases detected even in adolescents.
During pregnancy varicose veins are diagnosed in almost half of the patients. Some form of CVI detected in 85% of expectant mothers.
The causes of disease and predisposing factors
Among the factors that increase the likelihood of developing CVI include:
- hereditary (genetically determined) predisposition;
- frequent (chronic) constipation;
- sedentary lifestyle;
- prolonged static load;
- frequent overheating of the body;
- excess weight or obesity;
Previously it was thought that the immediate cause of CVI is valve dysfunction in different areas of the venous system of the lower extremities. To date revealed many cases of syndrome without violations on the part of the vein valves, so there is reason to think that venous insufficiency is caused by abnormalities of the vascular walls. Great importance is attached to microcirculatory disorders and damage to the endothelial layer.
Please note:there is a hypothesis according to which the defeat of the venous valves caused by “leukocyte aggression,” i.e., infiltration of leukocytes.
Adhesion (sticking) of leukocytes plays a crucial role in the pathogenesis of CVI patients with chronic venous hypertension. These blood cells is able to partially occlude vessels of small caliber. The accumulation of the leukocytes leads to the release of proteolytic enzymes and metabolites of oxygen from the granules of the cytoplasm, which leads to chronic aseptic inflammation and, as a result of trophic disorders and thrombosis.
Pregnant women in the later stages the uterus is able to compress the inferior caval and iliac vein, twice reducing the blood flow through the femoral veins. Elevated levels of progesterone leads to a decrease of the tonus of the vessel walls, one and a half times increasing their extensibility. The condition of the veins is normalized after 2-3 months after delivery. Complications during pregnancy and its mismanagement can cause serious complications (thrombosis and thromboembolism).
Classification and the degree of chronic venous insufficiency
According to one of the classifications there are 3 forms of chronic venous insufficiency. The first is characterized by lesions of the saphenous veins and their tributaries 1-2 orders of magnitude. While the second reveals the extension and lengthening of small surface vessels. The third form is telangiectasia (persistent extension with the formation of spider veins or veins).
The most convenient is clinical classification, which is based on objective signs of pathology.
It includes 7 classes:
- — during the inspection and palpation of the study of vascular pathology is not detected;
- — telangiectasias or reticular veins (mild varicose);
- — varicose veins;
- — chronic swelling;
- — symptoms of skin (venous eczema, hyperpigmentation, etc.);
- — cutaneous manifestations combined with sagusa trophic ulcer;
- — skin lesions + active sores.
The symptoms of chronic venous insufficiency
Classic symptoms of vein disease are:
- a feeling of heaviness in the legs;
- pain pulling and aching;
- convulsive twitching of the muscles of the lower extremities (particularly the calf);
- trophic skin lesions (ulcers).
In the initial stages of development, clinical manifestations are non-specific. Patients generally complain of vague discomfort in the legs and cosmetic defects – telangiectasia.
In rare cases at an early stage possible changes in the skin and muscle spasms at night.
With the development of pathology is edema of the ankles and feet, increasing to the end of the day. The calf muscles begin to ache and a feeling of “crawling ants” (possible burning and itching). The sensitivity in the legs is reduced; in parallel, there is a cold extremities, caused by violation of local blood flow. The skin in the area of the legs becomes dry, it visually identifies areas of hyperpigmentation. In severe venous insufficiency discomfort and fatigue in the legs of the patient are constantly pursuing.
The severity of symptoms increases during exercise and under the influence of heat. The pain intensity is not always correlated with the degree of enlargement of the superficial veins. The pain caused by the reflux of blood against the background of valvular insufficiency.
When running CVI formed poorly healing trophic ulcers and, often, acute thrombophlebitis.
Among the complications of the syndrome of venous insufficiency include:
- thrombophlebitis (blockage of the lumen of blood vessels with concomitant inflammation);
- phlebitis (inflammation of the vascular walls);
- periflebity (inflammation of the surrounding tissue along the vessels).
Important:tromboamboliceski complications often preceded by erythema of the skin in the projection of the affected veins.
For chronic venous insufficiency is characterized by the reduction of the severity or complete disappearance of symptoms when walking or performing active movements in the ankle joint.
Diagnosis requires a medical history, physical examination and a palpation study of subcutaneous and deep veins.
Please note:even in the absence of varicose changes, visual inspection is often determined by the vascular pattern, which suggests a decrease in the tone of the vein walls. The modified vessels are characterized by increased sensitivity upon probing.
The most informative methods of hardware diagnostics is ultrasound dopplerography and duplex scanning. With their help, in particular, define the reverse zone of the casting of blood and clears clots.
To assess the status of the valves and the degree of patency of the perforated, deep and saphenous veins are used for compression tests.
Necessarily conducted a study of gemostaziogramma what the patient fasting blood is taken from veins. The analysis determined prothrombin index, fibrinogen, platelet aggregation, etc.
Chronic venous insufficiency it is important to differentiate with circulatory failure (on the background of ischemic heart disease, myocarditis and cardiomyopathies), kidney damage (in particular glomerulonephritis), lymphedema, and reactive polyarthritis.
Treatment of chronic venous insufficiency
The most important tasks of therapy are to prevent progression of the pathological process and thromboembolic complications.
Important: thrombophlebitis, pulmonary embolism and deep vein thrombosis is grounds for immediate space of the patient to the relevant Department of a hospital.
One of the main methods of treatment of CVI is the use of pharmacological preparations of local action (for example, venitan and Venitan-Forte). They reduce swelling and decrease the heaviness in the legs, fatigue and muscle spasms.
Especially effective are ointments and gels containing heparin. Note that this substance reduces the severity of local symptoms, but does not prevent the probable complications are thromboembolic in nature. Gels with heparin useful as a component of complex therapy.
Pharmacotherapy of venous insufficiency of any origin involves the prescribing of medication to improve the condition of the vascular walls of phlebotonics (phleboprotector). Currently, the Russian Federation has registered over two dozen of venotonic drugs. These drugs have systemic effects, so not only improve the condition of the vessels of the legs, but also have a beneficial effect on the veins of the small pelvis, retroperitoneal, etc. Drugs in this group (e.g., Diosmin or Naphazoline) take courses whose duration typically ranges from 1 to 2.5 months.
The positive effect is usually observed after 3-4 weeks of treatment. If a particular drug does not work, the question of his replacement or increase dosages.
To improve blood rheology and microcirculation shows platelet disaggregants – Pentoxifylline, Clopidogrel and Dipyridamole.
To combat pain, the patient need to take NSAIDs, the most effective of which is known to all acetylsalicylic acid. It not only reduces pain, but also reduces platelet aggregation and promotes fibrinolysis.
If you develop dermatitis or skin eczema, appointed antihistamines. When erysipelatous inflammation or infected trophic ulcers of the necessary antibacterial and antifungal therapy. Pronounced edematous syndrome is an indication for prescription of potassium-sparing diuretics.
In severe cases, prescribed hormonal therapy (corticosteroids).
The goal of surgical treatment against the leading etiological factor, i.e., a reflux of blood. Affected vein and anastomosis during the operation, overlap or bind. To surround and traumatic interventions such as penectomy, now almost running.
Please note: eLa the prevention of CVD, especially during pregnancy, it is advisable to wear special compression stockings. It can reduce swelling, improve Central hemodynamics and speed of venous blood flow, reduce the diameter of the veins and reduce veno-venous reset. Compression therapy is able to stimulate the drainage function of the lymphatic system.
Plisov Vladimir, doctor, medical commentator