Chronic venous insufficiency
Chronic venous insufficiency - it is a symptom that occurs when impaired blood flow in the lumen of the veins.This pathology is a modular concept and includes several diseases associated with similar clinical manifestations: venous vascular malformations network traumatic venous postromboticheskaya disease and varicose veins of the lower limb disease.
danger of this disease lies in its long period hidden symptoms and delayed treatment of patients for medical help.Generally, a vascular surgeon to treat patients in the later stages of the disease with complications and pronounced cosmetic defects that are very difficult healing process.
Chronic venous insufficiency of the lower limbs veins
Chronic venous insufficiency of the lower limbs vein occupies a leading position among all known vascular pathologies.The incidence of the pathological condition in women is 3 times higher than the incidence among the male half of the population.This pattern is due to the
Pathogenesis occurrence of chronic venous insufficiency of lower limb veins is that prolonged obstruction of outflow of blood veins, occur for any particular reason, the conditions for increasing the pressure in the lumen of the vein and, as a consequence, its extension.
Expansion of the lumen of the venous vessel entails the development failure of the valve apparatus, there is an incomplete closure of the valve leaflets, and therefore, the blood moves not only up, but flows away downwards.At this stage of the disease occur feeling of heaviness in the legs and overcrowding, as well as through the skin dilated superficial veins are visualized.
If untreated, the pressure in the venous vessels increases and the walls of blood vessels lose their elasticity.Ultimately vascular permeability increase, and this process is manifested as appearance of regional edema of lower limbs.Trophic disorders occur as a result of compression of the surrounding soft tissues and the violation of their power.
Chronic venous insufficiency causes
main etiological factor for chronic venous insufficiency is a decrease in blood flow in the veins, resulting from a violation of the system-venous muscle pump.Considered normal venous outflow blood when 90% of the moves in the deep vein system and 10% in the surface veins.In order that the blood did not flow down under the weight down and moved to the heart, all the vessels of the lower limbs venous valves are available.In addition, the promotion of blood to the heart muscle contractions contribute to the large muscles of the lower extremities, located in the projection of the femur and tibia.
In this regard, all the causes that lead to violations of the valve apparatus of the veins and the absence of muscle contractions of large muscles of the lower extremities, inevitably lead to chronic venous insufficiency.
most common cause of the disorders associated with the emergence of chronic venous insufficiency is phlebothrombosis, and related inflammatory changes in the vein wall (thrombophlebitis).
modifiable and non-modifiable There are risk factors that can not independently cause chronic venous insufficiency, but exacerbate it over and provoke complications.
To modifiable risk factors include obesity, physical inactivity, prolonged stay in a person sitting or standing position, regularly lifting heavy objects, chronic colitis with constipation.
non-modifiable factors of chronic venous insufficiency: gender, genetic inheritance of this disease (a congenital lack of the content of collagen fibers in the wall of the venous vessel for causing weakness of the venous tone).
Chronic venous insufficiency symptoms
The main symptoms indicating the development of chronic venous insufficiency include: a feeling of heaviness in the lower extremities, pain Expander nature in the projection of the tibia, the presence of paresthesias, and seizures.Depending on the duration of these symptoms of the disease have varying degrees of severity.
main sign of chronic venous insufficiency is that all of the above clinical manifestations worried sick after a long stay in a standing position and improvement observed even after a short rest to ensure limbs.
With increasing pressure in the veins and venous insufficiency of the valves, significantly worsens the patient's condition - there are external changes in the form of a network of education subcutaneous veins and changes of the skin in the form of dermatitis, and venous ulcers of the lower extremities.
Under the stagnant venous dermatitis meant the emergence of brown hyperpigmentation in combination with induration of the surface layers of the skin and the appearance of fibrosing subcutaneous panniculitis.
varicose ulcers, unlike venous ulcers arising from the violation of blood circulation develops suddenly after the slightest trauma of the skin and are located superficially, ie do not penetrate deep fascia.A typical arrangement of ulcers is the area of the medial malleolus.Patients report painfully these plagues, and the emergence of local edema of the lower extremity.
emergence of lower extremity edema can be due to other causes, so should be a differential diagnosis with other diseases with similar chronic venous insufficiency of the clinical manifestations.
Cardiovascular diseases are accompanied by the appearance of swelling, but they are often localized, and there is double-sided, depending on the exercise.When deforming arthritis limited mobility in the joint is often accompanied by swelling, but this type of edema, on the contrary, disappears after exercise.When lemfedeme marked edema, but its localization often projected in the hip area and no trophic changes of the skin.
In chronic venous insufficiency occur central hemodynamic disturbances which are caused by the redistribution and accumulation of venous blood in the dilated venous vessels of the lower limbs and its deficiency in the brain, heart and lungs.Clinically, these changes are manifested in the form of short-term loss of consciousness, fatigue, drowsiness, headache and dizziness.
degrees of chronic venous insufficiency
presence of only one symptom or set of clinical manifestations suggest that the patient develops chronic venous insufficiency.Classification of the disease based on the severity of clinical symptoms and complications, and represented by four degrees:
0 degree - no any clinical manifestations, despite the presence of the extended visual subcutaneous venous network.
1 degree - the feeling of heaviness in the legs in the evening and the emergence of local swelling in the ankles, which disappear in the morning.Visually note the presence of telangiectasias on the surface of the skin of the lower extremities.
2 degree - arching burning pain in the lower extremities and swelling are ongoing and intensified after physical exertion.External signs is the appearance of areas of hyperpigmentation and Lipodermatosclerosis on the surface of the skin.Over areas of varicose veins marked thinning of the skin and local itching.
3 degree - to the occurrence of the above symptoms joins trophic changes of the skin in the form of ulcers and related complications - thrombosis, bleeding ulcers.
In practice phlebologists use another classification that allows to assess the patient's disability:
0 degree - the patient does not complain, and when an objective examination of the patient is not determined by the changes;
1 degree - the patient complains of a feeling of heaviness in the lower limbs at the end of the day, during the inspection visualized telangiectasia and varicose veins, the patient is considered to be able to work without the use of drugs;
2 degree - the clinical symptoms of chronic venous insufficiency are observed throughout the day, and the patient is able to work is recognized only when the use of drugs;
3 degree - the patient is incapacitated.
Chronic venous insufficiency treatment
to determine the tactics of patients with chronic venous insufficiency is necessary to conduct a comprehensive examination of the patient, which includes not only the objective research methods and instrumental methods to determine the root cause of this disease (ultrasonography of lower extremities vessels, contrastvenography).
the main approaches to the treatment of patients with chronic venous insufficiency are: continuity, comprehensiveness (a combination of different methods of treatment) and personality.
duration and method of treatment of chronic venous insufficiency is directly dependent on the stage of disease and presence of complications.There are two basic ways of treatment: conservative and operative.In most cases, to achieve positive results fails conservative treatment, which consists of several areas: addressing modifiable etiologic risk factors, the use of drugs, the recommendations of physiotherapists, physiotherapy and the use of elastic compression.
mandatory step treatment in patients with chronic venous insufficiency is a correction of their physical activity - a special set of training exercises and the exclusion of certain sports that involve sudden quick movements and lifting heavy objects.Permitted sports include swimming and hiking with the mandatory use of means of elastic compression.
Among the means for elastic compression is most effective: medical jersey and elastic bandages.Application of elastic compression effectively reduces the risk of disease progression, and therefore, this method of treatment is used in all stages of chronic venous insufficiency.
Useful properties of elastic compression means: the elimination of edema, resorption lipodermoskleroza, reducing the diameter of the venous vessel, improve venous hemodynamics, improvement of muscle-pump valve, restoring microcirculation, improving drainage of the lymph vessels of the lymphatic system.
There are certain principles of proper bandaging limbs.Start bandaging the next morning, without getting up from the bed.Bandage should be applied from the bottom up from the heel to the upper thigh with a mandatory fixing of the foot.Bandaging should be dense enough, but do not cause discomfort.
for long-term use elastic bandages are unsuitable, as they quickly lose their elasticity when washing, and therefore, it is better to use special medical compression hosiery.Depending on the desired amount and the desired degree of compression applied various kinds of knitwear - socks, tights, stockings.Absolute contraindications to the use of medical hosiery are: cardio-respiratory failure decompensation, atherosclerotic lesions of arterial vessels, damage the skin at the site of the proposed compression.
at different degrees of chronic venous insufficiency apply different methods of conservative therapy:
When the first degree is preferred to use as sclerotherapy to eliminate cosmetic defects caused by the presence of telangiectasia.The method is based on the introduction of a special widened portion vein substance (sclerosant) which stops the blood flow at the site vein and thus contributes spadenie vessel and eliminate cosmetic defects.
When the second degree appropriate to use drugs containing active substances capable of enhancing venous tone and improve microcirculation of the surrounding tissues.Duration of treatment is not less than 6 months and often for the emergence of a visible effect of the patient required several courses of receiving these drugs.
At the third degree the main focus of treatment is to combat complications.In this situation, the patient needs a combined treatment with drugs of general validity and use of drugs for local treatment.
topical preparations are widely used in the treatment of chronic venous insufficiency of the lower limb veins, as they are easy to use and are deprived of a number of adverse reactions specific to flebotonikov common action.Compulsory component of drugs for topical treatment (gels, ointments) is the heparin at a concentration of 100 U to 1,000 U per 1 g in combination with anti-inflammatory, analgesic and desensitizing components.Ointments containing Heparin (Troksevazinovaya, Heparin, Lioton 1000) should be applied rate of at least 1 month and to improve the effect needs to be combined with drugs of general validity.
as selection of an individual regimen of a patient with symptoms of chronic venous insufficiency, use of several groups of drugs, given the stage of the disease.The main groups of pharmacological agents in this situation are: flebotoniki (Detraleks 500 mg 2 p. Per day, Flebodia 600 mg 1 p. Day Vazoket 600 mg 1 p. Per day), non-steroidal anti-inflammatory drugs (Ibuprofen 200 mg 2 p. Per day, Diclofenac 1 tablet 3 p. per day), anticoagulants (Clexane 1.5 mg per kg of body weight 1 p. per day), disaggregants (Trental 400 mg 2 p. per day, pentoxifylline Bean 1 2 p. per day) and antihistamines(Tsetrin, Laura Eden 1 tablet 1 p. per day).
as a means to improve the microcirculation and metabolic processes used Aktovegin 1 tablet 3 times a day or Solkoseril 1 ampoule intramuscular course of 10 days.
great importance is the use of topical preparations to stage venous dermatitis and eczema.Early treatment of anti-inflammatory drugs to prevent the progression of venous disorders.In this situation, are appropriate medicines for external use, containing corticosteroids (Akortin, mesoderm Polkortolon, flutsinar).
include physical therapy for the treatment of chronic venous insufficiency of the greatest results can be achieved by assigning the course of electrophoresis, balneotherapy and diadynamic currents.
Particular attention should be paid to the treatment of chronic venous insufficiency in the stage of development of venous ulcers, as they are often complicated by inflammatory changes and bleeding.The basic principles of treatment of venous ulcers include: strict bed rest, three-treatment of ulcers soapy water, use of local antiseptics (Miramistin Ointment 0.01%), antibiotic therapy after determining the sensitivity of flora.
To accelerate the process of epithelization of venous ulcers using products containing natural ingredients (propolis, sea buckthorn oil) in combination with the constant wearing of medical hosiery preventing trauma skin and the emergence of infectious complications.