Venous insufficiency – symptoms, treatment of the lower extremities

What is the cause of chronic venous insufficiency of the lower extremities? Having heard the diagnosis from the doctor, the first thing the patient thinks about is why did he develop this disease? Unfortunately, the causes of chronic venous insufficiency are multifactorial and complex. This means that the development of this vascular pathology leads to a combination of genetic causes and what kind of person leads a lifestyle:

  • hereditary predisposition to vascular diseases (connective tissue weakness);
  • congenital pathologies of the venous system;
  • long static loads;
  • hot climatic conditions;
  • the presence of bad habits (alcohol and smoking);
  • damage to the lower extremities (dislocations, fractures, sprains, etc.);
  • overweight and metabolic disorders;
  • chronic constipation;
  • age over 40 years;
  • lack of physical activity or lack of activity / mobility;
  • change in hormonal levels by taking medication;
  • constant overstrain of the lower extremities caused by playing sports, choosing a profession, etc.

Separately, it is necessary to highlight such reasons as gestation and labor. Chronic venous insufficiency in pregnant women is detected in 35% of cases, and in half of women this pathology developed precisely during gestation. This vascular disease aggravates an already physiologically difficult period of 9 months.

There are many etiological factors for the development of the disease in pregnant women; here we can attribute both genetics and microcirculation disturbance due to an increased uterus. The peak of the disease occurs in the later stages, when the uterus exerts great pressure on the iliac and vena cava. Hormonal bursts at this time lead to a reduced tone of the vascular walls, which causes their deformation. Illiterate management of such a pregnancy can cause complications: thrombosis and thromboembolism.

In addition, chronic and acute venous insufficiency can occur against the background of:

  • varicose veins;
  • phlebothrombosis;
  • phlebopathy;
  • postthrombophlebitis syndrome.

Classification and types of venous insufficiency

As you can judge, there are a large number of risk factors for the development of vascular pathology. Therefore, it is extremely important to know what clinical picture is inherent in the disease.

Chronic venous insufficiency (CVI) progresses gradually. And in order to systematize all the signs they were combined and divided into stages and degrees. Foreign and Russian specialists evaluate the CVI of the lower extremities in accordance with different classifications.

In the mid-90s of the last century, the international classification or, in other words, the classification according to the CEAP system (Clinical, Etiologic, Anatomic, Pathophysiologic) played a great role in the development of phlebology. It assesses the severity of manifestations and the nature of chronic venous insufficiency. Over time, this classification has been finalized and supplemented. Today it looks like this:

  • C – Clinical classification section;

0. the absence of external and determined by palpation signs of vascular pathology; 1. reticular varicose veins and telangiectasias; 2. varicose veins reaching a diameter of more than 0,3 cm; 3. impaired venous and lymphatic outflow, giving swelling; 4. change in trophism of the skin and subcutaneous tissues (lipodermatosclerosis or congestive dermatitis in chronic venous insufficiency); 5. change in trophism of the skin with a healed venous ulcer; 6. a change in trophism of the skin with an open venous ulcer.

It should be noted that each of the above symptoms can occur both on its own and in conjunction with any other. In addition, there is no consistent connection between the symptoms.

  • E – Etiological section of the classification;

1. En – the pattern of the origin of the pathological process has not been established; 2. Ec – congenital pathology; 3. Ep – primary disease; 4. Es is a secondary disease.

    A – Anatomical >

1. An – the level of damage has not been established; 2. As – superficial venous vessels; 3. Ap – perforating veins; 4. Ad – deep venous vessels.

  • P – Pathophysiological classification section.

1. Pn – violations in the venous system are not detected; 2. Pr – with reflux; 3. Po – with vascular occlusion; 4. Pr, o – with reflux and vascular occlusion.

The phlebologists name the most frequently used section of this classification the clinical part, surgeons call the etiological part, the pathophysiological part, as a rule, is used by medical statistics.

0. asymptomatic course of the disease; 1. the patient is considered able-bodied, does not need supporting means; 2. the patient can work for 8 hours a day, only with maintenance therapy; 3. the patient is disabled even when using maintenance therapy.

According to the CEAP classification, chronic venous insufficiency of each patient is evaluated in accordance with the clinical scale, where each symptom is equated to a specific score. Ideally, the patient’s medical history should be complemented by the clinical level of examination. Subsequently, this is all useful for tracking the dynamics and effectiveness of treatment.

Russian specialists use a less global classification developed by Acad. RAMS and RAS, prof. V. S. Savelyev, corresponding member RAMS E. G. Yablokov and corresponding member. RAMS A. I. Kiriyenko and approved at the IX International Congress of Surgeons in 2000. It is considered the most convenient and, in accordance with it, 4 degrees of CVI of the lower extremities are distinguished.

According to the domestic classification, 0 and 1 are the initial degrees of chronic venous insufficiency. Zero degree will be the so-called starting point. At this stage, there are practically no clinical manifestations. In rare cases, certain microcirculatory changes of varying severity are possible. Basically, there is only a predisposition to vascular disease.

Stage 1 CVI is characterized by the main clinical signs, such as transient edema and a feeling of heaviness in the lower extremities. Possible pain and night cramps in the muscles of the legs. If at this stage of the disease the patient does not attach importance to the indicated manifestations due to the fact that he does not associate them with the development of vascular pathology or for some other reasons, then more and more vessels are involved in the pathological process. Which certainly, after a certain period of time, will lead to the transition of the disease to a new degree, which will already be considered neglected.

If there is no adequate treatment for the first two stages of the disease, it progresses and proceeds to a new stage. Like varicose veins of the 2nd degree, CVI of the 2nd degree is the stage of the disease at which it is already considered to be neglected.

At this stage, the following symptoms will be noted that will increase the severity of the disease:

  • intense pain syndrome;
  • a feeling of fullness and burning along the venous bed;
  • increased involuntary painful contractions of the muscles of the legs;
  • persistent painful edema that forms at any time of the day;
  • the skin in the affected area may become cyanotic;
  • local inflammatory process;
  • the formation of dry and weeping eczema, accompanied by skin itching, is possible.

The 3rd degree of this vascular disease is considered extremely neglected and the most severe, changes in which are irreversible. In this regard, CVI 3 tbsp, as well as postphlebitis syndrome, are the basis for the patient to receive disability groups II-III. The medical commission determines which disability group will be given to the patient.

In different sources you can find another name for this degree of CVI – the stage of decompensation. When it is characterized by an increase in all the symptoms of the previous stage. The occurrence of trophic ulcers and atrophy of the skin, sometimes tissue, lymphostasis, bleeding, etc. aggravate the situation. At the same time, there is a high probability of infection, and this is fraught with the development of serious complications.

After the doctor has confirmed or refuted the preliminary diagnosis, and accurately differentiated the disease, he will tell you how to treat it. It is important to understand that it is impossible to cure chronic venous insufficiency of the lower extremities by removing only varicose veins. The doctor will arrange the treatment process in such a way as to restore the normal functioning of the venous and lymphatic systems of the lower extremities.

CVI involves conservative and surgical treatment. According to world statistics, surgical treatment is used in 10% of cases. Studies of domestic statisticians indicate that in the territory of the Russian Federation the use of surgical methods of treatment is used more often due to the treatment of patients at the stage of the disease with persistent clinical manifestations.

Conservative therapy is based on the use of physiotherapeutic treatment, massage, medical elastic compression knitwear (the characteristics of the product depend on the severity of the disease and its localization), topical agents and medications. A balanced diet is also extremely important for treatment, so a certain diet is often prescribed for CVI of the lower extremities.

Chronic venous insufficiency (CVI) is a pathology that occurs due to violations of the venous outflow of blood in the lower extremities. It is one of the most common diseases related to the vascular system.

CVI affects the female half of the population more than the male. [1] [2] A quarter of the inhabitants of developed countries of the world can identify this condition.

Often, CVI is confused with varicose veins of the lower extremities, which is a delusion. CVI can exist without visible manifestations of vein expansion.

Heredity, overweight, physical inactivity, previously transmitted diseases of the vascular system (thrombophlebitis or thrombosis), hormonal imbalance and increased intra-abdominal pressure can be the causes of impaired blood outflow in the lower extremities.

In women, the development of the disease often begins during pregnancy and childbirth. During pregnancy, progesterone and estrogen levels increase significantly. They weaken the walls of the veins. In addition to hormonal changes, the progression of CVI can be associated with displacement of venous vessels in the pelvis, as well as with an enlarging uterus. The deterioration of the state of the venous walls can be associated with a change in pressure in the veins during contractions during childbirth. High estrogen background, tension of the walls of the veins during childbirth are the main culprits of the onset of the disease. [7]

Frequent and prolonged static loads, heavy lifting lead to the onset of the disease and its progression. Patients consider the clinical manifestations of CVI to be normal, associate them with fatigue and lack of physical activity. Unfortunately, patients untimely turn to specialists at the first symptoms of the disease. Most often, CVI affects athletes, overweight people, and pregnant women.

Underestimation of the severity of the disease leads, as a rule, to grave consequences: vein expansion, inflammation, thrombosis, formation of trophic ulcers on the lower extremities (frequent complications of CVI). [2]

If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!

The clinical signs of CVI are diverse and do not depend on the progression of the disease.

The initial stage is manifested by one or immediately a complex of symptoms. The reason for contacting a specialist can only be a cosmetic defect of the “star” (telangiectasia – TAE), as well as the appearance of discomfort, heaviness in the legs, intensifying with prolonged stay on the legs. Muscle spasms and irritations of the skin can occur much less frequently, which can manifest to varying degrees. Varicose veins may not be present, but, as a rule, examination reveals signs of damage to the intradermal veins. [5]

In general, the manifestation and course of CVI are reduced to the following complaints:

  • the appearance of “stars”, increased by the end of the day swelling of the feet and legs;
  • muscle cramps and a feeling of running ants;
  • lowering the temperature and violation of the sensitivity of the legs;
  • the appearance of pigmentation on the legs;
  • discomfort and fatigue of the lower extremities.

As pregnancy develops in women, the incidence of these symptoms begins to increase. Their appearance is reduced within a week after the birth of the baby. [7]

Often, people with CVI complain of a feeling of warmth in their legs, the appearance of itching, burning and a feeling of heaviness. Most often, the intensity of CVI symptoms increases in the afternoon or in connection with an increase in air temperature.

The occurrence of pain in the lower extremities is due to a malfunction of the valves, leading to a transition of blood flow from deep veins to superficial. Due to increased pressure in the superficial veins, a gradual increase in pain occurs, swelling, dryness and hyperpigmentation of the skin occur. [6] Severe trophic abnormalities may cause the opening of ulcers.

A significant amount of circulating blood (BCC) begins to delay in the lower extremities, which leads to dizziness, fainting, and heart failure. Since BCC decreases, people with severe CVI are not able to cope with physical and mental stress.

With soreness of the veins and reddening of the skin over them during the course of symptoms of CVI, there is a risk that they may precede thrombosis of the veins in the lower extremities.

The pathogenesis of CVI is very specific. In a healthy person, blood outflow occurs through the deep veins of the lower leg. Thanks to the joint work of the constantly contracting and relaxing skeletal muscles and valve apparatus, the blood goes to the heart, where it is saturated with oxygen. In the process of this work, smooth skeletal muscles increase pressure on the veins, and the valve system, which consists of closing valves, does not allow blood to succumb to gravity.

Due to long-existing risk factors, venous hypertension occurs, and the vein wall expands and protrudes. Valve flaps diverge and cannot prevent the pathological outflow of blood. The increased volume of blood presses more strongly on the wall of the vein, so the vein expands. If treatment is not started, the vein will continue to expand. The walls of blood vessels will begin to rapidly lose their elasticity, their permeability will increase. Through the walls in the surrounding tissue will come out elements of blood, plasma. Thus, tissue edema occurs, which further depletes them with oxygen. Free radicals, inflammatory mediators accumulate in the tissues, and the mechanism of activation of leukocytes is triggered. This disrupts the nutrition and metabolism of tissues. The end result is the formation of venous trophic ulcers, which significantly reduces the patient’s quality of life. [4] [6]

According to clinical signs, the following stages of CVI are distinguished:

  • Stage 0 – a cosmetic defect, the appearance of TAE, which does not cause any clinical manifestations;
  • Stage I – swelling of the legs and feet, intensifying closer to the evening;
  • Stage II – pain along the varicose veins, growing at night. Palpation of the veins can be painful;
  • Stage III – constant swelling of the soft tissues, a feeling of numbness and cooling of the legs, soreness significantly increases, cramps that also increase at night join;
  • Stage IV – skin changes, pigmentation, venous eczema, lipodermatosclerosis (varicose dermatitis);
  • Stage V – skin changes indicated above, and a healed ulcer. At this stage, bleeding may begin, veins become clogged with thrombi, thrombophlebitis occurs.
  • Stage VI – skin changes indicated above, and an active ulcer.

Thrombophlebitis can only be cured by surgery. [3] [5]

Complications of CVI include bleeding from an enlarged vein, thrombophlebitis, and venous ulcer. All these complications arise in the late stages of CVI with a prolonged course of the disease.

Hemorrhage from the dilated vein may occur after trauma or may begin spontaneously. The reason is a violation of the integrity of ulcerated skin over a vein. Typically, these veins are located in the ankle region. This zone is characterized by very high pressure in the veins, especially in the vertical position of the body. Venous blood has a low coagulability, so these bleeding with late diagnosis are very plentiful. Emergency care consists in the immediate transfer of the patient to a horizontal position, the limbs give an elevated position and impose pressure bandages, if it is possible elastic bandaging is performed. Phlebologists can flash a bleeding vessel or glue it with special drugs. [6]

A trophic ulcer develops in the lower third of the leg, in the zone of maximum skin disorders. First, brown spots appear there – pigmentation. Then, whitish seals appear in the center, resembling a paraffin leak. This is considered a pre-ulcerated condition. Even the slightest injury to this area can lead to a skin defect.

The resulting skin defect begins to increase progressively, around the skin inflammation begins. An ulcer infection occurs. She begins to get wet, thereby increasing the area of ​​inflammation. With the preservation of the causes that caused the formation of the ulcer, it occurs again and again. Therefore, the optimal treatment tactic is the primary elimination of the causes of the ulcer and the prevention of its relapse. Conservative treatment consists of adequate elastic compression, the selection of compression knitwear for patients with trophic ulcers, the use of special wound coverings for various stages of inflammation of the trophic ulcer. [3]

It is important to know that in the treatment of any disease the main thing is to identify it in the early stages, thereby it is possible to prevent possible complications, minimize costs and significantly reduce the treatment time.

Diagnosis of CVI in the early stages helps to accelerate treatment. When diagnosing, it is important to determine the stage of the disease. After a general clinical examination, the doctor performs a duplex angioscanning of the veins of the lower extremities to determine the treatment tactics. Duplex angioscanning will help assess the condition of the test vessels, see the places of their narrowing or expansion, and also identify thrombosis.

For self-diagnosis of CVI, just look at your legs. Symptoms such as swelling, pain and cramps, as well as the appearance of vascular nets and veins on the legs, are an “alarm bell” for going to a phlebologist.

One of the most affordable methods for diagnosing this disease is ultrasound, the main advantage of which is its reusability without health risks, painlessness, and the ability to detect irregularities in the current operation of the venous apparatus. [3]

For best results, the examination is recommended in the afternoon. Since it is after the daily load on the legs that a more accurate assessment of the condition of the valves, the diameter of the veins and the degree of damage to the walls can be made. The tactics of treatment are affected by the presence of a blood clot in the lumen of the veins, which leads to disruption of blood flow and poses the greatest threat to the patient’s life.

There are a lot of ways to treat CVI. In specialized clinics, the main place is occupied by minimally invasive methods of treatment, that is, surgical interventions with minimal damage to the skin.

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Endovasal Laser Coagulation (EVLK)

In developed countries, up to 40% of patients suffering from this disease receive help using laser technology. With early diagnosis, treatment takes a little time and leaves no residue. Many clinics use a phlebological water laser with a wavelength of up to 1500 nm, supporting radial fibers. This technology allows you to close veins of any diameter through a small puncture of the skin.

Sclerotherapy

The method of sclerotherapy is based on the introduction of a sclerosant into the lumen of the affected vessel. Thanks to this substance, the vein heals and subsequently disappears completely. With a deeper location of varicose veins, the method of echo sclerotherapy is used. For more accurate intravenous administration of the drug, the procedure is performed under the supervision of an ultrasound scan. Using this technique, connective tissue is replaced, which disappears within a few months. Sclerotherapy is also used to eliminate the external cosmetic manifestations of varicose veins.

The technique of diode luminescent sclerotherapy consists in highlighting with a fluorescent lamp telangiectasias (up to 0,4 mm) or reticular veins (up to 2 mm), into the lumen of which a special solution is introduced.

A promising direction in aesthetic phlebology is the combined use of a diode laser and sclerotherapy – laser cryotherapy (ClaCS). This method allows you to eliminate the reticular veins and telangiectasia without much discomfort.

Conservative treatment of CVI is:

  • taking phlebotonics, which improve the rheological properties of the blood, support the tone of the veins;
  • elimination of factors of the occurrence of CVI (weight loss of patients, increased physical activity, etc.);
  • wearing compression hosiery. [4] [6]

The patient should not worry about the choice of treatment method, as the phlebologist will select an individual treatment option depending on the age and type of activity of the patient, on the form of his disease and the presence of pathologies. Typically, when contacting large phlebological centers, specialists simultaneously use many methods to treat one patient. For example, for the most effective and efficient treatment of CVI, a laser operation is performed in combination with injection methods for treating veins. [4]

Pathogenesis

The pathogenesis of the development of acute and chronic venous insufficiency is peculiar. With prolonged obstruction of the outflow of blood through the vessels (the reasons for circulatory disorders may be different), an optimal environment is created to increase the pressure in the lumen of the vein.

Due to the expansion of the veins, valve insufficiency develops. In each vein in the human body are valve flaps, the work of which is to regulate blood circulation.

If for some reason the valves will not close tightly, then the blood will begin to not only move up (back to the heart), but also flow down into the limbs.

This will be the first symptom of venous insufficiency – a feeling of constant heaviness and overcrowding in the legs.

If treatment is not done in a timely manner, then the pressure in the veins will gradually increase and the walls of the vessels will lose their elasticity. Their permeability will increase. Regional edema of the lower extremities will develop. Later, trophic disorders occur. They develop due to compression of the tissues that surround the venous vessels, and a violation of their normal nutrition.

  • acute venous insufficiency (OVN). It develops quite sharply, due to the overlap of the deep veins of the legs. Accordingly, the outflow of blood from them is immediately impaired. This syndrome develops in people of advanced and working age. Several reasons provoke its development: acute forms of thrombosis, as well as injuries resulting in the ligation of veins located in deep tissues. The pathological process affects the extremely deep veins, it does not extend to the superficial. Symptoms of ARI appear almost immediately – a person develops swelling of the legs, the skin acquires a bluish tint. A distinctive sign of the presence of OVN – the pattern of veins on the skin is clearly visible. A person feels severe pain in the direction of the great vessels. You can relieve pain with a regular cold compress. Its effect is due to the fact that cold helps to reduce the volume of blood in the vessels;
  • chronic venous insufficiency (CVI). Pathology is localized only in venous vessels located subcutaneously. It does not apply to the deep. Only at first glance it may seem easy and harmless, but in fact, due to constant circulatory disorders, pathological changes in the trophic ankle joint develop. This form of failure has several stages. Not the first stage, pigment spots appear on the skin at the site of blood flow disturbance. If the patient does not seek medical help in a timely manner, then gradually they become several times larger and grow into soft tissues. As a result, trophic ulcers arise (it is difficult to cure them in a conservative way). At the last stage of CVI, blood clots form, pyoderma and other vascular anomalies develop.

Causes

  • postthrombotic syndrome;
  • varicosity;
  • congenital vascular pathology;
  • phlebothrombosis;
  • limb injuries.
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Negative factors in which the likelihood of progression of venous insufficiency of the lower extremities significantly increases:

  • drugs that contain hormones in their composition;
  • genetic predisposition;
  • female. In a woman’s body, the level of estrogen is quite high, so they often have ARI and CVI. Also, during pregnancy and childbirth, the load on the venous vessels increases (venous insufficiency of both the legs and the brain can develop);
  • obesity;
  • weak motor activity;
  • age. CVI, most likely, will develop in people of advanced age, since adverse factors influenced their body for a longer time;
  • static loads;
  • chronic constipation;
  • weight lifting (permanent).

Risk groups

Lymphatic venous insufficiency develops in people in the most active period of their life – from 20 to 50 years. But only a few patients seek the help of qualified doctors as soon as they begin to feel the first symptoms of the disease. There are some groups of people whose pathology develops most often:

  • athletes;
  • people who have a genetic tendency to CVI;
  • overweight people;
  • pregnant women.

Classification

The following classification of chronic venous insufficiency is considered the most common:

  • degree 0. In this case, severe symptoms of the disease are absent. The patient does not notice any changes. Performance saved;
  • degree 1. For this degree, the appearance of the first symptoms, indicating the presence of a pathological process in the body, is characteristic. The patient feels pain in the lower extremities, a feeling of heaviness and bursting. Soon pronounced persistent swelling and cramps appear (more pronounced at night);
  • degree 2. Edema does not disappear. On examination, eczema, hyperpigmentation, lipodermatosclerosis are noted;
  • grade 3. Trophic ulcers form on the surface of the limbs. This condition is most dangerous for the health of the patient.

There is also an international classification of OVN and CVI – the CEAP system.

According to the clinical picture:

  • 0 – there are no visual signs of a person having pathology of venous vessels;
  • 1 – telangiectasia;
  • 2 – varicose veins on the legs are visually observed;
  • 3 – persistent edema appears;
  • 4 – changes appear on the skin;
  • 5 – changes in the skin in the presence of an already healed ulcer;
  • 6 – changes in the skin with the presence of a fresh ulcer.

The etiological classification is of great importance, since the treatment of vein pathology largely depends on the causes that provoked chronic circulatory failure.

  • EU – genetic addiction;
  • EP is an unknown reason;
  • ES – failure develops in humans due to trauma, thrombosis, etc.

Anatomical classification according to the CEAP system makes it possible to display the level of lesion, segment (deep, superficial or communicative), as well as the localization of the pathological process (inferior vena cava or large saphenous vein).

Classification of CVI according to the CEAP system, taking into account pathophysiological points:

  • chronic venous circulation insufficiency with reflux phenomena;
  • CVI with manifestations of obstruction;
  • CVI combined (combination of reflux and obstruction).

Classification of acute and chronic circulatory failure is used in medical institutions by phlebologists to determine the stage of the disease, as well as its severity. This is necessary in order to prescribe an appropriate effective treatment.

symptomatology

Symptoms of ARI are manifested rapidly, since blockage of blood vessels occurs very quickly. Due to the impossibility of the outflow of blood from the lower extremities, edema is formed.

Along the vessels, the patient notes the occurrence of severe pain, which does not go away when changing position or at rest. The skin acquires a bluish tint and a vein pattern appears on it. This form of the disease is easier to treat.

Symptoms of CVI

  • most often a person begins to worry about the heaviness in the legs, which is significantly amplified after a long stay in a standing position;
  • the formation of edema in the lower extremities;
  • night cramps;
  • hypopigmentation or hyperpigmentation of the skin;
  • integuments lose their elasticity and become dry;
  • at later stages, trophic ulcers form on the surface of the skin;
  • due to the deposit of a large amount of blood in the legs, a person experiences dizziness, fainting.

In the presence of at least one of the above symptoms, it is recommended to immediately seek emergency medical help at a medical institution. There, based on the data of the initial examination and diagnosis, the doctor will determine the severity of the disease (using the approved classification), and will also prescribe the appropriate course of treatment.

Diagnostics

  • Oak;
  • blood chemistry;
  • Ultrasound of the lower extremities. With its help, you can identify areas in which the veins are dilated and blood circulation is impaired. Also, the doctor can detect the presence of blood clots, varicose veins. This examination should be done immediately as soon as the first symptoms of CVI appeared;
  • if the ultrasound data is doubtful, then in this case they resort to phlebography.

Treatment

Acute venous insufficiency is eliminated in several stages. During the active phase of the disease, it is necessary to apply a cold compress to the localization of the pathological process.

Chilled tissue is applied for two minutes, after which it is placed in a container with ice and water to cool. These actions are recommended to be repeated for an hour. After removing the inflammation, the second stage begins – improving blood circulation.

You can use ointments, which contain substances that slow down blood coagulation.

CVI is much more difficult to treat than acute.

In determining the correct treatment tactics for chronic circulatory failure, it should be clearly understood that this pathological condition is a systemic process.

The main goal of all therapeutic measures is the restoration of normal blood circulation in the venous system of the lower extremities, as well as the prevention of the development of possible relapses.

  • treatment of the disease is carried out in several courses. It all depends on the severity of symptoms and the severity of the pathology;
  • treatment of venous insufficiency is selected strictly individually;
  • drug therapy is combined with other methods of treatment of chronic venous circulation.

Of greatest importance in the treatment of CVI is the use of synthetic drugs (prescribed phlebotropic drugs), as well as elastic compression. Topical preparations are also prescribed.

Surgical treatment is carried out in order to remove pathological venous discharge, as well as to remove areas of varicose veins.

Surgical treatment of CVI

Due to the expansion of the veins, valve insufficiency develops. In each vein in the human body are valve flaps, the work of which is to regulate blood circulation. If for some reason the valves will not close tightly, then the blood will begin to not only move up (back to the heart), but also flow down into the limbs. This will be the first symptom of venous insufficiency – a feeling of constant heaviness and overcrowding in the legs.

Symptoms

Symptoms of venous insufficiency depend on the form in which it occurs – acute (ARI) or chronic (CVI), severity, stage of the disease. ARI of the lower extremities develops rapidly, accompanied by severe pain, swelling, the appearance of a venous pattern on the skin. The main symptoms of CVI of the lower extremities are:

  • systematic feeling of heaviness in the legs;
  • muscle cramps at night and during rest;
  • swelling;
  • hypo- or hyperpigmentation of the skin, venous dermatitis;
  • trophic ulcers, dryness, redness on the skin;
  • dizziness, fainting state.

The clinical picture of venous insufficiency depends on the form of the disease. In acute venous insufficiency, symptoms develop rapidly. Due to a blockage of a vein by a thrombus, blood flow through it suddenly stops, swelling of the affected limb arises and quickly progresses. Along the main vein, severe pain is felt that does not subside either at rest or when trying to change the position of the body.

In the initial stages of chronic venous insufficiency, the patient has the following symptoms:

  • heaviness and feeling of fullness in the legs, intensifying towards the end of the working day;
  • swelling of the lower extremities;
  • convulsions that occur mainly at night;
  • discoloration of the skin (hyper- and hypopigmentation);
  • loss of skin elasticity.

If treatment for venous insufficiency is not started in a timely manner, trophic ulcers develop. In addition, the deposition of a significant amount of blood in the veins of the affected limb becomes the cause of the patient’s attacks of dizziness, fainting.

Chronic venous insufficiency of the brain for a long time runs unnoticed by the patient, which is explained by significant compensatory capabilities and a developed system of blood vessels in the brain. Clinical symptoms of venous insufficiency of the brain appear only when there is a significant violation of the outflow of blood from the brain tissue. These include:

  • frequent headaches;
  • dizziness attacks;
  • transient visual disturbances (diplopia, sudden darkening in the eyes);
  • violations of skin sensitivity in the limbs (numbness, tingling, “crawling creeps”);
  • apathy.

Long-lasting violations of the venous outflow become the cause of cerebral edema, the development of irreversible changes in it, which leads to the appearance of neurological symptoms.

CVI is distinguished by different symptoms at different stages of the disease. At the initial stage of its course, the symptoms of venous insufficiency may either be completely absent or to a small extent. Patients in this case express the following complaints:

  • a feeling of heaviness in the legs, aggravated by prolonged stay in the standing position;
  • increased swelling;
  • periodically short-term cramps, 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 it can also appear. At deeper stages of CVI, such a violation, on the contrary, occurs in almost all patients.

With the development of pathology, the following can be added to the symptoms listed above:

  • impaired ability of the circulatory system to 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 sites;
  • the appearance of signs of heart failure.

In patients with CVI of the lower extremities, the volume of circulating blood increases (in the vessels located in this zone), therefore they usually can hardly tolerate the increased volume of physical and mental stress.

Symptoms of ARI are manifested rapidly, since blockage of blood vessels occurs very quickly. Due to the impossibility of the outflow of blood from the lower extremities, edema is formed. Along the vessels, the patient notes the occurrence of severe pain, which does not go away when changing position or at rest. The skin acquires a bluish tint and a vein pattern appears on it.

Chronic venous insufficiency is considered the most common violation in the functioning of blood vessels. And the treatment should be of high quality and timely. If you hesitate in contacting specialists, disability is possible.

At an early stage, treatment can be conservative and surgery can be avoided.

Without medical assistance, CVI of the 2nd to 3rd degree leads to severe circulatory disorders, edema, thrombosis, thrombophlebitis, trophic ulcers, severe convulsions, and expansion of venous walls.

With a diagnosis of deep vein thrombophlebitis of a pronounced stage, more than 30% of patients receive disabilities and lose their previous ability to work.

With pronounced manifestations of chronic venous insufficiency, loads on the limbs are prohibited, therefore, work should be facilitated, the army is contraindicated in this case (with grade 2 pathology of chronic venous insufficiency, recruits are exempted from service).

And then other signs join in:

  • Heaviness in the lower extremities.
  • Convulsions.
  • Dark spots.
  • Ulcers of the lower extremities.
  • Transient edema.
  • Dry skin of the lower leg.

Pain, heaviness, swelling of the limbs initially rarely occur, mainly after prolonged standing work or walking. But as CVI progresses, these symptoms appear regardless of physical activity.

Pathology variations

The classification of the disease allows you to assess the risks of complications, make predictions for the future and choose the appropriate treatment.

The classification, depending on the severity of the symptoms of CVI, is divided into 3 degrees:

  • Grade 0. There are no obvious symptoms of chronic venous insufficiency. Sometimes there are unpleasant sensations in the calf area, a feeling of heaviness appears at the end of the working day.
  • Grade 1. The patient complains of pain, cramps of the lower extremities. Edema occurs after standing work, walking with high heels, prolonged overstrain of the calf muscles.
  • Grade 2. Pain and cramps intensify, pigmentation and erosion are possible, edema can appear even after a slight load on the legs.
  • Degree 3. The patient reveals open or already healed trophic ulcers. All other symptoms of chronic venous insufficiency, characteristic for the 0-2 degree of the disease, only intensify.

Also, phlebologists, depending on the manifestations of the disease, distinguish the clinical classification of CVI. At the first stage, there are no obvious symptoms, spider veins (telangiectasias) may appear. Usually patients do not attach importance to this symptom.

But it is telangiectasias that should alert and force to undergo examination, and then complex treatment.

The progression of vein diseases at an early stage of development can be stopped if you change your lifestyle, remove increased stress from your legs, use local drugs, systemic drugs, and perform medical appointments.

At the 2nd stage of the chronic process, obvious signs of varicose veins are observed. The third stage of CVI is characterized by the appearance of edema after long standing work or general overwork.

At first, swelling may be insignificant in the form of tissue pastiness, but as the disease develops, edema increases. At stage 4, signs of venous eczema appear, as well as age spots.

And stages 5 and 6 of the disease are characterized by the appearance of trophic ulcers.

On the first connection of thrombophlebitis, spider veins may appear.

The phlebologist makes an accurate diagnosis on the basis of examination data, anamnesis and examination results. The specialist determines the stage of the pathological process with the help of additional studies. The main diagnostic methods are duplex angioscanning and an ultrasound method for studying veins of the lower extremities.

Treatment for chronic venous insufficiency is selected depending on the degree of the disease and the severity of the clinical manifestations. It can be operational and conservative, as well as combined.

The duration of therapy depends on the degree of the disease.

Surgical treatment not only removes veins with dilated walls and nodal deformities – the lymphovenous system of the lower extremities begins to function normally.

To do this, it is necessary to identify risk factors (hormonal contraception, overweight, sedentary work) and, if possible, reduce their effect on the human body.

The doctor selects the dosage, focusing on the severity of chronic venous insufficiency and its degree (classification of CVI allows you to establish the exact degree of the disease).

Locally prescribed ointments, creams with antiseptic, regenerating, anti-inflammatory, cooling effects. Treatment necessarily involves the use of elastic compression.

Forms of venous insufficiency

This disease can be divided into the following forms:

  • Aries (acute venous insufficiency of the lower extremities)

The occurrence of acute leg failure occurs after prolonged overlapping (for example, due to strong compression) of the deep veins and a violation of the outflow of blood caused by this process. Acute venous insufficiency of the legs is accompanied by pain in the region of the 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 a bluish tint. Veins located superficially cannot be affected by an OVN.

  • CVI (chronic venous insufficiency of the lower extremities)

It is expressed by a constant violation of blood circulation in the vascular region. The disease in this form may be accompanied by the development of pathological changes in the process of cellular nutrition of the ankle joint. CVI, depending on the degree of its course, can be divided into several stages. At the initial stage of the disease, pigmentation disorders are noticeable in patients in the form of the appearance of age spots in the area where pathological changes have already begun to appear (in the area of ​​blood flow disturbance).

In the absence of treatment for venous insufficiency of this form, age spots will become larger and then they can grow into soft tissues and cause trophic ulcers that are difficult to remove. The last stage of CVI is accompanied by the formation of blood clots, pyoderma – purulent lesions of the skin due to ingestion of pyogenic cocci and other pathologies on any of its sections.

Depending on the duration of the pathological process, two forms of venous insufficiency of the lower extremities are distinguished:

  • acute – occurs as a result of deep vein thrombosis. A blood clot blocks almost the entire lumen of a deep vein and the outflow of blood through it stops. Symptoms increase very quickly: the limb swells, the skin acquires a bluish skin tone, the pattern of saphenous veins is clearly visible on it, and severe pain along the main vessel is noted. If a cold compress is applied to the affected limb, the pain subsides;
  • chronic – a pathological process is localized in superficially located veins. For a long time, it proceeds with minimal manifestations, until the patient begins to appear trophic changes in the affected limb. Initially, areas of hyperpigmentation appear on the skin, which increase in size over time, then trophic ulcers appear in their place, which are difficult to treat.

Acute and chronic forms of venous insufficiency of the lower extremities are distinguished (there is also venous insufficiency of the brain). OVN is formed as a consequence of the overlap of the deep veins of the lower extremities during thrombosis or injury to the legs. Subcutaneous vessels are not affected. The main symptom of ARS is severe pain that stops after applying a cold compress, as cold reduces the volume of blood in the vessels.

CVI, in contrast, affects the veins located close to the surface of the skin, therefore it is accompanied by degenerative and pigmentation changes in the skin – pigment spots, trophic ulcers. If you delay the treatment, the appearance of vascular anomalies such as pyoderma, blood clots, pathology of the ankle joint traffic becomes inevitable.

Methods for the diagnosis of venous insufficiency

Diagnosis of venous insufficiency is carried out on the basis of the characteristic clinical signs of the disease, objective examination data, laboratory and instrumental examination of the patient.

The degree of venous insufficiency can be determined by the results of Doppler ultrasound scanning (the accuracy of this method reaches 80-90%), duplex angioscanning. To clarify the causes of venous blood flow disturbance, in some cases, phlebography (X-ray contrast study of the affected vein) is indicated.

Changes in the results of laboratory blood tests for venous insufficiency are nonspecific. An increase in the prothrombin index is noted. With the addition of a secondary infection and the development of phlebitis (inflammation of the venous wall) in the general blood test, an increase in the number of leukocytes (leukocytosis), a shift in the leukocyte formula to the left, and an increase in ESR are observed.

Differential diagnosis is carried out with lymphangitis, erysipelas. Acute venous insufficiency is differentiated with stretching or rupture of muscles, compression of a vein from the outside by enlarged lymph nodes or a tumor, lymphedema, rupture of a Baker cyst, cellulitis.

Treatment of acute venous insufficiency begins with a cold compress applied to the affected limb. To do this, the cotton cloth is moistened in ice water, squeezed and applied to the skin. After 1,5-2 minutes, the tissue is removed and moistened in water, and then applied to the skin again. The total duration of the procedure is one hour.

Patients are provided with strict bed rest. In order to prevent further thrombosis, heparin injections are prescribed, which are performed under the control of blood coagulation time and platelet count. Indirect anticoagulants are indicated below. In the first days of therapy, the prothrombin index is determined daily, in the future it is monitored once every 7-10 days for several weeks, and after stabilization of the patient’s condition – once a month for the entire duration of treatment.

In acute venous insufficiency of the lower extremities due to the formation of a floating thrombus, surgical intervention is indicated, consisting in installing a cava filter in the inferior vena cava below the level of the renal veins. This operation prevents the development of thromboembolic complications, including potentially life-threatening pulmonary embolism (pulmonary embolism).

Therapy of chronic venous insufficiency, as a systemic pathological process, is aimed not only at restoring normal venous blood flow, but also at preventing relapse of the disease.

Drug treatment of venous insufficiency in its chronic form is carried out with drugs that reduce blood coagulation (acetylsalicylic acid, indirect anticoagulants) and phlebotropic drugs. In addition to drug therapy, the method of elastic compression is used (bandaging the limbs with elastic bandages, wearing compression hosiery).

In case of chronic venous insufficiency, according to the indications, surgical removal of varicose veins is performed, or surgery is replaced with sclerotherapy – a special drug is injected into a pathologically altered vein, which causes inflammation of its walls, and then they stick together.

Most often, this pathology is detected at working age (20-50 years), which is due to stagnant processes, sedentary work, or prolonged standing. Often CVI is combined with trophic ulcers.

Causes

Risk factors for developing CVI of the lower extremities are:

    Postthrombophlebitis syndrome. With this pathology, a chronic violation of the outflow of venous blood against a background of thrombosis and deep vein inflammation is observed. A blood clot forms in the lumen of the vessel. With its lysis (dissolution), the valves are destroyed, which are responsible for the un >

More often this pathology affects women, especially those taking hormonal contraceptives, and smokers. Experienced phlebologists know not only the causes of CVI, but also the classification of chronic venous insufficiency.

Classification

Classification of CVI includes two types of pathology – acute (occurs due to sudden occlusion of the deep veins of the legs) and chronic. In chronic venous insufficiency of the 1st degree, signs of blood flow disturbance are clearly expressed. The following symptoms are observed:

  • convulsions mainly at night;
  • leg pain
  • constant severity (most pronounced in a standing position);
  • periodic swelling of the legs.

CVI of the 2nd degree differs in that edema is constantly disturbing. Symptoms such as hyperpigmentation of the skin (darkening), dryness and peeling, itching are possible. Often there are signs of lipodermatosclerosis.

If chronic venous insufficiency of the 2nd degree is not treated, then the next stage of the disease develops, which is characterized by the appearance on the skin of the legs of long non-healing trophic ulcers.

Most often, patients have a CVI of the 1st degree and the second.

Symptoms

Symptoms of venous insufficiency are:

  • Heaviness in the legs. In the morning, it is weak or absent. The severity increases with prolonged stay in a standing or sitting position.
  • Swelling. They are bilateral (on both legs) and unilateral (only on one limb). The most common localization of edema is the lower leg. Unlike pathology of the kidneys and heart, with CVI there is no swelling in the face.
  • Cramps. They are one of the earliest symptoms of the disease. They occur mainly at night and can make it difficult to sleep. Most often, cramps occur in the calf muscles.
  • Discoloration of the skin. Hypo- and hyperpigmentation are possible. Most often, skin color changes in the distal (located further from the midline) part of the leg.
  • Decreased skin elasticity.
  • Dryness of the skin.
  • Signs of varicose veins in the form of spider veins (dilated small blood vessels), protruding veins and nodes. In the early stages of CVI, these symptoms may be absent.
  • Trophic ulcers. This is a superficial skin defect in the form of a wound incapable of healing. In case of attachment of a secondary infection, suppuration occurs. Early manifestations of trophic ulcers include thinning of the skin, itching, pallor, burning, swelling and the presence of a bluish spot. Some patients develop dermatitis.
  • Dizziness.
  • Change in vascular pattern.
  • Periodic syncope. They arise as a result of stagnation of venous blood in the vessels of the legs.
  • Symptoms of heart failure.
  • Poor tolerance of mental and physical stress.
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Diagnostics

If there are signs of CVI, you should contact a phlebologist. To make a diagnosis and exclude another pathology, you will need:

  • Poll. The doctor determines the duration of the disease, identifies the patient’s complaints and risk factors.
  • Visual inspection.
  • Palpation.
  • Harness functional tests.
  • Duplex scanning. This is a type of ultrasound that allows you to assess the condition of the veins, valvular apparatus and blood supply to the desired area. During this procedure, the doctor receives a two-dimensional image of the tissues. The advantages of scanning are simplicity, accessibility, safety (no radiation exposure) and information content.
  • Doppler ultrasound. It allows you to evaluate the speed of blood flow, the condition of the veins, their patency, as well as to detect the presence of blood clots and sinuosity of blood vessels.
  • Phlebography. It is an auxiliary diagnostic method. A radiopaque substance is introduced into the vessel, after which pictures are taken.
  • General and biochemical blood tests.
  • Coagulogram.

If trophic ulcers form on the skin of the legs, laser flowmetry, multispiral computed tomography and bacteriological analysis may be required.

Differential diagnosis is carried out with atherosclerosis and obliterating endarteritis.

How to treat

Treatment for venous insufficiency of the lower extremities is complex. Therapy includes:

  • The use of drugs.
  • Elimination of the root cause.
  • Static load reduction. Patients should not be in a standing position and sitting for a long time. It is recommended to move more. During sedentary work, you need to do warm-ups. To normalize the outflow of blood, you can raise your legs.
  • Elastic compression To increase the speed of blood flow it is recommended to wear compression hosiery (socks, knee-high socks, stockings, tights). They squeeze veins, reducing their clearance and improving blood flow.
  • Minimally invasive interventions. With CVI, laser coagulation, radiofrequency ablation, and sclerotherapy may be required. In the presence of sp >

Risk groups

If treatment of venous insufficiency is not started at this stage, then in the future, due to increasing pressure, the walls of the vein lose their elasticity. In addition, their permeability increases, which leads to the development of regional edema. This edema compresses the blood vessels, thereby disrupting the blood supply to the tissues and causing trophic disorders.

Most often, venous insufficiency of the legs develops against the background of the following pathological conditions:

  • varicose disease of the lower extremities;
  • postthrombophlebotic syndrome;
  • traumatic injuries of the limbs;
  • phlebothrombosis;
  • congenital or acquired abnormalities in the structure of blood vessels.

Factors that contribute significantly to venous insufficiency include:

  • female;
  • genetic predisposition;
  • long-term hormone therapy;
  • pregnancy;
  • obesity
  • elderly age;
  • lack of exercise.

CVI: >

In Russia, phlebologists – specialists “in the veins” – adopted the following classification of CVI, structuring this disease depending on its stage:

  • Grade 0. Absence of CVI symptoms;
  • Grade 1. Patients complain of pain in the legs, a feeling of heaviness, periodic cramps and swelling;
  • Grade 2. Edema becomes more pronounced and stable, increased pigmentation, changes in the subcutaneous tissue of a degenerative-dystrophic nature (lipodermatosclerosis or “inductive cellulite”) are noticeable, and dry or weeping eczema may occur.
  • Grade 3. It is expressed by the appearance in the patient of an open or healed trophic ulcer.

The “zero” degree was designated by Russian specialists in order to correctly determine the treatment of symptoms of chronic venous insufficiency of the lower extremities, as well as the disease itself. In this case, it will differ from that required for CVI 1 or 2 degrees of therapy.

In medical practice, another structuring of venous diseases, called CEAP, is international. It implies a “symptomatic” separation of CVI according to the following criteria:

  1. Symptoms of the disease are absent; palpation (palpation) of CVI also does not make itself felt.
  2. Steady expansion of small vessels is noticeable, the inflammatory process is not started.
  3. Varicose veins are observed.
  4. Puffiness is observed.
  5. The increased pigmentation of the skin is noticeable, eczema and degenerative-dystrophic changes in the subcutaneous tissue are possible.
  6. There are the symptoms listed in the previous paragraph in the presence of a healed trophic ulcer.
  7. Similar requirements for the previous paragraph, but subject to fresh trophic ulcers.

Each of the listed features in this classification is considered separately, and depending on the degree of manifestation, a corresponding score is assigned to it – “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-bodied, the symptoms of the disease are absent, 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 under the condition of treatment with prescribed drugs;
  • Degree 3. Complete disability.

In addition, there are other criteria, based on which CVIs were classified into 3 types:

  1. CVI is a congenital disease (EC).
  2. primary CVI, the cause of which is unknown (EP).
  3. secondary CVI with a >

In chronic venous insufficiency, treatment includes the use of traditional medicine. Compresses, homemade ointments, creams, lotions, decoctions and infusions of herbs are used. In CVI treatment includes the use of the following agents:

  • garlic ointment (for its preparation you will need chopped cloves of garlic and butter);
  • a mixture based on garlic and honey;
  • raw potato juice;
  • calendula ointment;
  • compresses with bitter wormwood;
  • hazelnut infusion;
  • cucumber juice;
  • mountain ash decoction;
  • calamus root.

In the treatment of CVI, such herbs as a string, lemon balm, lemongrass, meadow clover, coltsfoot, Japanese Sophora and hawthorn are widely used.

If the veins of the lower extremities are disturbed against the background of varicose veins, the following complications are possible:

  • thrombosis;
  • eczema;
  • dermatitis;
  • trophic ulcers;
  • suppuration and tissue necrosis;
  • compaction of the subcutaneous fat layer;
  • thromboembolism;
  • violation of the heart;
  • edematous syndrome.

Prevention

To reduce the risk of leg vein dysfunction, you must:

  • move more;
  • abandon many hours of travel and flights;
  • change position more often during static work;
  • take vasoconstrictors;
  • use cosmetics in the form of creams;
  • normalize stool (get rid of constipation);
  • quit smoking and alcohol;
  • do not supercool;
  • timely treat phlebitis and varicose veins;
  • eat well;
  • take vitamins;
  • wear compression hosiery;
  • control body weight;
  • do not lift weights;
  • refuse to wear squeezing clothes;
  • give up standing or sitting work;
  • do gymnastics or give the legs a horizontal position during static work;
  • refuse to take hormonal contraceptives;
  • visit a doctor regularly;
  • treat existing diseases accompanied by an increase in blood viscosity.

Secondary prevention includes a timely visit to a phlebologist and full treatment. There are no specific measures for the prevention of CVI.

There is an international classification system for venous insufficiency CEAP. According to this system, three stages of CVI are distinguished:

  • CVI of the 1st degree – is accompanied by pain, swelling, convulsive syndrome, the patient is disturbed by a feeling of heaviness in the legs;
  • CVI of the 2nd degree – is accompanied by eczema, dermatosclerosis, hyperpigmentation;
  • CVI 3 degrees – trophic ulcers on the skin of the lower extremities.

What is elastic compression?

People suffering from venous insufficiency of the legs – exercise is recommended taking into account their condition. Walking, swimming, therapeutic exercises are allowed, but using elastic compression is necessary. These include – special elastic bandages and medical knitwear.

The regular use of these funds significantly reduces the risks of further development of the disease and the occurrence of relapses. With the correct use of bandages, edema decreases, the diameter of the vessels decreases, the operation of the valve pump improves, and blood circulation is restored. But the use of bandages has some disadvantages and inconveniences for patients:

  • insufficient fixation on the body;
  • the need to independently regulate the compression force of the diseased limb;
  • regular washings are required, after which the bandages are stretched and become unusable.

Rewinding a leg with an elastic bandage

Modern medicine offers compression medical underwear, which is a more convenient and aesthetic form of care, in the treatment of vascular diseases. Specialized knitwear is able to provide three degrees of compression of the limb, so before buying you should consult a doctor about the required characteristics of the laundry. Compression underwear is available in stockings, tights and golfs.

The following health indicators are a contraindication for wearing compression hosiery:

  • severe cardiopulmonary failure;
  • the presence of dermatitis, eczema or leg ulcers;
  • serious diseases of the arteries of the lower extremities.

In such cases, the issue of elastic compression is decided individually.

Treatment of venous insufficiency of the lower extremities

Folk remedies

If chronic venous insufficiency (CVI) has developed against the background of advanced varicose veins, surgery can be prescribed. To date, the methods that surgery offers are quite numerous: sclerotherapy, laser therapy, physical removal by stretching a vein, phlebectomy, etc. The doctor will choose the surgical method depending on the nature of the disease and the individual characteristics of the patient.

When the diagnosis of chronic venous insufficiency (CVI) of the lower and upper extremities, as well as the brain is made to older people, then, as usual, they are interested in treatment with folk remedies. In no case should you replace drugs or surgery for herbal treatment. In the case of vascular disease of the brain, the use of alternative recipes is strictly prohibited.

For an accurate diagnosis, contact a specialist.

Depending on the severity of clinical symptoms, the stages of chronic venous insufficiency of the lower extremities are determined:

  1. Initial. There is a feeling of fullness and / or heaviness in the affected limb. After a while, persistent edema appears, convulsions occur (usually at night). Performance saved.
  2. Expanded clinical manifestations. Swelling increases, areas of hyperpigmentation appear on the skin, eczema, lipodermatosclerosis occurs.
  3. Trophic disorders. The formation of long-term non-healing trophic ulcers is characteristic.

Sometimes another 0 stage of chronic venous insufficiency is isolated. With it, there are no clinical signs of the disease, and damage to the veins can be detected only by conducting special tests.

In clinical practice, the international classification of acute and chronic venous insufficiency (CEAP system) is also used:

  • 0 – pathology of venous vessels is not visually noticeable;
  • 1 – the appearance of telangiectasias on the skin (persistent expansion of small blood vessels, vascular “stars”);
  • 2 – dilated saphenous veins become noticeable;
  • 3 – the occurrence of persistent edema of the limb;
  • 4 – changes in the color of the skin;
  • 5 – skin hyperpigmentation in the presence of healed trophic ulcers;
  • 6 – skin hyperpigmentation and fresh trophic ulcers.

In clinical practice, classification by etiological factor is also used. The fact is that the choice of a treatment regimen for venous insufficiency is determined by the cause that has howled its development. Given the etiological factor, the following types of venous insufficiency are distinguished:

  • ES – associated with the effects of injuries;
  • EP – the cause of the pathology is unknown;
  • EC – due to hereditary predisposition.

The anatomical classification is based on the display of the level of damage, the localization of the pathological process (large saphenous vein, inferior vena cava), segment (superficial, deep or communicative veins).

Depending on the pathophysiological mechanisms:

  • chronic venous insufficiency with obstruction;
  • chronic venous insufficiency with manifestations of reflux;
  • combined chronic venous insufficiency (combines obstruction and reflux).

0 – symptoms of the disease are completely absent;

1 – symptoms of venous insufficiency are poorly expressed, the patient’s ability to work is fully preserved;

2 – the patient’s ability to work is reduced, he can work a full day only if receiving supportive therapy;

3 – there is a persistent disability, which is not restored even against the background of the treatment.

Complications of chronic venous insufficiency are:

  • deep vein thrombophlebitis;
  • pulmonary embolism;
  • streptococcal lymphangitis.

Acute venous insufficiency can cause the development of white or blue pain phlegmia, which, in turn, can lead to gangrene of the limb, hypovolemic shock (due to the significant deposition of blood in the limb). Another complication of this condition can be a purulent thrombus fusion, with the development of an abscess, phlegmon, and in the most severe cases, even septicopyemia.

Doppler ultrasound allows you to study the blood flow in a particular patient due to the ability of the waves to change frequencies when interacting with the studied object. In addition, with the help of this manipulation, it is possible to determine the pressure in the vessels due to the reflection of ultrasonic waves from red blood cells.

Duplex ultrasound scanning is a research method that also allows you to establish the presence of pathologies regarding the flow of blood, as well as objectively assess the condition of the veins.

To determine the cause of the origin of CVI, radiopaque diagnostic methods are used, for example, phlebography. Phlebography is carried out in the following way: a contrast agent is injected into the vein under investigation, after which it is examined using radiography.

Venous insufficiency of the lower extremities ranks first in prevalence among vascular pathologies. Most often, women suffer from it, and, according to statistics, almost a third of the adult population is affected. When, for a number of reasons, including an increased load, the valves of the venous valves that regulate the blood circulation are disrupted, a constant outflow of blood begins in the lower extremities, against the upward movement to the heart, the first symptom appears – a feeling of heaviness in the legs.

If the disease develops, the pressure on the walls of the vessels is constantly increasing, which leads to their thinning. Venous blockages may form, and if timely therapy is not started, trophic ulcers of the tissues surrounding the venous vessels. Symptoms of varicose expansion are manifested – swelling of the lower extremities, cramps at night, a clear venous pattern at the surface of the skin.

  • elimination of risk factors;
  • drug therapy;
  • correction of the patient’s physical activity using therapeutic exercises;
  • physiotherapy;
  • surgical intervention;
  • elastic compression method.

Drugs

The mechanism for treating CVI with medications is developed depending on the stage of development of the disease. In the first degree of CVI, sclerotherapy is used – an intravenous injection of the drug, which significantly reduces blood flow in the deformed section of the vessel. During the second degree, drug therapy is used to increase the general tone of the venous vessels and establish the processes of circulation of adjacent tissues. In this case, the main results are achieved only for 3-4 months of treatment, and the total duration of the course is 6-8 months.

In the third stage, the patient needs a comprehensive treatment of the main symptoms and complications. General-spectrum preparations and ointments for topical administration are prescribed. During the course of complex therapy, the appointment of phlebotonics, non-steroidal anti-inflammatory drugs, anticoagulants, antiplatelet agents and antihistamines is mandatory. Topical preparations are selected from the group of drugs containing corticosteroids.

It is important to assign the correct physiotherapeutic procedures and the selection of a complex of therapeutic exercises. In most cases, assigned;

  • electrophoresis;
  • balneotherapy;
  • diadynamic current.

Trophic ulcers associated with the third stage are a very dangerous type of skin disease, fraught with a number of serious complications and infections. The patient is prescribed bed rest, prolonged antibiotic therapy, regular local hygienic treatment with the use of antiseptics. To speed up the process, it is recommended to use products containing natural plant antiseptics – propolis, sea buckthorn – and wearing medical knitwear.

In the initial stages of venous insufficiency of the lower extremities, and as a preventive measure to improve blood circulation and reduce pain, resort to folk remedies. From an illness help:

  • horse chestnut infusion;
  • chamomile oil;
  • alcohol tincture of fragrant rue;
  • tincture of silver wormwood;
  • compresses from the butyx – common thistle;
  • whey wraps;
  • alcohol tincture of Kalanchoe.

For the prevention of venous insufficiency of the lower extremities, it is important to follow a dietary diet – refuse fried and fatty foods. It is recommended to eat foods with anticoagulant properties:

Treatment with elastic compression involves two main points – wearing compression underwear (highly recommended for pregnant women) and bandaging the lower extremities with an elastic bandage. With the help of compression therapy, a significant improvement in the condition of a patient with venous insufficiency of the lower extremities is achieved by the following signs:

  • decrease puffiness;
  • restoration of normal functioning of the muscular-valve pump;
  • improvement of microcirculation of tissues and hemodynamics of veins.

Bandages lose their elasticity after several washes, so you should replace them on average once every two to three months, and alternate with wearing compression stockings or pants. Compression bandaging of the lower extremities is carried out according to the following rules:

  • it is made before rise;
  • legs are bandaged from the bottom up, from the ankle to the middle of the thigh;
  • the bandage should be tight, but pain and squeezing should not be felt.

When a patient is treated at a late stage of development of venous insufficiency of the lower extremities, the doctor may prescribe an operation of the following type:

  • sclerotherapy;
  • laser irradiation;
  • phlebectomy;
  • abelion.

Physiotherapeutic procedures are an indispensable tool in the treatment of chronic venous insufficiency. Their use gives a positive effect regardless of the degree of the disease. In the treatment of vascular diseases, the following procedures are most common:

  • electrophoresis;
  • magnetotherapy;
  • intermittent pneumatic compression;
  • laser therapy.

Prevention

Despite the fact that venous insufficiency is a disease genetically embedded in a person, some measures can be taken that will significantly reduce the risk of its development:

  • Do not overheat in the sun;
  • do not wear too tight underwear and clothes (the same rule applies to the prevention of CVI in the brain);
  • Do not sit or stand motionless for a long period of time;
  • diet;
  • rejection of high heels.

Prevention of acute venous insufficiency includes:

  • early activation of patients after surgery;
  • the use of elastic stockings;
  • performing periodic compression of the lower leg by a bed patient;
  • drug prophylaxis of thrombosis with its increased risk.

Preventive measures aimed at preventing the formation of chronic venous insufficiency:

  • prevention of constipation;
  • active lifestyle (playing sports, walking in the fresh air, morning exercises);
  • avoidance of prolonged stay in a static position (sitting, standing);
  • when carrying out hormone replacement therapy with estrogens, women are recommended to wear elastic stockings, the prothrombin index is regularly monitored;
  • refusal to wear tightening clothes, outerwear with a tight collar;
  • fight against excess weight;
  • refusal to regularly wear high-heeled shoes.

There are several methods that help reduce the risk of developing pathology and stop the progression of CVI.

The greatest positive effect is an increase in physical activity. Daily walks (preferably 2-3 km), walking, running, swimming, cycling increase venous pressure. If your work is characterized by prolonged orthostatic loads, then try to take 10-15 minute breaks during the working day, during which to stretch the muscles of the legs or take a horizontal position, while the legs should be raised.

With CVI, taking hot baths, visiting a bath and sauna is strictly contraindicated, since it causes an increase in veins, their overflow and disrupts the outflow of blood.

Reducing the risk of increasing symptoms of CVI allows reducing the time spent in the sun and in a solarium, which reduces muscle and venous tone.

In stopping the progression of CVI, an important role is played by constant monitoring of body weight, because the greater the weight of a person, the greater the load on the vessels of the legs. Fats, salt and sugar, all spicy and spicy, should be excluded from the diet as much as possible. The use of spicy and salty foods causes fluid retention in the body, fat deposition and weight gain. It is necessary to eat as much coarse fiber and dietary fiber as possible.

Women are advised to wear high-heeled shoes (over 4 cm) as little as possible. Due to the high heel, the muscles of the lower extremities give way to continuous tension, thereby increasing the load on the veins. To restore the natural outflow of blood, the legs need to rest for several minutes, removing shoes every 2-3 hours. Remember that choosing loose, stable, and comfortable shoes can help prevent vessel problems.

People at risk of developing this pathology should wear exclusively loose clothing and socks without tight elastic. For people with a tendency to CVI, it is recommended to wear compression hosiery, selected with the help of a consultation of phlebologists. [5] [6]

As a prevention of venous insufficiency, risk factors are reduced by maintaining an active lifestyle, adjusting eating habits, quitting smoking and alcohol, uncomfortable shoes and tight clothes. If there is a genetic history in the presence of a medical history, it is recommended to undergo a prophylactic ultrasound examination of the veins to detect pathological symptoms and timely treatment of venous insufficiency.

  • genetic predisposition;
  • taking drugs containing hormones;
  • obesity;
  • sedentary lifestyle;
  • carrying heavy items;
  • repeated pregnancies;
  • prolonged stay of a person in a standing or sitting position;
  • trauma;
  • the presence of bad habits – smoking, alcohol abuse.

In the presence of the above factors, disorders of the human circulatory system develop. At the same time, the walls of the vessels become less elastic and their valves, with the help of which the blood moves upward, cease to function normally, which causes blood stasis and, as a result, CVI.

The most prone to the formation of venous vascular insufficiency, giving birth to women, since during pregnancy in their body significant hormonal changes occur. An increase in the amount of progesterone and physiological changes in the uterus lead to squeezing and weakening of the walls of blood vessels, therefore, the risk of diseases associated with circulatory disorders increases.

  • Stage 1 – contains the main clinical indicators: swelling of the legs, severity, the presence of vascular patterns;
  • Stage 2 – the appearance of brown pigmentation on the skin of the legs, eczema, dermatitis, a visible increase in veins;
  • Stage 3 – the appearance of ulcers and signs of skin atrophy are added to the existing symptoms of the disease.

One of the symptoms of venous insufficiency is an ulcer on the leg.

According to the CEAP classification (International Classification), depending on the stage of violation of the blood supply to the legs, CVI is divided into the following degrees:

  • The degree is zero – characterized by the appearance of a vascular network. At the same time, a person does not experience pain and any discomfort.
  • The first degree – at the end of the day a person experiences a feeling of heaviness and fatigue in his legs. Signs of puffiness are not yet available, so most do not attach much importance to this, but in the meantime, venous insufficiency is already developing. The treatment started at this stage is quite successful.
  • CVI of the 2nd degree – pains in the lower extremities are characteristic of this stage, which intensify at night. Swelling occurs not only in the evening, but also in the morning. When feeling veins with fingers, pain is felt.
  • The third degree – edema takes a permanent character, against the background of an intensifying pain syndrome. Muscle cramps appear. The skin of the legs is pale and cold. Experts do not recommend independently combating these manifestations of insufficiency.

  • The fourth degree – due to a pathological violation of blood flow, pigment spots and inflammatory processes appear on the skin of the legs. In some cases, eczema develops. At this stage, the patient urgently needs qualified medical assistance from a specialist who will prescribe medications.
  • Fifth degree – at this difficult stage trophic ulcers begin to form, and clotting of veins may occur.
  • At the sixth stage of venous insufficiency, the ulcers no longer heal and the affected area expands. The only treatment at this stage is surgery.

First of all, you need to analyze your lifestyle. Of course, not everyone has the opportunity to change work, but if it involves a long stay of a person in one position, you need to find a few minutes to warm up a little from time to time. It is advisable to devote your free time to active types of recreation – swimming, running, more to be in the fresh air.

When choosing shoes, you should mainly focus on its convenience. Now there is a large selection of special orthopedic insoles. While at rest, you should try to keep your legs slightly raised with a pillow under them. If a person is overweight, you need to adjust your diet and lifestyle. It is important to remember that overweight negatively affects the condition of almost all organs.

With the right attitude to your health, the human body will certainly thank him for many years of a happy and healthy life.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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