Chronic venous insufficiency: causes of development, symptoms and treatment
Mar 22, 2018
Chronic venous insufficiency( CVI) is a pathology in which the blood vessels( veins) of the lower extremities are primarily affected.With this syndrome, venous outflow is disrupted, resulting in disorganization of regional microcirculation( local circulation).CVI develops against a background of varicose veins, characterized by the transformation of the subcutaneous veins.
Note: among the main causes of varicose disease development include genetic predisposition, hormonal imbalance( including pregnancy), metabolic disorders( obesity), and the specific lifestyle of the patient( in particular, hypodynamia or increased stress on the legs).Table of contents: Prevalence of the syndrome in the population Causes and predisposing factors Classification and degrees of chronic venous insufficiency Symptoms of chronic venous insufficiency Diagnosis Treatment of chronic venous insufficiency
According to the international classification, CVI includes:
- varicose veins;
- congenital anomalies of the structure of veins;
- post-traumatic vascular changes;
- posttrobotic disease.
Prevalence of the syndrome in the
According to the statistics, chronic venous insufficiency is diagnosed in 10-15% of adults. According to the World Health Organization, in the United States and a number of European countries almost one in four suffer from this pathology.
Important: people are the only creatures on the planet who can develop CVI.The appearance of pathology is directly related to movement only in an upright position.
In our country, chronic pathologies of veins are three times more often diagnosed in women( prevalence in the population reaches 62%). More recently, vascular problems have been considered to be characteristic primarily for patients 50 years of age or older.Now, early signs of venous reflux( pathological reverse blood flow) in some cases are detected even in adolescents.
During pregnancy, varicose veins are diagnosed in almost half of patients.Some forms of CVI are found in 85% of expectant mothers.
Causes of the disease and predisposing factors
Among the factors that increase the likelihood of developing CVI include:
- hereditary( genetically determined) predisposition;
- frequent( chronic) constipation;
- is a sedentary lifestyle;
- long static loads;
- frequent overheating of the body;
- excess weight or obesity;
- repeated delivery;
It was previously thought that the direct cause of CVI is valve dysfunction in various zones of the venous system of the lower extremities.To date, many cases of the development of the syndrome without violations from the valves of the veins have been revealed, so there is reason to believe that venous insufficiency is caused by pathologies of the vascular walls.Great importance is attached to microcirculatory disorders and damage to the endothelial layer.
Note: there is a hypothesis according to which the defeat of the venous bed and valves is caused by "leukocyte aggression", that is, leukocyte infiltration.
Adhesion( adherence) of leukocytes plays a crucial role in the pathogenesis of CVI in patients with chronic venous hypertension .These shaped elements of the blood are able to partially clog the vessels of small caliber.The accumulation of leukocytes leads to the release of proteolytic enzymes and oxygen metabolites from the cytoplasm granules, which leads to chronic aseptic inflammation, and as a result to trophic disorders and thrombosis.
In pregnant women late in life, the uterus is able to squeeze the lower vena cava and iliac veins, halving the blood flow through the femoral veins.An increased level of progesterone leads to a decrease in the tone of the walls of the vessels, increasing their extensibility by one and a half times. The condition of the veins is normalized 2-3 months after delivery.The complicated course of pregnancy and its incorrect management can cause serious complications( thrombosis and thromboembolism).
Classification and degrees of chronic venous insufficiency
According to one of the classifications, there are 3 forms of chronic venous insufficiency. The first is characterized by the defeat of the subcutaneous veins and their tributaries of 1-2 orders.At the second, the expansion and elongation of small surface vessels is revealed.The third form is telangiectasia( persistent expansion with the formation of vascular asterisks or meshes).
The most convenient is the clinical classification, which is based on objective signs of pathology.
It includes 7 classes:
- - during the examination and palpation examination of the pathology of the vessels were not found;
- - there is telangiectasia or reticular veins( mild form of varicose veins);
- - varicose veins;
- - chronic edema;
- - skin symptoms( venous eczema, hyperpigmentation, etc.);
- - cutaneous manifestations are combined with a healed trophic ulcer;
- - skin lesions + active trophic ulcers.
Symptoms of chronic venous insufficiency
The classic symptoms of venous diseases are:
- Feeling of heaviness in the legs;
- pains pulling and aching nature;
- convulsive twitching of the muscles of the lower extremities( in particular - the gastrocnemius);
- trophic skin lesions( ulcers).
At the initial stages of development, clinical manifestations are nonspecific.Patients complain mostly of an undefined feeling of discomfort in the legs and cosmetic defects - telangiectasia.
In rare cases, early changes in skin and muscle spasms at night are possible.
As the pathology develops, swelling of the area of the ankles and feet appears, increasing by the end of the day.The calf muscles begin to ache, and there is a feeling of "crawling crawl"( burning and itching are possible). Sensitivity in the legs is somewhat reduced;In parallel, there is a cooling of the limbs, caused by a violation of the local blood flow.The skin in the region of the shins becomes dry, the areas of hyperpigmentation are visually determined on it.With severe venous insufficiency, the feeling of discomfort and fatigue in the legs persists patient constantly.
Severity of symptoms increases with physical activity and under the influence of heat. The intensity of the pain syndrome does not always correlate with the degree of expansion of the superficial veins.Pain is caused by reflux of blood on the background of valvular insufficiency.
With the onset of CVI, poorly healing trophic ulcers and, often, acute thrombophlebitis form.
The complications of venous insufficiency syndrome include:
- varicose dilatation;
- thrombophlebitis( occlusion of lumen of vessels with concomitant inflammation);
- phlebitis( inflammation of the vascular walls);
- periflebitis( inflammation of surrounding tissues along the vessels).
Important: Thromboembolic complications often precede the erythema of the skin in the projection of the affected vein.
Chronic venous insufficiency is characterized by a decrease in severity or complete disappearance of symptoms when walking or performing active movements in the ankle.
For the diagnosis, an anamnesis, a general examination and a palpation examination of the subcutaneous and deep veins are required.
Please note: , even in the absence of varicose veins, a vascular pattern is often determined by visual inspection, which indicates a decrease in the tone of the vein walls.Modified vessels are characterized by increased sensitivity during palpation.
The most informative methods of hardware diagnostics are ultrasound dopplerography and duplex scanning of .With their help, in particular, are determined the zones of the reverse casting of blood and the thrombi are detected.
Compression tests are used to assess the condition of the valves and the degree of permeability of the perforated, deep and subcutaneous veins.
The study of the haemostasiogram is mandatory, for which the patient's blood is taken from the veins on an empty stomach.The prothrombin index, fibrinogen, platelet aggregation, etc. are determined during the analysis.
Chronic venous insufficiency is important to differentiate with circulatory insufficiency ( against IHD, myocarditis and cardiomyopathy), kidney damage( in particular glomerulonephritis), lymphostasis and reactivePolyarthritis.
Treatment of chronic venous insufficiency
The most important tasks of therapeutic measures are to prevent the progression of the pathological process and thromboembolic complications.
Important : thrombophlebitis, pulmonary embolism and deep vein thrombosis are grounds for the immediate placement of a patient in the hospital profile section.
One of the main methods of treatment of CVI is the use of locally produced pharmacological agents( for example, Venitan and Venitan-forte). They reduce puffiness and reduce heaviness in the legs, fatigue and muscle spasms.
Especially effective are ointments and gels, which include heparin. It should be noted that this substance reduces the severity of local symptoms, but does not prevent possible complications of thromboembolic character.Gels with heparin should be used as one of the components of complex therapy.
The pharmacotherapy of venous insufficiency of any genesis presupposes the administration of drugs to improve the state of vascular walls - phlebotonics( phlebotectics). Currently, more than two dozen venotonizing drugs are registered in the Russian Federation.These drugs have a systemic effect, due to which not only improve the state of the vessels of the legs, but also have a beneficial effect on veins of the small pelvis, retroperitoneal space, etc. Preparations of this group( eg Diosmin or Escuzan) take courses, the duration of which usually amounts toFrom 1 to 2.5 months.
The positive effect is usually observed after 3-4 weeks of treatment.If a certain drug does not help, the question is whether to replace it or increase dosages.
To improve the rheological properties of blood and microcirculation, platelet deaggregants-Pentoxifylline, Clopidogrel and Dipyridamole are shown.
To combat pain, the patient needs to take NSAIDs, the most effective of which is the known acetylsalicylic acid.It not only reduces pain, but also reduces platelet aggregation and stimulates fibrinolysis.
If dermatitis or skin eczema develops, then antihistamines are prescribed.In erysipelas or infected trophic ulcers, antibacterial and antifungal therapy is necessary. Pronounced edematous syndrome is an indication for the appointment of potassium-sparing diuretics.
In severe cases, hormone therapy is prescribed( corticosteroid preparations).
The aim of surgical treatment is to control the leading etiologic factor, i.e., blood reflux. The affected veins and anastomosis during the operation are intersected or bandaged.To volume and traumatic interventions, such as a venectomy, now practically do not resort.
Note: q For the prevention of CVI, especially during pregnancy, it is advisable to wear a special compression jersey.It allows you to reduce puffiness, improve central hemodynamics and the speed of venous blood flow, reduce the diameter of the veins and reduce the veno-venous discharge.Compression therapy can stimulate the drainage function of the lymphatic system.
Vladimir Plisov, doctor, medical reviewer