Chronic venous insufficiency (CVI ) - Causes, Symptoms and Treatment .MF .
Chronic venous insufficiency (CVI) - a set of clinical manifestations that occur as a result of violations of the outflow of blood in the veins of the system.CVI includes diseases such as varicose veins, post-thrombotic disease, congenital and traumatic abnormalities of the veins.
CVI is currently the most common vascular disease.Women CVI occurs three times more often than men.
Causes of chronic venous insufficiency
Predisposing factors of chronic venous insufficiency include:
- repeated pregnancy;
- lack of physical activity;
- hard physical work associated with heavy lifting, prolonged stay in a standing or sitting position.
main cause of the disease is considered to be the disruption of the musculo-venous pump.The normal blood flow in the lower extremities is carried on the deep system (90%) and the superficial veins (10%).To promote blood to the heart valves in the veins exist that impede the movement of blood down by gravity.Also play an important role re
worst conditions for normal blood flow occur in the vertical position of the body in the absence of active muscle contractions.Thus, there is congestion, increased pressure in the venous system and as a consequence, their extension.Formed failure of the valve device, the valve flaps are closed not completely, and there is an abnormal blood flow from the top down.
valvular insufficiency at CVI.
This leads to a further increase in pressure in the veins.As a result of high blood pressure increases the permeability of the venous wall, it swells, compressing the surrounding tissue, disrupting their food.In the final at this point it is formed trophic ulcer.
symptoms of chronic venous insufficiency If you experience these symptoms you should contact a specialist in order to avoid chronic venous insufficiency: a little heaviness in the legs that occurs mostly in the evening or after the static load;swelling of the ankles (toes are not affected).Swelling occur in the evening (can be identified by the presence of traces of gum socks), the severity depends on the duration of exercise.It is important that in the morning the swelling is not defined.Perhaps the presence of varicose veins or "spider veins" (a visible enlargement of small wreath).All these signs indicate the presence of chronic venous insufficiency of the first degree.
external manifestations of CVI.
Eventually join intense, arching pain in the legs, burning;leg cramps that occur, usually at night.Swelling become resistant (identified at any time of the day), the skin is pale, cold to the touch, in addition, as a result of poor blood circulation in the skin appearing areas of hyperpigmentation (brownish coloring) Lipodermatosclerosis (inflammation of the skin is red, painful on palpation) and eczema (thinning of the skin over the enlarged vein, it becomes spotty, severely scratched).In this case, there is a CVI 2 degrees.
presence of open or healed trophic ulcer and chronic venous insufficiency complications (bleeding, deep vein thrombosis or thrombophlebitis) confirms CVI 3 degrees.
formation of ulcers in chronic venous insufficiency occurs in several stages.Initially, there is lot of brownish coloration of the skin.Over time, the center of the seal is formed, having a whitish, lacquer look, reminiscent Nateq paraffin.In the future, even minimal trauma leads to the discovery of the ulcer.In belated treatment of ulcer sizes progressively increased, possibly joining infection.
0 degree CVI also stands out, even when pronounced veins and "spider veins" are not accompanied by heaviness in the legs, pain and swelling.At this stage, the disease is also necessary to carry out treatment.
the presence of at least one feature is recommended to consult a doctor.As a rule, routinely require consultation phlebologist (a specialist in diseases of the veins), if necessary - a vascular surgeon or other specialist.
CVI with incorrect or untimely treatment can bring to severe complications such as deep vein thrombosis (complete or partial closure of the lumen of the vein thrombus) and thrombophlebitis (inflammation of the vein wall, concomitant thrombosis).In this case there is a sudden, rapid swelling increases, which covers the entire lower limb, accompanied by intense pain arching.In the eyes of redness or blueness, painful thickening of the skin, with no connection to the previous exercise, may not be varicose veins, brownish staining areas of skin and ulcers.If a blood clot detaches, then through the blood he can get into the lungs and cause serious disease - pulmonary embolism (complete or partial closure of the lumen of the artery thrombus).This complication is often fatal.For suspected deep vein thrombosis or thrombophlebitis should immediately lie down, give the leg elevated position, call the team ambulance.It is strictly forbidden to knead muscles, lubricate any ointments, stepping on the injured leg.
should also be wary of injuries affected area, as they can lead to severe bleeding.If bleeding is necessary to tie up his leg above the wound place a tourniquet (medical or impromptu), so much so that the bleeding has stopped, and immediately call the team ambulance.Bleeding from varices also applies to complications, life-threatening.
CVI symptoms, such as pain in the lower extremities, and edema, and is characterized by a number of other diseases:
«Heart" swelling.The presence of heart disease, hypertension.Swelling of the lower extremities occur at any time of the day, often permanent, always bilateral.No connection with the exercise.Pain in the lower extremities is usually absent only expressed at significant edema.in the field of skin swelling warm, normal color.
with lymphedema edema (impaired lymph drainage).As with CVI edema appear in the late afternoon, associated with physical activity.Skin edema in normal color and temperature.When expressed swelling during capture thigh area.Pain of varying intensity.But there are no varicose veins and ulcers.To distinguish the disease from CVI possible during lymphography (instrumental study of the lymphatic system).
When arthrosis swelling and intense pain are defined only in the affected joint area.joint mobility is severely restricted in the beginning of the movement, then with continued movement, the mobility is somewhat improved, the pain is less intense.To differentiate this disease and allow CVI ultrasound and X-ray of the joint.
When osteochondrosis of the lumbar spine the greatest intensity of pain in the popliteal fossa.Pain pulling can "shoot" in the thigh and gluteal region arises, usually at night.The intensity is reduced after a course of anti-inflammatory therapy.Edema is not typical.
distinguish the disease from the CVI data in a state only by a qualified specialist.
Diagnosis of chronic venous insufficiency
Turning to the doctor, you will be asked the following survey:
Complete blood count. The level of red blood cells and hemoglobin can be judged on the degree of viscosity of blood, according to the number of platelets is assessed state of the blood coagulation system, increasing the number of white blood cells indicates the presence of inflammation.
Biochemical analysis of blood and urine. Changes in these indicators are not specific, depend on the presence and severity of comorbidities.
most accurate method of diagnosis of venous pathology is ultrasound vessels of the lower extremities , during which determined areas veins, the presence of varicose veins, blood clots.Ultrasound of the lower extremities should be carried out in the presence of any of the above symptoms of CVI.
When doubtful ultrasound data resort to surgical methods, such as venography (intravenous contrast agent to assess the state of the venous system).
treatment of chronic venous insufficiency CVI
treatment - a complex process, the duration of which depends on the stage of the disease.Therapeutic measures are divided into surgical and conservative (non-surgical).Despite the high prevalence of the disease, accounting surgical techniques accounts for only 10%.Timely treatment will restore normal venous blood flow and avoid complications.
Conservative treatment of venous insufficiency includes reduction in the severity of risk factors, recommendations for physical activity, elastic compression, drugs and physical therapy.The adoption of these measures in the complex provides the best results.
If possible, it is necessary to identify the risk factors for the progression of the disease, such as obesity, oral contraceptives, irregular physical activity, and try to correct them.
doctor should also give advice on physical exercise for each stage of the disease.
Regardless of the stage is recommended: as often as possible to attach the legs in an elevated position, at night under the underlay them a pillow, wearing comfortable shoes.From sports we recommend walking, swimming, with CVI stage 0-2 - cycling, jogging.Physical exercise (except for swimming) conducted using the elastic compression.It is necessary to exclude a class by sports, at which there is an increased likelihood of injury and limb requires sharp (snatch) the load on the lower limbs: football, basketball, volleyball, tennis, skiing, various types of martial arts, exercise, associated with heavy lifting.At home, regardless of the stage of the disease is possible to conduct the next set of exercises.
set of exercises at CVI.
elastic compression - use elastic bandage or medical hosiery.At the same time, by dosed compression of the lower limb muscles improves blood flow through the veins, which prevents further expansion of veins and blood clots.It also provides skin protection from mechanical damage, reduces the risk of ulcers.The use of elastic compression shown at any stage of the disease.
Elastic bandaging begins in the morning, to rise from the bed.Bandage is applied from the bottom up with the mandatory seizure of the foot, heel to the hip area.Each overlying turn of the bandage should cover the previous half.Compression should not be intense, does not cause pain.In the case of "sliding" it is necessary to tie a bandage.
Disadvantages of using elastic bandages:
- not fixed to the leg;
- difficult to achieve the desired compression of the muscles;
- stretched after several washings.
Data deficiencies deprived of medical compression hosiery (socks, stockings, tights).Depending on the stage of CVI release Class 3 compression (compression) that need to be considered when buying these products.
Compression knitwear does not apply if:
- Severe cardiopulmonary failure
- serious diseases of the arteries of the lower extremities
- lower limb lesions of the skin (dermatitis, eczema, acute erysipelas, infected ulcer).In this case, the elastic compression is carried out in a special way.
on 0-1 stages of the disease the gold standard for the treatment of cosmetic defects is sclerotherapy - treatment of advanced surface veins and "spider veins".In the vein injected sclerosant (a special substance that leads to the cessation of the vein for blood flow).In the final, Vienna collapses, disappears cosmetic defect.
on 0-1 stages to prevent, at the stage of 2-3 for the treatment requires the use of drugs.Most drugs are aimed at improving the tone of veins, improving nutrition of the surrounding tissues.The course of treatment lasting 6 months or more.
currently in use: Detraleks, Cyclo 3 Fort Ginkor-fort Troxevasin, Anavenol, Aescusan, Asklezan, Antistax, Phlebodia 600. The use of a drug, as well as the treatment regimen should be discussed with a specialist.The use of topical treatment (ointments, gels) in the absence of complications (thrombophlebitis) is inappropriate.
Z stage of the disease is characterized by the presence of ulcers.Treatment of venous ulcers - a complex process, involving both general and local impact.Local treatment area comprises treating wounds antiseptics, use of enzymes, if necessary - the surgical removal of dead skin particles.Every day - two, three toilet wound using a standard medicines (dioxidine, dimexide, chlorhexidine), and cooked at home (a weak solution of potassium permanganate, a decoction of chamomile or series).After machining is applied ointment (levomikol, Levosin).
Physiotherapy is of secondary importance in chronic venous insufficiency.Used in any degree of severity on the testimony of the process.For instance, have a good effect Diadynamic currents electrophoresis, laser, magnetic field.
With good results of conservative treatment is recommended further correction lifestyle, regular exercise, elastic compression.The decision to conduct re-treatment is necessary for recurrent disease, complications arise or as a prophylactic measure.
With the ineffectiveness of conservative treatment addressed the issue of surgical treatment.In addition, surgical treatment is necessary when:
- CVI complications (thrombosis, thrombophlebitis, bleeding).
- Availability of nonhealing ulcers.
- expression of cosmetic defects.
Surgical treatment consists in removing the modified vein.The volume of surgery depends on the severity and complications of the process.
Rehabilitation after surgery depends on its volume, but it is necessary to mention the general principles.Stitches finally formed after 6 months, so in order to avoid their differences and then the cosmetic defect is necessary to exclude a strong mechanical action on them (use coarse scouring pads, tight clothing).Wash only need to warm, cool water is best.After surgery, it is recommended to wear bandages for 3 months, followed by another 3 months to wear elastic therapeutic stockings.In the future, elastic compression is applied in the case of a proposed "harmful" exercise (long journeys, flights, long stay on his feet, hard work).It may need prophylactic use of products that will improve the tone of veins.
Prevention of chronic venous insufficiency
Nowadays great importance is the prevention of CVD.Performing simple measures can significantly reduce the occurrence of disease of the lower extremities:
- Keeping the mobile lifestyle, the alternation of static load with walking, running, swimming.
- During the rest to keep your feet in the raised position.
body weight - Wear comfortable shoes with a heel 4 cm, in case of need to use orthotics.
- When using estrogen drugs (oral contraceptives), pregnancy routinely perform ultrasonography of the lower extremities.
- If necessary to use elastic compression and pharmaceuticals.
therapists Sirotkin EV