Chronic venous insufficiency( CVI) - Causes, symptoms and treatment. MF.

Chronic venous insufficiency( CVI) is a combination of clinical manifestations that arise as a result of a violation of the outflow of blood in the veins. CVI includes such diseases as varicose veins, postthrombotic disease, congenital and traumatic anomalies of venous vessels.

CV of lower limbs is currently the most common vascular disease. In women, CVI occurs three times more often than men.

Causes of Chronic Venous Insufficiency

Predisposing factors in the development of CVI include:

- heredity;
- female gender;
- repeated pregnancy;
- excess body weight;
- insufficient physical activity;
- heavy physical labor associated with lifting weights, long standing in a standing or sitting position.

The main cause of the disease is considered to be a malfunction of the muscular-venous pump. Normally, the outflow of blood in the area of ​​the lower limbs is carried out through a system of deep( 90%) and superficial veins( 10%).To advance blood to the heart in the veins, there are valves that prevent the blood from moving downward under the influence of gravity. Also important are the contractions of the muscles of the thigh and lower leg, which prevents the reverse flow of blood.

The worst conditions for normal blood flow occur in the vertical position of the body in the absence of active muscle contractions. Thus, blood stasis, increased pressure in the veins and, consequently, their expansion. The valve apparatus is inadequate, the valve flaps are not completely closed, and an abnormal blood flow from the top to the bottom occurs.

Insufficiency of the valve apparatus in CVI.

This leads to an even greater increase in pressure in the veins. As a result of increased pressure, the permeability of the venous wall increases, it swells, compressing surrounding tissues, disrupting their nutrition. In the final in this place a trophic ulcer is formed.

Trophic ulcer.

Symptoms of chronic venous insufficiency

If the following symptoms occur, you need to contact a specialist for the purpose of excluding CVI: a small heaviness in the legs that occurs mainly in the evening or after a static load;edema of the ankles( fingers are not affected).Swelling occurs in the evening( you can determine by the presence of traces from the rubber bands of socks), the degree of expression depends on the duration of exercise. It is important that swelling is not determined in the morning. There may be varicose veins or "vascular asterisks"( visible widening of small wreaths).All these signs indicate the presence of CVI of the first degree.

External manifestations of CVI.

Over time, intense, burgeoning pains in the legs, burning;cramps calf muscles that appear, as a rule, at night. The swelling becomes persistent( can be detected at any time of the day), the skin is pale, cold to the touch, in addition, as a result of poor blood circulation, areas of hyperpigmentation( brownish staining), lipodermatosclerosis( inflamed skin of the red color, painful at palpation) and eczema( thinning of the skin over the dilated vein, it becomes spotty, it itches very much).In this case, CVI of the 2nd degree takes place.

The presence of open or healed trophic ulcers, as well as complications of CVI( bleeding, deep vein thrombosis or thrombophlebitis) confirms grade III CV.

The formation of ulcers in CVI occurs in several stages. Initially, a brownish coloration of the skin appears. Over time, a dense, whitish, lacquer appearance resembling paraffin wax forms in the center. In the future, even a minimal trauma leads to the discovery of a ulcerative defect. With belated treatment, the size of the ulcer progressively increases, possibly joining the infection.

There is also 0 degree of CVI, when even pronounced expansion of veins and "spider veins" are not accompanied by weight in the legs, pain and swelling. At this stage of the disease, treatment is also necessary.

If you have at least one symptom, it is recommended that you consult a doctor. As a rule, in consultation with a phlebologist( specialist in vein diseases), if necessary, a vascular surgeon or other specialists.

CVI in case of incorrect or untimely treatment can lead to formidable complications, such as deep vein thrombosis( complete or partial closure of the vein thrombus) and thrombophlebitis( venous wall inflammation, concomitant thrombosis).In this case, suddenly there is, rapidly growing edema, which covers the entire lower limb, accompanied by intense raspiruyuschimi pain. Reddening or blueing, painful densification of the skin may appear on the eyes. There is no connection with the previous physical exertion, varicose veins, brownish skin spots and ulcers may be absent. If the thrombus ruptures, then with blood flow, it can enter the lungs and cause a severe disease - thromboembolism of the pulmonary artery( complete or partial closure of the lumen artery thrombus).This complication is often fatal. If you suspect a deep vein thrombosis or thrombophlebitis, you should immediately lie down, give your leg a lofty position, call an ambulance team. It is strictly forbidden to knead muscles, lubricate with any ointments, step on the aching leg.

You should also be wary of the injuries of the affected area, as they can lead to the development of severe bleeding. In case of bleeding, it is necessary to bandage the leg above the injury site with a tourniquet( medical or improvised), so much so that the bleeding stops, and immediately call an ambulance team. Bleeding from varicose veins also refers to complications that threaten life.

Symptoms of CVI, such as pain in the lower extremities and edema, are typical for a number of other diseases:
"Cardiac" edema. The presence of heart disease, hypertension. Edema of the lower extremities appear at any time of the day, often permanent, always bilateral. There is no connection with physical activity. Pain in the lower extremities, as a rule, is absent, is expressed only at a considerable edema. Skin in the area of ​​edema is warm, normal color.

Edema with lymphedema( violation of lymph drainage).As well as with CVI edema appear later in the evening, associated with physical exertion. Skin in the area of ​​swelling of normal color and temperature. With a pronounced process, swelling affects the thigh area. Pain of different intensity. But there are no enlarged veins and ulcers. Distinguish this disease from CVI is possible when carrying out lymphography( instrumental examination of the lymphatic system).

With arthrosis, edema and intense pain sensations are determined only in the area of ​​the affected joint. The mobility of the joint is sharply limited at the beginning of the movement, then, with the continuation of the movement, the mobility improves somewhat, the pain becomes less intense. Differentiating this disease and CVI will allow ultrasound and joint radiography.

In osteochondrosis of the lumbar spine, the greatest severity of pain in the popliteal fossa. The pain is pulling, can "shoot" in the thigh and gluteal region. It usually occurs at night. The intensity decreases after the course of anti-inflammatory therapy. Edema is not typical.

Only the qualified specialist can distinguish the given disease from CVI.

Diagnosis of chronic venous insufficiency

When you contact a doctor, you will be offered the following examination:

General blood test. The level of erythrocytes and hemoglobin can be used to judge the degree of blood viscosity, the state of the blood coagulation system is estimated by the number of platelets, the increase in 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 concomitant diseases.

The most accurate method for diagnosing venous pathology is the ultrasound of the lower extremities vessels , during which the sites of the veins, the presence of varicose veins, blood clots are determined. Ultrasound of the vessels of the lower extremities should be performed in the presence of any of the above signs of CVI.

In case of doubtful data, ultrasound is used for surgical methods, for example phlebography ( intravenous contrast agent for the evaluation of the venous system).

Treatment of chronic venous insufficiency

Treatment of CVI is a complex process, the duration of which directly depends on the stage of the disease. Medical activities are divided into surgical and conservative( not surgical).Despite the high prevalence of the disease, surgical methods account for only 10%.The timely treatment will restore normal venous blood flow and avoid complications.

Conservative treatment of venous insufficiency includes a reduction in the severity of risk factors, recommendations for physical activity, elastic compression, medications and physical therapy. The application of these measures in the complex provides the best result.

If possible, it is necessary to identify risk factors for the progression of the disease, such as, for example, obesity, taking oral contraceptives, improper physical activity, and trying to correct them.
Also for each stage of the disease the doctor should give recommendations on physical activity.

Regardless of the stage it is recommended: as often as possible to give legs to an elevated position, put a pillow under them at night, wear comfortable shoes. From sports it is recommended to walk, swim, with stage 0-2 stage - cycling, easy running. Physical education( except for swimming) is performed using elastic compression. It is necessary to exclude classes in those sports that have an increased likelihood of injuries to the limbs and require sharp( jerky) loads on the lower limbs: football, basketball, volleyball, tennis, mountain skiing, various types of martial arts, exercises related to lifting weights. At home, regardless of the stage of the disease, the following complex of exercises is possible.

Complex exercises in CVI.

Elastic compression - the use of elastic bandage or medical knitwear. At the same time, through the metered compression of the muscles of the lower limbs, the outflow of blood through the veins improves, which prevents further expansion of the veins and formation of thrombi. In addition, the skin is protected from mechanical damage, the risk of ulceration is reduced. The use of elastic compression is indicated at any stage of the disease.

Rules for the use of elastic bandages:

Elastic bandaging starts in the morning, before rising from the bed. Bandage is imposed from the bottom up with a mandatory capture of the foot, heel to the region of the thigh. Each overlying turn of the bandage should cover the previous one by half. Squeezing should not be intense, do not cause pain. In case of "slipping" bandage it must be bandaged.

Drawbacks when using elastic bandages:

- badly fixed on the leg;
- it is difficult to achieve the required compression of muscles;
- after several washings is stretched.

These shortcomings are devoid of medical compression knitwear( knee socks, stockings, tights).Depending on the stage of CVI, there are 3 classes of compression( compression), which must be taken into account when buying these products.

Compression knitwear does not apply if:

- Severe cardiopulmonary insufficiency
- Severe arterial disease of the lower extremities
- Defeat of the skin of the lower extremities( dermatitis, eczema, acute erysipelas, infected ulcer).In this case, elastic compression is carried out in a special way.

At 0-1 stage of the disease, the gold standard for the treatment of cosmetic defects is sclerotherapy - a method of treating enlarged superficial veins and "vascular asterisks".The sclerosant( a special substance that leads to the cessation of blood flow in this vein) is inserted into the vein. In the final, the vein recedes, the cosmetic defect disappears.

At the 0-1 stage for prevention, at 2-3 stages for the purpose of treatment, the use of drugs is necessary. Most drugs are aimed at increasing the tone of the veins, improving the supply of surrounding tissues. The course of treatment is long, 6 months or more.

Currently used: Detralex, Cyclo 3 Fort, Ginkor Fort, Troxevasin, Anvenol, Escuzan, Asklezan, Antistax, Flebodia 600. The use of a particular 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 inexpedient.

The third stage of the disease is characterized by the presence of ulcers. Treatment of trophic ulcers is a complex process, involving both general and local effects. Local treatment involves treating the wound area with antiseptics, using enzymes, if necessary, surgically removing dead particles. Daily - two, three-time wound toilet using both standard medicines( dioxidin, dimexide, chlorhexidine), and cooked at home( a weak solution of potassium permanganate, sequin broth or chamomile).After machining, the ointment( levomycol, levosin) is applied.

Physiotherapy has an auxiliary value for chronic venous insufficiency. They are applied at any degree of process intensity according to the indications. For example, diadynamic currents, electrophoresis, laser, and a magnetic field have a good effect.

With good results of conservative treatment, further correction of lifestyle, regular exercise, elastic compression is recommended. The decision to conduct a second course of treatment is necessary for relapse of the disease, for complications or for a preventive purpose.

In case of ineffectiveness of conservative treatment, the question of surgical treatment is solved. In addition, surgical treatment is necessary for:

- Complication of CVI( thrombosis, thrombophlebitis, bleeding).
- Presence of long-lasting non-healing ulcers.
- Expressed cosmetic defect.

Surgical treatment consists in the removal of altered veins. The scope of the operation depends on the severity of the process and the complications.

Rehabilitation after surgery depends on its volume, but it is necessary to mention general principles. Sutures are finally formed after 6 months, so to avoid their divergence and subsequently cosmetic defect, it is necessary to exclude a strong mechanical effect on them( use of coarse wool, hard clothing).You need to wash yourself only warm, preferably with cool water. After operation, it is recommended to wear elastic bandages for 3 months, after which 3 more months to wear elastic medical stockings. In the future, elastic compression is used in case of planned "harmful" physical activity( long travel, flights, long stay on the legs, hard work).You may need a prophylactic use of drugs that improve the tone of the veins.

Prophylaxis of chronic venous insufficiency

Prevention of chronic venous insufficiency is of great importance. The implementation of simple measures can significantly reduce the occurrence of diseases of the veins of the lower extremities:

- Carrying a mobile lifestyle, alternating static load with walking, running, swimming.
- During rest, keep your legs in a raised position.
- Follow body weight
- Wear comfortable shoes with a heel up to 4 cm, if necessary, use orthopedic insoles.
- When using estrogen preparations( oral contraceptives), during pregnancy in a routine order to perform ultrasound of the veins of the lower extremities.
- If necessary, use elastic compression and medications.

Doctor therapist Sirotkina EV