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Chronic venous insufficiency (CVI).

Venous insufficiency is a condition in which the veins cannot transport enough blood from the extremities to the heart. Venous insufficiency of the lower extremities - its symptoms are familiar to men and women, and treatment is difficult even for specialists.

The most common symptom is a dull pain in the legs, which becomes unbearable by the end of the day. Pain is aggravated after a long standing position. The symptoms are due to the stagnation of venous blood in the legs, which leads to swelling. This causes swelling, tingling, and even cramps.

The skin becomes pale and then turns red and looks brown-red. In the ankles, the limb increases in volume, itching joins. If venous insufficiency is associated with the expansion of the veins, then they become noticeable, as they turn blue and become bulging.

Then trophic disorders progress, the skin looks scaly and covered with ulcers. The patient is accompanied by heaviness of the legs and noticeable swelling.

Venous insufficiency develops in the absence of proper blood circulation in the extremities. Circulation does not occur because a blockage in the vein or valve insufficiency interferes with blood flow. As a result, blood begins to collect in the lower extremities. The venous valve apparatus serves to direct blood flow in the right direction (to the heart). If the valves are damaged, then some of the blood remains in the lower extremities. Other reasons:

Formation of blood clots in deep veins;
Varicose veins of superficial veins;
Blood clots that obstruct blood flow;
Age over 50;
fluctuations in progesterone associated with pregnancy;
Excess weight;
Sedentary work;
muscle weakness;
oncological diseases;
Injuries;
genetic anomalies;
Smoking.

Venous insufficiency is diagnosed by a doctor during a visual examination. An additional method is the use of Doppler ultrasound. The examination shows valve defects, blood clots, the size and shape of the vessel. To clarify the diagnosis, MRI or tomography is used.

Treatment of venous insufficiency of the lower extremities

The most disturbing symptoms are pain and swelling. Therefore, treatment primarily consists of stopping these signs.

Drug treatment - taking drugs that thin the blood. Anticoagulants dissolve blood clots and restore patency of the vessel. The drugs also prevent the formation of blood clots.

Medications for the treatment of venous insufficiency:

Avenue - the drug increases the tone of the vascular wall, increases lymphatic outflow, reduces fragility and capillary permeability.
Detralex - protects the vascular wall from damage, tones the veins.
Aescusan is a preparation made from horse chestnut. Increases the production of catecholamines, protects the veins from damage, increases the elasticity of the vascular wall.
Venarus - improves circulation and venous outflow.
Phlebodia - promotes venous blood flow, reduces swelling of the legs.

Possess similar action: laminin, bilobil, normoven.

Compression clothing - the mechanism of action is due to mechanical pressure on the vessels, which pushes the blood in the right direction. They are in the pharmacy and available to everyone. They differ in size, color and material. Compression stockings are characterized by a compression gradient.

Medical dressings for the treatment of trophic ulcers - use antiseptics, ointments, folk remedies. For the treatment of the acute stage, cold compresses are used - a chilled gauze swab is applied to the affected area for two minutes, then again cooled in a container with ice. The procedure is carried out for 40 minutes.

Non-surgical treatments

Endovenous thermal ablation is an effective and painless procedure for the treatment of venous insufficiency. It is performed using a laser and high-frequency radio waves. This prevents the progression of the disease.

The method consists in the introduction of a sclerosing solution into the vein, which fills the expansion and causes the vessel to stick together. This eliminates pain and swelling. The drug is excreted from the body on its own. In the early stages, the technique gives positive results no worse than after surgery. In more advanced cases, combined treatment is necessary: surgical, medical and physiotherapy.

Benefits of sclerotherapy:

Does not leave scars;
The integrity of the vein is preserved;
Well tolerated psychologically;
It is convenient to use for chronic varicose veins;
May be given in combination with other treatments.

Surgical treatment of venous insufficiency: venous bypass grafting - eliminating the problem by transplanting a healthy part of the vessel.

Ligation and purification

The surgical procedure consists in flashing the affected area and cleaning the varicose veins. Through the skin, with the help of a special tool, loops (ligatures) are applied, the sutures are tied from the outside. After contraction of the vessel, the thrombus is removed. The disadvantage of the method is that relapse is possible.

Phlebectomy - removal of blood clots and the affected area of the vein. Microinvasive intervention is performed through the skin on an outpatient basis. Modern methods: laser phlebectomy and radiofrequency obliteration.

Chronic venous insufficiency of the lower extremities

Prolonged violation of the venous outflow of blood and the development of venous obstruction leads to chronic venous insufficiency. The pathogenesis is associated with the destruction of valves by thrombosis, phlebitis, injuries and burns. The weakening of the muscle strength, which is necessary to create sufficient blood pressure, is not the direct cause of chronic venous insufficiency, but contributes to the exacerbation of the disease.

Chronic venous insufficiency: clinical models

Symptoms of chronic venous insufficiency are grouped into the most common clinical variants:

Uncomplicated venous varicose veins;
Superficial thrombophlebitis;
Varicose veins is a generalized vascular lesion in combination with pain, swelling and skin changes. Often the cause is the pathology of the superficial veins, the treatment of which will help correct the situation;
Venous hypertension syndrome - pain in the legs when standing. In a sitting position, the pain goes away. Sometimes, this is the only sign. The patients are young women. The reason is deep obstruction of the veins, surgical treatment relieves pain.
Edema of the extremities - occurs in older people who lead a sedentary lifestyle. More common in women.
The complex of multisystem venous pathologies is a violation in the system of superficial, deep and perforated veins.

Chronic venous insufficiency is diagnosed using anamnestic data, an external objective examination. duplex ultrasound procedure allows you to establish the stage of the disease and confirm or refute the presence of venous thrombosis. Other methods: venography, CT, MR angiography.

Minor vein injuries may occur without symptoms. On the other hand, the pathology of deep veins, as well as a combination with a violation of the outflow from the superficial ones, leads to serious consequences. Another factor that causes peeling, impaired capillary circulation, lymph stagnation and decreased sensitivity is high blood pressure. The symptoms of chronic venous insufficiency are as follows:

Trophic venous ulcers are difficult to cure, they progress and relapse. Risk factors for exacerbation of venous ulcers:

Post-thrombotic symptom;
Blockage in the iliac-femoral system;
Insufficiency of deep veins;
Resistant venous hypertension.

Development chronic insufficiency depends on the rate of disease progression.

Chronic venous insufficiency: prevention

mobile lifestyle, physical exercise aimed at strengthening the muscles of the lower leg is an excellent way to prevent venous insufficiency. Physical activity should not be only static, they must be alternated with dynamic (running, swimming). Daily walking for 40 minutes will strengthen the muscles and the venous wall.

In the supine position, the legs should be kept elevated. It should be borne in mind that excess weight increases the load on the venous system, making it difficult to drain from the limbs. A high heel also prevents the venous system from freely moving blood in the vessels.

The use of oral contraceptives is a risk of developing venous insufficiency. In this case, you should regularly (twice a year) undergo ultrasound of the vessels of the legs. The same measures should be taken by pregnant women. If necessary, compression stockings should be used.

Chronic venous insufficiency (CVI) is a disease characterized by impaired venous outflow against the background of the development of varicose veins, postthrombophlebic disease and other vascular pathologies. It occurs more often in women than in men. Chronic venous insufficiency is considered the most common vascular disorder. And the treatment must be of high quality and timely. If you delay in contacting specialists, disability is possible. At an early stage, treatment can be conservative and surgery can be avoided.

Characteristics of the disease

Without medical care, CVI of 2-3 degrees leads to severe circulatory disorders, edema, thrombosis, thrombophlebitis, trophic ulcers, severe convulsions, and expansion of the venous walls. With a diagnosis of "deep vein thrombophlebitis" of a pronounced stage, more than 30% of patients become disabled and lose their former ability to work. With pronounced manifestations of chronic venous insufficiency, loads on the limbs are prohibited, therefore, work should be lightened, the army in this case is contraindicated (with 2 degrees of pathology of chronic venous insufficiency, conscripts are exempted from service).

Some people do not even know that they are predisposed to the development of chronic pathologies of the venous system, they try to cope with the disease on their own, and seek help already at an advanced stage of venous insufficiency. Pathologies of the veins of the lower extremities develop imperceptibly for the patient. At an early stage, quickly passing heaviness in the legs appears.

And then other signs join:

Heaviness in the lower extremities.
Seizures.
Dark spots.
Ulcers of the lower extremities.
Transient edema.
Dryness of the skin of the leg.

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

Variations in pathology

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

Classification depending on the severity of CVI symptoms 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, there is a feeling of heaviness at the end of the working day.
Grade 1. The patient complains of pain, cramps in the lower extremities. Edema occurs after standing work, walking in high heels, prolonged overstrain of the calf muscles.
Grade 2. Pain and cramps increase, pigmentation and erosion are possible, swelling may appear even after a slight load on the legs.
Grade 3. The patient has open or already healed trophic ulcers. All other symptoms of chronic venous insufficiency, characteristic of 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 feature. But it is telangiectasias that should alert and force you to undergo an 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 remedies, systemic drugs, and follow medical prescriptions.

At stage 2 of the chronic process, there are clear signs of varicose veins. The third stage of CVI is characterized by the appearance of edema after long standing work or general overwork. At first, the swelling may be slight in the form of tissue pastosity, but as the disease progresses, the swelling increases. At stage 4, signs of venous eczema appear, as well as age spots. And the 5th and 6th stages of the disease are characterized by the appearance of trophic ulcers.

Spider veins may appear on the first connection of thrombophlebitis.

The phlebologist makes an accurate diagnosis based on the 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 ultrasound method for studying the veins of the lower extremities.

Important points of therapy

Treatment for chronic venous insufficiency is selected depending on the degree of the disease and severity. clinical manifestations. It can be operational and conservative, as well as combined. The duration of therapy directly depends on the degree of the disease. Surgical treatment not only removes veins with dilated walls and nodular 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 impact on the human body. To prevent the development of complications and relieve acute signs CVI is prescribed phlebotropic drugs. The dosage is selected by the doctor, focusing on the severity of chronic venous insufficiency and its degree (the 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 includes the use of elastic compression. Special compression underwear creates support for blood vessels, improves the general well-being of the patient. In chronic venous insufficiency in the advanced stage, urgent surgical treatment is performed. Otherwise, there is a high risk of complications, getting sick disability in the future.

Excess weight can aggravate the disease.

If you notice the first signs of diseases of the veins of the lower extremities, pay attention to the prevention of the development of CVI. Give up uncomfortable shoes, try to lose weight, raise your legs every 2-3 hours to ensure the outflow of blood from the lower extremities. When characteristic symptoms diseases, contact a phlebologist.

Surgical treatment

In chronic venous insufficiency of 2-3 degrees, specialists often resort to surgery. Surgical treatment of CVI is carried out using phlebectomy. During the operation, deformed veins are removed through small incisions. After the patient must wear compression stockings for a long time to prevent the formation of blood clots. The operation allows not only to remove dilated vessels, but to normalize venous blood flow and prevent the development of complications.

Surgical intervention is tolerated in most cases easily. The next day after the operation, you are allowed to get out of bed, bend your legs, start walking. Early activity speeds up the recovery process. At the rehabilitation stage, the patient is prescribed water procedures, massage, physiotherapy exercises. Compression stockings are recommended to be worn continuously for 1-2 months after surgery. To prevent the recurrence of chronic venous insufficiency, venotonic agents are prescribed.

Restriction on the VKK line

movement - I st.;

labor activity - I st.

movement - II st.;

labor activity - II, III Art.

movement - III Art.

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Symptoms and treatment of CVI at stages 1,2 and 3

A whole army of diseases is attacking modern man. Among them are diseases of the veins of the lower extremities. Internet portals are full of information about varicose veins and how to deal with this disease. But not many people know about venous insufficiency. The term "chronic venous insufficiency (CVI)" implies a complex set of symptoms that describe certain stages of pathological changes in blood vessels and other anatomical structures lower limbs. Such manifestations occur with a constant, that is, chronic violation of the venous outflow from the lower extremities.

How the disease develops

Chronic venous insufficiency is a chain of pathological changes in the lower extremities, which has a certain staging and classification. The main causes of this condition are varicose veins of the lower extremities, as well as deep venous thrombosis and thrombophlebitis. If the treatment of the above diseases was not carried out on time or there was insufficient effectiveness of therapeutic measures, CVI gradually develops.

Chronic stagnation of blood in the venous system of the lower extremities leads to vasodilation and increased internal pressure. Such abnormal pressure also extends to the system of the smallest capillaries that supply and drain all the anatomical structures of the leg. The inner layer of capillaries is gradually damaged, which leads to malnutrition and metabolism in the lower extremities. These pathological processes are the cause of unpleasant symptoms. Such chronic insufficiency progresses gradually, has its own stages and degrees of severity. Currently, there is the following classification of CVI:

Subclinical stage - no symptoms.
Grade 1 is characterized by moderate transient symptoms.
2 degree reflects persistent symptoms requiring a careful approach to treatment.
Grade 3 is characterized by persistent chronic changes in the structures of the lower leg.

In this article, we will try to analyze the symptom complex of each stage of venous insufficiency separately. This is necessary in order to start treatment of the disease in a timely manner and avoid possible complications.

Capillaries are gradually damaged, which leads to unpleasant symptoms.

The onset of the disease

It is most difficult to identify the subclinical stage of CVI, especially if the patient is silent about the presence of symptoms and chronic diseases of the veins of the lower extremities, however, pathological microcirculatory changes of varying degrees already occur.

Constantly increased venous pressure begins to damage the smallest capillaries, but the patient practically does not feel any discomfort. At this stage, such a symptom as swelling of the legs and feet is absent in the majority. The most common complaints with this degree of chronic venous insufficiency are moderate pain and burning symptoms in the legs with prolonged standing in an upright position.

Gradually, chronic venous insufficiency passes to the next stage, which already has obvious symptoms. Among them:

Transient swelling of the legs of a mild degree that occurs at the end of the day and disappears during the night.
In the evening, patients complain of symptoms such as a feeling of heaviness, discomfort and fullness in the legs and feet.

At this stage, the transient nature of the symptoms is due to hard work. lymphatic system for drainage and outflow of excess fluid from the legs. However, lymphovenous insufficiency already occurs, since compensatory mechanisms cannot cope with the forces of gravity of the earth. Edema disappears only after a long night's sleep in a horizontal position.

The treatment of venous insufficiency of the lower extremities is optimal at this stage. In this way, disability can be prevented, an acceptable quality of life and exercise tolerance can be maintained.

At the initial stage, the patient practically does not feel discomfort.

Further scenario

In a situation where CVI treatment was not started on time, the pathological process moves to a new level. The second degree of the disease is characterized by further damage to the capillary bed. Red blood cells - erythrocytes - leave the vascular bed through the damaged walls of small vessels.

There is a deposition of the product of their degradation - hemosiderin - in the skin. This gives the skin a characteristic purple-bluish hue. Sometimes, with chronic venous insufficiency of the lower extremities, there is also hypopigmentation of the skin due to a violation of its nutrition.

Edema is permanent and does not go away even at night. At this stage, chronic insufficiency of the lymphatic system, sclerotic changes in the skin and nails join. There is eczema or itching on the skin of the legs and back of the feet.

Treatment at this stage is not as effective as in CVI of the first degree. Venous insufficiency has already led to irreversible changes in the microvascular bed. Therapy can only stop the further progression of the disease.

With CVI of the third degree, there is a total violation of circulation in the legs. At this stage of the disease, the exchange of oxygen and nutrients severely broken. Trophic ulcers appear on the skin of the legs. They are open wounds on the skin. Such ulcers do not heal for a long time, they are prone to growth and infection.

Treatment of trophic ulcers is a very difficult task, because venous insufficiency is extremely severe, and the pathological process is almost impossible to stop. Sometimes the addition of a secondary infection at this stage of CVI leads to suppuration and, in extremely severe cases, even to amputation of the leg. Disability is a common occurrence with advanced CVI.

Therapy in the second stage prevents the progression of the disease, but does not cure it.

The classification of chronic venous insufficiency described above clearly explains all stages of the pathological process. It is best to start the fight against the disease on early stages. We'll talk about this below.

How to beat the disease

Treatment of chronic venous insufficiency of the legs should be started in the early stages of the disease. It is at this stage that it is possible to break the pathological vicious circle and restore normal microcirculation and venous outflow. Consider the main therapeutic measures for CVI:

Regular use of compression stockings. Special stockings, stockings or pantyhose have a different degree of compression depending on the stage of the disease. There are models for both men and women. Such therapeutic knitwear contributes to external compression of the superficial veins of the legs, which improves the outflow of blood from them. This makes a significant contribution to the treatment of chronic venous insufficiency in its initial stages, that is, in the first degree of the disease.
Reception medicines with venotonic effect. These are herbal preparations that effectively increase the tone of the venous wall. These remedies help to get rid of unpleasant symptoms.
Minimally invasive interventions that eliminate pathologically altered veins. We are talking about sclerosis, laser coagulation or ligation of dilated vessels with incorrectly functioning valves. Such measures stop the pathological process at its initial stages.
Surgical operation to remove varicose veins. It is performed when all of the above treatment has exhausted itself.
Taking anticoagulants and antiplatelet agents to prevent recurrent thrombosis and deep vein thrombophlebitis.

Compression hosiery is effective in the first stage of the disease.

At the last stage of venous insufficiency, namely in the presence of trophic ulcers, treatment should be aimed at their healing, that is, relief of symptoms. When infected, therapy should be supplemented antibacterial drugs general and local action.

Chronic venous insufficiency is a complex long-term disease. His classification, dividing the pathological process into stages, explains the need for timely treatment. It is quite possible to avoid trophic manifestations with a serious approach, careful attention to symptoms and strict adherence to medical recommendations.

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Chronic venous insufficiency of the lower extremities

Chronic venous insufficiency (CVI) is a pathology caused by a violation of the outflow of blood through the veins of the lower extremities. CVI is a collective concept, it includes several diseases with a similar clinical picture: long-term varicose veins, post-thrombophlebitic syndrome, congenital anomalies of venous vessels.

According to Russian studies, as a result of detailed diagnostics, signs of CVI are detected in every second inhabitant of the country aged 20–50 years. Moreover, in approximately 15% of cases, phlebologists are faced with a decompensated form of CVI, often accompanied by trophic changes in the skin, recurrent and open venous ulcers. One of the most important problems that negatively affect the development and progression of pathology, phlebologists consider the untimely treatment of patients for medical care, as well as a long period of latent symptoms. Most patients mistakenly believe that the complex of symptoms of CVI is only a consequence of prolonged static loads or physical fatigue. Some do not realize the severity of the pathology and the seriousness of the complications that this disease can lead to.

An important point: often varicose veins of the lower extremities are confused with chronic venous insufficiency. However, the latter can also appear without visible changes in the saphenous veins, since the cause of the development of CVI is congenital and acquired pathologies that lead to impaired blood flow through the deep vein system.

Development mechanism

Normally, 90% of the blood volume flows through the deep veins, and the remaining 10% moves through the superficial vessels. Venous return is provided by a number of factors. The most important role is played by motor activity. During physical exertion, the muscles of the limbs contract, while squeezing the veins, as if “squeezing out” the blood from the venous vessels. Due to gravity, the blood tends to go down, and here the valves work, directing the blood flow up to the heart. Thus, maintaining normal blood flow through the venous system of the lower extremities is possible provided:

viability of the valve apparatus,
stable tone of the venous wall,
normal physiological change vessel lumen caused by a change in body position.

Due to insufficiency of venous circulation in the small vessels of the affected tissues, the following occurs:

local thickening of the blood;
accumulation of metabolites (substances chemically altered during metabolism);
activation of leukocytes and macrophages, as well as increased secretion of lysosomal enzymes;
increase in biological active substances mediators of inflammation and free radicals.

Normally, some volume of lymph is discharged into the venous bed through a system of fistulas (cava-caval anastomoses) connecting the tributaries of the superior and inferior vena cava. But against the background of increased pressure in the venous system, this process is disrupted. As a result, the lymphatic system is overloaded, the outflow of lymph worsens, aggravating tissue trophic disorders and provoking the formation of trophic ulcers.

Causes of chronic venous insufficiency

There are a number of modifiable and non-modifiable factors that increase the risk of developing CVI.

Low physical activity. Lack of work of the muscular-venous pump leads to stagnation of blood and starts the pathological process.
Obesity. The risk of developing CVI increases with the degree of obesity.
genetic predisposition. Weakness of the vein wall due to congenital insufficiency connective tissue may lead to the development of this pathology.
Gender identity. Women suffer from CVI three times more often than men. Phlebologists (http://modernsurgeon.ru/o-tsentre/) explain this fact by a high level of estrogen hormones, increased stress caused by pregnancy and childbirth, as well as a high life expectancy compared to men.
Taking hormone-containing drugs, including hormonal contraceptives.
Age. Due to prolonged exposure to provoking factors, older people suffer from CVI much more often.
Prolonged static loads and heavy physical labor associated with professional necessity.

In some cases, chronic venous insufficiency may be the result of phlebothrombosis. The cause of the development of CVI is considered to be the so-called. phlebopathy is a condition in which a violation of the outflow of blood in the veins of the lower extremities occurs in the absence of any data objectively confirming the presence of pathology. In rare cases, the disease can develop against the background of a traumatic lesion of the veins.

Chronic venous insufficiency: symptoms

The clinical symptoms of CVI are varied. For early stages the manifestation of one or more signs is characteristic, among them: bursting pains in the lower extremities;

transient swelling;
heaviness in the legs, aggravated by prolonged standing;
night cramps in the lower extremities;
changes in the skin: hyperpigmentation, dryness, loss of skin elasticity at the level of the distal third of the leg.

Varicose veins in initial stages CVI is not observed in all cases. As the pathology progresses, the consequences of venous circulatory insufficiency are exacerbated. Trophic skin disorders become pronounced, trophic ulcers occur. An increase in blood volume in the venous system of the lower extremities can cause a significant deterioration general condition patient's health. The above symptoms may be accompanied by signs of heart failure, dizziness and fainting. Due to a decrease in the volume of circulating blood, patients suffering from severe chronic venous insufficiency experience difficulties in physical and mental work.

Chronic venous insufficiency: degrees (classification)

In Russia, the following classification of chronic venous insufficiency of the lower extremities has been adopted (ICB code 10):

grade 0. No symptoms of chronic venous insufficiency of the lower extremities. Clinicians singled out this degree, since in practice a pronounced varicose vein change can occur without any signs of CVI;
chronic venous insufficiency of the 1st degree. Patients complain of arching pains and heaviness in the legs, transient swelling, cramps at night;
chronic venous insufficiency of the lower extremities of the 2nd degree. characteristic feature- the phenomena of fibrous degeneration of the subcutaneous tissue and skin (lipodermatosclerosis), edema (edema), hyperpigmentation (the skin becomes brown), the formation of weeping or dry eczema;
chronic venous insufficiency of the 3rd degree. At this stage, a venous trophic ulcer is observed.

Chronic venous insufficiency: stages of the disease according to the international CEAP classification system, reflecting the scale of disability:

"zero" - signs of CVI are completely absent;
"chronic venous insufficiency of the 1st degree" - the symptoms of the disease appear, while the patient is considered able-bodied, there is no need for supporting agents;
"chronic venous insufficiency of the lower extremities of the 2nd degree" - the patient is able to work for a full day, provided that supportive means are used;
"chronic venous insufficiency of the 3rd degree" - the patient is considered disabled.

Severe stages of lipodermatosclerosis or prolonged lack of therapeutic measures for the first episode of venous ulcer formation often cause non-healing and constantly recurring trophic ulcer, one of the most difficult conditions that people suffering from CVI face.

Diagnosis of chronic venous insufficiency of the lower extremities

The success of CVI treatment depends primarily on an accurate diagnosis. Multiple causes and manifestations of the disease create the need for instrumental diagnostics in addition to a medical examination. Currently, the main diagnostic method of CVI is ultrasound duplex angioscanning. The study allows us to determine the nature of venous insufficiency and localization of the affected vessels. In some cases, additional instrumental diagnostic measures may be prescribed:

radiopaque phlebography. The study is necessary for the diagnosis and choice of methods of surgical treatment. It allows assessing the anatomical and functional state of deep, superficial and perforating (connecting the first two) veins of the lower extremities, localization, extent of pathological changes;
computed tomography (CT). A highly informative method that allows visualizing the nature of the pathological process in a 3D image;
magnetic resonance angiography of the veins of the lower extremities allows you to examine the state of blood vessels, lymphatic tracts, collateral blood flow and assess the extent of the pathological process.

Since CVP often indicates the neglect of the disease, timely diagnosis and the subsequent set of therapeutic measures are extremely important for the patient.

Chronic venous insufficiency: treatment

When diagnosed with chronic venous insufficiency, the methods of treatment and their duration are directly related to the stage of the disease and the presence of complications. Among the main techniques are conservative and operational.

Phlebologists are guided by the following principles for the treatment of chronic renal failure:

Therapy should be carried out in courses. Some patients are treated in short and episodic courses, while others require long-term and regular treatment. The average duration of the course is 60-75 days.
Medications should be combined with other treatments.
The treatment plan is selected strictly individually.
Achieving a positive effect of treatment is possible with the direct participation of the patient. The patient must clearly understand the essence of the disease and be aware of the consequences of non-compliance with the recommendations of the attending physician.

In most cases, a positive effect of treatment can be achieved using a conservative method, consisting of the following areas:

drug treatment;
elimination of modifiable risk factors;
compression therapy;
physiotherapy;
complex therapeutic gymnastics.

An obligatory condition that patients must comply with in the treatment of CVS is the correction of motor activity. The phlebologist recommends a special set of exercises that will not include heavy lifting or sudden and fast movements. Patients with CVI are shown:

Compression therapy is an integral part of the entire treatment complex for CVI. This technique allows:

eliminate swelling;
reduce the diameter of the lumen of the vein;
improve venous hemodynamics;
improve the functioning of the valve apparatus;
restore microcirculation;
improve lymphatic drainage through the lymphatic vessels.

An elastic bandage on a diseased limb should be formed by a phlebologist, since this process requires professional skills. Self-use of an elastic bandage can only aggravate the symptoms of the disease. As a rule, an elastic bandage is used in cases where short-term continuous wear is required. For long-term use, compression stockings are preferred. The attending physician will select products: tights, stockings or stockings with the desired degree of compression. Independent use of compression stockings is undesirable, as the patient will not be able to choose the right required level product pressure.

In addition, compression therapy has a number of absolute contraindications. It cannot be used for:

atherosclerosis of arterial vessels;
cardio-respiratory failure;
the presence of damage to the skin in the area of \u200b\u200bthe intended use of compression products.

Choice of method conservative therapy depends on the stages of CVI.

At stage 1, against the background of CVI, varicose saphenous veins are observed. In order to eliminate this defect, sclerotherapy is prescribed. The essence of the method is the introduction of a small diameter chemical agent into the vein, which, as it were, “glues” the vessel, after which the vein completely resolves. To achieve the expected effect, it is necessary to use compression therapy. Perhaps the appointment of a short course of medication.
If chronic venous insufficiency of the 2nd degree is detected, the treatment will be aimed at improving microcirculation in the surrounding tissues and increasing venous tone. For this purpose, the phlebologist will appoint medications. The duration of their intake and the number of courses will depend on the speed of manifestation of the visible therapeutic effect.
Chronic venous insufficiency of the 3rd degree, treatment should be aimed at combating the complications of the disease. In this case, the doctor prescribes a combination therapy, which includes general medications and medicines. local application. Drugs are selected depending on individual indicators and the level of neglect of the disease. As a rule, non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac), phlebotonics (Phlebodia, Detralex, Vasoket), anticoagulants (Clexane), antiplatelet agents (Pentoxifylline, Trental), antihistamines(Eden, Tsetrin, Lorano). Phlebologists do not recommend continuing treatment in the absence of a therapeutic effect for two months. Local pharmacotherapy consists in the use of medicines (gels, ointments) with the active ingredient Heparin. This is Lyoton 1000, heparin or troxevasin ointment. To prevent the progression of trophic disorders, topical pharmaceuticals containing corticosteroids (Flucinar, Mesoderm, Polcortolone, Akortin) are prescribed. In some cases, in the presence of multiple lesions of the skin, additional treatment by a dermatologist is necessary.

Doctors pay special attention to the treatment of trophic ulcers, since these injuries are often complicated by bleeding and irreversible changes in the skin. It requires bed rest, treatment of ulcers with a special solution, the use antiseptics, for example Miramistin ointment, and antibiotic therapy. The CVI treatment complex includes physiotherapy techniques. Well proven: diadynamic currents, electrophoresis and balneotherapy.

Surgical treatment options are aimed at eliminating the main link in the pathology of CVI - impaired venous blood flow and the cause that led to the onset of the pathology.

If this is varicose veins of the superficial veins, then the following types of interventions are indicated:

classical open operations on the saphenous veins. To perform them, several incisions are made in order to remove the affected vessels;
methods of intravascular obliteration. This includes minimally invasive methods: radiofrequency ablation (RFA) and endovenous laser ablation (EVLA). Manipulations are carried out without incisions (puncture). Under ultrasound guidance, the surgeon "closes" the diseased vessel, and does not remove it.

Surgical interventions on perforating veins:

miniphlebectomy. The essence of the operation is the separation of the perforating vein;
endovenous laser obliteration is an alternative to miniphlebectomy. Manipulation is carried out on perforating veins in the area of trophic lesions of the skin.

In post-thrombotic disease, the following reconstructive operations are indicated:

Deep vein stenting. In 1-6% of patients with trophic ulcers, narrowing of the iliac veins is observed. Stenting greatly improves clinical condition patients, slows down the further progression of reflux and allows you to refuse complex surgical intervention. The operation is carried out in a specialized vascular hospital, requires modern medical equipment and highly qualified personnel.
Reconstructive operations on deep veins. The purpose of the intervention is the formation of the valve structure in deep venous vessels. At this stage, this section is considered one of the most problematic among the entire arsenal of operational phlebology.

Photos BEFORE and AFTER CVI treatment

Regardless of the cause of CVI and the stage of the disease, patients need to:

Observe active driving mode.
Avoid prolonged static loads (standing or sitting for a long time).
Regularly perform a complex of therapeutic exercises prescribed by the attending physician.
Constantly wear compression stockings recommended by a phlebologist during the day.

To prevent the development of the disease, it is necessary to regularly conduct a preventive examination by a phlebologist, including instrumental diagnostic methods. The implementation of this recommendation is especially important for people at risk of developing CVI.

Varicose disease of the lower extremities CVI 2nd degree

Varicose veins of the lower extremities CVI of the 2nd degree is a violation of the vascular system, which occurs in 25% of the population. What is the reason for such a high figure, we will understand today.

Diagnosis of CVI 2nd degree

Chronic venous insufficiency (CVI) is a pathological phenomenon caused by a violation of the outflow of blood in the legs. Russian phlebologists are extremely concerned - every second Russian is diagnosed with CVI of the 2nd degree. Some cases of CVI are accompanied by a severe complication - trophic ulcers. Separately, it is worth noting about the opinion that problems with veins are the lot of people of age. In fact, varicose veins of the lower extremities of CVI of the 2nd degree can become a problem for very young, twenty-year-old citizens.

The complexity of the treatment of venous insufficiency chronic form lies in the late diagnosis and delayed treatment. Many carriers of the disease are not even aware of its presence. Thus, pathology from the initial level moves to the second stage.

It is extremely important to be aware of the symptoms of CVI. For owners of CVI degree 2, the standard manifestations of varicose veins are supplemented by a new range of symptoms. In general, the picture of venous insufficiency of the 2nd degree is as follows:

pain that worsens with prolonged standing;
"syndrome of tired legs", an uncomfortable feeling of heaviness in the legs;
swelling of the legs;
increased sweating;
the appearance of vascular patterns on the legs in the form of nets, stars;
cramps in the calf muscles, which in most cases disturb at night;
a significant change in skin color, the leg acquires a pale bluish tint;
the lower limb affected by CVI of the 2nd degree is much colder to the touch than a healthy leg;
the appearance of hyperpigmentation, which is characterized by dark spots in the lower leg;
inflammatory process of the skin.

Gradually, the skin begins to darken, acquiring a reddish tint. The patient begins to torment itching, eczema appears. Such symptoms indicate the progression of the disease, the excessive thinning of the skin at the site of pathological damage to the veins.

CVI 2 degrees of the lower extremities, photo

The 2nd degree of venous insufficiency is characterized not only by a deterioration in well-being, but also by external manifestations of the disease. The visual representation is posted below.

CVI 2 degrees of the lower extremities, photo:

The danger of the 2nd degree of venous insufficiency also lies in the fact that due to the deposition of a large amount of blood, general well-being worsens. The patient is extremely difficult to endure mental and physical exercise, he is regularly disturbed by dizziness and fainting. In some cases, there are signs of heart failure.

CVI 2nd degree and army

Many conscripts are concerned about the question - are CVI 2 degrees compatible and the army? A conscript is exempt from military service if:

diagnosis of post-thrombotic varicose veins of the lower extremities;
diagnosis of varicose veins of the lower extremities with the manifestation of chronic venous insufficiency of the 2nd degree.

The conscript is assigned a category of fitness B. This means that he is fit to a limited extent and is credited to the reserve. A conscript in the reserve receives a military ID.

Treatment of chronic venous insufficiency of the 2nd degree

Treatment of chronic venous insufficiency of the 2nd degree must necessarily be complex. It will no longer be possible to cope with a progressive disease solely with the help of pills!

Compression underwear. Wearing medical underwear is mandatory at all stages of the disease. These can be special stockings, stockings for varicose veins on the legs or tights made of compression stockings. Models of underwear are somewhat different - they are for men and for women, they have different degrees of compression. The consultant will help you choose the right medical underwear, depending on the individual characteristics of the patient.

Medical underwear contributes to squeezing the veins, thereby improving blood flow in the legs. Phlebologists insist that compression hosiery is a mandatory component of complex therapy.

Medicines. List assigned by doctor medicines with venotonic action. Drug therapy helps to alleviate the patient's condition, increases the tone of the vascular walls. Drugs are prescribed on an individual basis, depending on the patient's contraindications. Frequent companions of the patient are drugs Detralex and Venoruton.
Minimally invasive intervention. It refers to sparing methods of treatment that do not require serious trauma to the skin. With CVI 2 degrees can be assigned:

sclerotherapy - intravenous administration sclerosant substance, which allows you to restore the normal outflow of blood;
laser coagulation - elimination of blood reflux by inserting a catheter into the affected vein and exposure to laser radiation.

However, not everything is so rosy. Doctors say that at the second stage of venous insufficiency, the presented methods of treatment are not able to cure the patient. The disease is at the stage of active progression, which has already led to irreversible changes in the vascular bed. Varicose disease of the lower extremities CVI grade 2 is not treated by conservative methods. Such complex therapy only allows you to stop the process further development pathology.

Surgery for CVI 2nd degree

Indications for surgical intervention:

progression of the disease, the absence of a positive result of therapeutic therapy;
reflux (abnormal blood flow);
development of trophic disorders.

Contraindications for the operation:

advanced age of the patient;
inflammatory process;
the presence of severe comorbidity.

The operation can be carried out in two ways:

Crossectomy. Through a small incision in the groin, the surgeon cuts (ligates) the great saphenous vein. The intersection is done at the level of fistulas with a deep vein.
Stripping. A medical probe is inserted through a small incision into the vein. When removing a small vein, the thinnest probe is inserted; when removing a large vein, a large probe is used. After the introduction of the probe, the surgeon completely excised the venous trunk.

The operation is dangerous with complications in the form of bleeding, lymphatic leakage, the appearance of hematomas, thrombosis.

CVI 2 degree disability

According to statistics, with CVI of the 2nd degree, disability is established in 30% of cases. In most patients, disability occurs due to the neglect of the disease and its active progression. Group 2 or 3 disability is established. Group 3 is determined by moderate disability due to disability. Group 2 is a persistent pronounced limitation of life.

The degree of disability may directly depend on the type of activity of the patient. For example, for office workers, disability is established only in the presence of trophic changes. In the presence of rapidly healing ulcers and pathological hyperpigmentation, disability for knowledge workers is not provided!

However, if the degree of disability is refused, the patient can achieve more loyal working conditions. For example, exemption from night shifts, business trips, freelance duties.

Varicose disease of the lower extremities CVI of the 2nd degree is an extremely severe pathology of the vascular system. To stop development at the second stage is a chance to maintain an optimal state of health. However, it is much more important to prevent the disease! At the first sign of problems with veins and blood vessels, you should immediately seek advice from a phlebologist!

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Information site about varicose veins, how to treat leg veins

For citation: Klimova E.A. Chronic venous insufficiency and methods of its treatment // BC. 2009. No. 12. S. 828

Chronic venous insufficiency (CVI) of the lower extremities is a syndrome characterized by impaired venous outflow, which leads to disorganization of the regional microcirculation system. CVI is a common disease, registered in 10-15% of the adult population. This is a syndrome that develops with a polyetiological disease - varicose veins of the lower extremities. Thus, a group of leading Russian phlebologists developed a capacious definition: “Varicose veins of the lower extremities are a polyetiological disease, in the genesis of which heredity, obesity, hormonal status disorders, lifestyle features, and pregnancy are important. The disease is manifested by varicose transformation of the saphenous veins with the development of CVI syndrome. The disease is characterized by high prevalence. So, in the USA and Western Europe, about 25% of the population suffers from various forms of varicose veins.

Etiology
Nevertheless, the etiology of CVI is currently still a debated issue. Modern studies of endothelial functions indicate the dominant role of venules in this pathological syndrome. In the lower extremities, the surface area of the venules in contact with blood is greater than in all other venous vessels combined. Endothelial cells, due to their location at the interface between blood and other tissues, are responsible for maintaining vascular homeostasis. They regulate the passage of plasma contents and leukocytes from the bloodstream into the interstitium. These properties of the endothelium are associated with the presence of specific molecules - membrane receptors, adhesion molecules, intracellular enzymes and a special configuration of the cytoskeleton. Also, endothelial cells synthesize various substances that regulate the function of platelets - a factor that activates platelets, prostaglandins; leukocytes - interleukin-1, interleukin-8, granulocyte-macro-phage colony-stimulating factor; smooth muscle cells - endothelin, growth factors. Inflammatory or other pathological processes in the inner wall of venules activate endothelial cells. Activated endothelium releases inflammatory mediators, leading to influx, adhesion, and activation of polymorphonuclear neutrophils and platelets. If this process becomes chronic, T-lymphocytes and monocytes are attached to the surface of the endothelium, which release highly reactive radicals, eventually leading to the destruction of the endothelial barrier of venules. The contact that occurs between plasma coagulation factors and tissue factor located in the extravascular space, and especially on the pericytes of adjacent capillaries, can trigger intravascular coagulation.
Until recently, various forms of classification of varicose veins of the lower extremities and CVI could be found in the domestic literature. In 2000, at a meeting of experts, "Standards for the diagnosis and treatment of varicose veins of the lower extremities" were adopted. Based on these standards, our country currently has a classification presented in table 1.
Pathogenesis
The leading place in the pathogenesis of CVI is occupied by the "valve" theory. Valvular insufficiency of various parts of the venous bed of the lower extremities leads to the appearance of a pathological, retrograde blood flow, which is the main factor in damage to the microcirculatory bed, which was proven using radiopaque phlebography, and then with the involvement of non-invasive ultrasonic methods. Indirect confirmation of the "valve" theory of CVI was the results of well-known epidemiological studies conducted in Germany and Switzerland, on the basis of which it was concluded that the primary need to correct valvular insufficiency of the venous bed using elastic compression or surgery. However, the question remained about the cause of the development of valvular insufficiency itself as a trigger for the development of CVI. Thus, a large number of patients were found with complaints characteristic of CVI in the absence of valvular pathology. At the same time, the use various options plethysmography recorded a violation of the tone of the venous wall of varying severity. Due to this, a hypothesis was put forward that CVI is not a disease of the valves, but a pathology of the vein wall.
It has now been proven that in the presence of various risk factors and under the influence of gravity in the venous knee of the capillary, the pressure increases, reducing the arteriovenular gradient necessary for normal perfusion of the microvasculature. The consequence is first periodic, and then permanent tissue hypoxia.
TO the most important factors risk of developing CVI include:
1) Pregnancy and childbirth.
2) Heredity.
3) Overweight.
4) Chronic constipation.
5) Hormonal contraception.
6) Systematic sports.
In addition, a constant change in body position and an uneven load on various parts of the venous bed of the lower extremities triggers another little-studied mechanism, called mechanotransduction, or shear forces. This means that under the influence of pressure constantly changing in strength and direction, there is a gradual loosening of the connective tissue frame of the venule wall. Violation of the normal intercellular relationships of the endothelium of the venous capillaries leads to the activation of genes encoding the synthesis of various adhesion molecules.
The main symptoms that occur with CVI are: heaviness in the legs, pain in the calf muscles, which is caused by a decrease in venous tone and hypoxemia; convulsions, swelling of the lower extremities in the evening, which is caused by an overload of the lymphatic system, increased capillary permeability and inflammatory reactions; persistent skin itching. More often these symptoms are combined.
Treatment
Common methods of CVI treatment are pharmacotherapy, compression therapy and surgical methods of treatment. The mechanical method of therapy, which is effective only during its application, does not affect the significantly increased permeability of the venule endothelium. Such an effect can only be achieved with the help of pharmacotherapy, using a drug that binds to the endothelium of venules and has the ability to suppress or prevent inflammation, leading to a decrease in the permeability of small vessels and, as a result, to a decrease in edema.
Compression therapy improves the activity of the musculo-venous pump of the lower leg, reduces swelling and relieves heaviness and arching pain in the legs. The greatest comfort for the patient and the optimal physiological distribution of pressure is achieved with the help of special therapeutic knitwear.
Surgical treatment: the initial form of varicose veins (telangiectasias and reticular varices) is only a cosmetic problem, and all its external manifestations can be completely eliminated with the help of modern techniques such as sclerotherapy. The main goal of surgical treatment is to eliminate the mechanism of the disease, namely, pathological vein-venous discharges. This is achieved by crossing and ligating insufficient perforating veins, sapheno-femoral and sapheno-popliteal fistulas. With the development of modern minimally invasive technologies, the old ideas about venectomy as a voluminous and traumatic operation are a thing of the past.
Medical treatment
Among the main means used at all stages of the disease, venotonics, or phleboprotectors, are most widely used. These are diverse pharmacological preparations, which are united by a common property - stabilization of the structural components of the venous wall and an increase in its tone. Of the main venotonics, g-ben-zo-pyrones, flavonoids, preparations based on micronized diosmin, are best studied. In severe forms of chronic venous insufficiency, accompanied by a violation of the hemostasis system with the development of hyperviscosity and hypercoagulation syndromes leading to thrombosis, anticoagulants are used as a means of basic therapy. Among anticoagulants, the most convenient to use is low molecular weight heparin, which causes a lower incidence of hemorrhagic complications, rare thrombocytopenia, has a longer duration of action and no need for frequent laboratory monitoring compared to unfractionated heparin. In the future, indirect oral anticoagulants are used, represented by coumarin and phenidine derivatives, their dose is individually selected depending on the value of the international normalized ratio. Platelet disaggregants are used to purposefully improve hemorheology and microcirculation. The most commonly used low molecular weight dextrans, dipyridamole and pentoxifylline. In recent years, the possibility of using clopidogrel has been studied, which seems to be more appropriate.
Also, for the treatment of CVI, auxiliary, symptomatic agents are used. For example, antibacterial and antifungal agents - with infected venous trophic ulcers or in the case of the development of erysipelas. Anti-histamine drugs are prescribed in the treatment of such frequent complications of CVI as venous eczema and dermatitis. In cases of severe edematous syndrome, it is advisable to use potassium-sparing diuretics. NSAIDs are used for severe pain and convulsive syndromes, as well as for aseptic inflammation of the skin of the lower leg - acute indurative cellulitis. Also, do not forget about the use of acetylsalicylic acid (ASA), which is perhaps the only representative of NSAIDs that is actively used in phlebological practice. Under the influence of ASA, the aggregation response of platelets to various thrombogenic stimuli is weakened. In addition, ASA inhibits the synthesis of vitamin K-dependent coagulation factors, stimulates fibrinolysis, and inhibits the lipoxygenase pathway of arachidonic metabolism in platelets and leukocytes. The usual dosage is 125 mg ASA per day. Corticosteroids are used in the most severe forms of chronic venous insufficiency, accompanied by acute indurative cellulitis, venous eczema, hemosiderosis, lamellar dermatitis, etc.
Topical drugs (ointments and gels) occupy an important place in the treatment of chronic venous insufficiency and are very popular among both doctors and patients. This is due to the fact that the cost of these drugs is relatively low, and their use is not associated with any difficulties. Ointments and gels based on venoactive drugs, along with some distracting effect, can have veno- and capillary-protective effects. An example of the highest quality drug on the Russian pharmaceutical market is Venitan gel or cream for external use. Active substance Venitana aescin - active ingredient chestnut fruit extract, is a mixture of triterpene saponins. Escin has anti-inflammatory, angioprotective properties, improves microcirculation, reduces capillary permeability, prevents the activation of lysosomal enzymes that break down proteoglycan, reduces capillary fragility and increases the tone of the venous wall, which helps to reduce venous congestion and fluid accumulation in tissues, thereby preventing the appearance of edema (Fig. 1).
The most favorable effect of the use of this drug is achieved when Venitan is used in the initial stages of the development of chronic venous insufficiency.
Of particular note is the new form of the drug - Venitan Forte, which, in addition to escin, includes heparin, this combination acts not only on the venous wall, but also on the blood flow inside the vessel. Venitan Forte also contains dexpanthenol and allantoin, which improve the absorption of heparin and escin through the skin, promote tissue regeneration and improve skin condition. The drug is used not only for the initial degree of development of chronic venous insufficiency, but also for severe symptoms of venous insufficiency (II, III stage): swelling, feeling of heaviness, fullness and pain in the legs, for complex treatment varicose veins and thrombophlebitis of superficial veins. The mechanism of action of Venitan Forte is presented in Table 2.
The doctor should not forget that the treatment of chronic venous insufficiency is a complex measure aimed at both the pathogenetic mechanisms of the development of the disease and various etiological factors. For successful treatment, it is necessary to rationally and balancedly use the existing arsenal of medicines, compression stockings and surgical methods of treatment.

Literature
1. Savelyeva V.S. Phlebology. Guide for doctors. M.: Medicine, 2001.
2. A. I. Kirienko, V. M. Koshkina, and V. Yu. outpatient angiology. Guide for doctors. M., 2001.
3. Becker C., Zijistra JA. New aspects of the pathogenesis of chronic venous insufficiency and the direction of action of oxyrutins. Consilium-Medicum Volume 3/N 11/2001.
4. Bogachev V.Yu. Initial forms of chronic venous insufficiency of the lower extremities: epidemiology, pathogenesis, diagnosis, treatment and prevention. Consilium-Medicum Volume 06/N 4/2004.
5. Bogachev V.Yu. Chronic venous insufficiency of the lower extremities: modern principles of treatment. Consilium Medicum. Volume 05/N 5/2000.

Venous insufficiency (VN) is a complex of clinical manifestations that develop in the human body due to a violation of the outflow of blood in the vein system. This disease is one of the most common of its kind. About 15–40% of the population suffer from this circulatory failure.

The prevalence of acute and chronic venous insufficiency is due to upright posture, because of this, the load on the vessels of the legs is constantly increasing. Most often, patients seek medical help in the last stages of the disease. Therein lies its greatest danger. People assume that the symptoms that have arisen are nothing more than the consequences of fatigue due to constant stress on the legs. The severity of the pathology is not objectively assessed by any patient who has it. Most often, venous insufficiency of the lower extremities is confused with, but these two conditions are not the same. The disease can also develop not only in the legs, but also in the brain.

Pathogenesis

The pathogenesis 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 for increasing pressure in the lumen of the vein.

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

If timely treatment is not carried out, then the pressure in the veins will gradually only increase and the walls of the vessels will lose their elasticity. Their permeability will increase. Regional edema of the lower extremities will develop. Trophic disturbances will occur later. They develop as a result of compression of the tissues that surround the venous vessels, and disruption of their normal nutrition.

Forms

acute venous insufficiency (AVN). It develops quite abruptly, due to the overlap of the deep veins of the legs. Accordingly, the outflow of blood from them is instantly disturbed. This syndrome develops in elderly and working age. Its development is provoked by several reasons: sharp forms, as well as injuries due to which there was a ligation of veins located in deep tissues. The pathological process affects exclusively deep veins, it does not apply to superficial ones. Symptoms of OVN appear almost immediately - a person develops swelling of the legs, the skin acquires a bluish tint. A distinctive sign of the presence of OVN is that the pattern of veins on the skin is clearly visible. A person feels severe pain in the direction of the main vessels. appease pain You can use a regular cold compress. Its action 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 the venous vessels located subcutaneously. It does not apply to deep ones. Only at first glance, it may seem easy and harmless, but in fact, due to constant circulatory disorders, develop pathological changes in the trophism of the ankle joint. This form of insufficiency has several stages. Not the first stage, age spots appear on the skin at the site of impaired blood flow. If the patient does not seek help from a doctor in a timely manner, then gradually they become several times larger and grow into soft tissues. As a result, trophic ulcers appear (they are difficult to cure in a conservative way). At the last stage of CVI, blood clots form, and other vascular anomalies develop.

Causes

Venous insufficiency most often develops in the following conditions:

post-thrombophlebitic syndrome;
varicose veins;
congenital vascular pathologies;
phlebothrombosis;
limb injuries.

Negative factors that significantly increase the likelihood of progression of venous insufficiency of the lower extremities:

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 develop ARI and CVI. Also, during pregnancy and childbirth, the load on the venous vessels increases (venous insufficiency of both the legs and the brain may develop);
obesity;
weak motor activity;
age. CVI is most likely to develop in elderly people, since unfavorable factors affected their bodies for a longer time;
static loads;
chronic constipation;
lifting weights (permanent).

At-risk groups

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

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

Classification

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

degree 0. In this case, there are no pronounced symptoms of the disease. The patient does not notice any changes. The working capacity is preserved;
degree 1. This degree is characterized by the appearance of the first symptoms indicating the presence of a pathological process in the body. The patient feels pain in the lower extremities, a feeling of heaviness and fullness. Soon there are pronounced non-passing edema and convulsions (more pronounced at night);
degree 2. Edema does not disappear. On examination, eczema, hyperpigmentation, lipodermatosclerosis are noted;
degree 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 - SEAR system.

Classification of venous insufficiency according to CEAR

According to the clinical picture:

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

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

Etiological classification:

EU - genetic propensity;
EP - unknown cause;
ES - insufficiency develops in a person due to trauma, thrombosis, and so on.

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

CVI classification according to the CEAP system, taking into account pathophysiological aspects:

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

The 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 to prescribe the appropriate effective treatment.

Symptoms

Symptoms of OVN appear rapidly, as the blockage of blood vessels occurs very quickly. Due to the impossibility of outflow of blood from the lower extremities, edema is formed. Along the course of the vessels, the patient notes the occurrence severe pain that does not go away with a change of position or at rest. The skin acquires a bluish tint and a pattern of veins appears on it. This form diseases are easier to treat. First aid - applying a cold compress and taking painkillers. Further treatment will be prescribed only by a phlebologist.

Symptoms of the chronic form of the disease can be different. Therefore, different people clinical picture chronic circulatory failure may be slightly different. At the first stages of the development of the pathological process, either one or a complex of symptoms appears at once:

most often, a person begins to be disturbed by heaviness in the legs, which increases significantly after a long stay in a standing position;
the formation of edema in the lower extremities;
night cramps;
hypopigmentation or hyperpigmentation of the skin;
the skin loses its elasticity and becomes dry;
at later stages, trophic ulcers form on the surface of the skin;
due to the deposition of a large amount of blood in the legs, a person develops dizziness, fainting.

If you have at least one of the above symptoms, it is recommended to immediately seek emergency medical care at a medical institution. There, based on the data of the initial examination and diagnosis, the doctor determines the severity of the disease (using the approved classification), and also prescribes a suitable course of treatment.

Diagnostics

Ultrasound of the lower extremities. With its help, it is possible to identify areas in which the veins are dilated and blood circulation is disturbed. 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 appear;
if the ultrasound data is doubtful, then in this case they resort to phlebography.

Treatment

Acute venous insufficiency removed in several steps. During the active phase of the disease, it is necessary to apply to the place of localization of the pathological process cold compress. The cooled 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 clotting.

CVI treated much more difficult than acute. When determining the correct tactics for the treatment of chronic circulatory failure, it should be clearly understood that this pathological condition is a system process. The main goal of all therapeutic measures is to restore normal blood circulation in the venous system of the lower extremities, as well as to prevent the development of possible relapses.

treatment of the disease is carried out in several courses. It all depends on the severity of the 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 circulatory chronic insufficiency.

The most important in the treatment of chronic venous insufficiency is the use of synthetic drugs (phlebotropic drugs are prescribed), 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.

Chronic cerebrovascular insufficiency

This disease should be highlighted especially, since it can develop in absolutely any person and is a rather serious pathology. Chronic venous insufficiency of the brain can occur even with singing, physical exertion, squeezing the neck with a too tight collar, and so on. As a rule, patients do not complain about the deterioration of their general condition for a long time. This is due to the fact that the brain has an amazing compensatory mechanism and a developed circulatory system. Therefore, even serious difficulties in the outflow of blood for a long time do not manifest themselves in any way. This is the greatest danger of this condition.

Prevention

Despite the fact that venous insufficiency is a disease inherent in a person genetically, 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 still for a long period of time;
diet;
giving up high heels.

Acute and chronic venous insufficiency of the brain and lower extremities is a complex and insidious disease, which sometimes proceeds completely asymptomatically and makes itself felt in the last stages. Its consequences can be very severe, up to thromboembolism. Therefore, if a person feels constant heaviness in the legs and swelling appears in the evening, you should immediately visit a doctor to rule out venous insufficiency or confirm it.