Venous insufficiency is a very common problem. For such disappointing statistics, we can thank the modern lifestyle. Sedentary work, lack of physical activity, unhealthy diet - all this negatively affects the functioning of the vascular system.

So what is this disease? What are its first symptoms? How dangerous can venous insufficiency be? Are there effective treatments? These questions are of interest to many patients.

What is this disease?

Venous insufficiency is a disease that some doctors jokingly call the price of walking upright. It's no secret that veins are vessels through which blood moves to the heart, and therefore against the force of gravity. The reverse flow of blood is prevented by special venous valves. But with prolonged static loads (sitting, standing), the pressure on the valves and vessel walls is too great.

First, the valves are stretched, after which the so-called venous reflux is often observed - the reverse flow of blood from top to bottom. The additional volume of liquid presses on the vessel wall, causing it to stretch and thin. Over time, plasma begins to seep through the thin vascular wall, which then accumulates in the soft tissues, forming edema. Thus, not only the structure of the vessels is disturbed, but also the nutrition of nearby tissues.

Recent statistical studies have shown that in developed countries, at least 15-40% of the population suffers from venous insufficiency. And in most cases, the disease is diagnosed in people aged 20 to 50 years.

Unfortunately, most sick people go to the doctor already in the very late stages of the disease. This is what phlebologists consider the main problem. After all, the sooner the patient is helped, the easier it will be to eliminate the main symptoms and prevent the development of complications.

The main causes of the development of venous insufficiency of the lower extremities

In fact, chronic venous insufficiency of the lower extremities can develop under the influence of various factors. To begin with, it is worth noting that this disease often appears against the background of varicose veins. In addition, vascular insufficiency can be caused by some congenital abnormalities of the superficial or deep veins. This group of diseases includes hypoplasia, aplasia, as well as the presence of arteriovenous fistulas.

Quite often, insufficiency is the result of a flambothrombosis previously transferred by the patient. Much less often, the disease develops after an injury.

On the other hand, there are some risk factors that increase a person's chance of developing the disease. For example, some people have a certain genetic predisposition that is associated with insufficient connective tissue, resulting in a lack of collagen - the walls of blood vessels in such patients are less elastic.

Risk factors also include prolonged static loads, which is observed in people whose profession requires a constant stay in a sitting or standing position (salespeople, cashiers, office workers). Do not forget about obesity, as extra pounds are an additional burden for the cardiovascular system.

Chronic venous insufficiency in women is diagnosed much more often than in men. This is due to the constant fluctuations in estrogen levels, which is observed during pregnancy or taking hormonal drugs. The risk of developing deficiency increases with age. In addition, people suffering from chronic constipation can be attributed to the risk group.

Classification and severity of the disease

In fact, in modern medicine there are several systems for classifying this disease at once. For example, depending on the etiology, chronic venous insufficiency can be congenital (associated with some anatomical features of the body), primary (the cause of the disease is not exactly known) or secondary (the disease developed as a result of trauma, thrombosis or other venous disease).

Most often, phlebologists use the following classification system, which takes into account the presence and intensity of symptoms:

Grade 0 - the person has no symptoms of the disease. This category of people was not randomly singled out, since the absence of signs does not always indicate complete health. Some patients who have been diagnosed with deficiency do not experience any discomfort, and there are also no external symptoms.
In the first degree, there are intermittent pains in the legs, as well as night cramps and a feeling of heaviness, which increases with prolonged static loads. Edema appears only from time to time.
The second degree of severity is characterized by persistent edema. On the skin, hyperpigmentation, as well as areas of weeping or dry eczema, can be replaced.
In the third degree, trophic ulcers appear on the skin, which periodically open and heal.

The main signs of the disease

Surely in the life of almost every person there is at least one risk factor, under the influence of which venous insufficiency can develop. It is extremely important to know the symptoms of this disease, because the sooner a person pays attention to the deterioration of well-being, the sooner he will consult a doctor and receive high-quality treatment.

The first signs of venous insufficiency of the lower extremities are pain and swelling. As a rule, heaviness and soreness in the legs appear in the late afternoon. Discomfort increases with prolonged stay in an upright position. Puffiness also appears in the evening, and swelling is noticeable only on the ankles and does not extend to the toes. In the morning, a person, as a rule, feels good, which is the most common reason for refusing a medical consultation.

If left untreated, venous-lymphatic insufficiency moves to a new level - now the symptoms become more noticeable. A sick person suffers from constant arching pains and burning sensations in the legs. Edema becomes persistent - they can be seen at any time of the day. Many patients complain of night cramps that affect the quality of sleep.

In connection with insufficient blood circulation, trophism (nutrition) of tissues is disturbed. Hyperpigmented areas may appear on the skin, which look like small brown spots. The skin over the affected vessels becomes thinner and begins to peel off - this is how eczema develops.

This is what venous insufficiency looks like. Her symptoms are getting worse every month. The third stage of the disease is characterized by the appearance of trophic ulcers. Such skin lesions form gradually. First, a dark spot forms on the surface. Over time, a small seal appears in its center, the appearance of which resembles a paraffin sag. This area of the skin is extremely sensitive to mechanical stress - any blow or injury leads to the opening of an ulcer, which will only increase in size over time.

This is not the whole danger with which venous insufficiency is associated. The photo shows the appearance of the future trophic ulcer. Such an open area on the skin becomes an excellent gateway for infection. Often, the ulcerative process is complicated by various bacterial and fungal inflammations.

Modern diagnostic methods

Of course, when the first symptoms of the disease appear, you need to go to the doctor. Only a specialist can correctly assess the condition of the patient's body and make a diagnosis of "venous insufficiency".

As a rule, the doctor suspects that there are problems with the vessels during the initial examination. However, the patient needs to undergo some examinations. The standard tests are biochemical studies of blood and urine samples. These are not specific tests, but they make it possible to determine the presence of inflammation and some concomitant diseases. A general blood test helps to find out the number of red blood cells, platelets and, accordingly, the index of blood viscosity.

The most informative procedure is an ultrasound examination of the vessels of the lower extremities. During the examination, the specialist can determine the presence of dilated sections of veins, nodules or clots.

In rare cases (if the ultrasound did not give an accurate result), the patient is prescribed more complex procedures. In particular, phlebography is considered a fairly accurate method. During research, a special contrast agent is injected intravenously into the patient, and then its progress through the venous system is monitored.

Venous insufficiency of the lower extremities: treatment by conservative methods

When such a disease is detected, the question of therapy arises. How to treat venous insufficiency? To begin with, it is worth noting that this disease is chronic, so therapy in this case must be comprehensive and long-term.

The course of treatment is selected individually. Some patients take medication for two months, while others require longer periods. In most cases, doctors prescribe medications that can strengthen the venous wall and normalize blood flow. Medications are also used to help improve tissue nutrition - this prevents the appearance of trophic ulcers.

Special care is required for patients who have already begun an ulcerative process. Damaged areas of the skin should be regularly treated with various antiseptic and wound healing solutions or ointments. Sometimes doctors prescribe anti-inflammatory drugs - in more severe cases, corticosteroids are needed. If there is a high likelihood of blood clots, heparin or some other blood-thinning medication is prescribed.

It is this therapy that venous insufficiency requires. The treatment also includes various physical therapy methods that speed up the healing process. The most effective procedures include treatment with magnetic fields, dynamic currents. Also, patients with this diagnosis often go for electrophoresis. Laser therapy gives good results.

To normalize blood circulation, sick people are recommended to wear special compression stockings or tights. Such devices help to get rid of edema, partially restore blood circulation and prevent blood stasis in soft tissues.

And, of course, therapeutic exercises are an integral part of quality therapy. Venous insufficiency of the lower extremities often develops against the background of a sedentary lifestyle. This risk factor can and should be eliminated. Naturally, those sports that involve heavy loads on the legs (football, basketball, weightlifting) are not suitable. But swimming or gymnastics will help improve your health.

Surgical treatment of CVI

Surgery is usually prescribed if conservative treatment has failed. Today, there are many surgical procedures. And the choice here depends both on the severity of the disease, and on the state of the patient's body, the presence of contraindications, etc.

At the first stage of the disease, sclerotherapy may be effective. During the procedure, a special drug is injected into the affected vessel, which blocks the lumen of the vessel and stops the blood flow in this area of the vascular network.

Unfortunately, this method cannot always get rid of a disease called chronic venous insufficiency. Treatment of the second and third degree of the disease is an indication for a more massive surgical intervention. Depending on the state of the vascular system, either ligation or removal of the expanded portion of the vessel is performed. Sometimes during the procedure, vascular plasty is also required - this makes it possible to normalize blood flow. Naturally, after the operation, a rehabilitation period follows. Some patients require an additional course of taking various drugs. And, of course, it is extremely important in the future to maintain a healthy lifestyle and avoid exposure to risk factors, as the disease may return.

Possible complications of venous insufficiency

Venous insufficiency of the lower extremities is an extremely dangerous condition that should never be taken lightly. To begin with, it is worth noting that the accumulation of significant volumes of blood in the vessels of the legs negatively affects the work of the whole organism. Since the nervous system does not receive enough oxygen and nutrients, patients with this diagnosis often complain of constant dizziness, fainting, problems with mental stress. Cardiovascular insufficiency is also a common complication.

These are not all the problems associated with venous insufficiency. The result of the disease can be phlebitis (inflammation of the venous walls) or thrombophlebitis (inflammation of the walls with the formation of blood clots). In turn, the detachment of a blood clot and its entry into the bloodstream can lead to a pulmonary embolism - blockage of the pulmonary vessels in the absence of emergency assistance, as a rule, ends fatally.

Treatment with folk remedies

Today, many people of different ages are faced with the diagnosis of "venous insufficiency of the lower extremities." Treatment is a long and painstaking process. Of course, the doctor must choose the treatment for the patient. But there are some traditional medicine recipes that can help speed up the recovery process of the body.

For example, folk healers highly recommend an extract from horse chestnut, since the extract of this plant really strengthens the venous walls. Another effective remedy is hazelnut infusion. Both the bark and leaves of the plant are used as raw materials.

Kalanchoe is another useful plant that is used for compresses. To prepare, you need to grind 50 g of plant leaves and pour them with 500 ml of alcohol. The jar must be closed and kept in a dark place for seven days. After that, the infusion is ready for use. But you can disinfect the surface of trophic ulcers with the help of Japanese Sophora extract.

In any case, it should be understood that the treatment of venous insufficiency with folk remedies is possible only after prior consultation with a doctor. The above recipes can only be used as adjuvant therapy. In no case should you neglect the doctor's prescriptions.

Are there effective methods of prevention?

Today, many people are diagnosed with venous insufficiency. Treatment is a long and complex process. That is why it is much easier to try to prevent its development. Of course, there are no drugs that can permanently protect against vascular insufficiency. Nevertheless, following some simple rules will help minimize the risk of developing the disease.

Since the main risk factor in this case is a sedentary lifestyle, it is with him that you need to start. Not everyone has the opportunity to change their lifestyle. But if you have to spend most of your working time in a sitting position, then be sure to take breaks from time to time in order to stretch your legs. Physical activity is also a prerequisite - from time to time do some gymnastic exercises, sign up for fitness or swimming courses, walk more often in the fresh air, run in the morning, etc.

Be sure to pay attention to shoes - they should be comfortable. If necessary, you can always purchase special orthopedic insoles. When resting or sleeping, try to keep your legs in a slightly elevated position (for example, put a pillow under them). And, of course, watch your body weight, as extra pounds negatively affect not only the work of the vascular system, but also the state of the whole organism.

If you regularly take hormonal contraceptives, be sure to undergo an ultrasound examination of the veins of the lower extremities from time to time. And, of course, at the first signs of illness, you should definitely consult a doctor. In the early stages, the problem is much easier to fix.

Insufficiency of cerebral vessels: what is it?

A common pathology today is venous insufficiency of cerebral circulation. Such a disease develops under the influence of many factors that can lead to disruption of the normal outflow of blood from the cranial cavity.

As a rule, the disease develops against the background of other pathological conditions. The main causes of cerebral vascular insufficiency include craniocerebral trauma, dropsy of the brain, cardiovascular and pulmonary insufficiency, as well as brain tumors, pleurisy. Symptoms of the disease often occur in people who have had pleurisy or pneumothorax. Risk factors include hypertension, thrombosis and thrombophlebitis, as well as asthma. Sometimes the disease develops after asphyxia.

Venous insufficiency of the brain is sometimes asymptomatic. However, in most cases, patients complain of persistent headaches. Soreness, as a rule, increases with sudden turns of the head, changes in temperature or atmospheric pressure, as well as during severe stress or alcohol intoxication.

In addition to the headache, other symptoms are also present. In particular, patients note constant fatigue, apathy and muscle weakness. From time to time there are dizziness, tinnitus. Symptoms of venous insufficiency include sleep disorders, darkening of the eyes, mental disorders, epileptic seizures.

In any case, it should be understood that cerebral circulatory failure is an extremely serious problem. Lack of timely treatment can lead to dangerous consequences. Therefore, if you have symptoms, do not hesitate to visit a doctor. In this case, complex therapy is needed, which is aimed at reducing edema, normalizing blood flow and improving the tone of the vascular walls.

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 allows you to establish the stage of the disease and confirm or deny 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.

The development of chronic insufficiency depends on the rate of disease progression.

Chronic venous insufficiency: prevention

A mobile lifestyle, physical exercises aimed at strengthening the muscles of the lower leg are 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.

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Man is an upright creature. And we pay for the vertical position of the body with many diseases that can be called not “diseases of civilization”, like obesity, physical inactivity and hypertension, but diseases of “upright walking”. These include, for example, osteochondrosis of the spine and CVI.

About osteochondrosis, which is the aging and wear of the intervertebral discs, and the numerous complications associated with it - hernia and protrusion - have been repeatedly mentioned in previous articles. And HVN - what is it?

Meet - HVN

“It is known that when a person is standing and sitting, his legs are down, and only at night, when he is resting in a horizontal position, his legs are not lowered down. And during the day, it’s just hard for the heart to raise blood up, so blood stagnation occurs in the legs, and heaviness appears. This high school graduate answer to a biology exam may seem clumsy, but it captures one of the mechanisms of impaired venous return.

In scientific terms, chronic venous insufficiency (CVI) is a group of diseases in which the veins of the lower extremities suffer. They disrupt the valve apparatus, which facilitates the return of blood to the heart. As a result, there is a narrowing, or obliteration of the main vessels.

Venous circulation is disturbed, and then external manifestations appear: trophic changes in the skin, which, in the end, lead to the appearance of ulcers, the formation of complications such as thrombophlebitis, and the addition of a secondary bacterial infection.

You should know that chronic venous insufficiency of the lower extremities is not a cause, but a consequence of a well-known varicose disease, as well as post-thrombophlebitic syndrome.

Why does venous insufficiency occur in the legs?

Heaviness in the legs and spider veins?

It is known that in order for the blood to flow upwards from below, active muscle contractions are needed, which “push” the blood higher and higher, and valves that are located only in the veins prevent it from going down. In the event that any process begins that interferes with the coordinated work of the veins, valves and muscles, a pathological process develops, sooner or later leading to CVI.

Very briefly, the stages of CVI development can be represented as 7 steps:

There is a primary dilation (expansion of the vein) under the valve;
There is a malfunction of the venous valve;
The occurrence of reflux, that is, the discharge of blood from top to bottom, through the valve;
venous congestion develops;
Increased blood pressure on the vessel wall;
An increase in the permeability of the vascular wall develops;
There is a perspiration of the liquid part of the blood in the tissue, with the development of edema and subsequent disturbance of trophism.

It is important to know that this mechanism starts faster in the presence of aggravating factors. These include:

Hereditary weakness of the connective tissue, in which "defective" valves are formed, due to a lack of collagen;
Fair sex. High estrogen levels, pregnancy, which is a test for blood vessels, and simply longer life expectancy lead to an increased incidence of CVI;
Elderly age;
The use of drugs containing sex hormones. These include oral contraceptives;
The presence of obesity and hypodynamia;
Prolonged sitting or standing. It can be both driving and standing work.

Given that predisposing factors are very common, as a result, the incidence of various forms of CVI in civilized countries can even reach 50%, subject to careful and comprehensive diagnosis in the early stages.

How is venous insufficiency manifested, and what is it like?

Degrees and symptoms of CVI of the lower extremities

How is venous insufficiency manifested?

There are many different classifications of chronic venous insufficiency, but the classification according to which any doctor, not being a vascular surgeon, can make a preliminary diagnosis to a patient based on complaints and visible signs, has gained the most popularity, without resorting to instrumental methods. It includes four degrees:

The zero stage includes conditions in which there is some discomfort in the legs, which intensifies in the evening, there is a burning sensation, muscle fatigue, and fullness in the legs. The appearance of edema is characteristic, but also insignificant. At this stage, there are no pain sensations yet;
The first stage is characterized by the appearance of night cramps in the muscles, there is a noticeable pain syndrome. On the skin of the legs and thighs, one can notice single areas of enlarged saphenous veins, as well as the appearance of spider veins, or telangiectasias;
The second stage is the "flourishing" of CVI, in which there are no pronounced trophic disorders yet. With CVI of the second degree, pain often worries, it is stronger, the veins protrude in numerous areas, and they are more than 5 cm long, varicose nodes appear;
At the third stage, focal hyperpigmentation of the skin over the altered veins joins the above signs. Sometimes you can read that this condition is called "varicose dermatitis." This condition means that if urgent measures are not taken, then skin defects will appear;
The fourth stage is the formation of trophic ulcers, which are difficult to treat, since the blood supply and microcirculation are disturbed.

If anyone thinks that the fourth stage is the final, then this is not true. A secondary infection usually accompanies, thrombophlebitis may occur, and infected emboli may reach the right side of the heart, causing pulmonary embolism. However, much more often, patients experience septic complications, and death is possible due to sepsis and multiple organ failure.

Thus, the main symptoms of chronic venous insufficiency in the initial stages are discomfort in the legs, swelling, convulsions, and the appearance of pain. In the extended stage, visible contours of veins and nodes join, and in the later stages, ulcers develop, which are difficult, long, and, of course, expensive to treat.

That is why the diagnosis of chronic venous insufficiency, and especially in the early stages, is of particular importance.

There are other classifications of CVI. It is necessary to indicate the international classification of CEAP, which phlebologists around the world are focused on. It is divided into 6 stages. The zero stage is the absence of external signs, at the first stage spider veins are visible, at the third stage there are varicose veins visible to the eye. In the fourth stage, there are skin changes (pigmentation, or hyperkeratosis). The fifth stage is the presence of a healed ulcer, and the sixth stage is the presence of an active ulcer in the patient.

Diagnostics

There is nothing complicated in the above classification: every doctor can determine the stage of CVI. To do this, it is imperative to conduct an examination in the patient's standing position, be sure to examine and compare both legs, carefully palpate.

Vascular surgeons and phlebologists conduct additional functional tests (Troyanova-Trendelenburg with a tourniquet or cuff, Pratt test), which show the failure of the venous system and valvular insufficiency.

But in order to make an accurate diagnosis - CVI, and choose the best method of treatment, you need to apply additional research methods. These methods include:

Ultrasound - dopplerography. With its help, you can see how well the valvular apparatus is, how passable the veins are, and get a direct picture of the blood flow rates and its volume. This is the main method of instrumental diagnostics;
Ultrasound - angioscanning, or "color doppler". This is an additional "plug-in" to conventional ultrasound, which shows the features of changes in the venous bed, and allows you to choose the most favorable type of treatment;
Phlebography. This is an x-ray study in the form of a series of images of the venous system of the lower extremities, with the introduction of a contrast agent;
Reovasography. Shows the functional state of the vessels, and is an auxiliary research method.

After making an accurate diagnosis, it is necessary to choose the type of treatment. In the case of the second stage and above, conservative treatment does not lead to recovery, but only delays the progression of the disease for a while, although it can cause a lasting improvement.

It has been proven that only surgical correction of the disease can lead to recovery. But in the event that venous insufficiency is diagnosed in the early stages, then its timely treatment can avoid surgery.

CVI treatment - drugs or surgery?

Before using drugs for the treatment of chronic venous insufficiency, it is necessary to pay due attention to non-drug methods, which are perhaps the leading ones in the early, subclinical stages. These include:

Modification of risk factors. It is necessary to lose weight, eliminate long periods of sitting or standing. You need to take daily walks, and give up bad habits;
Physiotherapy. A special set of exercises, most of which are carried out with legs up, allows you to normalize the outflow from the superficial veins into the deep ones, which prevents swelling of the limbs;
Swimming. When swimming, a person makes a variety of leg movements, connecting other muscles than when walking. At the same time, his body is horizontal, which has a very good effect on the normalization of blood outflow;
Finally, it is sometimes useful to rest with your legs up.

About compression stockings

A very important step in the treatment of CVI and varicose veins is compression underwear (stockings, stockings, tights). You need to purchase it only in specialized orthopedic salons. The underwear is graduated in millimeters of mercury and, according to the pressure generated, has several compression classes.

The first, the weakest class, can be used at the zero stage and even in healthy people, for example, during pregnancy and when staying in bed for a long time to prevent venous thrombosis. Underwear of the highest compression classes is usually prescribed by prescription, and is prescribed by the attending physician - phlebologist. Compression hosiery is put on in the morning, lying in bed, and removed in the evening, also lying down. With the appearance of trophic ulcers, wearing compression stockings no longer makes sense.

Preparations

Currently, there are many different drugs that are tried on for the treatment of CVI. The main group is venotonics, which do not allow the veins to expand and disrupt the valve mechanism of blood outflow. The most famous drugs include Detralex, Phlebodia and their numerous analogues containing diosmin and hesperedin. An extract of horse chestnut is effective, on the basis of which a whole family of drugs has been created - Aescusan and its derivatives.

In addition to venotonics, in the treatment they use:

NSAIDs for relief of inflammation and pain relief (meloxicam, ketoprofen);
Antispasmodics that stop vascular spasm (papaverine and "No - shpa");
Means for improving microcirculation (aspirin, pentoxifylline, clopidogrel);
Vitamins of various groups and especially derivatives of routine, which strengthens the wall of blood vessels (Anavenol, Venoruton, Troxevasin, Troxerutin);
Preparations containing heparin and its derivatives: heparin ointment;
Physiotherapeutic techniques (various sessions of electrophoresis).

Surgical treatment

Currently, the “gold standard” is endovascular laser correction, in which the great saphenous vein is punctured under ultrasound control, and a miniature disposable flexible probe is passed through it, with a laser LED at the end. It releases heat and "brews" the lumen of the vein, and after a few weeks it resolves, and thus the blood flow through the deep veins is restored, and reflux stops.

The operation is quick and painless, without general anesthesia, incisions and stitches: the patient leaves on his own feet.

This is a wonderful alternative to the classic "bloody" operations, which are associated, for the most part, with the removal of the great saphenous vein of the thigh. But sometimes, (for example, with severe tortuosity and the inability to pass a catheter), one has to resort to these interventions.

About the treatment of trophic ulcers

Perhaps this is the most difficult problem, especially if ulcers exist against the background of severe general pathology: diabetes mellitus, alimentary insufficiency, severe atherosclerosis. Most often, trophic ulcers, for example, with varicose veins, occur in the area of \u200b\u200bthe internal, or medial ankle.

In the treatment of trophic ulcers, enzymes ("Wobenzym"), reparants ("Panthenol", methyluracil ointment) are used. Necrectomy is performed, or excision of dead tissue, surgical treatment, antiseptics (chlorhexidine, miramistin, hydrogen peroxide).

Forecast

CVI of the lower extremities is a disease that is a “litmus test” of how a person relates to his health. It is bitter to admit, but almost 80% of patients with trophic ulcers simply did not pay the necessary attention to their condition. After all, during this disease there are several “alarm calls”: if you don’t do gymnastics and don’t change your lifestyle, you need conservative treatment, drugs, compression stockings. If ignored, then only surgery can cure. Finally, if ulcers have formed, then the operation no longer makes sense.

Thus, after reading this article, it is worth considering: “do I have heaviness and discomfort in my legs”? And in the event that you yourself answer in the affirmative - sign up for an ultrasound scan of the vessels of the lower extremities and visit a phlebologist, or a vascular surgeon. If everything is in order, then you can simply check the condition of the vessels annually, and be calm for your future.

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 using non-invasive ultrasound 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 of various variants of 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.
The most important risk factors for 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 various 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. The active substance of Venitana escin is an active component of chestnut fruit extract, it 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 with the initial degree of development of chronic venous insufficiency, but also with severe symptoms of venous insufficiency (II, III stage): swelling, feeling of heaviness, fullness and pain in the legs, for the complex treatment of 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.

Chronic venous insufficiency of the lower extremities is extremely common in the modern world. In Russia, more than 35 million people suffer from its various forms, and 15% of them already have trophic skin changes, open or recurrent trophic ulcers. Chronic venous insufficiency is a pathological condition characterized by stagnation or perversion of blood flow in the venous system of the lower extremities.

The main mechanisms of venous return from the lower extremities:

systemic arterial pressure transmitted to the origins of the venous system;

systolic-diastolic movement of the arteries, transmitted to the accompanying venous vessels;

compression of the plantar venous network that periodically occurs during walking, from which blood is evacuated into deep and superficial veins;

muscular-venous pump of the lower leg and thigh, the action of which, when the muscles contract, leads to the outflow of blood from the venous sinuses into the deep veins;

respiratory movements of the chest and diaphragm ("suction" action).

The two main causes of chronic venous insufficiency are:

varicose disease;

post-thrombophlebitis disease.

essence varicose disease- gradual expansion of the lumen of the saphenous veins and perforators, resulting in the development of relative valve insufficiency (they remain intact, but their valves do not close). Venous reflux occurs from top to bottom in the saphenous veins (vertical) and from the deep veins to the superficial (horizontal).

Postthrombophlebitic disease- these are clinical manifestations that develop in a number of cases (70%) in patients after acute deep vein thrombosis and are associated with the presence of venous hypertension and lymphovenous insufficiency of the lower extremities (synonyms: chronic thrombophlebitis, post-thrombotic syndrome, post-thrombotic disease, post-thrombophlebitic syndrome). Occurs as a result of acute thrombosis of the veins of the lower extremities.

Classification (A.N. Vedensky 1986, V.S. Saveliev 1983):

Form: sclerotic, varicose.

Stage: I, II, III;

Localization (isolated, combined)

inferior vena cava;

iliac vein;

popliteal vein;

tibial veins.

The nature of the lesion:

occlusion;

recanalization;

The degree of venous insufficiency:

compensation;

subcompensation;

decompensation.

In the diagnosis of post-traumatic syndrome, such examination methods as vascular ultrasound and X-ray instrumental examination play an important role.

The quality of ultrasound diagnostics of the pathology of the veins of the lower extremities is constantly increasing with the improvement of diagnostic equipment. It is possible to assess and direct blood flow, localize occlusions and decompensate communicating veins.

Flaw - the complexity of diagnosis in conditions of a large number of collateral blood flow pathways, false-positive and false-negative results are possible. X-ray instrumental examination allows a more detailed study of the features of blood flow in the limb, but refers to invasive techniques, requires the use of contrast agents.

Options for both antegrade and retrograde contrasting of veins are possible.

The process captures all basins of the veins of the lower extremities. The line between thrombosis and post-thrombotic changes in deep veins is rather arbitrary. The process of transformation of thrombi consists in the adhesion of the latter to the venous wall and retraction with partial lysis (plasma and leukocyte), their germination by fibroblasts, followed by canalization and revascularization. These processes lead to the restoration (at least partial) of the lumen of the main veins. Occlusive forms of post-thrombophlebitic disease (deep veins undergo complete obstruction) are quite rare. In post-thrombophlebitic disease, the integrity and function of the valves of the deep and perforating veins are never restored. Hence the conclusion: with varicose veins and post-thrombophlebitic disease, there are similar mechanisms of venous outflow disorders (vertical and horizontal refluxes), which determine similar clinical symptoms.

Clinical picture of varicose veins and post-thrombophlebitic disease varies at the stage of collecting an anamnesis of the disease.

Clinical (physical) examination of patients with chronic venous insufficiency is carried out in the patient's standing position. The appearance of the limb is assessed: the color of the skin, the presence and localization of varicose saphenous veins, telangiectasia, the presence of areas of hyperpigmentation and induration of the skin of the lower leg. Depending on the degree of decompensation of the venous outflow, the external signs of the disease can be from subtle to pronounced. When examining a patient, there is no need to carry out so-called functional tests, since vertical and horizontal reflux can be reliably determined using only two clinical tests: the failure of the ostial valve of the great saphenous vein is determined by Hackenbruch samples - with a sharp increase in intra-abdominal pressure (cough, straining), palpation under the inguinal fold in the projection of the saphenofemoral fistula, a retrograde blood wave is felt, this test can be repeated by moving the hand down along the trunk of the great saphenous vein and determining the failure of the stem valves of this venous line; horizontal reflux determine indirectly: by palpation of defects in the aponeurosis in those places where incompetent perforators are usually localized.

Distinguishing features of post-thrombophlebitic disease from varicose veins In addition to the anamnesis, there are significant hemodynamic disturbances in the presence of minor superficial varicose veins (or even its absence), pronounced varicose saphenous veins in the groin and pubis.

The clinical picture of chronic venous insufficiency is very variable because it depends on its cause, localization of venous reflux, individual characteristics of the venous system of the lower extremities and its compensatory capabilities.

There are four degrees of chronic venous insufficiency:

0 degree of chronic venous insufficiency - the main clinical symptoms are: heavy legs syndrome, telangiectasia, reticular varicose veins.

I - main symptoms: transient edema, varicose transformation of the saphenous veins.

II degree of chronic venous insufficiency - main clinical symptoms: persistent edema, hyperpigmentation, lipodermatosclerosis, eczema.

III degree of chronic venous insufficiency - indurative cellulitis, trophic ulcer, secondary lymphedema.

Diagnostic principles:

To select the strategy and tactics of treatment for chronic venous insufficiency, it is necessary to solve the following diagnostic tasks:

clarify the cause of chronic venous insufficiency (varicose or post-thrombophlebitic disease);

assess the condition of deep veins (their patency and viability of the valves);

detect reflux through the sapheno-femoral and sapheno-popliteal fistulas;

determine the state of the valve apparatus of the trunks of the great and small saphenous veins;

identify and localize insufficient perforating veins.

Only an objective and accurate solution of these problems allows you to choose an adequate method of treatment and guarantees against tactical errors.