Chronic venous insufficiency is a pathology characterized by impaired blood flow from the vessels located under the skin of the lower extremities. In women, such vein damage occurs much more often than in men.

The chronic form of venous insufficiency is an extremely dangerous disease, since in the early stages it is rarely accompanied by significant symptoms, and in the later stages it causes severe complications that are extremely difficult to treat.

Reasons

The appearance of chronic venous insufficiency (CVI) is the result of a decrease in the intensity of blood flow through the vessels, which develops due to disruption of the venous-muscular pump. This is a subtle mechanism that prevents backflow and helps push fluid up toward the heart. A similar effect is achieved through the coordinated operation of the valves, contraction of the muscles in the legs and the pressure created in the system by the work of the heart.

The most unfavorable conditions for pushing blood upward are created when a person is in a sitting or standing position, but does not make movements that would properly involve the leg muscles. This provokes blood stagnation, gradual failure of valves, increased intravascular pressure and expansion of the diameter of blood vessels. Factors that increase the risk of developing chronic venous insufficiency include:

• hormonal disorders;
• congenital anomalies of vascular structure;
• obesity;
• lifting weights;
• taking certain types of drugs;
• increased static loads;
• old age;
• chronic constipation and colitis;
• low physical activity.

Various inflammatory vascular pathologies can provoke chronic venous insufficiency. With this course, blood clots often form. This causes acute venous insufficiency, which eventually becomes chronic.

Hereditary predisposition also matters. Many people with chronic venous insufficiency have close blood relatives who have similar health problems. In most cases of a family history, a reduced level of collagen in the structure of the fibers that form the vessels is determined.

Symptoms

For a long time, the symptoms of chronic venous insufficiency remain vague, so many patients do not pay attention to them. As the pathology progresses, complaints arise about:

• heaviness in the legs;
• transient or persistent swelling;
• varicose veins;
• muscle weakness;
• pain;
• night cramps;
• the appearance of pigmentation.

Due to venous insufficiency, the skin becomes dry and loses its elasticity. In the later stages of the pathology, signs of progression of trophic changes in the soft tissues of the lower extremities begin to clearly appear.

The retention of a large volume of blood in the dilated vessels of the legs can cause symptoms of heart failure, attacks of dizziness and fainting.

With moderate physical activity, symptoms may worsen.

Degrees of the disease

In medical practice, several classifications of the severity of pathology are used, the parameter of which is the presence of signs. The most popular are the assessment systems according to V. S. Sevel’ev and the international CEAP scale. Many doctors use the simpler first version of the classification. It distinguishes 4 degrees of development of chronic venous insufficiency.

Zero

It is no coincidence that this degree has been identified by clinicians. Severe symptoms do not bother the patient, and palpation of the legs does not reveal characteristic changes. Only during the study are signs of valve dysfunction and dilation of the walls of blood vessels determined.

First

With grade 1 chronic venous insufficiency, patients begin to complain of heaviness and pain in the limbs, which clearly manifest themselves during prolonged standing. Incoming swelling is observed, disappearing after a short period of rest. The patient may be bothered by isolated cases of night cramps. Multiple spider veins are visible on the surface of the skin.

Second

With stage 2 chronic venous insufficiency, complaints of severe arching pain in the lower leg appear. Edema becomes chronic. These symptoms intensify even after minor exertion. Thinning of the skin is observed over the areas of the affected veins. The appearance of itching and the first manifestations of hyperpigmentation are often noted.

Third

With grade 3 pathology, there is a worsening of all previously present symptoms. Venous insufficiency, which occurs in a chronic form, provokes an increase in trophic changes in soft tissues. The course of the disease is accompanied by the development of complications.

This system for assessing the course of chronic venous insufficiency is based on a number of parameters. Depending on the severity of clinical manifestations, 6 stages are distinguished, including:

• 0 – there are no subjective or palpable symptoms of venous lesions;
• 1 – spider veins are present;
• 2 – the lumens of the veins expand; Main classification of CVI
• 3 – chronically persistent edema;
• 4 – increasing skin changes;
• 5 – skin changes against the background of a healed ulcer;
• 6 – presence of trophic changes and fresh ulcers.

Depending on the cause of its occurrence, the pathology can be congenital, idiopathic and secondary, developing as a result of injury, thrombosis, etc. Depending on the anatomical segment affected, venous insufficiency, which occurs in a chronic form, can be deep, communicative and superficial.

There are large subcutaneous and inferior hollow forms of the pathology. Depending on the pathophysiological aspects, venous insufficiency, which occurs in a chronic form, may be accompanied by a reflex, obstruction, or both phenomena simultaneously. CEAP has a scale of decreased ability to work:

• 0 – no restrictions on activities;
• 1 – continued ability to work without maintenance therapy;
• 2 – ability to work full-time with the use of supportive means;
• 3 – disability even with the use of supporting means.

According to the CEAP classification, the intensity of all existing symptoms is assessed from 0.1 to 2 points.

Diagnostics

If any signs of this disease appear, you should contact a vascular surgeon or phlebologist. Anamnesis is collected and existing complaints are assessed, and the affected areas are examined. Subsequently, a coagulogram is performed, which allows you to determine coagulation indicators. General and biochemical blood tests are required. If there are signs of damage to the veins of the lower extremities, an ultrasound scan is performed.

Often, duplex scanning is required to clarify the diagnosis. This study allows you to determine the condition of deep, perforating and superficial veins. It helps to assess vascular patency and blood flow speed. Phlebography is often performed, which allows you to visualize blood vessels in a separate area of ​​the body and identify certain damage that disrupts the normal flow of blood.

Treatment methods

Treatment of chronic venous insufficiency is carried out comprehensively. As part of prevention and to eliminate the manifestations of the initial stages of pathology, medications and some types of physiotherapy can be used. In addition, drug therapy is used to normalize the condition in the postoperative period. In the later stages of the disorder, surgical intervention is required.

Compression therapy

Often, to eliminate the manifestations of chronic venous insufficiency, elastic bandages and special knitwear are used to create pressure on the affected areas. Such products can have varying degrees of compression on the legs. Such therapy can improve the functioning of the muscular-venous pump, reduce the severity of edema and relieve discomfort.

Physiotherapy

In the treatment of chronic venous insufficiency, various methods of physiotherapy can be used. When treating venous insufficiency, the following are used:

• dynamic currents;
• electrophoresis;
• magnetotherapy.

After the condition has stabilized, a special massage is prescribed. It should only be done by a specialist, as it can cause harm if used incorrectly. Hirudotherapy, i.e. the use of medicinal leeches, helps thin the blood and improve microcirculation.

Medicines

In the treatment of chronic venous insufficiency, drugs from the following groups are used to stabilize microcirculation, correct blood flow disorders, increase the tone of vascular walls, and improve lymph flow:

• venotonics;
• anticoagulants;
• fibrinolytics;
• NSAIDs;
• antihistamines;
• antibiotics;
• vitamin complexes;
• local painkillers.

Medicines and their dosages are selected by the doctor individually. In the treatment regimen for venous insufficiency, the basic ones are venotonics, which help improve the condition of the walls of the blood vessels of the lower extremities. The most commonly used means of this type include:

1. Detralex.
2. Venarus.
3. Phlebodia.

In chronic venous insufficiency, an increase in blood viscosity is almost always observed, so the use of anticoagulants is a necessary measure. Drugs of this type that are often used for venous insufficiency include:

1. Heparin.
2. Warfarin.
3. Fraxiparine.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve severe pain, swelling and other signs of inflammation. When a venous trophic ulcer becomes infected, antibiotics are prescribed. In addition, in the treatment of venous insufficiency, various ointments and gels are often used to help eliminate symptoms. Other drugs are introduced into the treatment regimen if indicated.

Surgery

There are several intervention options available for chronic venous insufficiency, including:

• miniphlebectomy;
• venous bypass;
• Troyanov-Trendelenburg procedure;
• Linton's operation;
• sclerotherapy.

Microphlebectomy is used in the treatment of chronic venous insufficiency, when the problem can be eliminated by removing the affected area of ​​the blood vessel through a small puncture. Venous bypass grafting involves removing the affected area and creating a bypass path by transplanting a healthy area.

During the Troyanov-Trendelenburg operation, the first step is to eliminate a group of veins affected by the pathological process. In addition, the junction of the saphenous vein and the femoral vein is ligated. During the Linton operation, ligation of the perforating and communicating veins is performed. The procedure is performed through a small incision in the thigh.

Sclerotherapy involves the introduction of a special drug into the cavity of the affected vein. This type of intervention is used mainly in cases where the diameter of dilated veins does not exceed 2-3 mm.

In the treatment of chronic venous insufficiency, other types of surgical interventions can be used. A combination of surgical treatment methods is often used.

Preventive measures

To reduce the risk of developing chronic venous insufficiency, you should avoid wearing constrictive and too tight clothing. It is not advisable to wear high-heeled shoes every day. It is imperative to monitor your diet and prevent excess body weight. As part of the prevention of chronic venous insufficiency, it is advisable for people with a hereditary predisposition to avoid visiting a solarium and avoid prolonged exposure to direct sunlight.

To prevent overloading of blood vessels, it is advisable to reduce visits to baths and saunas to a minimum. As part of the prevention of chronic venous insufficiency, it is recommended to take a contrast shower every day. Regular dosed physical activity helps preserve the venous system. It is necessary to perform special gymnastics for the legs. Existing vascular diseases should be promptly identified and treated.

Consequences and complications

The development of chronic venous insufficiency becomes the cause of extremely severe complications. This pathology creates a springboard for the development of thrombophlebitis. This condition is an inflammatory lesion of the veins, accompanied by the formation of blood clots in their lumens.

With this pathology, patients develop acute complaints of acute pain. Often, against the background of chronic venous insufficiency, the development of trophic ulcers is observed. Such defects on the skin occur when soft tissues begin to suffer from a lack of oxygen and nutrients.

Thrombosis often occurs against the background of chronic venous insufficiency. This pathological condition is accompanied by the formation of blood clots that clog the lumens of the vessel. In the future, postthrombophlebitis syndrome may develop, and a detached blood clot can provoke pulmonary embolism.

Features of the course in pregnant women

Women over 35 years of age have an extremely high risk of developing venous insufficiency during pregnancy. This is due to the fact that during this period the body experiences severe stress due to hormonal changes and increased pressure in the abdominal cavity.

This condition can cause severe complications. During pregnancy, it is not recommended to take potent medications. And surgery is impossible due to anesthesia. Drug therapy can only be started in the last trimester.

Venous insufficiency- a set of symptoms that develop as a result of a violation of the outflow of venous blood. This diagnosis ranks first among vascular diseases. According to various statistical sources, up to 60% of people of working age, mostly women, suffer from impaired blood flow. Acute venous insufficiency is a condition that can be fatal. The chronic form of the disease, constantly progressing, worsens the patient's quality of life. However, only every tenth sick person consults a doctor about the disease.

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Reasons for development

The high prevalence of venous insufficiency is due to human upright posture. This position of the body creates an ever-increasing load on the vessels of the lower extremities. Chronic venous insufficiency, having mild symptoms in the initial stages, is often attributed to fatigue. The danger of the condition lies in the fact that severe symptoms, which become the reason for contacting a specialist, develop only in the last stages of the development of the pathology.

Reasons for the development of venous insufficiency:

• postthrombotic syndrome;
• varicose veins;
• congenital vascular pathologies;
• phlebothrombosis;
• injuries;
• concomitant diseases: cirrhosis, metabolic disorders, neoplasms, drug poisoning can cause the development of acute venous insufficiency.

In addition, there is a group of secondary factors that do not directly cause the development of the disease, but significantly increase the likelihood of its occurrence and aggravate the course of chronic venous insufficiency:

• hereditary predisposition;
• being female (due to the high content of the hormone estrogen, women suffer from venous insufficiency three times more often than men);
• pregnancy;
• excess weight;
• atherosclerosis;
• metabolic disorders;
• excessive drinking and smoking;
• low physical activity;
• hard physical work;
• taking hormonal medications;
• old age;
• chronic constipation.

Based on the factors contributing to the formation of chronic venous insufficiency of the lower extremities, risk groups can be distinguished: professional athletes, people with relatives suffering from venous insufficiency, obese people, the elderly, and pregnant women.

Mechanism of disease development

Normal venous circulation is carried out in the direction from various parts of the body, including the lower extremities, to the heart. Cardiac output creates pressure, due to which blood flows through the vessels to the periphery. Under the influence of negative pressure that occurs when the heart muscle relaxes, blood flows back. There are additional mechanisms that help blood rise:

• the work of the valves of the veins prevents the blood from flowing back (regurgitation);
• vascular tone;
• muscle contraction creates pressure and promotes upward movement of blood.

Venous insufficiency of the lower extremities is formed as a result of certain processes occurring mainly in the vascular wall:

• stretching of the wall at the location of the valves leads to their loose closure;
• stagnant blood puts even more pressure on the vessel and stretches its walls, as a result it becomes deformed;
• decreased muscle tone aggravates blood regurgitation and changes in the structure of the venous wall;
• due to stagnation of blood, high pressure is created inside the blood vessel;
• the venous walls protrude, become damaged, their permeability increases, blood flows out, causing staining of the tissues surrounding the vessel.

As a result, the blood supply to the part of the body in the affected area is disrupted, cellular metabolic products accumulate, an inflammatory process occurs, an insufficient amount of oxygen enters the tissues, blood viscosity increases, and blood clots form.

Classification

Venous insufficiency can occur in acute (AVI) and chronic (CVI) forms. It is advisable to apply this distribution to pathology affecting the vessels of the lower extremities. Acute and chronic venous insufficiency differ in the location of the lesion, the cause of development, symptoms and possible complications.

In the chronic form of the disease, superficial veins are affected; acute failure occurs when the lesion is localized in the deep vessels of the lower extremities. This pattern is due to the specific structure of the circulatory system in these sections: when a superficial vein is blocked, the blood flow is redirected along the branches (perforating veins), thanks to this process, the disruption of outflow in the first stages of the disease is compensated.

The two forms have different causes. Chronic venous insufficiency often occurs under the influence of a hereditary factor: a genetically inherent predisposition, manifested by weakness of the venous wall, valves, and impaired muscle tone. The acute form occurs against the background of stagnant, inflammatory processes, with a violation of blood clotting. With this type of pathology, a blood clot blocks the lumen of the vein.

Symptoms
In the early stages, chronic insufficiency has no symptoms, but as the disease progresses, the manifestations increase. Acute disturbance of venous outflow occurs rapidly, symptoms appear quickly.

Signs of chronic outflow disorder:

• heaviness in the legs;
• bursting feeling;
• pain;
• formation of spider veins;
• edema in the initial stages occurs in the evening; as the disease progresses, edema persists throughout the day;
• convulsions;
• pigmentation (coloring) of the skin over the lesion;
• decreased elasticity, dry skin;
• formation of cracks, areas of weeping, necrosis and trophic ulcers.
• progressive congestion in the lower extremities causes a decrease in the volume of circulating blood, so the symptoms are general: shortness of breath, dizziness, fainting.

Acute venous insufficiency is manifested by pain, the affected limb changes color - from bluish to marbled, the temperature at the site of the lesion decreases, the general temperature, on the contrary, increases and can reach 37-40 degrees, severe swelling develops, and sensitivity is impaired. As the disease progresses, the pain becomes stronger and radiates to the groin.

Classification of CVI is based on determining the stage of the disease and the degree of damage to the vascular wall. As the pathology progresses, the patient’s well-being worsens, symptoms progress, and performance deteriorates.

Degrees of chronic venous insufficiency:

• 0 degree – no symptoms, quality of life is not impaired;
• 1st degree (compensation) - the first signs may appear: heaviness, cramps, swelling, pain in the legs in the evening, after rest the symptoms disappear. The ability to work is not impaired, the quality of life is at the same level.
• 2nd degree (subcompensation) - the manifestations are pronounced, in addition to the symptoms inherent in the 1st degree, pigmentation of the skin over the lesion is observed, the patient suffers from skin diseases. Physically demanding activities are difficult to perform. Working capacity, already reduced at this stage, is restored through conservative therapy.
• 3rd degree (decompensation) – severe metabolic disorders, the appearance of trophic ulcers, the patient is unable to work.

There are classifications of venous insufficiency according to CEAP (international classification of chronic venous diseases):

Symptomatic:

• 0 – there are no visual signs of a person;
• 1 – spider veins;
• 2 – varicose veins;
• 3 – persistent swelling;
• 4 – trophic changes on the skin;
• 5 – changes on the skin in the presence of an already healed ulcer;
• 6 - changes on the skin in the presence of a fresh ulcer.

Etiological:

• EU – genetic predisposition;
• ER – unknown cause;
• ES – trauma, thrombosis.

Pathophysiological:

• HAN with reflux;
• CVI with obstruction;
• combined CVI.

A similar classification is used by phlebologists. It allows you to assess the extent and nature of the lesion. This is important for determining the stage of the disease and prescribing treatment.

Diagnostics

The main problem in diagnosing chronic venous insufficiency is low awareness of the population. Many patients consider the symptoms of the initial stage of pathology to be a sign of fatigue, not illness. As a result, a person does not see a doctor and chronic venous insufficiency is detected in the later stages, when large areas are affected.

To provide the necessary medical care, it is necessary to establish an accurate diagnosis, reflecting the location and lesions, the degree, presence and severity of symptoms. During the examination, the doctor pays attention to swelling of the legs, determines the presence of pain and night cramps, checks for changes in skin color, eczema, dermatitis and trophic ulcers.

When determining the patient’s condition, each symptom of venous insufficiency is assigned a score on a scale from 0 to 2 (0 – absence of a sign, 1 – moderate manifestations, 2 – severe symptoms). In the same way, the duration of the disease and the occurrence of repeated episodes are assessed: absence - 0, duration of active symptoms less than 3 months or the presence of one relapse - 2 points, manifestations of pathology for more than 3 months and repeated recurrence - 2 points.

If, after a general examination, the doctor has reason to suspect the presence of venous insufficiency, the patient is sent for instrumental and laboratory tests:

• a coagulogram allows you to determine blood clotting indicators: prothrombin index, clotting time, platelet count;
• duplex examination of the veins of the lower extremities reflects the state of blood flow and valves;
• Ultrasound examination allows you to determine the presence of blood flow disorders, the extent of congestive processes, and the condition of blood vessels.

Treatment

Acute venous insufficiency requires step-by-step treatment. In the active stage of the disease, a cold compress should be applied to the site of the outbreak. The fabric is applied for 2 minutes, after which it is placed in cold water. The action should be repeated for an hour. After eliminating the inflammation, the second stage of therapy begins - normalization of blood circulation. Use ointments that reduce blood clotting.

When treating venous insufficiency of the lower extremities, it is important to understand that the disease is systemic in nature. The main goal is to restore blood flow and prevent relapses. Therapy includes a number of principles: treatment must be comprehensive, individual in nature, and several courses may be required.

Complex treatment includes:

• drug therapy;
• compression therapy;
• physiotherapy;
• surgical treatment;
• use of traditional medicine.

Drug therapy

The use of medications is aimed at eliminating inflammation processes, normalizing blood flow, improving local circulation, influencing lymph flow, and increasing the tone of the vascular wall. The following groups of drugs are used to treat chronic venous insufficiency:

• Phlebotonics (Detralex, Antistax, Ginkor Fort). In the initial stages of the disease, these remedies are sufficient to eliminate the main symptoms. However, if the process is aggravated by inflammation or changes appear on the skin, the use of additional medications is required.
• Anti-inflammatory drugs (Meloxicam, Diclofenac).
• Antiplatelet agents (Dipyridamole, Clopidogrel).
• Antihistamines (Promestazine, Clemastine).
• Antioxidant agents (Emoxipin).
• Enzymes and antibiotics (fluoroquinolones, cephalosporins) are used to treat skin manifestations of venous insufficiency.

The use of these drugs should be appropriate and based on the existing symptoms. Treatment of venous insufficiency of the superficial veins includes the use of ointments, but this is only permissible if there are no complications on the skin. Used:

• indomethacin ointment reduces pain and relieves inflammation;
• heparin ointment reduces blood clotting and prevents the formation of blood clots;
• Lyoton 1000 eliminates inflammation;
• Venobene reduces blood clotting, dissolves blood clots, and improves tissue trophism.

Treatment tactics using pharmacological drugs are selected based on the stage of disease development and the activity of symptoms. In the first degree of the pathological process, intravenous sclerotherapy is used - injection of the drug into the vessel. The result is a decrease in blood flow in the affected area of ​​the vein. The second degree requires the use of medications that improve tone and trophism in adjacent tissues. Results are achieved after 3-4 months of therapy, the course duration is at least six months.

At the third stage, treatment is required not only for symptoms, but also for existing complications; during this period, almost a whole range of drugs are prescribed: phlebotonics, anti-inflammatory drugs, anticoagulants, antiplatelet agents and antihistamines.

Compression therapy

Compression therapy occupies one of the key places in the treatment of chronic venous insufficiency. Wearing elastic knitwear is indicated for any severity of the disease, regardless of the causes of its occurrence. The effect is achieved as a result of the following factors:

• decrease in venous blood supply due to compression of perforating veins;
• improving valve function by narrowing the vein and increasing the speed of blood flow;
• improvement of tissue fluid resorption with increased pressure in the edema area;
• improvement in fibrinolytic activity associated with increased production of plasminogen in tissues.

Compression therapy is performed using:

• bandages
• products made from compression knitwear (tights, stockings).

Compression hosiery has a number of advantages compared to bandages:

• the products are manufactured in such a way that when used, a physiological distribution of pressure is achieved throughout the entire limb, with maximum values ​​being achieved in the distal sections;
• better aesthetic properties;
• the ability to use a product of the required compression class;
• elastic knitwear is more comfortable and does not require assistance when using it;
• optimal temperature and water balance of the skin is maintained;
• With proper care, long-term use is possible (up to 8 months).

The degree of compression should be selected by a doctor, taking into account the severity of the disease. The type of product: stockings, stockings or tights is determined based on the localization of the process. The necessary therapeutic effect is achieved only by using correctly selected knitwear that is suitable in size. Otherwise, the Products do not exert the necessary pressure on the lower limb or cause discomfort when worn.

Physiotherapy

Physiotherapy methods are used in the complex treatment of chronic venous insufficiency. Among them:

• Magnetic therapy is used at all stages and for all forms of the disease. The device “Polimag 01” is used. The duration of the procedure is 20-30 minutes, treatment is carried out daily, the course of therapy is 15 sessions.
• Darsonvalization can be used in the early stages of the disease, treatment is carried out using the Iskra-2 apparatus, the effect occurs for 10-15 minutes daily, the course consists of 10-15 procedures.
• Infrared therapy is carried out using the Mustang apparatus, the exposure time on the lesion is 128 seconds, treatment is carried out daily, in a course of 10 procedures.
• Intermittent pneumocompression is carried out with the Lymfa-E apparatus; during the procedure, the limb is covered with a cuff from the foot to the inguinal fold, the pressure is set in 7 sections, and gradual compression is created in the “traveling wave” mode. The cycle is 15 seconds, at each subsequent procedure the pressure increases, the duration of treatment is 40 minutes, the course is 10 days.
• Laser therapy involves the use of continuous radiation, the source is fixed above the lesion, the effect occurs for 6-8 minutes daily, the course of treatment is 10-12 minutes.
• After the inflammatory processes have subsided, electrophoresis can be used. Heparin, lidase, and, if necessary, antibiotics are used.

Surgical treatment

The indication for surgical intervention is severe varicose veins in combination with pathological reflux. Surgery is also necessary in case of progression of trophic disorders and recurrence of varicothrombophlebitis. The indication is the ineffectiveness of conservative therapy and persistent progression of symptoms of venous insufficiency.

All surgical interventions can be divided into two types:

• surgical separation is carried out to eliminate blood reflux from deep vessels to superficial ones;
• removal of varicose veins.

The need for surgery is usually caused by the patient’s late seeking of medical help, which leads to the progression of the disease. With timely diagnosis of the disease, in most cases the symptoms can be relieved using conservative therapy.

Treatment using traditional medicine

One of the methods of treating venous insufficiency is the use of traditional medicine. However, such products should be used in parallel with medications and wearing compression stockings, since plant extracts alone are not able to cope with the cause of the disease.

Folk remedies are time-tested drugs for the treatment of chronic venous insufficiency at home, which help normalize blood flow, dilate the blood, and reduce thrombosis. The most commonly used recipes are:

• Kalanchoe tincture: 50 grams of crushed, washed leaves should be poured with vodka, left in a cool place for 10 days, used to rub the affected leg;
• Grind dry hazelnut bark and leaves, pour 200 milliliters of boiling water over 2 tablespoons of raw material, leave for 3 hours in a warm place, use 50 milliliters after meals;
• Pour 100 grams of dry rowan bark with 500 milliliters of boiling water, leave for 10 hours, take 2 spoons three times a day;
• Mix valerian roots, hop inflorescences, mint and trifoliate, pour a tablespoon of the resulting raw material with 2 cups of boiling water, put in a warm place for 1 hour, use a quarter cup 3 times a day;
• Pour crushed sweet clover leaves into a glass container, add vodka, leave for 2 weeks, consume 50 milliliters, after diluting in 100 milliliters of boiled water;
• Pour 30 grams of crushed calamus roots with 500 milliliters of apple cider vinegar, leave in a cool place for 3-4 days, take 1.5 tablespoons 2 times a day before meals.

When using traditional medicine, it is important to remember that they do not have a quick and pronounced effect. Only their long-term use can bring results. However, it is worth remembering that using them without consulting a doctor may cause an allergic reaction or negatively affect the health of a patient suffering from concomitant diseases.

Possible complications of the disease

Venous insufficiency is a dangerous disease that needs to be taken seriously. The accumulation of large volumes of blood in the lower extremities negatively affects the entire body. As a result, the brain does not receive enough oxygen and nutrients. As a result, the patient feels dizzy, fatigues, and sometimes faints. Cardiovascular failure often develops.

The nature of complications depends on the form of the disease. In case of acute insufficiency, thromboembolism may develop - blocking the lumen of the pulmonary artery. This condition can be fatal. Chronic venous insufficiency provokes the development of varicose veins, periphlebitis (the tissue surrounding the vessel becomes inflamed), the formation of blood clots and the development of thrombophlebitis, the occurrence of necrosis and trophic ulcers.

Forecast

The prognosis for impaired venous outflow depends on the severity of the pathology at the time of diagnosis. In the early stages, the disease can be successfully stopped and complications can be avoided. The course of therapy ranges from 2.5 months to six months, repeated up to 2-3 times a year. Severe stages are less amenable to treatment, and the patient may become disabled.

Acute venous insufficiency is a pathology that occurs in 2-3% of cases; the prognosis for this condition depends on the timeliness of hospitalization and the success of dissolving the blood clot. The danger is that in some cases this condition occurs without symptoms and the first sign is pulmonary embolism.

Prevention

Despite the fact that chronic venous insufficiency is genetic, a number of measures can be taken to reduce the risk of its development. The main ways to prevent the disease:

• playing sports;
• diet;
• refusal of high-heeled shoes;
• limiting exposure to open sun;
• refusal to wear too tight underwear and socks;
• limiting prolonged stay in one position;
• using a contrast shower: washing your feet alternately with hot and cool water;
• maintaining an ideal body mass index;
• wearing preventive compression stockings.

When preventing chronic venous insufficiency, special attention should be paid to the principles of nutrition and physical activity.

Diet

A diet for venous insufficiency, as well as a measure to prevent its development, should include split meals - at least 4-5 meals per day. This regimen normalizes metabolism and helps avoid gaining excess body weight. It is also important to monitor your water balance. At least 2-2.5 liters of fluid should be supplied per day. Water thins the blood and prevents the formation of blood clots. Fluid deficiency is fraught with serious disturbances in metabolic processes, hormone synthesis, and disruption of the structure of connective and muscle tissue.

Nutrition for venous insufficiency should comply with the following principles:

1. exclude fatty foods, processed foods, sausages, fatty dairy products, fried, canned foods, fast food and sweets;
2. eat fresh fruits and vegetables;
3. Fruit drinks and teas will also be beneficial;
4. You should avoid alcohol, carbonated drinks, strong tea and coffee;
5. the use of table salt should also be limited;
6. Once a week, fasting days should be carried out, on which the patient should eat only vegetables and fruits.

If the disease is at the initial stage of development, a properly adjusted diet in combination with the use of drugs for external use can completely stop the progression of the disease. In the case of an advanced stage, the diet will speed up the recovery and healing processes and reduce the risk of developing dangerous consequences.

Gymnastics

Gymnastics is an important element of complex therapy for venous insufficiency, which helps prevent recurrence and complications of the disease. It is impossible to completely cure the disease using physical exercise, however, even in the most advanced cases, positive effects are achieved:

• improving the functioning of the cardiovascular system;
• improved regeneration;
• restoration of function of the lower extremities;
• reducing the risk of complications;
• reducing the risk of relapse.

Before starting a course of therapeutic exercises, you should consult a doctor who, based on the severity of the disease, will determine the presence or absence of contraindications.

Exercises used for venous insufficiency of the lower extremities:

• In a lying position, place a cushion under your feet so that they are elevated by 20 degrees. There should be no tension in the body. You should remain in this position for 10 minutes, as a result, the load is removed from the vessels of the lower extremities. You should begin and end the exercise complex with this exercise; you can do it several times a day if you feel tired and have pain in your legs.
• Lying on your back, twist your legs, as if riding a bicycle, changing direction. Perform the exercise with your legs raised 20 degrees until you feel slightly tired.
• The “scissors” exercise should be performed with raised legs for 1 minute, repeated 2-3 times.
• In a lying position, raise your straightened legs 90 degrees, perform rotations with your feet, bends, and alternately squeeze your toes.

After completing a set of exercises, the patient may feel slight fatigue in the legs, followed by a decrease in pain. This indicates the effectiveness of the exercises. It should be remembered that to treat impaired venous outflow, one method is not enough. Only complex therapy will bring lasting positive effects.

Video: about CVI

It occurs more often in women than in men. Chronic venous insufficiency is considered the most common vascular disorder. And treatment must be of high quality and timely. If you hesitate to contact specialists, you may end up with disability. At an early stage, treatment can be conservative and surgery can be avoided.

Characteristics of the disease

Without medical care, grade 2-3 CVI leads to severe circulatory disorders, edema, thrombosis, thrombophlebitis, trophic ulcers, severe convulsions, and dilation of the venous walls. With a diagnosis of deep vein thrombophlebitis at an advanced stage, more than 30% of patients become disabled and lose their previous ability to work. With pronounced manifestations of chronic venous insufficiency, stress on the limbs is prohibited, so work should be light; the army is contraindicated in this case (with grade 2 pathology of chronic venous insufficiency, conscripts are exempt 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 unnoticed by the patient. At an early stage, a quickly passing heaviness in the legs appears.

And then other signs join:

• Heaviness in the lower extremities.
• Cramps.
• Pigment spots.
• Ulcers of the lower extremities.
• Transitory swelling.
• Dry skin of the lower leg.

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

Variations of pathology

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 symptoms of CVI 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, and a feeling of heaviness appears at the end of the working day.
• Degree 1. The patient complains of pain, cramps of the lower extremities. Swelling occurs after standing work, walking in high heels, or prolonged overstrain of the calf muscles.
• Degree 2. Pain and cramps intensify, pigmentation and erosion are possible, swelling may appear even after slight stress on the legs.
• Degree 3. The patient has open or already healed trophic ulcers. All other symptoms of chronic venous insufficiency, characteristic of grade 0-2 of the disease, only intensify.

Also, phlebologists, depending on the manifestations of the disease, distinguish a 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 sign. But it is telangiectasias that should alert you and force you to undergo examination and then comprehensive treatment. The progression of venous diseases at an early stage of development can be stopped by changing lifestyle, removing increased stress from the legs, using local remedies, systemic medications, and following medical prescriptions.

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

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

Important points in therapy

Treatment for chronic venous insufficiency is selected depending on the degree of the disease and the severity of clinical manifestations. It can be operative 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, excess weight, sedentary work) and, if possible, reduce their impact on the human body. To prevent the development of complications and relieve acute signs of CVI, phlebotropic drugs are prescribed. The dosage is selected by the doctor, focusing on the severity of chronic venous insufficiency and its degree (the classification of CVI allows one to determine the exact degree of the disease).

Ointments and creams with antiseptic, regenerating, anti-inflammatory, and cooling effects are prescribed locally. Treatment necessarily includes the use of elastic compression. Special compression garments provide support for blood vessels and improve the patient’s overall well-being. In case of chronic venous insufficiency in an advanced stage, urgent surgical treatment is performed. Otherwise, there is a high risk of complications and the patient becoming disabled in the future.

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. Avoid uncomfortable shoes, try to lose excess weight, elevate your legs every 2-3 hours to ensure blood flow from your lower extremities. If characteristic symptoms of the disease appear, contact a phlebologist.

Surgical treatment

For chronic venous insufficiency of grade 2-3, specialists often resort to surgery. Surgical treatment of CVI is performed using phlebectomy. During the operation, deformed veins are removed through small incisions. Afterwards, 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.

Surgery is easily tolerated in most cases. The next day after the operation, you are allowed to get out of bed, bend your legs, and start walking. Early activity speeds up the recovery process. At the rehabilitation stage, the patient is prescribed water treatments, massage, and physical therapy. It is recommended to wear compression stockings continuously for 1-2 months after surgery. To prevent relapse of chronic venous insufficiency, venotonic drugs are prescribed.

Is disability possible with thrombophlebitis?

Any disease, if left untreated, can lead to disability. The same applies to thrombophlebitis. But in order to obtain such status, it is necessary to pass a commission for medical and social examination. She is provided with documents that clearly indicate information about her health before the illness and after treatment.

Experts pay attention to the heart muscle, which takes into account its size, ejection fraction, pulmonary artery pressure and other factors. To obtain disability for thrombophlebitis, the commission must carefully examine the patient’s medical history.

On what basis is disability granted?

To begin undergoing a medical and social examination, the patient must first contact his local doctor. He will issue a referral to MSEC. In fact, getting a disability is not difficult, since according to statistics, 98% of all cases of illness leave behind some kind of consequences. And only 50% of patients after suffering acute thrombophlebitis can calmly perform their official duties, as before.

The most common consequence is chronic venous insufficiency. Often this condition accompanies thrombophlebitis, which developed during pregnancy. And as you know, during this period, most medications are contraindicated for women.

Accordingly, there is a high risk of developing blockage of the pelvic veins and vena cava. Such a patient has to endure swelling, which can even develop into extensive ulcers. And these manifestations are practically incurable. As a result, it is difficult for a woman to return to her previous way of life and work.

Thrombophlebitis and disability group

In order to assign disability due to deep vein thrombosis, the medical and social commission is guided by certain criteria. Let's look at them in more detail.

I group. Such a group for venous thrombophlebitis does not exist.

Group II. Here, life limitations are characterized as persistent. Group 2 is assigned to those who have a diagnosis:

• inferior vena cava syndrome;
• bilateral ileofemoral thrombosis, which led to chronic venous insufficiency of grades 2 and 3;
• post-thrombophlebic syndrome of both lower extremities or varicose veins, which are complicated by repeated heart attacks - pneumonia (here the degree of chronic venous insufficiency is not taken into account);
• with postthrombophlebic syndrome of both legs and chronic venous insufficiency, when relapses occur, expressed in erysipelas (and therapy does not give the desired result);
• with post-thrombophlebic syndrome, which appeared in the first year after installation of a vena cava filter;
• in the presence of trophic ulcers with a total area of ​​35 sq. cm, which smell unpleasant and are characterized by copious discharge (the number of dressings per day exceeds the mark of 4 pieces).

III group. This category includes persons who, as a result of an illness, are now moderately limited in their life activities, due to which a partial loss of ability to work has occurred. The following diseases can lead to this situation:

• chronic venous insufficiency of the 1st, 2nd and 3rd degrees or postthrombophlebic syndrome of one leg (if the ulcers do not require constant dressing);
• if the patient had varicose veins, which is characterized by low venovenous discharge.

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To avoid complete or partial loss of performance, it is necessary to recognize thrombophlebitis of the lower extremities in time. A timely response determines how quickly the illness will pass and whether any complications will appear. And this is not to mention how important it is to follow all the instructions of the attending physician.

A proven method of treating varicose veins at home in 14 days!

Varicose veins of the lower extremities CVI stage 2

Varicose veins of the lower extremities CVI stage 2 is a disorder of the vascular system that occurs in 25% of the population. We will find out today what is the reason for such a high indicator.

Diagnosis of CVI stage 2

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

The difficulty of treating chronic venous insufficiency lies in late diagnosis and delayed treatment. Many carriers of the disease do not even suspect its presence. Thus, the pathology moves from the initial level to the second stage.

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

• pain that worsens with prolonged standing;
• “tired legs syndrome”, 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 meshes and stars;
• cramps in the calf muscles, which in most cases bother you at night;
• a significant change in skin color, the leg acquires a pale bluish tint;
• the lower limb affected by stage 2 CVI feels significantly colder to the touch than the healthy leg;
• the appearance of hyperpigmentation, which is characterized by dark spots in the lower leg area;
• inflammatory process of the skin.

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

CVI stage 2 of the lower extremities, photo

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

CVI stage 2 of the lower extremities, photo:

The danger of stage 2 venous insufficiency also lies in the fact that due to the deposition of a large amount of blood, general health worsens. The patient has an extremely difficult time withstanding mental and physical stress, and is regularly bothered by dizziness and fainting. In some cases, signs of heart failure appear.

CVI 2nd degree and the army

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

• diagnosis of postthrombotic varicose veins of the lower extremities;
• diagnosis of varicose veins of the lower extremities with the manifestation of venous insufficiency of the chronic form of 2 degrees.

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

Treatment of CVI stage 2

Treatment of stage 2 CVI must be comprehensive. It is no longer possible to cope with a progressive disease solely with the help of pills!

• Compression garments. Wearing therapeutic underwear is mandatory at all stages of the disease. These could be special knee socks, stockings for varicose veins on the legs, or tights made of compression knitwear. Underwear models are somewhat different - they are for men and women, and have different degrees of compression. A consultant will help you choose the right medical underwear depending on the individual characteristics of the patient.

Therapeutic underwear helps to compress the veins, thereby improving blood flow in the legs. Phlebologists insist that compression hosiery is an essential component of complex therapy.

• Medicines. The doctor prescribes a list of medications with a venotonic effect. Drug therapy helps alleviate the patient’s condition and increases the tone of the vascular walls. Drugs are prescribed on an individual basis, depending on the patient’s contraindications. The drugs Detralex and Venoruton become frequent companions for the patient.
• Minimally invasive intervention. Refers to gentle methods of treatment that do not require serious trauma to the skin. For stage 2 CVI, the following may be prescribed:

1. sclerotherapy - intravenous administration of a sclerosant substance, which allows you to restore normal blood flow;
2. 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 claim that at the second stage of venous insufficiency, the presented treatment methods 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 veins of the lower extremities CVI stage 2 cannot be treated with conservative methods. Such complex therapy only allows you to stop the process of further development of the pathology.

Surgery for stage 2 CVI

Indications for surgical intervention:

• progression of the disease, lack of a positive result of treatment therapy;
• reflux (pathological blood flow);
• development of trophic disorders.

Contraindications for surgery:

• advanced age of the patient;
• inflammatory process;
• the presence of severe concomitant pathology.

The operation can be performed in two ways:

1. Crossectomy. Through a small incision in the groin area, the surgeon crosses (ties) the great saphenous vein. The intersection is made at the level of the anastomosis with the deep vein.
2. Stripping. A medical probe is inserted into the vein through a small incision. When removing a small vein, the thinnest probe is inserted; when removing a large vein, a large probe is used. After inserting the probe, the surgeon completely excises the venous trunk.

The operation is dangerous due to complications such as bleeding, lymphatic leakage, hematomas, and thrombosis.

CVI 2nd 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. Disability group 2 or 3 is established. Group 3 is defined by moderate limitation of life activity due to loss of legal capacity. Group 2 is a persistent severe limitation of life activity.

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 quickly healing ulcers and pathological hyperpigmentation, disability is not provided for mental workers!

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

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

Medical and social examination

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Medical and social examination and disability in varicose veins, postthrombophlebitic disease

disability, it was found that for the majority (69.8%), disability occurred due to the neglect and severity of the disease, errors in treatment, and the performance of contraindicated work [Turovich EA., 1977].

With insufficiency of the supramalleolar perforating veins - the most unfavorable form of the disease - patients are bothered by a feeling of heaviness and pressure in the distal parts of the leg, and with prolonged standing, dull pain occurs over the medial malleolus and swelling in the lower third of the leg.

Stage of formation of PTFS.

Stage I is the period of thrombus organization and the formation of basic compensation mechanisms; its duration is 9-12 months.

It is characterized by a reverse development of the main clinical symptoms of deep vein thrombosis: a decrease or disappearance of the feeling of fullness and pain in the leg, cyanosis of the skin and swelling. Temperature, biochemical and hematological parameters are normalized. The speed and severity of regression depends on the localization of the process, the extent of venous thrombosis and the intensity of therapy. At this stage, the risk of embolism of the pulmonary artery or its branches is highest.

Heavy and moderate physical labor;

Forced working posture - prolonged standing and sitting in one place;

Work in conditions of high and low temperatures and high humidity;

Working in vibration conditions.

Patients are subject to referral for MTU:

With varicose veins with low venovenous discharge. PTFS and CVI degrees I and II if employment is necessary;

With inferior vena cava syndrome, bilateral ileofemoral thrombosis and thrombosis complicated by thromboembolism after temporary disability;

With PTFS, stage III CVI, recurrent erysipelas, bilateral lesions with ineffective treatment due to an unfavorable work prognosis;

With PTPS complicated by repeated thromboembolism, regardless of the degree of CVI;

After implantation of a vena cava filter;

After ineffective surgical treatment of PTFS.

Moderate persistent limitation of life activity due to loss of ability to work in contraindicated professions (disability group III) is determined for patients:

With varicose veins with low venovenous discharge. PTFS and CVI degrees I and II;

With PTFS of one lower limb and stage III CVI with ulcers that do not require multiple daily dressings.

Severe persistent limitation of life activity (disability group II) can be determined by patients: - with inferior vena cava syndrome, bilateral ileofemoral thrombosis with CVI of II and III degrees;

With varicose veins or PTFS, complicated by repeated infarction-pneumonia, regardless of the degree of CVI;

With PTFS of both lower extremities, stage III CVI (recurrent erysipelas with ineffective treatment; - with extensive trophic ulcers with a total area of ​​more than 35 sq. cm with copious, foul-smelling discharge and the need for dressings 4 or more times a day.

Damage to the main veins does not lead to pronounced impairment of life activity (disability group I).

Is disability prescribed for thrombophlebitis?

Whether or not to assign disability for thrombophlebitis is decided by MSEC (Medical and Social Expertise). The commission's conclusions are based on documented information about the patient's health status. Treatment of deep vein thrombophlebitis does not pass without leaving a trace for a person; the disease has its consequences. First of all, the condition and size of the heart, especially its right parts, ejection fraction and pressure in the pulmonary artery are assessed. As well as a whole range of factors influencing the quality of life of a patient who has suffered from thrombophlebitis.

Why can disability be prescribed for thrombophlebitis?

To clarify whether disability is prescribed for thrombophlebitis, you need to contact your local doctor, who will issue a referral for MSEC. According to medical statistics, only 2% of patients who have suffered acute thrombophlebitis recover completely. 98% experience various complications, including postthrombophlebitis syndrome. Only 50% of patients can return to their previous work, and disability occurs in almost every third person.

A patient’s history of thrombophlebitis determines the development of chronic venous insufficiency. Often this condition occurs when thrombophlebitis and pregnancy occur simultaneously, because the phlebologist is limited in treatment options. The most severe consequences are caused by blockage of the pelvic veins and vena cava. In this case, the patient experiences severe swelling and, over time, extensive ulcers develop that are practically untreatable. The patient loses the ability to work.

What disability group can you get for thrombophlebitis?

When assigning a disability group after thrombophlebitis, the MSEC commission is guided by several criteria. The definition of group III occurs with persistent moderate limitation of the patient’s life activity and partial loss of ability to work due to one of the diagnoses:

• varicose veins accompanied by low venovenous discharge;
• postthrombophlebitic syndrome and CVI degree I or II;
• PTFS of one leg and stage III CVI, if the ulcers do not require frequent dressings.

Determination of disability group II is possible with severe persistent limitation of life activity with a diagnosis of:

• inferior vena cava syndrome, bilateral ileofemoral thrombosis with chronic venous insufficiency of degree II or III;
• PTFS or varicose veins, complicated by repeated infarction-pneumonia. The degree of CVI is not taken into account;
• PTFS of both legs, stage III CVI, accompanied by recurrent erysipelas when treatment is ineffective;
• PTFS within a year after installation of a vena cava filter;
• extensive trophic ulcers, the total area of ​​which exceeds 35 cm2, accompanied by foul-smelling and profuse discharge, requiring more than four dressings per day.

Damage to the veins does not lead to disability group I.

In order to prevent complete or partial loss of performance, it is important to promptly and competently treat thrombophlebitis; compresses and leeches are not always effective. When the first signs of the disease appear, you should consult a phlebologist.

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, postthrombophlebitic syndrome, congenital anomalies of venous vessels.

According to Russian studies, as a result of detailed diagnostics, signs of CVI are detected in every second resident 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. Phlebologists believe that one of the most important problems that negatively affects the development and progression of pathology is the untimely request of patients for medical help, as well as a long period of hidden 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: varicose veins of the lower extremities are often confused with chronic venous insufficiency. However, the latter can manifest itself without visible changes in the saphenous veins, since the development of CVI is caused by congenital and acquired pathologies that lead to disruption of blood flow through the deep venous 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 ensured by a number of factors. Physical activity plays the most important role. During physical activity, the muscles of the limbs contract, compressing the veins, as if “squeezing” blood out of the venous vessels. Subject to the force of gravity, the blood tends downwards, and this is where the valves are activated, directing the blood flow upward, towards the heart. Thus, maintaining normal blood flow through the venous system of the lower extremities is possible provided:

• consistency of the valve apparatus,
• stable tone of the venous wall,
• normal physiological changes in the lumen of the vessel caused by changes in body position.

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

• local blood thickening;
• accumulation of metabolites (substances chemically changed during metabolism);
• activation of leukocytes and macrophages, as well as increased secretion of lysosomal enzymes;
• an increase in the amount of biologically active substances - inflammatory mediators and free radicals.

Normally, a certain volume of lymph is discharged into the venous bed through a system of anastomoses (cava-caval anastomoses) connecting the tributaries of the superior and inferior vena cava. But against the backdrop of increased pressure in the venous system, this process is disrupted. As a result, the lymphatic system experiences overload, lymph outflow worsens, exacerbating 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. Insufficient functioning of the muscular-venous pump leads to stagnation of blood and triggers the pathological process.
• Obesity. The risk of developing CVI increases with the degree of obesity.
• Genetic predisposition. Weakness of the vein wall, caused by congenital insufficiency of connective tissue, can provoke the development of this pathology.
• Gender. Women suffer from CVI three times more often than men. Phlebologists (http://modernsurgeon.ru/o-tsentre/) explain this fact by the high level of estrogen hormones, increased stress caused by pregnancy and childbirth, as well as high life expectancy compared to men.
• Taking hormonal medications, including hormonal contraceptives.
• Age. Due to prolonged exposure to provoking factors, older people suffer from CVI much more often.
• Long-term static loads and heavy physical labor associated with professional needs.

In some cases, the disease chronic venous insufficiency may be a consequence of previous phlebothrombosis. The reason for the development of CVI is also 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 traumatic damage to the veins.

Chronic venous insufficiency: symptoms

Clinical symptoms of CVI are varied. The early stages are characterized by the manifestation of one or more signs, among them: bursting pain in the lower extremities;

• transient swelling;
• heaviness in the legs, worsening with 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 the initial stages of CVI are not observed in all cases. As the pathology progresses, the consequences of venous circulation insufficiency worsen. Trophic skin disorders become pronounced, trophic ulcers appear. An increase in blood volume in the venous system of the lower extremities can cause a significant deterioration in the patient’s general health. The above symptoms may be accompanied by signs of heart failure, dizziness and fainting. Due to a decrease in circulating blood volume, patients suffering from severe CVI experience difficulty in physical and mental work.

Chronic venous insufficiency: degrees (classification)

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

• grade 0. No symptoms of chronic venous insufficiency of the lower extremities. Clinicians have identified this degree, since in practice, pronounced varicose veins can occur without any signs of CVI;
• chronic venous insufficiency of the 1st degree. Patients complain of bursting pain and heaviness in the legs, transient swelling, cramps at night;
• chronic venous insufficiency of the lower extremities 2 degrees. A characteristic symptom is the phenomenon of fibrous degeneration of the subcutaneous tissue and skin (lipodermatosclerosis), edema (swelling), hyperpigmentation (the skin acquires a brown tint), 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” - symptoms of the disease appear, while the patient is considered able to work, there is no need for supportive measures;
• “chronic venous insufficiency of the lower extremities of the 2nd degree” - the patient is able to work full time, subject to the use of supportive measures;
• “chronic venous insufficiency of the 3rd degree” - the patient is considered disabled.

Severe stages of lipodermatosclerosis or a long-term lack of treatment for the first episode of venous ulcer formation often become the cause of a non-healing and constantly recurrent trophic ulcer, one of the most severe conditions faced by people suffering from CVI.

Diagnosis of chronic venous insufficiency of the lower extremities

The success of treatment for CVI 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 for CVI is ultrasound duplex angioscanning. The study allows us to determine the nature of venous insufficiency and the location of the affected vessels. In some cases, additional instrumental diagnostic measures may be prescribed:

• X-ray contrast venography. The study is necessary for diagnosis and selection of surgical treatment methods. It allows you to assess the anatomical and functional state of the deep, superficial and perforating (connecting the first two) veins of the lower extremities, the localization, extent of pathological changes;
• computed tomography (CT). A highly informative method that allows you to visualize the nature of the pathological process in 3D images;
• Magnetic resonance angiography of the veins of the lower extremities allows you to examine the condition of blood vessels, lymphatic tracts, collateral blood flow and assess the extent of the pathological process.

Since CWD often indicates advanced disease, timely diagnosis and the subsequent set of treatment measures are extremely important for the patient.

Chronic venous insufficiency: treatment

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

Phlebologists are guided by the following principles for the treatment of CP:

• Therapy should be carried out in courses. Some patients receive treatment in short and episodic courses, while others require long-term and regular treatment. The average course duration is 60–75 days.
• Taking medications must be combined with other treatment methods.
• The treatment plan is selected strictly individually.
• Achieving a positive treatment effect 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 failure to follow the recommendations of the attending physician.

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

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

A mandatory condition that patients must comply with during the treatment of chronic hepatitis is 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 vein lumen;
• improve venous hemodynamics;
• improve the functioning of the valve apparatus;
• restore microcirculation;
• improve drainage of lymph through lymphatic vessels.

An elastic bandage on a sore limb should be formed by a phlebologist, since this process requires professional skill. Using an elastic bandage on your own can only worsen the symptoms of the disease. Typically, an elastic bandage is used in cases where short-term continuous wear is required. For long-term use, preference is given to compression hosiery. The attending physician will select products: tights, stockings or knee socks with the desired degree of compression. Independent use of compression hosiery is undesirable, since the patient will not be able to correctly select the required level of pressure of the product.

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

• atherosclerosis of arterial vessels;
• cardiorespiratory failure;
• presence of damage to the skin in the area where compression products are intended to be used.

The choice of conservative therapy method depends on the stages of CVI.

• At stage 1, against the background of CVI, varicose dilated saphenous veins are observed. In order to eliminate this defect, sclerotherapy is prescribed. The essence of the method is to inject a small-diameter chemical agent into a vein, which “glues” the vessel, as it were, after which the vein completely resolves. To achieve the expected effect, compression therapy must be used. A short course of medication may be prescribed.
• If chronic venous insufficiency of the 2nd degree is detected, treatment will be aimed at improving microcirculation in the surrounding tissues and increasing venous tone. For this purpose, the phlebologist will prescribe medications. The duration of their use 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 complications of the disease. In this case, the doctor prescribes combination therapy, which includes general medications and topical medications. 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, Cetrin, Lorano) are used. Phlebologists do not recommend continuing treatment if there is no therapeutic effect for two months. Local pharmacotherapy consists of using medications (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, Polcortolon, Akortin) are prescribed. In some cases, in the presence of various 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. This requires bed rest, treatment of ulcers with a special solution, the use of antiseptics, such as Miramistin ointment, and antibacterial therapy. The treatment complex for CVI includes physiotherapeutic techniques. Well-proven methods include diadynamic currents, electrophoresis and balneotherapy.

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

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

• classical open operations on saphenous veins. To perform them, several incisions are made to remove the affected vessels;
• methods of intravascular obliteration. These include minimally invasive methods: radiofrequency obliteration (RFO) and endovenous laser obliteration (EVLO). Manipulations are carried out without incisions (puncture). Under ultrasound guidance, the surgeon “closes” the diseased vessel rather than removing it.

Surgical interventions on perforating veins:

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

For postthrombotic 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 significantly improves the clinical condition of patients, inhibits further progression of reflux and allows one to avoid complex surgical intervention. The operation is performed in a specialized vascular hospital and requires modern medical equipment and highly qualified personnel.
• Reconstructive operations on deep veins. The purpose of the intervention is to form the structure of valves in deep venous vessels. At this stage, this section is considered one of the most problematic among the entire arsenal of surgical phlebology.

Photos BEFORE and AFTER CVI treatment

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

• Maintain an active motor mode.
• Avoid prolonged static loads (standing or sitting for a long time).
• Regularly perform a set of therapeutic exercises prescribed by your doctor.
• Constantly wear compression hosiery during the daytime, recommended by a phlebologist.

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

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

A whole army of diseases attacks modern man. Among them are diseases of the veins of the lower extremities. Internet portals are full of information about varicose veins and ways to combat 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 of the lower extremities. Such manifestations occur with constant, that is, chronic disruption 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 stage 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. This abnormal pressure also extends to the system of tiny capillaries that provide nutrition and drainage to all anatomical structures of the leg. The inner layer of capillaries is gradually damaged, which leads to disruption of nutrition and metabolism in the lower extremities. These pathological processes are the cause of unpleasant symptoms. This chronic deficiency progresses gradually and has its own stages and severity. Currently, there is the following classification of CVI:

1. Subclinical stage – no symptoms.
2. Grade 1 is characterized by moderate transient symptoms.
3. Grade 2 reflects persistent symptoms that require a careful approach to treatment.
4. 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 begin treatment of the disease in a timely manner and avoid possible complications.

The capillaries are gradually damaged, which leads to unpleasant symptoms.

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 feels virtually no discomfort. At this stage, symptoms such as swelling of the legs and feet are absent in most people. The most common complaints with this degree of chronic insufficiency of venous vessels are moderate pain and burning symptoms in the legs when standing in an upright position for a long time.

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

• Transient mild swelling of the legs, occurring at the end of the day and disappearing overnight.
• In the evening, patients complain of symptoms such as a feeling of heaviness, discomfort and swelling in the legs and feet.

At this stage, the transient nature of the symptoms is explained by the intense work of the lymphatic system to drain and remove excess fluid from the legs. However, lymphovenous insufficiency already occurs, since compensatory mechanisms cannot cope with the forces of gravity. Swelling disappears only after a long night's sleep in a horizontal position.

It is optimal to treat venous insufficiency of the lower extremities 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 experiences virtually no discomfort.

Further scenario

In a situation where treatment for CVI 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 damaged walls of small vessels.

The product of their degradation, hemosiderin, is deposited in the skin. This gives the skin a characteristic purplish-bluish tint. Sometimes, with chronic venous insufficiency of the lower extremities, hypopigmentation of the skin occurs due to a violation of its nutrition.

The swelling 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 occur. Eczema or itching occurs on the skin of the legs and back of the feet.

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

With CVI of the third degree, there is a total disruption of circulation in the legs. At this stage of the disease, the exchange of oxygen and nutrients is greatly impaired. Trophic ulcers appear on the skin of the legs. They are open wounds on the skin. Such ulcerations do not heal for a long time and 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 in advanced CVI.

Therapy at 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 fighting the disease in the initial stages. We'll talk about this below.

How to overcome the disease

Treatment of chronic venous insufficiency of the legs should be started in the first stages of the disease. It is at this stage that the pathological vicious circle can be broken and normal microcirculation and venous outflow can be restored. Let's consider the main treatment measures for CVI:

• Constant use of compression stockings. Special socks, stockings or tights have varying degrees of compression depending on the stage of the disease. There are models for both men and women. Such therapeutic knitwear promotes 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.
• Taking medications with a venotonic effect. These are plant-based drugs that effectively increase the tone of the venous wall. These remedies help get rid of unpleasant symptoms.
• Minimally invasive interventions that eliminate pathologically altered veins. We are talking about sclerotherapy, laser coagulation or ligation of dilated vessels with incorrectly functioning valves. Such measures stop the pathological process at its initial stages.
• Surgery to remove varicose veins. Performed when all of the above treatments have exhausted themselves.
• 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. In case of infection, therapy should be supplemented with general and local antibacterial drugs.

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

Chronic venous insufficiency of the lower extremities is observed in 25% of the total population. In most cases, the disease occurs in residents of eastern countries. The reason is a sedentary lifestyle and work that requires constant sitting or standing. Chronic lower extremity pain (pathogenesis) occurs due to poor blood circulation. The vertical position of the body is a condition that is not characteristic of any mammal on earth. The lower limbs always have poor blood circulation due to gravity.

Features of the circulatory system

Blood passes through the largest vessels - arteries, which have branches into small vessels - arterioles and capillaries. The movement of blood through small blood vessels does not have any difficulty because the blood flows at high pressure.

Through the venous system, blood does not flow to the lower extremities in full, since it is affected by the force of gravity. The movement of blood through the veins is ensured by valves, the main function of which is to close and open. When the valve is closed, blood moves upward. This happens due to the contractile function of the muscular system of the legs. When the walls of the blood vessels lose their elasticity and begin to stretch, the valve stops functioning correctly. The situation is aggravated by blockage of blood vessels with blood clots and cholesterol plaques.

Chronic venous insufficiency of the legs is provoked due to any circulatory disorders. A complete cure for venous insufficiency is not possible.

Chronic venous insufficiency of the lower extremities can be congenital or acquired due to leg injuries or blockage of the veins. The disease is a violation of the circulatory process in the legs, when blood, moving from bottom to top, cannot completely pass through the veins and stagnates in them, causing dilation of the blood vessels. Blood presses on the walls of blood vessels, causing them to weaken and expand.

The symptoms of the disease and the causes of its occurrence depend on the type of blood flow disorder.

Chronic venous insufficiency of the lower extremities:

• Zero stage– the onset of a disease in which damaged vein walls are not detected upon examination. The main symptom is the appearance of a vascular venous network, which does not cause pain or discomfort.
• Stagnant processes of 1st degree of venous insufficiency- in the evening, after a day of work, the lower limbs swell. This is expressed in the fact that a person has traces of the elastic bands of his socks and the seams of his trousers. There is no swelling of the toes. There is a feeling of heaviness in the lower extremities. Most patients do not pay attention to these signs, delaying treatment and aggravating the condition.
• Signs of 2nd degree– pain in the lower extremities, feeling of fullness. The pain intensifies at night. Swelling is observed both in the evening and in the morning. Swollen veins appear through the skin and cause pain upon palpation. At this stage of the development of the disease, patients, unfortunately, are in no hurry to see a doctor, trying to use traditional medicine methods, which in some cases gives positive dynamics.
• 3rd degree– constant swelling of the lower extremities, the skin is pale and cold. The pain syndrome is pronounced. In many cases, convulsive muscle contractions begin.
• 4th degree– disruption of the blood circulation process has a negative effect on the skin. Brown spots begin to appear on the legs, and inflammatory lesions appear. Some patients develop eczema - the skin at the site of damaged veins becomes too thin and peeling appears. At this stage of the disease, a person requires emergency medical care.
• Symptoms of the fifth,very severe Chronic leg insufficiency is characterized by formation. The skin begins to thicken and becomes very pale. At this stage, the vein may begin to become clogged with blood clots.
• Sixth, extremely severe stage of chronic venous insufficiency of the lower extremities- has the following symptoms - the ulcers do not heal on their own, they constantly expand. If blood clots form, the disease can only be cured through surgery.

Reasons

Most people on the planet have a genetic predisposition to the disease. In some cases, the development of the disease is associated with age-related changes, since the walls of the veins become less elastic over time, stretch, and the venous valve is not able to ensure tight closure of the lumen.

The main factors that can cause the development of venous circulation insufficiency in the lower extremities:

• Regular intake of medications containing hormones.
• Pregnancy and labor. During the period of bearing a child, the lower limbs and pelvic organs experience excessive stress. The expanding uterus and the increasing weight of the fetus puts pressure on the veins in the pelvis, leading to their compression and provoking stagnant processes.
• Sedentary lifestyle. In people who have a “sedentary” job and do not bother themselves with physical activity, a venous network appears over time, which provokes the development of more serious pathological processes in the circulatory system.
• A position of the body in a lying or sitting position that lasts for hours. In some cases, the patient is recommended to change the nature of his work activity in order to recover from the disease.
• Excess body weight.
• Lifting heavy loads, which is associated with professional activities, is observed among athletes - weightlifters.
• Frequent visits to the steam room, taking hot baths.

As medical practice shows, most patients diagnosed with chronic venous insufficiency seek medical help only in cases where the disease has caused a number of severe complications, and the treatment will be very complex and long.

Treatment methods include drug and surgical treatment of venous insufficiency, depending on the stage of the disease. Each patient undergoing treatment needs to change their daily routine to include several hours of physical activity. If you are overweight, you need to lose weight.

The first two stages of the disease do not require serious treatment. As a rule, the patient is prescribed medications that increase the tone of the walls of blood vessels - Ginkor-Fort, Detralex. A method is used in which a drug is administered that stops the process of blood outflow in the damaged vein in order to narrow it.

The second - fourth stage is treated with antihistamines. If there is a high risk of complications, medications that have an anti-inflammatory effect are prescribed. The choice of medications depends on the individual characteristics of the patient and is prescribed only by the attending physician.

The most severe stages of the disease are 5 and 6, during which ulcers form, and medications with a general and local spectrum of action are prescribed. Daily treatment of ulcers with decoctions of chamomile and other agents that have a soothing and disinfecting effect is required.

Surgical operations are performed only in the last stages of the disease, in the absence of positive dynamics from taking medications. The main types of operations are phlebectomy: removal of the damaged part of the vessel and bypass surgery - complete removal of the vein, and creation of a bypass to ensure blood flow.

Use is only possible to relieve symptoms. For example, to relieve swelling and pain, it is recommended to apply cold compresses to the lower extremities daily.

To normalize the composition of the blood and reduce its viscosity to prevent the formation of blood clots, you can use the following recipe - hops or sweet clover herb in the form of a decoction. Take one glass before meals.

Horse chestnut has a beneficial effect on veins and blood. To prepare the decoction, you need to pour a tablespoon of the ingredient into one glass of boiling water.

Prevention

Measures to prevent the development of complications:

• Wearing comfortable shoes. Shoes with stiletto heels are excluded.
• Regular rest for the lower extremities, during which the feet should be higher than the level of the head.
• Playing sports. Preference is given to active activities - running, cycling, swimming, dancing, aerobics.
• Wearing compression stockings and socks.
• Contrast shower. Alternating exposure of the skin to cold and hot water causes the veins to contract, which helps maintain the elasticity of their walls.

To prevent the occurrence of venous disease of the legs, it is necessary to lead an active lifestyle and take preventive measures to prevent the development of varicose veins.

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Venous insufficiency is a vascular pathology in which the outflow of venous blood is disrupted. The vessels of the legs are most often affected. This pathology is the outcome of varicose veins or thrombophlebitis. The prevalence of CVI among the adult population reaches 15-30%. Most often, this pathology is detected in working age (20-50 years), which is due to stagnant processes, sedentary work or prolonged standing. CVI is often combined with trophic ulcers.

Reasons

Risk factors for the development of CVI of the lower extremities are:

• Postthrombophlebitic syndrome. With this pathology, there is a chronic disturbance of the outflow of venous blood against the background of thrombosis and inflammation of the deep veins. A blood clot forms in the lumen of the vessel. When it lysis (dissolves), the valves, which are responsible for the unidirectional outflow of venous blood, are destroyed. This causes stagnation of blood, backflow, increased pressure and insolvency of the veins.
• Varicose veins of the legs. CVI develops many years after the onset of varicose veins. With this pathology, the walls of the veins become thinner and less elastic. The veins expand and twist, and the valve apparatus is destroyed. Risk factors for the development of varicose veins are sedentary or standing work, long flights and travel, wearing compressive clothing, pregnancy and childbirth, hereditary predisposition, excess weight, heavy lifting, chronic constipation, lack of fiber in the diet and physical inactivity.
• Congenital anomalies of vascular development.

Women most often suffer from this pathology, especially those taking hormonal contraceptives, and smokers. Experienced phlebologists know not only the causes of CVI, but also the classification of chronic venous insufficiency.

Classification

The classification of CVI includes two types of pathology - acute (occurs as a result of sudden occlusion of the deep veins of the legs) and chronic. In case of chronic venous insufficiency of the 1st degree, signs of blood flow disturbance are clearly expressed. The following signs are observed:

• convulsions mainly at night;
• leg pain;
• constant heaviness (most pronounced in a standing position);
• periodic swelling of the legs.

Stage 2 CVI differs in that swelling is a constant concern. Signs such as hyperpigmentation of the skin (darkening), dryness and flaking, and itching are possible. Signs of lipodermatosclerosis are often observed. If chronic venous insufficiency of the 2nd degree is not treated, then the next stage of the disease develops, which is characterized by the appearance of long-term non-healing trophic ulcers on the skin of the legs. Most often, patients are diagnosed with stage 1 and stage 2 CVI.

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Symptoms

Symptoms of venous insufficiency are:

• Heaviness in the legs. In the morning it is weakly expressed or absent. The severity increases with prolonged standing or sitting.
• Edema. They can be bilateral (on both legs) or unilateral (only on one limb). The most common location of edema is the lower legs. Unlike pathologies of the kidneys and heart, with CVI there is no swelling in the facial area.
• Cramps. They are one of the earliest symptoms of the disease. They occur primarily at night and can make it difficult to sleep. Most often, cramps occur in the calf muscles.
• Change in skin color. Hypo- and hyperpigmentation are possible. Most often, skin color changes in the distal (located further from the midline) part of the lower leg.
• Decreased skin elasticity.
• Dry skin.
• Signs of varicose veins in the form of spider veins (dilated small blood vessels), protruding veins and nodes. In the early stages of CVI, these symptoms may be absent.
• Trophic ulcers. This is a superficial skin defect in the form of a wound incapable of healing. If a secondary infection occurs, suppuration occurs. Early manifestations of trophic ulcers include thinning of the skin, itching, pallor, burning, swelling and the presence of a bluish spot. Some patients develop dermatitis.
• Dizziness.
• Changes in vascular pattern.
• Periodic fainting. They arise as a result of stagnation of venous blood in the vessels of the legs.
• Symptoms of heart failure.
• Poor tolerance to mental and physical stress.

Diagnostics

If there are signs of CVI, you should contact a phlebologist. To make a diagnosis and exclude other pathologies you will need:

• Survey. The doctor determines the duration of the disease, identifies the patient’s complaints and risk factors.
• External inspection.
• Palpation.
• Tourniquet functional tests.
• Duplex scanning. This is a type of ultrasound examination that allows you to assess the condition of the veins, valve apparatus and blood supply to the desired area. During this procedure, the doctor obtains a two-dimensional image of the tissue. The advantages of scanning are simplicity, accessibility, safety (no radiation exposure) and information content.
• Ultrasound Dopplerography. Allows you to assess the speed of blood flow, the condition of the veins, their patency, as well as identify the presence of blood clots and tortuosity of blood vessels.
• Phlebography. It is an auxiliary diagnostic method. A radiopaque contrast agent is injected into the vessel, after which photographs are taken.
• General and biochemical blood tests.
• Coagulogram.