Venous insufficiency
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
-
Symptoms of venous insufficiency
- Venous insufficiency of the lower extremities
- Chronic venous insufficiency of the brain
- Diagnostics
- Treatment of venous insufficiency
- Potential consequences and complications
- Forecast
- Prevention
Venous insufficiency is a symptom complex caused by impaired blood outflow through the venous system. About 40% of adults suffer from this pathology. Venous insufficiency of the lower extremities is more often observed. This is due to a person's upright posture, as a result of which the load on the veins of the legs increases significantly, as blood flows through them, overcoming the forces of gravity. Venous insufficiency can also be observed in other parts of the body - internal organs, the brain.
Vein swelling with venous insufficiency of the lower extremities
Chronic venous insufficiency is a slowly progressing pathology that is practically asymptomatic for a long time, which is why patients often seek medical help in advanced stages. This is the insidiousness of the disease. According to statistics, no more than 8-10% of patients receive timely treatment.
Often, patients confuse varicose veins and venous insufficiency of the lower extremities. These two pathologies have a lot in common in symptomatology, but still they are not identical.
Causes and risk factors
The pathological mechanism for the development of venous insufficiency is rather complicated. Prolonged obstruction of the outflow of blood through the veins leads to an increase in intravascular pressure and an expansion of the lumen of blood vessels. On the inner lining of some large and most middle veins, there are semilunar valves that prevent the reverse direction of blood flow. Against the background of vasodilatation, the flaps of the valves cease to close together, and the blood begins to flow not only towards the heart, but also back out.
If the treatment of venous insufficiency is not started at this stage, then later, due to the increasing pressure, the vein walls lose their elasticity. In addition, their permeability increases, which leads to the development of regional edema. This edema compresses the blood vessels, thereby disrupting the blood supply to tissues and causing trophic disorders.
In case of venous insufficiency, the vessels dilate, and the valve cusps cease to close together
Most often, venous insufficiency of the legs develops against the background of the following pathological conditions:
- varicose veins of the lower extremities;
- post-thrombophlebotic syndrome;
- traumatic injuries of the limbs;
- phlebothrombosis;
- congenital or acquired anomalies of the structure of the blood vessels.
The causes of venous insufficiency of the brain can be:
- professional vocal lessons;
- significant physical activity;
- systematic wearing of clothing that squeezes the neck;
- scoliosis;
- asphyxia;
- injuries of the cervical spine;
- traumatic brain injury;
- constant difficulty in nasal breathing (curvature of the nasal septum, chronic rhinitis);
- cerebral thrombosis;
- bronchial asthma;
- arteriovenous or venous hypertension.
Factors that contribute significantly to venous insufficiency include:
- female;
- genetic predisposition;
- long-term hormone therapy;
- pregnancy;
- obesity;
- elderly age;
- hypodynamia.
Forms of the disease
Depending on the duration of the pathological process, two forms of venous insufficiency of the lower extremities are distinguished:
- acute - occurs as a result of deep vein thrombosis. The thrombus blocks almost the entire lumen of the deep vein and the outflow of blood through it stops. Symptoms grow very quickly: the limb swells, the skin acquires a bluish tint of the skin, the pattern of the saphenous veins is clearly visible on it, there is severe soreness along the main vessel. If a cold compress is applied to the affected limb, the pain subsides;
- chronic - the pathological process is localized in superficial veins. For a long time, it proceeds with minimal manifestations, until the patient begins to develop trophic changes in the affected limb. Initially, areas of hyperpigmentation appear on the skin, which increase in size over time, then trophic ulcers appear in their place, which are difficult to treat.
Chronic venous insufficiency manifestations
Disease stages
Depending on the severity of clinical symptoms, the stages of chronic venous insufficiency of the lower extremities are determined:
- Initial. There is a feeling of fullness and / or heaviness in the affected limb. After a while, persistent edema appears, convulsions occur (more often at night). The operability is preserved.
- Expanded clinical manifestations. Edema grows, areas of hyperpigmentation appear on the skin, eczema, lipodermatosclerosis occurs.
- Trophic disorders. The formation of long-term non-healing trophic ulcers is characteristic.
Sometimes another stage 0 of chronic venous insufficiency is distinguished. With her, there are no clinical signs of the disease, and venous damage can only be detected with special tests.
Stages of venous insufficiency
In clinical practice, the international classification of acute and chronic venous insufficiency (CEAP system) is also used:
- 0 - the pathology of venous vessels is not visually noticeable;
- 1 - the appearance of telangiectasias on the skin (persistent expansion of small blood vessels, vascular "stars");
- 2 - dilated saphenous veins become noticeable;
- 3 - the occurrence of persistent limb edema;
- 4 - changes in the color of the skin;
- 5 - hyperpigmentation of the skin in the presence of healed trophic ulcers;
- 6 - skin hyperpigmentation and fresh trophic ulcers.
In clinical practice, classification by etiological factor is also used. The fact is that the choice of a treatment regimen for venous insufficiency is determined by the cause that raised its development. Taking into account the etiological factor, the following types of venous insufficiency are distinguished:
- ES - associated with the consequences of trauma;
- EP - the cause of the pathology is unknown;
- EC - due to a hereditary predisposition.
Anatomical classification is based on displaying the level of lesion, localization of the pathological process (great saphenous vein, inferior vena cava), segment (superficial, deep or communicating veins).
Depending on the pathophysiological mechanisms:
- chronic venous insufficiency with obstruction symptoms;
- chronic venous insufficiency with manifestations of reflux;
- combined chronic venous insufficiency (combines obstruction and reflux).
Phlebologists, within the framework of the CEAP classification of venous insufficiency, use a special scale that assesses the degree of disability:
0 - symptoms of the disease are completely absent;
1 - symptoms of venous insufficiency are poorly expressed, the patient's ability to work is fully preserved;
2 - the patient's ability to work is reduced, he can work full time only if he receives supportive therapy;
3 - there is a persistent disability, which is not restored even against the background of the treatment.
Symptoms of venous insufficiency
Venous insufficiency of the lower extremities
The clinical picture of venous insufficiency depends on the form of the disease. In acute venous insufficiency, symptoms develop rapidly. Due to the blockage of a vein by a thrombus, blood flow through it suddenly stops, edema of the affected limb arises and rapidly progresses. In the course of the main vein, severe pain is felt, which does not subside either at rest or when trying to change the position of the body. The only way to reduce pain is to apply a cold compress to the limb and take non-steroidal anti-inflammatory drugs. The skin acquires a cyanotic color, the pattern of the subcutaneous vein network is clearly visible on it.
In the initial stages of chronic venous insufficiency, the patient develops the following symptoms:
- heaviness and a feeling of fullness in the legs, increasing by the end of the working day;
- swelling of the lower extremities;
- convulsions that occur mainly at night;
- discoloration of the skin (hyper- and hypopigmentation);
- loss of skin elasticity.
Feeling of heaviness and fullness in the legs - the first symptoms of venous insufficiency of the lower extremities
If the treatment of venous insufficiency is not started in a timely manner, trophic ulcers develop. In addition, the deposition of a significant volume of blood in the veins of the affected limb causes the patient to experience attacks of dizziness and fainting.
Chronic venous insufficiency of the brain
Chronic venous insufficiency of the brain for a long time proceeds unnoticed by the patient, which is explained by significant compensatory capabilities and a developed system of cerebral blood vessels. Clinical symptoms of venous insufficiency of the brain appear only when there is a significant violation of the outflow of blood from the brain tissue. These include:
- frequent headaches;
- attacks of dizziness;
- transient disturbances in visual function (diplopia, sudden darkening in the eyes);
- disturbances of skin sensitivity in the extremities (numbness, tingling, "creeping creeps");
- apathy.
With venous insufficiency of the cerebral vessels, headaches often occur, dizziness appears, and visual function is impaired
Long-term disorders of venous outflow cause cerebral edema, the development of irreversible changes in it, which leads to the appearance of neurological symptoms.
Diagnostics
Diagnosis of venous insufficiency is carried out on the basis of characteristic clinical signs of the disease, data of an objective examination, laboratory and instrumental examination of the patient.
The degree of venous insufficiency can be determined by the results of Doppler ultrasound scanning (the accuracy of this method reaches 80-90%), duplex angioscanning. To clarify the cause of the violation of venous blood flow, in some cases, phlebography (X-ray contrast study of the affected vein) is indicated.
A reliable type of diagnosis of venous insufficiency - Doppler ultrasound scanning
Changes in the results of laboratory blood tests in venous insufficiency are nonspecific. There is an increase in the prothrombin index. With the addition of a secondary infection and the development of phlebitis (inflammation of the venous wall) in the general blood test, an increase in the number of leukocytes (leukocytosis), a shift in the leukocyte formula to the left, and an increase in ESR are observed.
Differential diagnosis is carried out with lymphangitis, erysipelas. Acute venous insufficiency is differentiated with stretching or rupture of muscles, compression of a vein from the outside by enlarged lymph nodes or a tumor, lymphedema, rupture of Baker's cyst, cellulite.
Treatment of venous insufficiency
Treatment of acute venous insufficiency begins with the application of a cold compress to the affected limb. To do this, a cotton cloth is moistened in ice water, wrung out and applied to the skin. After 1.5-2 minutes, the fabric is removed and moistened in water, and then again applied to the skin. The total duration of the procedure is one hour.
Patients are provided with strict bed rest. In order to prevent further thrombus formation, heparin injections are prescribed, which are performed under the control of blood clotting time and platelet count. In the following, indirect anticoagulants are shown. In the first days of therapy, the prothrombin index is determined daily, then it is monitored once every 7-10 days for several weeks, and after stabilization of the patient's condition - once a month during the entire period of treatment.
In acute venous insufficiency of the lower extremities due to the formation of a floating thrombus, surgical intervention is indicated, which consists in installing a cava filter in the inferior vena cava below the level of the renal veins. This operation prevents the development of thromboembolic complications, including potentially life-threatening pulmonary embolism (PE).
If venous insufficiency threatens the formation of a floating thrombus, an operation is performed to install a cava filter
Therapy of chronic venous insufficiency, as a systemic pathological process, is aimed not only at restoring normal venous blood flow, but also at preventing recurrence of the disease.
Medical treatment of venous insufficiency in its chronic form is carried out with drugs that reduce blood clotting (acetylsalicylic acid, indirect anticoagulants) and phlebotropic agents. In addition to drug therapy, the method of elastic compression is used (bandaging the limb with elastic bandages, wearing compression hosiery).
In case of chronic venous insufficiency, according to indications, surgical removal of varicose veins is performed, or the operation is replaced with sclerotherapy - a special drug is injected into the pathologically altered vein, which causes inflammation of its walls, and then their adhesion to each other.
Potential consequences and complications
Complications of chronic venous insufficiency are:
- deep vein thrombophlebitis;
- pulmonary embolism;
- streptococcal lymphangitis.
Acute venous insufficiency can cause the development of white or blue painful phlegmasia, which, in turn, can lead to gangrene of the limb, hypovolemic shock (due to the significant deposit of blood in the limb). Another complication of this condition can be purulent fusion of a thrombus, with the development of an abscess, phlegmon, and in the most severe cases, even septicopyemia.
Chronic venous insufficiency of the brain leads to intracranial hypertension, causes irreversible changes in the nervous tissue, and can cause permanent disability.
Forecast
With timely diagnosis and active treatment of venous insufficiency, the prognosis is generally favorable.
Prevention
Prevention of acute venous insufficiency includes:
- early activation of patients after surgery;
- use of elastic stockings;
- performing recumbent patients with periodic compression of the lower leg;
- drug prevention of thrombus formation at its increased risk.
Preventive measures aimed at preventing the formation of chronic venous insufficiency:
- prevention of constipation;
- an active lifestyle (playing sports, walking in the fresh air, morning exercises);
- avoiding a long stay in a static position (sitting, standing);
- when carrying out hormone replacement therapy with estrogens, women are recommended to wear elastic stockings, the prothrombin index is regularly monitored;
- refusal to wear shaping underwear, outerwear with a tight collar;
- the fight against excess weight;
- refusal to regularly wear high-heeled shoes.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
