Chronic venous insufficiency symptoms. Venous insufficiency of the legs: types, causes, manifestations, complications, treatment. Rules for applying a cold compress

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– a condition that can lead to death. 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 veins;
• congenital vascular pathologies;
• phlebothrombosis;
• injuries;
• associated diseases: cirrhosis, metabolic disorders, neoplasms, poisoning medicines may 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;
• elderly age;
• chronic constipation.

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

Mechanism of disease development

Normal venous circulation occurs in the direction from various parts 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 blocked superficial vein 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 blood clotting disorders. With this type of pathology, a blood clot blocks the lumen of the vein.

Symptoms
On early stages Chronic insufficiency has no symptoms; as the disease progresses, the manifestations increase. Acute disorder venous outflow proceeds brightly, 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 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 impairment metabolic processes, 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 initial stage pathology is a sign of fatigue, not illness. As a result, a person does not see a doctor and chronic venous insufficiency is detected on late 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 the 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;
• ultrasonography allows you to determine the presence of blood flow disorders, the extent of stagnant 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 may require several courses.

Complex treatment includes:

• drug therapy;
• compression therapy;
• physiotherapy;
• surgery;
• use of funds 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. Are used:

• indomethacin ointment reduces pain syndrome 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 development of the disease 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 increasing pressure in the edema area;
• improvement in fibrinolytic activity associated with increased production of plasminogen in tissues.

Compression therapy is performed using:

• bandages
• products from compression hosiery(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;
• at proper care long-term use is possible (up to 8 months).

The choice of the degree of compression should be made 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 wearing.

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. Cyclicity is 15 seconds, each following 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.

Surgery

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 presentation for medical care leading to the progression of the disease. At timely diagnosis In most cases, the symptoms can be controlled 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 it in 100 milliliters of boiled water;
• Pour 30 grams of crushed calamus roots into 500 milliliters 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 – dangerous disease, which needs to be taken seriously. Cluster large volumes 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, fatigue, sometimes fainting occurs. Cardiovascular failure often develops.

The nature of complications depends on the form of the disease. At acute failure thromboembolism may develop - blocking the lumen 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;
• usage contrast shower: washing 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 keep track of 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. use 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 initial stage 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 – important element complex therapy for venous insufficiency, allowing to prevent recurrence and complications of the disease. Completely cure the disease using physical exercise impossible, 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 performing 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, any one method is not enough. Only complex therapy will bring lasting positive effects.

Video: about CVI

is a pathology caused by a violation of the venous outflow in the lower extremities. With CVI, swelling and pigmentary disorders of the legs, fatigue and heaviness in the legs, and cramps at night are noted. Progressive venous insufficiency causes the appearance of trophic ulcers. The diagnosis is made on the basis of ultrasound examination of the veins and phlebography. Treatment is carried out conservatively (elastic bandaging, drug therapy) or surgical methods(phlebectomy, miniphlebectomy).

ICD-10

I87.2 Venous insufficiency (chronic) (peripheral)

General information

Pathogenesis

Blood from the lower extremities flows through deep (90%) and superficial (10%) veins. The outflow of blood from bottom to top is ensured by a number of factors, the most important of which is muscle contraction during physical activity. The muscle contracts and presses on the vein. Under the influence of gravity, blood tends downward, but its reverse outflow is prevented by venous valves. As a result, normal blood flow through the venous system is ensured. Maintaining a constant movement of fluid against gravity becomes possible thanks to the consistency of the valve apparatus, the stable tone of the venous wall and physiological change lumen of veins when changing body position.

In the case when one or more elements that ensure normal blood flow suffer, a pathological process begins, consisting of several stages. Dilatation of the vein below the valve leads to valvular incompetence. Due to constant high blood pressure the vein continues to expand from bottom to top. Venous reflux occurs (pathological discharge of blood from top to bottom). Blood stagnates in the vessel, pressing on the wall of the vein. The permeability of the venous wall increases. The plasma begins to sweat through the vein wall into the surrounding tissue. The tissues swell and their nutrition is disrupted.

Circulatory insufficiency leads to the accumulation of tissue metabolites in small vessels, local thickening of the blood, activation of mactophages and leukocytes, an increase in the number of lysosomal enzymes, free radicals and local inflammatory mediators. Normally, part of the lymph is discharged through anastomoses into the venous system. An increase in pressure in the venous bed disrupts this process, leading to overload of the lymphatic system and disruption of lymph outflow. Trophic disturbances are getting worse. Trophic ulcers form.

Classification

Currently, Russian phlebologists use the following classification of CVI:

• Degree 0. There are no symptoms of chronic venous insufficiency.
• Degree 1. Patients are bothered by leg pain, a feeling of heaviness, transient swelling, and night cramps.
• Degree 2. The swelling becomes persistent. Hyperpigmentation, lipodermatosclerosis, dry or weeping eczema are visually determined.
• Degree 3. Characterized by the presence of an open or healed trophic ulcer.

Grade 0 was not identified by clinicians by chance. In practice, there are cases when, with pronounced varicose veins, patients do not present any complaints, and the symptoms of chronic venous insufficiency are completely absent. The management tactics for such patients differ from the treatment tactics for patients with similar varicose veins, accompanied by grade 1 or 2 CVI.

There is an international classification of chronic venous insufficiency (CEAP system), which takes into account the etiological, clinical, pathophysiological and anatomical and morphological manifestations of CVI. Classification of CVI according to the CEAP system:

Clinical manifestations:

• 0 – there are no visual or palpable signs of venous disease;
• 2 – varicose veins;
• 3 – swelling;
• 4 – skin changes (hyperpigmentation, lipodermatosclerosis, venous eczema);
• 5 – skin changes in the presence of a healed ulcer;
• 6 – skin changes in the presence of a fresh ulcer.

Etiological classification:

1. the cause of CVI is congenital pathology (EC);
2. primary CVI of unknown cause (EP);
3. secondary CVI, which developed as a result of thrombosis, trauma, etc. (ES).

Anatomical classification.

Reflects the segment (deep, superficial, communicating), localization (greater subcutaneous, inferior hollow) and level of the lesion.

Classification taking into account the pathophysiological aspects of CVI:

1. CVI with reflux symptoms (PR);
2. CVI with symptoms of obstruction (PO);
3. CVI with symptoms of reflux and obstruction (PR, O).

When assessing CVI using the CEAP system, a scoring system is used, where each sign (pain, swelling, lameness, pigmentation, lipodermatosclerosis, ulcers, their duration, number and frequency of relapses) is scored 0, 1 or 2 points.

The CEAP system also applies a disability scale, according to which:

• 0 – complete absence symptoms;
• 1 – symptoms of CVI are present, the patient is able to work and does not need supportive measures;
• 2 – the patient can work full time only if he uses supportive measures;
• 3 – the patient is unable to work, even if he uses supportive measures.

Symptoms of CVI

Chronic venous insufficiency can manifest itself with a variety of clinical symptoms. In the early stages, one or more symptoms appear. Patients are concerned about heaviness in the legs, which intensifies after a long stay in vertical position, transient swelling, night cramps. There is hyper- (less commonly, hypo-) pigmentation of the skin in the distal third of the leg, dryness and loss of elasticity of the skin of the legs. Varicose veins do not always appear in the initial stage of chronic venous insufficiency.

As chronic renal failure progresses, local circulatory failure worsens. Trophic disturbances become more pronounced. Trophic ulcers form. Deposition of a significant volume of blood in the lower extremities can lead to dizziness, fainting, and signs of heart failure. Due to a decrease in blood volume, patients with severe chronic venous insufficiency do not tolerate physical and mental stress well.

Diagnostics

The diagnosis is made on the basis of anamnestic data, patient complaints, results of objective and instrumental research. A conclusion about the degree of disturbance of venous outflow is made on the basis of ultrasound scanning of the veins of the lower extremities and duplex angioscanning. In some cases, to clarify the cause of chronic renal failure, an X-ray contrast study (phlebography) is performed.

Treatment of CVI

When determining treatment tactics for chronic venous insufficiency, it should be clearly understood that CVI is a systemic pathological process that cannot be eliminated by removing one or more superficial varicose veins. The goal of therapy is restoration normal operation venous and lymphatic systems of the lower extremities and prevention of relapses.

Treatment for CVI should be individualized. Therapy should be a course. Some patients are shown short or occasional courses, others – regular and long ones. The average course duration should be 2-2.5 months. Taking medications must be combined with other methods of treating CVI. For achievement good results the active participation of the patient is necessary. The patient must understand the essence of his illness and the consequences of deviations from the doctor’s recommendations.

Conservative methods are of primary importance in the treatment of CVI: drug therapy (phlebotrobic agents) and the creation of an additional frame for the veins (elastic compression). Topical preparations: wound dressings, ointments, creams, antiseptics and creams are prescribed in the presence of appropriate clinical manifestations. In some cases, corticosteroid drugs are indicated.

Surgical treatment is performed to eliminate pathological venous discharge and remove varicose veins (phlebectomy). About 10% of patients with chronic venous insufficiency require surgical treatment. When CVI develops against the background of varicose veins, minimally invasive miniphlebectomy is often used.

Prevention

Prevention of CVI includes exercise, regular walks, and prevention of constipation. It is necessary, if possible, to limit the time spent in a static position (standing, sitting). Uncontrolled use of hormonal drugs should be avoided. Patients at risk, especially those prescribed estrogen, are advised to wear elastic stockings.

It is a fairly common disease. It is diagnosed in 20-40% of the population. What is it? CVI (chronic venous insufficiency) is a special clinical manifestations associated with impaired blood outflow in the venous system. The disease has become significantly younger in recent decades. It occurs even in teenagers. Middle-aged and elderly people are also very susceptible to it. Throughout life, a person develops various symptoms venous insufficiency. It is worth saying that the disease develops slowly if it has chronic form. The symptoms cannot be ignored. Many people turn to specialists only when the disease is already very advanced. But if you start fighting it as early as possible, then you will be able to avoid complications and the disease will stop developing. The prevalence of the disease is associated with upright posture. Because of this, the blood vessels in the legs experience excessive stress and can no longer cope. Varicose veins and venous insufficiency are not the same disease. The latter can affect not only the lower extremities, but also.

Stages of chronic venous insufficiency

Pathogenesis of the disease

There are acute and chronic venous insufficiency. There are many reasons for the disease. The disease is caused by a violation of the normal outflow of blood through the arteries and veins. In the lumen of the veins, the pressure increases. Insufficiency of the valve apparatus occurs. It is worth mentioning that people have valve flaps in their veins. Their function is to regulate blood circulation. The valve flaps should close tightly. Due to various reasons, this action is disrupted, that is, the valve flaps no longer close tightly. As a result, blood stops moving normally up to the heart. Some of the blood flows down to the legs. A person, in this case, loses a pleasant feeling of lightness in the lower extremities. He is constantly beginning to be haunted by unpleasant sensations in his legs. They seem crowded and there is a feeling of heaviness. This is one of the important ones that appears at first.

As the disease progresses, the pressure in the blood vessels increases. Because of this, the veins lose their elasticity. Their permeability increases. This threatens the development of regional edema. Next, the patient will encounter trophic disorders. The tissues surrounding the affected vessels are compressed and cease to receive adequate nutrition.

VN forms

Blue color of legs with swelling

Acute VL develops very quickly. There is overlap of the deep vessels of the legs. The outflow of blood into them is greatly impaired. Only deep vessels are involved in the pathological process; superficial vessels remain untouched. The skin of the patient's lower extremities becomes blue and swelling develops. The vascular pattern on the skin is clearly pronounced. In the direction of the main veins, a person experiences painful sensations. Symptoms of venous insufficiency may include the following:

• injuries due to which vascular ligation occurred;
• sharp forms.

The patient can relieve his suffering with a cold compress applied to the lower limbs. Due to cold, the volume of blood in the veins decreases.

Chronic LN affects the superficial subcutaneous vessels, deep veins remain untouched. The disease is unpleasant and quite severe. There is a constant circulatory disorder. Trophic ankle joint undergoes pathological changes. Several stages will pass before CVI becomes particularly severe. At the earliest stage, the skin is observed dark spots in the area of ​​circulatory problems. As the disease progresses, pigment spots increase. Next, trophic ulcers form. At the last stage of the disease, various vascular anomalies occur, including the formation of blood clots and the development of pyoderma.
Causes of the disease

Signs of venous insufficiency appear in patients due to the most various reasons. These may include:

• various vascular pathologies;
• previous limb injuries;
• phlebothrombosis;

There are a number of negative factors that have a direct impact on the occurrence of VN:

• taking hormonal medications;
• static loads;
• old age;
• constipation;
• constant lifting of weights;
• passive lifestyle;
• bad habits, including excessive drinking and smoking;
• hereditary predisposition;
• high level of estrogen in the blood in women;
• , childbirth;
• increased body weight.

Risk groups for developing VN include pregnant women, athletes, obese people, those who have genetic predisposition to this disease.

VN classifications

Swelling of the legs

A person already has problems with blood vessels, but he does not yet know about it, since there are no symptoms. Performance is fully preserved at 0 degree VN. Next comes 1st degree. The patient exhibits the first symptoms. Distension occurs in the lower extremities, followed by a feeling of heaviness and pain. Then the person suffers from cramps from time to time, and his legs constantly swell. The second degree is characterized by the presence of persistent swelling. Lipodermatosclerosis, eczema, and hyperpigmentation also appear. If treatment is not followed, the patient will not escape the third degree of the disease. At this stage, trophic ulcers form. This condition is quite dangerous for humans.

There is a CEAP system. According to it, CVI, as well as OVN, received an international classification.

Read more about the classification of AVI and CVI according to the CEAP system

The clinical picture is as follows. Stage zero is calm and asymptomatic. At the first stage, telangiectasias are observed. In the second stage, the veins in the legs begin to bulge and become noticeable. The third stage is characterized by the presence of edema. On the fourth, unsightly changes appear on the skin. At the fifth stage, there are changes on the skin, but already with a healed ulcer. At the sixth stage, a person is bothered by a non-healing ulcer. It is important to identify the reliable causes of venous insufficiency in order to successfully combat the disease.

Etiological classification: ER – unknown cause; EC – genetic predisposition; ES - venous insufficiency is caused by thrombosis, trauma, etc.

The classification of CVI and OVN is needed by phlebologists. It is used in hospitals to determine the stage of the disease and how severe its consequences are. This helps to prescribe quality treatment. Venous insufficiency can lead to serious consequences; symptoms should not be ignored. Depending on what illness a person suffers from, AVI or CVI, and at what stage of development the illness is, the symptoms are different. In the later stages of CVI, a person may develop fainting states and dizziness. This occurs due to the deposition of an impressive amount of blood in the lower extremities. If the patient consults a doctor, then a medical specialist. institution will conduct an examination, diagnose the disease using modern methods and then prescribe treatment.

Diagnosis of the disease

Ultrasound of legs

To diagnose the presence of venous insufficiency in a person, several various methods, namely:

• Ultrasound of legs;
• carry out biochemical analysis blood;

An ultrasound of the legs is performed to identify varicose veins and determine the presence of blood clots. It happens that with the help of such a study it is not possible to obtain reliable results. Then phlebography will help.
Treatment of CVI and OVN

To cope with acute venous insufficiency, a cold compress is first applied to the affected limb. After 2 minutes, the fabric is removed and placed in ice water and applied to the leg again. This procedure is carried out within an hour. This helps get rid of inflammation and reduce pain. Next, it is necessary to normalize blood circulation in the limb. To do this, use ointments, gels, creams that help reduce blood clotting.

Elastic leg compression

To overcome chronic venous insufficiency, you need to apply a number of measures over a long period of time. Getting rid of the disease cannot be called easy. It is aimed at normalizing blood circulation in the legs and preventing further pathological changes in the veins. To different people The same treatment is not prescribed to overcome CVI. Each patient requires an individual approach. Treatment of venous insufficiency largely depends on the severity of the pathology and the observed symptoms in the patient. A number of useful measures are carried out in courses. Doctors use drug therapy, as well as other techniques known today, to defeat the disease or at least stabilize it. The patient is greatly helped by elastic compression, as well as synthetic medications. Preparations for topical use are also indicated. If conservative treatment is not effective, then doctors use surgical intervention. This method helps to get rid of affected areas of blood vessels, as well as remove pathological venous discharge.

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Chronic venous insufficiency of the lower extremities is the most common peripheral vascular disease. The prevalence of this disease among the working population is 40-50 percent. In this connection, chronic venous insufficiency is a very important medical and social problem.

As a result of a prolonged increase in venous pressure, the subcutaneous veins expand with overload of the lymphatic vessels and microvasculature. As a result of circulatory disorders in the microcirculatory bed, tissue metabolites accumulate, leukocytes and macrophages are activated, and a large number of free radicals, lysosomal enzymes and local inflammatory mediators, which contributes to further progression of the disease.

A traditional mistake is the unambiguous identification of chronic venous insufficiency and varicose veins of the saphenous veins of the lower extremities. The fact is that varicose veins, although widespread, are far from the only disease of the veins of the lower extremities. In turn, varicose veins can be one of the manifestations of chronic venous insufficiency.

In the early stages of development, chronic venous insufficiency manifests itself symptom of heavy legs and swelling. Unlike cardiac and renal edema in pathology venous system they are localized on the foot and lower leg and are accompanied by pronounced daily fluctuations - a significant decrease or complete disappearance after an overnight rest.

In the later stages of progressive chronic venous insufficiency, the appearance of varicose veins, pain and convulsive syndromes.

The most a common complication chronic venous insufficiency are progressive disorders of the trophism of the soft tissues of the leg, quickly undergoing evolution from superficial hyperpigmentation to extensive and deep trophic ulcers. Along with local complications, CVI can lead to distant reactions. As a result of the deposition of large volumes of blood (up to 2.5-3 l) in the affected veins of the lower extremities, the volume of circulating blood decreases, resulting in the development of heart failure, which is manifested by a decrease in tolerance to physical and mental stress. A large number of different tissue breakdown products, which are antigens in nature, induce a variety of allergic reactions - venous eczema and dermatitis.

What are the causes of chronic venous insufficiency?

If high venous pressure persists in the lower extremities, chronic venous insufficiency may develop over time. Another reason for the development and progression of chronic venous insufficiency is deep vein thrombosis and phlebitis (inflammation of the vein wall), in which obstruction (blockage) of the veins develops, which leads to increased venous pressure and disruption of the function of the underlying veins (more about deep vein thrombosis and its complications of pulmonary embolism, see separate section). Phlebitis (inflammation of the vein wall) most often develops in the superficial veins and is manifested by swelling of the adjacent soft tissues, pain and inflammation. Inflammation, in turn, contributes to the formation of blood clots (thrombosis), including deep veins, and the progression of venous insufficiency.

What are the risk factors for chronic venous insufficiency?

Risk factors for chronic venous insufficiency include having a close relative with varicose veins, being overweight, pregnant, lack of physical activity, smoking, and having to remain stationary (sitting or standing) for a long time. However, not everyone develops chronic venous insufficiency. The risk of developing chronic venous insufficiency increases with age, develops more often in women, and appears most often over the age of 50 years.

Symptoms of the development of chronic venous insufficiency

Chronic venous insufficiency can also lead to edema due to increased venous pressure and impaired venous outflow. If you have chronic venous insufficiency, you may experience swelling in your ankles and legs, and you may also feel like your shoes are getting too small. Important symptoms Chronic venous insufficiency also includes a feeling of heaviness in the legs, rapid fatigue, anxiety, and cramps. Unpleasant pain may occur while walking or immediately after stopping.

Venous insufficiency is a pathology associated with venous outflow of blood (blood, instead of moving up, begins to move down), accompanied by vascular disorders of the lower extremities or brain. This disorder has both acute and chronic forms. Venous insufficiency is often confused with varicose veins.

This disease can be considered one of the most common in the world. In some regions, up to 40% of the population suffers from it. Such a large number of patients is due to a person’s upright posture - this increases the already considerable load on the vessels of the lower extremities, which increases even more with age.

In many cases, people do not notice the first symptoms appearing of this disease or associate them with normal fatigue. A huge number of patients seek help from a doctor only after the disease reaches an advanced stage.

Forms of venous insufficiency

This disease can be divided into the following forms:

• AVI (acute venous insufficiency of the lower extremities)

The occurrence of acute leg failure occurs after prolonged closure (for example, due to strong compression) of the deep veins and the resulting disruption of blood outflow. Acute venous insufficiency of the legs is accompanied by pain in the area great vessels which disappears when a cold compress is applied to them.

This phenomenon can be explained by the fact that the volume of blood in the vessels decreases under the influence of cold. In addition to pain, swelling of the legs is also possible, as a result of which the skin sometimes takes on a bluish tint. Veins located superficially cannot be affected by ROV.

• CVI (chronic venous insufficiency of the lower extremities)

It is expressed by constant disturbance of blood circulation in the vascular area. The disease in this form may be accompanied by the development of pathological changes in the process of cellular nutrition of the ankle joint. CVI, depending on the degree of its course, can be divided into several stages. At the initial stage of the disease, patients notice pigmentation disorders in the form of pigment spots in the area where pathological changes have already begun to appear (in the area of ​​impaired blood flow).

If venous insufficiency of this form is left untreated, pigment spots will become larger and larger, and then they can grow into soft fabrics and cause the occurrence of trophic ulcers that are difficult to remove. The last stage of CVI is accompanied by the formation of blood clots, pyoderma - purulent skin lesions due to the contact of pyogenic cocci in any of its areas and other pathologies.

Causes

The acute form of this disease can often occur in both older and younger people. Among possible reasons The appearance of OVN distinguishes acute forms of thrombosis, as well as injuries that necessitate ligation of veins located in deep tissues.

The main causes of CVI include diseases such as varicose veins and postthrombophlebitis disease. In addition, people with low level mobility and overweight have an increased risk of developing CVI of the lower extremities. Lifting heavy objects or working for long periods of time in an uncomfortable sitting (or standing) position can also be reasons for the appearance of this pathology.

The risk group of people with the greatest chance of developing CVI includes the following categories of the population:

• Pregnant and lactating women;
• Patients taking hormonal drugs(including women using oral hormonal contraceptives);
• Aged people;
• Adolescents (CVI at this age may appear due to hormonal changes in the body).

Symptoms

CVI is distinguished by different symptoms on different stages diseases. At the initial stage of its course, symptoms of venous insufficiency may either be completely absent or appear to a minor extent. Patients in this case express the following complaints:

• a feeling of heaviness in the legs, which intensifies with prolonged standing;
• increased swelling;
• periodically short-term convulsions, usually occurring at night;
• increased pigmentation of the skin in the area remote from the lower leg.

In the first stages of this disease, varicose veins are the exception rather than the rule, but sometimes they can also appear. At deeper stages of CVI, such a disorder, on the contrary, occurs in almost all patients.

As the pathology develops, the following symptoms may be added to the above symptoms:

• impairment of the ability of the circulatory system to deliver blood to tissues located in the lower
• limbs (in the affected area);
• the appearance of trophic ulcers;
• dizziness (sometimes accompanied by fainting) caused by excessive accumulation of blood in any of the vascular areas;
• the appearance of signs of heart failure.

Usually, with the disease “venous insufficiency,” the symptoms do not appear simultaneously, but complement each other gradually.

In patients with CVI of the lower extremities, the volume of circulating blood increases (in the vessels located in this area), so they usually have a hard time withstanding the increased volume of physical and mental stress.

Classification

In Russia, phlebologists – vein specialists – have adopted the following classification of CVI, structuring this disease depending on its stage:

• Grade 0. No symptoms of CVI;
• Degree 1. Patients complain of pain in the legs, a feeling of heaviness, periodic cramps and swelling;
• Degree 2. Edema becomes more pronounced and persistent, increased pigmentation and changes are noticeable subcutaneous tissue degenerative-dystrophic nature (lipodermatosclerosis or “indurative cellulite”), dry or weeping eczema may appear.
• Degree 3. Expressed by the appearance of an open or healed trophic ulcer in the patient.

The “zero” degree was designated by Russian specialists in order to correctly determine the treatment of symptoms of chronic venous insufficiency of the lower extremities, as well as the disease itself. In this case, it will differ from the therapy required for CVI of the 1st or 2nd degree.

International classification of venous diseases of the lower extremities

In medical practice Another structuring of venous diseases can be used, which is called CEAP and is international. It implies a “symptomatic” division of CVI according to the following criteria:

1. There are no symptoms of the disease; upon palpation (feeling), CVI also does not make itself felt.
2. Sustained dilation of small vessels is noticeable, but the inflammatory process is not started.
3. Varicose veins are observed.
4. Swelling is observed.
5. Increased pigmentation of the skin is noticeable, eczema and degenerative-dystrophic changes in the subcutaneous tissue are possible.
6. The symptoms listed in the previous paragraph are present in the presence of a healed trophic ulcer.
7. The requirements are similar to the previous paragraph, but subject to a fresh trophic ulcer.

Each of the listed signs in this classification is considered separately, and depending on the degree of manifestation, it is given the corresponding score - “0”, “1” or “2”.

Under the auspices of this classification, the degree of disability due to venous insufficiency is also established:

• Degree 0. The patient is fully able to work, there are no symptoms of the disease, the patient does not need special therapy;
• Grade 1. The patient has some symptoms of CVI, but does not have any disability. Such patients also do not require special treatment;
• Degree 2. The patient is able to perform work only if treated with prescribed medications;
• Degree 3. Complete loss of ability to work.

In addition, there are other criteria, based on which CVI was classified into 3 types:

1. CVI is congenital disease(EC).
2. primary CVI, the cause of which is unknown (EP).
3. secondary CVI with an identified cause.

Valve insufficiency

Valvular venous insufficiency is one of the types of the disease. Venous valves play important role in the fight against gravity, in addition, they take an active part in blood circulation, preventing the reverse movement of blood.

Valvular insufficiency occurs in cases where the venous valves for some reason cease to perform their functions normally. If the quality of treatment for valvular insufficiency of the veins of the lower extremities is poor, the patient may experience a deterioration in general well-being, a decrease in the body’s endurance, and an increased risk of cardiovascular diseases.

Venous cerebrovascular insufficiency (VCI)

Venous insufficiency cerebral circulation– a pathology caused by difficulty in the outflow of venous blood from the cranial cavity. With a severe cough, playing wind instruments, loud screaming, neck compression and some other phenomena, this condition often occurs in an easily reversible form.

The disease of cerebral venous insufficiency is a consequence of another diagnosis that has been made and is currently progressing. Its appearance is often observed in traumatic brain injuries, osteochondrosis, bronchial asthma, various brain tumors, some pathological changes liver, prolonged cessation of nasal breathing and other pathologies.

In many cases, IUD is asymptomatic. With the increasing deterioration of the brain's ability to adapt to working conditions with difficult blood circulation, patients may complain of frequent dizziness, memory loss, headaches (increased when moving the head in any direction), darkening of the eyes, swelling of the eyelids and redness of the eyes. In some cases, this disease may cause convulsions, fainting and epileptic seizures.

Therapy for cerebrovascular insufficiency involves alleviating the symptoms of the underlying disease, but if it occurs, physiotherapy, oriental massage and some other methods of non-drug therapy will not be superfluous.

Diagnosis of the disease

Diagnose chronic failure veins is possible using ultrasound methods - Doppler ultrasound and duplex ultrasound scanning.

Doppler ultrasound allows you to study the flow of blood flow in a particular patient due to the ability of waves to change frequencies when interacting with the object being studied. In addition, with the help of this manipulation it is possible to determine due to the reflection of ultrasonic waves from red blood cells.

Duplex ultrasound scanning– a research method that also makes it possible to establish the presence of pathologies regarding the flow of blood flow, as well as to objectively assess the condition of the veins.

To determine the cause of CVI, radiopaque contrast films are used. diagnostic methods, for example, phlebography. Phlebography is carried out in the following way: a contrast agent is injected into the vein being examined, after which it is examined using radiography.

Treatment

Treatment of venous insufficiency of the lower extremities is carried out using both conservative (with the help of medications) and surgical methods. The use of medications without surgical intervention is effective in cases where the disease has not yet reached an advanced stage. In addition, the “therapeutic” approach will be rational in preparation for operations and during the recovery period after it.

Treatment of CVI is carried out with phlebotropic (venotonic) drugs related to pharmacological group angioprotectors.

Phlebotonics include the following drugs:

1. Phlebodia. Available in tablet form. It is used to eliminate the symptoms of swelling, and is used to restore normal blood circulation in the vessels;
2. Detralex. Tonic tablets for veins, reducing the distensibility of the walls of blood vessels;
3. Angistax. The drug is available in the form of capsules, gel and cream. It has herbal composition, which includes red grape leaf extract. It has a venotonic effect and normalizes blood movement through the vessels. To increase the effectiveness of therapy, it is advisable simultaneous use both oral and external forms of the drug;
4. Troxevasin. A medicine available in the form of capsules and gel, which in most cases are preferably used simultaneously. The drug is able to relieve inflammatory syndrome and has an antioxidant effect;
5. Aescusan. Drops for oral administration. The drug contains vitamin B1, which helps dilate veins, and horse chestnut extract, which has an analgesic effect caused by venous diseases.

Drugs for the treatment of venous insufficiency of the lower extremities must be taken under the supervision of the attending physician in order to prevent the development of the disease.

In addition to phlebotonics, if necessary, the doctor may prescribe non-steroidal anti-inflammatory drugs such as Meloxicam and Diclofenac, as well as medicines, blood thinners.

To treat severe forms of CVI, when trophic ulcers occur on the skin, antibiotics of the penicillin series and the cephalosporin group can be prescribed. Their use can protect the body from sepsis and other possible serious consequences.

Rules for applying compresses

A cold compress is prepared and applied as follows:

1. Two pieces of gauze are folded several times and placed in a container with cold water or ice. 2 pieces are necessary for continuous therapy - while one piece of gauze is applied to the inflamed area in the form of a compress, the second is cooled at this time.
2. After both compresses have cooled sufficiently, one of them is placed on the affected surface and held there for 2 to 3 minutes. After this time, the compress is changed, and the “spare” one is cooled for reuse.
3. The above procedure must be repeated for at least 1 hour.

After eliminating the acute stage of inflammatory processes, the use of warming ointments that slow down blood clotting (for example, heparin) is allowed. The use of this ointment is permitted in the form of a warm compress. To apply such a compress correctly, you must adhere to the following procedure:

1. Fold the gauze used for the compress into 3–4 layers.
2. Soak the piece of gauze you are using with an ointment with a warming effect.
3. Apply gauze to the affected area.
4. Cover the soaked gauze with a plastic or compressor bag.
5. A sufficient amount of cotton wool should be placed on top of the bag for insulation, or even better, the compress should be insulated with woolen cloth. Secure the finished compress with a bandage. Leave it overnight.

In the morning, the area of ​​the leg subjected to compression therapy must be treated with alcohol.

Radical methods of treating venous insufficiency

In particularly severe cases, more radical approaches to treating the disease may be required, namely surgical intervention. IN modern medicine For these purposes the following manipulations are used:

• sclerotherapy. A procedure in which a special drug is injected into the lumen of the vessel, gluing its walls and causing subsequent resorption of the damaged vein. The manipulation is relatively painless, local anesthesia for its implementation it will be a completely sufficient method of pain relief. Used to remove veins of small diameter;
• laser surgery. A manipulation in which damaged veins are irradiated with laser light from the inside, after which they are glued and subsequently resorbed. The procedure does not require surgical incisions. With the help of laser surgery, it is possible to remove both large damaged veins and varicose veins on the legs;
• surgical removal of damaged veins. It involves the need to make incisions to gain access to the damaged vein, ligate it and then remove it. The operation is carried out only under general anesthesia. Surgical removal large diameter veins are exposed.

A timely visit to a doctor will avoid the need for the described manipulations, and, possibly, completely cure this pathology.