Symptoms of chronic venous insufficiency in the legs. Venous insufficiency - treatment. Venous insufficiency of the lower extremities. In what cases may surgical intervention be required?

Chronic venous insufficiency (CVI) is a set of clinical manifestations resulting from impaired blood outflow in the venous system. CVI includes diseases such as varicose veins, postthrombotic disease, congenital and traumatic anomalies of the venous vessels.

CVI lower limbs is currently the most common vascular disease. CVI occurs three times more often in women than in men.

Video about chronic venous insufficiency

Causes of chronic venous insufficiency

Predisposing factors for the development of CVI include:

Heredity;
- female;
- repeated pregnancies;
- excess body weight;
- insufficient physical activity;
- heavy physical labor associated with lifting weights, long stay in a standing or sitting position.

The main cause of the disease is considered to be a malfunction of the muscular-venous pump. Normally, the outflow of blood in the lower extremities is carried out through the system of deep (90%) and superficial veins (10%). To move blood towards the heart, the veins have valves that prevent the blood from moving downward due to gravity. Contractions of the muscles of the thigh and lower leg also play an important role, which prevents reverse current blood.

The worst conditions for normal blood flow occur in an upright position of the body in the absence of active muscle contractions. Thus, blood stagnation occurs, pressure increases in the vein system and, as a result, their expansion. Insufficiency of the valve apparatus is formed, the valve flaps do not close completely, and abnormal blood flow occurs from top to bottom.

This leads to an even greater increase in pressure in the veins. As a result high blood pressure The permeability of the venous wall increases, it swells, squeezing the surrounding tissues, disrupting their nutrition. Finally, a trophic ulcer forms in this place.

Symptoms of chronic venous insufficiency

If the following signs occur, you should contact a specialist to exclude CVI: slight heaviness in the legs, which occurs mainly in the evening or after static load; swelling of the ankles (the fingers are not affected). Swelling appears in the evening (can be determined by the presence of traces from the elastic of socks), the degree of severity depends on the duration of physical activity. It is important that swelling is not detected in the morning. You may have varicose veins or “spider veins” (visible enlargement of small veins). All these signs indicate the presence of CVI of the first degree.

External manifestations of CVI.

Over time, intense, bursting pain in the legs and burning begin; cramps of the calf muscles, which usually appear at night. The swelling becomes persistent (detected at any time of the day), the skin is pale, cold to the touch, in addition, as a result of poor blood circulation, areas of hyperpigmentation (brownish discoloration), lipodermatosclerosis (inflamed area of red skin, painful when touched) and eczema appear on the skin ( thinning of the skin over the dilated vein, it becomes spotty and itches a lot). In this case, stage 2 CVI occurs.

The presence of an open or healed trophic ulcer, as well as complications of CVI (bleeding, deep vein thrombosis or thrombophlebitis) confirms stage 3 CVI.

The formation of ulcers during CVI occurs in several stages. Initially, an area of brownish discoloration of the skin appears. Over time, a compaction forms in the center, having a whitish, varnished appearance, reminiscent of paraffin deposits. In the future, even minimal trauma leads to the opening ulcerative defect. With delayed treatment, the size of the ulcer progressively increases, and infection may occur.

Also, grade 0 CVI is distinguished, when even pronounced varicose veins and spider veins are not accompanied by heaviness in the legs, pain and swelling. At this stage of the disease, treatment is also necessary.

CVI, if treated incorrectly or untimely, can lead to serious complications, such as deep vein thrombosis (complete or partial closure of the vein lumen by a blood clot) and thrombophlebitis (inflammation of the vein wall accompanying thrombosis). In this case, swelling suddenly occurs and quickly increases, which covers the entire lower limb, accompanied by intense bursting pain. The eyes may appear red or blue, painful thickening of the skin. There is no connection with previous physical activity, varicose veins, areas of brownish discoloration of the skin and ulcers may be absent. If the blood clot will come off, then through the bloodstream it can enter the lungs and cause a serious disease - pulmonary embolism (complete or partial closure of the artery lumen with a blood clot). This complication is often fatal. If you suspect deep vein thrombosis or thrombophlebitis, you must immediately lie down, elevate your leg, and call an emergency medical team. It is strictly forbidden to stretch the muscles, apply any ointments, or step on the sore leg.

You should also be wary of injury to the affected area, as this can lead to severe bleeding. In case of bleeding, it is necessary to bandage the leg above the wound site with a tourniquet (medical or improvised), so tightly that the bleeding stops, and immediately call an ambulance team. Bleeding from varicose veins is also a life-threatening complication.

Symptoms of CVI, such as pain in the lower extremities and swelling, are also characteristic of a number of other diseases:
"Cardiac" edema. Having heart disease hypertension. Edema of the lower extremities appears at any time of the day, most often permanent, always bilateral. There is no connection with physical activity. Pain in the lower extremities is usually absent, expressed only with significant swelling. The skin in the area of edema is warm and of normal color.

Swelling due to lymphedema (impaired lymph flow). Just like with CVI, swelling appears in the late afternoon and is associated with physical activity. The skin in the area of edema is of normal color and temperature. When the process is severe, swelling affects the thigh area. Pain of varying intensity. But there are no dilated veins or ulcers. It is possible to distinguish this disease from CVI by performing lymphography (instrumental examination lymphatic system).

With arthrosis, swelling and intense pain are detected only in the area of the affected joint. The mobility of the joint is sharply limited at the beginning of the movement, then, as the movement continues, the mobility improves somewhat and the pain becomes less intense. Ultrasound and radiography of the joint will allow differentiation between this disease and CVI.

For osteochondrosis lumbar region spine, the greatest severity of pain is in the popliteal fossa. The pain is nagging, can “shoot” in the thigh and gluteal region. It usually occurs at night. The intensity decreases after a course of anti-inflammatory therapy. Swelling is not typical.

Only a qualified specialist can distinguish these diseases from CVI.

Diagnosis of chronic venous insufficiency

When you contact your doctor, you will be asked to undergo the following examination:

General blood analysis. The level of red blood cells and hemoglobin can be used to judge the degree of blood viscosity; the number of platelets assesses the state of the blood coagulation system; an increase in the number of leukocytes indicates the presence of inflammation.

Biochemical analysis of blood and urine. Changes in these indicators are not specific and depend on the presence and severity of concomitant diseases.

The most accurate diagnostic method venous pathology is Ultrasound of blood vessels of the lower extremities, during which areas of varicose veins, the presence of varicose nodes, and blood clots are determined. Ultrasound of the vessels of the lower extremities should be performed in the presence of any of the above signs of CVI.

If ultrasound data is questionable, surgical methods are resorted to, for example phlebography (intravenous administration contrast agent to assess the condition of the venous system).

Treatment of chronic venous insufficiency

Treatment of CVI is a complex process, the duration of which directly depends on the stage of the disease. Therapeutic measures are divided into surgical and conservative (non-surgical). Despite the high prevalence of the disease, surgical methods account for only 10%. Timely treatment will allow you to restore normal venous blood flow and avoid complications.

Conservative treatment of venous insufficiency includes reducing the severity of risk factors, recommendations for physical activity, elastic compression, medications and physical therapy. The use of these measures in combination provides the best result.

If possible, it is necessary to identify risk factors for disease progression, such as obesity, taking oral contraceptives, and improper physical activity, and try to correct them.
Also, for each stage of the disease, the doctor must give recommendations on physical activity.

Regardless of the stage, it is recommended to: elevate your legs as often as possible, place a pillow under them at night, and wear comfortable shoes. Among the sports recommended are walking, swimming, for CVI stages 0-2 - cycling, light running. Physical education (except swimming) is carried out using elastic compression. It is necessary to exclude participation in those sports that have an increased likelihood of limb injuries and require sharp (jerk) loads on the lower limbs: football, basketball, volleyball, tennis, skiing, various types of martial arts, exercises related to weight lifting. At home, regardless of the stage of the disease, the following set of exercises can be performed.

Elastic compression - the use of an elastic bandage or medical knitwear. At the same time, due to dosed compression of the muscles of the lower extremities, the outflow of blood through the veins improves, which prevents further expansion of the veins and the formation of blood clots. In addition, it protects the skin from mechanical damage, the risk of ulcer formation is reduced. The use of elastic compression is indicated at any stage of the disease.

Rules for using elastic bandages:

Elastic bandaging begins in the morning, before getting out of bed. The bandage is applied from bottom to top with the obligatory grip of the foot, heel to the thigh area. Each overlying turn of the bandage should cover the previous one by half. The compression should not be intense and should not cause painful sensation. If the bandage “slips”, it must be bandaged.

Disadvantages when using elastic bandages:

Poorly fixed on the leg;
- it is difficult to achieve the desired muscle compression;
- stretches after several washes.

Medical compression hosiery (socks, stockings, tights) does not have these shortcomings. Depending on the stage of CVI, there are 3 classes of compression (compression), which must be taken into account when purchasing these products.

Compression hosiery is not used if you have:

Severe cardiopulmonary failure
- Severe disease of the arteries of the lower extremities
- Skin lesions of the lower extremities (dermatitis, eczema, acute erysipelas, infected ulcer). In this case, elastic compression is carried out in a special way.

At stages 0-1 of the disease, the gold standard for the treatment of cosmetic defects is sclerotherapy - a method of treating dilated superficial veins and spider veins. A sclerosant (a special substance that leads to the cessation of blood flow through this vein) is injected into the vein. Finally, the vein collapses and the cosmetic defect disappears.

At stages 0-1 for prevention, at stages 2-3 for treatment it is necessary to use medicines. Most drugs are aimed at increasing the tone of the veins and improving the nutrition of surrounding tissues. The course of treatment is long, 6 months or more.

Currently used: Detralex, Cyclo 3 Fort, Ginkor-fort, Troxevasin, Anavenol, Aescusan, Asklezan, Antistax, Phlebodia 600. The use of a particular drug, as well as the treatment regimen, should be discussed with a specialist. The use of local treatment (ointments, gels) in the absence of complications (thrombophlebitis) is inappropriate.

Stage 3 of the disease is characterized by the presence of ulcers. Treatment trophic ulcers- a complex process that includes both general and local impact. Local treatment involves treating the wound area with antiseptics, using enzymes, and, if necessary, surgical removal dead particles. Every day - wash the wound two or three times using both standard medicines (dioxidine, dimexide, chlorhexidine) and those prepared at home (a weak solution of potassium permanganate, a decoction of string or chamomile). After mechanical treatment, ointment (levomikol, levosin) is applied.

Physiotherapy is of auxiliary value in chronic venous insufficiency. They are used for any degree of severity of the process according to indications. For example, diadynamic currents, electrophoresis, laser, and magnetic field have a good effect.

With good results conservative treatment Further lifestyle correction, regular physical activity, and elastic compression are recommended. The decision to conduct a second course of treatment is necessary in case of relapse of the disease, the occurrence of complications or for prophylactic purposes.

If conservative treatment is ineffective, the issue of surgical treatment is decided. In addition, surgical treatment is necessary for:

Complications of CVI (thrombosis, thrombophlebitis, bleeding).
- The presence of long-term non-healing ulcers.
- Pronounced cosmetic defect.

Surgical treatment consists of removing the damaged veins. The extent of the operation depends on the severity of the process and complications.

Rehabilitation after surgery depends on its volume, but it is necessary to mention the general principles. The seams are finally formed after 6 months, so to avoid their divergence subsequently cosmetic defect it is necessary to exclude strong mechanical impact on them (using a rough washcloth, hard clothing). You only need to wash with warm, preferably cool, water. After surgery it is recommended to wear elastic bandages for 3 months, after which another 3 months of wearing elastic therapeutic stockings. In the future, elastic compression is used in case of planned “harmful” physical activity (long journeys, flights, long periods of standing, hard work). Prophylactic use of drugs that improve venous tone may be necessary.

Prevention of chronic venous insufficiency

Currently, prevention of CVI is of great importance. Following simple measures can significantly reduce the occurrence of venous disease of the lower extremities:

Maintaining an active lifestyle, alternating static loads with walking, running, swimming.
- During rest, keep your legs elevated.
- Monitor your body weight
- Wear comfortable shoes with heels up to 4 cm, if necessary, use orthopedic insoles.
- When using estrogen drugs (oral contraceptives), during pregnancy, routinely perform an ultrasound scan of the veins of the lower extremities.
- If necessary, use elastic compression and medications.

General practitioner Sirotkina E.V.

Venous insufficiency- a set of symptoms that develop as a result of outflow disturbances 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;
phlebeurysm;
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 high content 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;
reception hormonal drugs;
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 blood stagnation, it is created high pressure inside a 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 circulatory system in these departments: during blockage 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. Two forms have various reasons occurrence. 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,, with blood clotting disorders. 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 disorder venous outflow progresses 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 cyanotic 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. Activities involving physical exertion 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 chronic diseases veins):

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 public awareness. 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 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 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 congestion, and the condition of blood vessels.

Treatment

Acute venous insufficiency requires step-by-step treatment. In the active stage of the disease, it should be applied to the site of the outbreak. cold compress. 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 traditional medicine.

Drug therapy

The use of drugs is aimed at eliminating inflammation, 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 is 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 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;
at 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. 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 seeking of medical help, which leads 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 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 allergic reaction or adversely 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. 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, fatigues, and sometimes faints. Cardiovascular failure often develops.

The nature of complications depends on the form of the disease. At acute failure 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;
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:

exclude fatty foods, processed foods, sausages, fatty dairy products, fried, canned foods, fast food and sweets;
eat fresh fruits and vegetables;
Fruit drinks and teas will also be beneficial;
You should avoid alcohol, carbonated drinks, strong tea and coffee;
the use of table salt should also be limited;
should be done once a week fasting days, in 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 – important element complex therapy for venous insufficiency, allowing to 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 feeling light fatigue.
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, 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 increased 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 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:

the cause of CVI is congenital pathology (EC);
primary CVI of unknown cause (EP);
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:

CVI with reflux symptoms (PR);
CVI with symptoms of obstruction (PO);
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 in a variety of ways 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 an upright position, transient swelling, and 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.

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. Average duration The course 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). Medicines for local application: 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). Should be excluded uncontrolled reception hormonal drugs. Patients at risk, especially those prescribed estrogen, are advised to wear elastic stockings.

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

The main mechanisms of venous return from the lower extremities:

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

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

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

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

breathing movements chest and diaphragm (“suction” action).

The two main causes of chronic venous insufficiency are:

varicose veins;

postthrombophlebitic disease.

The essence varicose veins- gradual expansion of the lumen of the saphenous veins and perforators, as a result of which relative valve insufficiency develops (they remain intact, but their leaflets do not close). Venous reflux occurs from top to bottom along the saphenous veins (vertical) and from the deep veins to the superficial (horizontal).

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

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

Form: sclerotic, varicose.

Stage: I,II,III;

Localization (isolated, combined)

inferior vena cava;

iliac vein;

popliteal vein;

tibial veins.

Nature of the lesion:

occlusion;

recanalization;

Degree of venous insufficiency:

compensation;

subcompensation;

decompensation.

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

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

Flaw - the difficulty of diagnosis in conditions of a large number of collateral blood flow paths, false-positive and false-negative results are possible. X-ray examination allows a more detailed study of the characteristics of blood flow in the limb, but is an invasive technique and requires the use of contrast agents.

Both antegrade and retrograde vein contrast options are possible.

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

Clinical picture of varicose veins and postthrombophlebitic disease varies at the stage of collecting the medical history.

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

Distinctive signs of postthrombophlebitic disease from varicose veins In addition to the medical history, there are significant hemodynamic disturbances in the presence of minor superficial varicose veins (or even its absence), pronounced varicose veins of the saphenous veins in the groin and pubic area.

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

There are four degrees of chronic venous insufficiency:

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

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

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

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

Diagnostic principles:

To select treatment strategies and tactics for chronic venous insufficiency, it is necessary to solve the following diagnostic problems:

clarify the cause of chronic venous insufficiency (varicose or postthrombophlebitic disease);

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

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

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

identify the presence and localize insufficient perforating veins.

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

The term “venous insufficiency” is used in medicine to indicate the mechanism of pathological changes. Any disease associated with impaired venous blood flow to the right side of the heart is eligible. Statistics show that in different forms This disease affects up to 40% of the population.

You cannot “blame” only the structure of the veins. There may be a variety of factors underlying this. The division into venous insufficiency as a consequence of general circulatory failure and local stagnation in peripheral vessels is more understandable. In this case, both the veins of the lower extremities and the brain are considered “equally extreme”.

Chronic or acute venous insufficiency is accompanied by stagnation and overflow of the venous bed, compression of adjacent tissues, and oxygen deficiency of organs and systems.

Main pathological changes

It is known that the venous vessels of most of the body are constantly working against the force of gravity. They push blood upward when a person is in an upright position. For this, the vein walls have sufficient muscle tone and elasticity.

Great importance is attached to the valve apparatus, thanks to which the blood mass is kept from returning to lower sections.

Local changes in the venous vessels most often occur in the legs. Due to loss of tone and sagging valves, the liquid and thick parts of the blood overflow. The portion of the reverse flow allowed by the valves is called the amount of reflux and determines the degree of venous dysfunction.

The international classification considers the signs of venous insufficiency according to the causes of occurrence:

failure as a consequence of injury, thrombosis and other identified diseases;
genetic predisposition;
the specific reason has not been established.

According to the anatomical location of the affected vessels:

a specific vein is called, for example, the inferior vena cava or the greater saphenous;
the level and depth of the lesion are indicated (superficial, deep or internal anastomoses).

Clinical manifestations on the extremities

Depending on the clinical signs, it is customary to distinguish 6 types or stages of the disease:

visible signs there are no vein pathologies;
there are dilated “spiders” in the superficial veins (telangiectasia);
varicose veins on the legs are manifested by protruding strands;
persistent tissue swelling occurs;
changes in the trophism of the skin of the feet and legs in the form of peeling, non-healing cracks, dryness;
characteristic scars from a healed ulcer;
fresh ulcers on the skin, without scarring.

The acute form differs from the chronic form in the rapid increase in symptoms. Almost immediately the following appear:

swelling of the legs;
bursting pain along the vessels, does not go away when changing body position and at rest;
the subcutaneous pattern of veins clearly protrudes;
bluishness of the skin (cyanotic) - depends on the optical effect (flor contrast phenomenon), when longer light waves (red) are absorbed by the fibers of the dense connective tissue skin, and shortwave radiation (Blue colour), have greater penetrating power, reach the cells of our retina and “show” a bluish range of colors.

At acute form venous insufficiency, the leg swells and takes on a cherry tint

Diagnostic value

Help to confirm the doctor’s opinion:

leukocytosis and accelerated ESR in general analysis blood, as a reaction to nonspecific inflammation inside the vein and pain;
changes in coagulogram parameters indicating increased coagulability;
Ultrasound examination - allows you to determine the area of expansion and size, localization of a blood clot, varicose nodes;
Phlebography is used only when the ultrasound conclusion is unclear; a contrast agent is injected intravenously, then a series of X-rays are taken.

Can venous insufficiency be detected in children?

Children have venous insufficiency cerebral vessels associated with:

violation of maternal behavior and nutrition during pregnancy;
birth injuries from the application of a vacuum extractor;
traumatic brain injury after birth;
prolonged screaming for any reason;
cough.

The child notices:

dizziness and unsteadiness when walking;
frequent complaints of headaches;
increased fatigue;
inability to concentrate.

Aggression may be caused by cerebral venous insufficiency

At school age, in addition to headaches, the following appear:

memory loss;
inability to study with due diligence;
tendency to faint;
apathy;
weakness and tremors of the hands;
cyanosis of limbs, lips, ears.

IN childhood You can’t ignore the listed symptoms. The child undergoes the same types of examination as an adult. It is especially important to identify the cause of the deficiency and treat before serious complications develop.

Manifestations in pregnant women

In pregnant women, the main mechanism is usually the pressing action of the growing uterus on the lower hollow and iliac veins, an increase in blood mass. This leads to slow blood flow and sagging saphenous veins. The pathology is called phlebopathy.

It differs from varicose veins in the legs by having symmetrical lesions on both sides and variable swelling of the feet and legs. Goes away on its own after childbirth.

Pregnant women are at risk of developing varicose veins and venous insufficiency in the legs

Chronic form According to statistics, up to 35% of pregnant women suffer from venous insufficiency. For most women it appears for the first time. Vein dilatation is detected in 1/3 in the first trimester, in the rest - later.

All the signs characteristic of external varicose veins and stagnation appear: pain, swelling, weakness. At the same time, there is an expansion of the hemorrhoidal outer ring of blood vessels. Women often complain of constipation and painful bowel movements.

The disease leads pregnant women to gestosis, labor disturbances, chronic oxygen deficiency of the fetus, bleeding during childbirth and early pregnancy. postpartum periods.

It is important that venous insufficiency sharply increases the risk of thromboembolism in the brain and pulmonary artery.

Treatment

Treatment of venous insufficiency requires identifying the specific cause of the disease. It makes no sense to use only symptomatic drugs. They can only give a temporary effect.

For acute venous insufficiency of the legs therapeutic measures carried out in 2 stages:

As first aid, apply a cold compress and change it every 2-3 minutes by dipping the cloth in a container of ice. These actions are repeated for about an hour.
To subsequently relieve inflammation, it is recommended to use ointment preparations with anticoagulant components.

For chronic venous insufficiency of the extremities, it is recommended to wear compression garments and take a course of medications. If the symptoms are caused by heart failure, medications are used that increase myocardial contractility (cardiac glycosides) and remove excess fluid (diuretics). At the same time, means are needed to restore energy balance.

Management of pregnant women (as some people call a management plan in the Western style) provides for preventive measures in the form compression stockings in the first trimester and special tights with thick pads in the lower abdomen - from the second trimester.

With increased intracranial pressure, Eufillin and diuretics have a good effect. If the cause is a tumor process, it is prescribed specific treatment(chemotherapy, radiation exposure). A consultation with a neurosurgeon determines the possibility of tumor removal.

In preparing hazelnut infusion, the bark, fruits and leaves are equally important.

As drug therapy prescribe:

venotonics - Diosmin, Detralex, Phlebodia, Vasoket;
angioprotectors - Troxevasin, Rutoside, Aescusan drops, Venoruton;
for topical use, heparin ointment, Lyoton gel, Troxevasin, Gepatrombin are recommended;
disaggregants that prevent the formation of blood clots - Aspirin, Dipidamol, Pentoxifylline.

For sleep disturbances, herbal sedatives are prescribed. Mental changes require consultation with a psychiatrist and combination therapy.

Great importance is attached to the elimination of risk factors. Some patients are recommended to change jobs, avoid strenuous sports, control weight, and engage in vigorous physical activity alternating with rest.

Alone folk remedies it is impossible to cope with venous insufficiency. But it is not forbidden to add herbal decoctions from the advice of healers to the main treatment:

It is better to purchase horse chestnut extract at a pharmacy, since it is inconvenient to prepare it yourself;
alcohol tincture of Kalanchoe is used for lotions and compresses in the treatment of trophic ulcers;
Preparations from Sophora japonica have an anti-inflammatory, venotonic and healing effect.

All methods of therapy must be discussed with the attending physician. This is especially true for the treatment of children and pregnant women. You should not take risks and try untested products on yourself and cause harm.