Venous insufficiency 2. Chronic venous insufficiency of the legs

CVI in most cases is caused by the gravitational factor, which has a significant impact on blood flow in the human body. Chronic venous insufficiency of the lower extremities is considered to be a disease of civilization as a "retribution" for upright walking. According to statistics, more than 35% of the world's population is prone to the development of certain vascular pathologies.

CVI is diagnosed mainly in socially active people aged 22 to 55 years, who, due to their activities, stay in a standing or sitting position for a long time. This puts undue stress on the lower extremities and eventually leads to venous insufficiency.

The concept of chronic venous insufficiency of the lower extremities (CVD) implies a whole set of disorders and includes the following pathologies:

Phlebeurysm.
Post-thrombotic pathology.
Congenital and acquired vascular pathologies are also possible.

With chronic venous insufficiency, there is a significant increase in pressure in the area of veins and vessels, an increase in permeability and swelling of the venous walls. As a result, venous insufficiency can lead to disruption of tissue trophism, which provokes the development of ulcers and eczema in the lower extremities, which are difficult to treat.

Reasons for development

Chronic venous insufficiency of degree 1 or 2 develops under the influence of the following factors:

Hereditary predisposition to the development of venous insufficiency.
Lack of physical activity.
Excess weight.
Susceptibility to systematic intense physical overstrain, which are accompanied by the lifting of heavy objects.
Prolonged stay in a hot climate.
Tendency to defecation disorders.
The period of pregnancy (especially the second or third).
In general, the fair sex is more predisposed to the development of CVI.

The main factor that provokes venous insufficiency in the lower extremities at stages 2 or 1 of development is a violation of the normal functioning of the venous-muscular pump.

The person is predominantly in an upright position, which makes it much more difficult for blood to move up to the region of the heart. Stagnation of blood leads to a gradual stretching of the veins and blood vessels, while the functional ability of the venous valves is impaired.

In the event that risk factors are present, a person may develop chronic venous insufficiency of the 1st degree, which will gradually progress in the absence of proper treatment.

Manifestations of pathology

Chronic venous insufficiency of the lower extremities has a number of characteristic symptoms that manifest themselves depending on the degree of venous damage.

CVI of the lower extremities can significantly impair the quality of life of men and women at any stage of their development. The danger lies in the fact that stage 1 chronic venous insufficiency may not manifest itself for a long time, while the pathology itself slowly progresses. Most patients seek help already with CVI of the 2nd degree or, worse, with CVI of the 3rd degree.

Zero and first stage

First of all, doctors distinguish grade 0 CVI. In this case, a small vascular pattern is formed on the surface of the skin, which is not accompanied by either swelling or the development of pain. Such a symptom is more of a cosmetic defect for the patient, but not a dangerous symptom. It is possible to remove the vascular pattern with a laser, but the disease itself may continue to progress.

Grade 1 venous insufficiency in the lower extremities will manifest as follows:

The development of moderate pain in the legs.
Complaints of heaviness in the legs of varying intensity, tired legs syndrome.
CVI degree 1 is accompanied by the formation of edema that occurs after a hard day's work and disappears on its own after rest. In most cases, the ankles swell, while the toes remain normal.
With CVI at this stage, a small vascular pattern can be seen in the form of protruding purple-blue "stars" and "cobwebs" on the surface of the skin.

The doctor will prescribe a comprehensive examination and, based on its results, recommend appropriate therapy. It is easiest to stop the progression of CVI of the 1st degree, so you should not leave the first alarming bells without due attention.

Treatment

The main goals of therapy are:

Normalize the functioning of the lymphatic and venous system.
Prescribe preventive treatment to stop further progression of the disease.

To eliminate cosmetic imperfections at stages 0 and 1 in the form of the formation of a vascular pattern, the technique of sclerotherapy is most often used. A special substance is injected into the vein area - a sclerosant, which glues the lesion from the inside and the blood continues to freely pass through healthy vessels and veins. For the purposes of prevention, drugs can be prescribed that strengthen the walls of blood vessels and prevent the development of trophic disorders. In the schemes of therapy, the following groups of medicines are most often involved:

Medicines based on diosmin: Phlebodia, Detralex.
Means based on troxerutin: Troxevasin.
Means, which includes horse chestnut extract: Aescusan, Venoton.

Such drugs can be used for a long time.

If there are no complications in the form of thrombophlebitis, the use of external preparations based on heparin is not advisable. The exact scheme and duration of treatment can only be determined by a phlebologist, taking into account the degree of development of the disease, its manifestations and the characteristics of the patient's body.

Second stage

In the absence of adequate therapeutic and preventive measures, chronic venous insufficiency continues to progress and reaches the 2nd degree of development. With CVI of the 2nd degree, the following symptoms may join, indicating the development of the problem:

The pain in the leg area becomes more intense. The patient may describe the feeling of pain as "bursting", a burning sensation joins.
The 2nd degree of damage is characterized by the development of convulsions in the calf muscles, which disturb the patient mainly at night.
With the defeat of the limbs at stage 2, edema becomes more persistent and can occur both in the evening and in the daytime.
For the 2nd degree of development of venous disorders, a change in the skin of the affected limb is characteristic: they can become pale in color and become cold to the touch. In some cases, CVI grade 2 is accompanied by hyperpigmentation in the form of the formation of brown spots in the lower leg.

With CVI at stage 2, the development of lipodermatosclerosis can be observed, which is accompanied by inflammation of the skin and the development of pain.

The skin acquires a red tint, a few eczemas may form. A similar reaction of the body in degree 2 of the development of the disease indicates excessive thinning of the skin in the area of dilated veins. In addition, the patient has severe itching at the site of the lesion, the skin can become spotty.

Benefits of Physiotherapy

Physiotherapeutic methods of treatment can be used at any stage of the development of venous insufficiency in the case of objective indications and on the recommendation of a doctor. A positive therapeutic effect is exerted by:

Involvement of diadynamic currents.
electrophoresis therapy.
Use of a laser.
magnetic fields.

If conservative methods of therapy have had a positive effect, in the future the patient will be recommended to adjust his usual lifestyle:

Review your diet.
Use compression stockings or elastic bandages, including before playing sports.
Preventive treatment with the involvement of certain groups of medicines that the doctor will recommend.

How to use elastic compression correctly

It is important to know how to properly use elastic bandages. The bandage should be applied to the affected limb immediately after waking up, when the patient has not yet got out of bed. The bandage should be applied from the bottom up, while capturing the foot. Each subsequent turn of the bandage around the foot should overlap the previous one by 2/3, and the compression should not be applied too tight. If the patient feels severe discomfort, a feeling of numbness in the area of \u200b\u200bthe fingers or pain, then it is necessary to bandage the leg.

If necessary, it is allowed to apply heparin ointment or troxerutin gel under the bandage to enhance the positive therapeutic effect.

The selection of suitable compression stockings should also be entrusted to the doctor. Elastic stockings, tights and stockings are distinguished by the degree of compression. For prevention, lighter compression is used; in severe cases, the degree of compression of the limb should be maximum.

Third stage

Chronic venous insufficiency of the 3rd degree is accompanied by the development of:

Trophic disorders: ulcerative skin lesions.
Bleeding.
Thrombosis affecting deep veins.
Thrombophlebitis.

The development of ulcerative skin lesions in CVI at stage 3 of the disease occurs as follows:

At the initial stage, the skin with venous insufficiency turns brown.
Further, a small dense formation forms in the center of the colored area, the skin in this place can shine, as if it had been covered with a layer of paraffin.
This condition can persist for a long time, in the future, even the smallest injury leads to the formation of an open wound and the development of ulcerative skin lesions.

In the event that there is no therapy, with the 3rd degree of damage there is a high probability of attaching an infectious agent, which threatens the development of serious complications.

Therapy

With the development of trophic disorders, the treatment of the disease becomes much more complicated. In this case, it is necessary to use a whole range of measures: the use of medicines for internal use and external application, elements of physiotherapy. The most commonly used external treatments are:

Antiseptic preparations for wound treatment.
The use of enzyme drugs.
Drugs that accelerate tissue regeneration.
If necessary, antibacterial agents can be used.

In severe cases, surgery may be required, which involves the removal of dead skin in order to prevent the spread of the necrotic process. After treating the wound with a solution of chlorhexidine, peroxide and saline, the patient should apply Levomekol ointment, Levosin or another drug recommended by the doctor.

The treatment of the affected surface should be carried out regularly and the patient will need to make a lot of effort so that the wound gradually begins to heal.

When may surgery be required?

Treatment with radical methods may be required in cases where conservative therapy does not have the desired effect, and the disease continues to progress. Indications for surgical intervention are:

The development of complications in the form of thrombosis, thrombophlebitis, bleeding.
Trophic ulcers that do not heal for a long period of time.
Expressed cosmetic imperfections in the form of the formation of volumetric nodes on the surface of the skin and a pronounced vascular pattern.

Radical treatment of venous insufficiency involves the removal of the affected area of the vein. In severe pathology, removal of the entire vein may be indicated. The selection of a suitable treatment method is carried out by the doctor, taking into account the results of the examination and examination.

During the recovery period, it is necessary to strictly follow all the recommendations of the doctor in order to speed up the healing process and minimize the risk of developing possible postoperative complications. In order to prevent the development of congestion, the patient is recommended to start moving on the 2nd day after the procedure. During the recovery period, it is necessary to use compression stockings, heparin-based topical preparations, and other groups of drugs recommended by the doctor.

Basic diagnostic methods

Symptoms of CVI can be similar to those of many other diseases. An accurate diagnosis can only be made by an experienced specialist after a comprehensive examination. In most cases, the patient is recommended to undergo the following diagnostic methods:

Carrying out a general blood test to determine the total number of red blood cells and hemoglobin levels. Such a study allows you to analyze the viscosity and degree of blood coagulation. Platelets indicate possible deviations of the blood coagulation system, the presence of leukocytes indicates the development of an inflammatory process.
Biochemical analysis of urine and blood.
A highly specialized diagnostic method is an ultrasound examination of the veins and vessels of the legs. According to the study, it is possible to identify the exact localization of the development of the inflammatory process, the presence of varicose veins, varicose veins, blood clots. Ultrasound examination is mandatory prescribed even for the most minor manifestations of CVI.

With insufficient information content of the results of an ultrasound examination, the patient is additionally prescribed a phlebography. In this case, the doctor injects a special contrast agent into the area of the affected limb and can assess the general condition of the venous system.

What complications can occur

Untimely or poor-quality treatment of venous insufficiency can lead to the development of the following complications:

Deep vein thrombosis, which is accompanied by the formation of thrombotic masses that can completely block the lumen of the vessel.
Thrombophlebitis, in which the inflammatory process affects the walls of blood vessels. A similar complication is often a concomitant condition of thrombosis.
Violations of the normal functioning of the lymphatic system. At the same time, edema bothers the patient regularly and no longer goes away on its own. This is due to a violation of the lymph flow in the area of the affected leg.

The danger lies in the fact that even a small injury can lead to the development of heavy bleeding. In this case, it is recommended to bandage the affected limb with a tourniquet slightly above the site of the lesion as soon as possible and take the patient to the hospital. The development of bleeding from the affected, dilated vein can pose a threat to the life of the patient, therefore, in this case, you should never hesitate.

Preventive actions

The doctor can give the patient recommendations regarding the primary prevention of venous insufficiency, advise to eliminate possible risk factors. The development of chronic venous insufficiency is easier to prevent than to cure. Therefore, patients at risk are advised to take into account the following recommendations regarding the prevention of the disease:

It is recommended to give up bad habits: drinking alcohol, smoking. Under the influence of harmful substances, thinning of the vascular wall occurs, the veins and vessels gradually stretch.
Moderate physical activity helps prevent the development of congestion. Therefore, daily walking, swimming pool, yoga and gymnastics will prevent premature development of problems with veins and blood vessels. During sports, it is recommended to use elastic bandages and compression stockings.
Women who are expecting a baby and are prone to the development of venous insufficiency are recommended to systematically do an ultrasound examination of the vessels of the legs.
Overweight patients are advised to normalize their weight.
It is also recommended to review the diet and introduce fresh fruits and vegetables, dried fruits, sour-milk products, greens into it.
During rest, it is recommended to keep the limbs in an elevated position and put a splint or a small pillow under them.
It is recommended to give preference to comfortable, non-constricting shoes and clothing. Women are advised to stop wearing high heels frequently.

For the purpose of prevention, patients may be recommended regular course intake of drugs and a group of phlebotonics. Some schemes of preventive therapy involve the internal administration of the drug Phlebodia and the external application of the drug Troxevasin in the form of a gel.

Chronic venous insufficiency

Chronic venous insufficiency is not an independent disease. Medicine defines it as a symptom complex, which most often occurs against the background of the progression of certain diseases of the veins of the lower extremities and is accompanied by similar clinical manifestations. These include varicose veins, post-thrombophlebic syndrome, deviations in the development of the vessels of the venous network, vein injuries.

In rare cases, the causes of venous insufficiency can be connective tissue pathology, hormonal failure in the body, excess weight, and neoplasms in the pelvic area.

Most often, CVI affects people who, for one reason or another, have to stand or sit for a long time. The consequence of this is a violation of blood flow, which leads to stagnation of blood in the veins of the lower extremities. The blood increases the pressure on the walls, forcing them to expand - there is an insufficiency of the veins.

The risk group also includes women during pregnancy, the elderly due to the aging process, adolescents in whom CVI may occur against the background of changes in the hormonal work of the body.

The insidiousness of the pathology lies in the fact that for a long time it proceeds in a latent form, without the manifestation of any external signs. Patients may be disturbed by only some of the symptoms that are characteristic of other diseases. The body becomes less resistant to static loads, the calf muscles quickly get tired, there is heaviness in the legs and discomfort associated with a feeling of "goosebumps" or heat. With varicose veins, pain and burning may occur in the area of the altered areas. After suffering deep vein thrombosis, acute pain in the calf area may appear, especially aggravated during physical exertion. The nature of the severity of symptoms depends on the duration of the course of the pathological condition. But the main sign of CVI is that all manifestations occur after a long stay in a standing position and almost disappear even after a short rest.

Chronic venous insufficiency is divided into several stages. At different stages of the development of pathology, the symptoms manifest themselves in different ways. The treatment of CVI also depends on this.

Degrees of the disease

Grade 0 is characterized by the absence of any signs, apart from visually dilated veins or spider veins. At this stage, the patient is not worried about anything. The examination does not reveal any pathological processes.

Grade 1 is accompanied by heaviness in the legs by the end of the working day and the appearance of incoming swelling in the ankles. After a night's rest, the symptoms go away and reappear in the evening. These signs may be accompanied by a visual manifestation of the disease - the appearance of spider veins and reticular veins. Patients suffering from chronic venous insufficiency of the 1st degree complain of discomfort in the legs and swelling, however, since the symptoms are variable, they can work without the use of medications.

Grade 2 of the disease involves acute arching pain in the legs and swelling of an enduring nature. Of the external signs: darkening (hyperpigmented areas) on the skin and lipodermatosclerosis may appear. In the areas of the affected veins, inflammation is observed - indurative cellulite, the skin becomes thinner and is replaced by connective tissue, itching may disturb. Patients complain of pain and swelling and cannot be able to work without the use of drugs.

Grade 3 has a pronounced clinical picture of grade 2 with the appearance of trophic skin changes with associated complications - thrombophlebitis, eczema, bleeding and trophic ulcers. Patients with grade 3 CVI are disabled.

Treatment

Treatment of chronic venous insufficiency is prescribed based on the results of a patient examination, which includes all methods for diagnosing this pathology: laboratory methods, ultrasound, radiopaque phlebography and, if necessary, 3D helical computed tomography, which is the most modern diagnostic method.

The duration of the course and the method of treatment depend on the stage and on the presence of complications. Due to the fact that most patients associate the symptoms of CVI with the peculiarities of their lifestyle, they begin to really worry only when the pain becomes unbearable. Unfortunately, this leads to the fact that the diagnosis is most often established already in the later stages. By that time, the treatment of venous insufficiency is more difficult, since the pathology has already affected large areas.

In modern phlebology, there are two ways to eliminate the disease: conservative and surgical. In the early stages, venous insufficiency can be treated with complex drug therapy, the use of compression stockings, and therapeutic exercises. During treatment, physical activity is also adjusted. Patients are shown walking and cycling, swimming and walking.

Treatment is individual at each stage. In the first degree, due to the appearance of spider veins, sclerotherapy is recommended along with the use of medications. The method is based on the introduction of a special substance, a sclerosant, into the lumen of the vein, which stops the blood flow in the affected area of the vein and provides an excellent cosmetic effect.

Treatment of CVI grade 2 takes at least 6 months. In the absence of complications, patients are prescribed drugs that strengthen the venous walls. To achieve the effect, patients need to take several courses of medication.

Surgical intervention is used with the ineffectiveness of conservative therapy methods, the occurrence of thrombophlebitis, bleeding from trophic ulcers, and in the presence of a cosmetic defect on the skin caused by the progression of the disease.

Varicose disease of the lower extremities CVI 2nd degree

Varicose veins of the lower extremities CVI of the 2nd degree is a violation of the vascular system, which occurs in 25% of the population. What is the reason for such a high figure, we will understand today.

Diagnosis of CVI 2nd degree

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

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

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

pain that worsens with prolonged standing;
"syndrome of tired legs", an uncomfortable feeling of heaviness in the legs;
swelling of the legs;
increased sweating;
the appearance of vascular patterns on the legs in the form of nets, stars;
cramps in the calf muscles, which in most cases disturb at night;
a significant change in skin color, the leg acquires a pale bluish tint;
the lower limb affected by CVI of the 2nd degree is much colder to the touch than a healthy leg;
the appearance of hyperpigmentation, which is characterized by dark spots in the lower leg;
inflammatory process of the skin.

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

CVI 2 degrees of the lower extremities, photo

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

CVI 2 degrees of the lower extremities, photo:

The danger of the 2nd degree of venous insufficiency also lies in the fact that due to the deposition of a large amount of blood, general well-being worsens. The patient is extremely difficult to endure mental and physical stress, he is regularly disturbed by dizziness and fainting. In some cases, there are signs of heart failure.

CVI 2nd degree and army

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

diagnosis of post-thrombotic varicose veins of the lower extremities;
diagnosis of varicose veins of the lower extremities with the manifestation of chronic venous insufficiency of the 2nd degree.

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

Treatment of chronic venous insufficiency of the 2nd degree

Treatment of chronic venous insufficiency of the 2nd degree must necessarily be complex. It will no longer be possible to cope with a progressive disease solely with the help of pills!

Compression underwear. Wearing medical underwear is mandatory at all stages of the disease. These can be special stockings, stockings for varicose veins on the legs or tights made of compression stockings. Models of underwear are somewhat different - they are for men and for women, they have different degrees of compression. The consultant will help you choose the right medical underwear, depending on the individual characteristics of the patient.

Medical underwear contributes to squeezing the veins, thereby improving blood flow in the legs. Phlebologists insist that compression hosiery is a mandatory component of complex therapy.

Medicines. The doctor prescribes a list of drugs with a venotonic effect. Drug therapy helps to alleviate the patient's condition, increases the tone of the vascular walls. Drugs are prescribed on an individual basis, depending on the patient's contraindications. Frequent companions of the patient are drugs Detralex and Venoruton.
Minimally invasive intervention. It refers to sparing methods of treatment that do not require serious trauma to the skin. With CVI 2 degrees can be assigned:

sclerotherapy - intravenous administration of a sclerosant substance, which allows you to restore the normal outflow of blood;
laser coagulation - elimination of blood reflux by inserting a catheter into the affected vein and exposure to laser radiation.

However, not everything is so rosy. Doctors say that at the second stage of venous insufficiency, the presented methods of treatment are not able to cure the patient. The disease is at the stage of active progression, which has already led to irreversible changes in the vascular bed. Varicose disease of the lower extremities CVI grade 2 is not treated by conservative methods. Such complex therapy only allows you to stop the process of further development of pathology.

Surgery for CVI 2nd degree

Indications for surgical intervention:

progression of the disease, the absence of a positive result of therapeutic therapy;
reflux (abnormal blood flow);
development of trophic disorders.

Contraindications for the operation:

advanced age of the patient;
inflammatory process;
the presence of severe comorbidity.

The operation can be carried out in two ways:

Crossectomy. Through a small incision in the groin, the surgeon cuts (ligates) the great saphenous vein. The intersection is done at the level of fistulas with a deep vein.
Stripping. A medical probe is inserted through a small incision into the vein. When removing a small vein, the thinnest probe is inserted; when removing a large vein, a large probe is used. After the introduction of the probe, the surgeon completely excised the venous trunk.

The operation is dangerous with complications in the form of bleeding, lymphatic leakage, the appearance of hematomas, thrombosis.

CVI 2 degree disability

According to statistics, with CVI of the 2nd degree, disability is established in 30% of cases. In most patients, disability occurs due to the neglect of the disease and its active progression. Group 2 or 3 disability is established. Group 3 is determined by moderate disability due to disability. Group 2 is a persistent pronounced limitation of life.

The degree of disability may directly depend on the type of activity of the patient. For example, for office workers, disability is established only in the presence of trophic changes. In the presence of rapidly healing ulcers and pathological hyperpigmentation, disability for knowledge workers is not provided!

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

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

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Information site about varicose veins, how to treat leg veins

Content

Violation of venous circulation, accompanied by pronounced symptoms, leads to a disease called venous insufficiency of the lower extremities - the symptoms, treatment and prevention of it are aimed at restoring blood flow inside the vein. The disease is associated with a sedentary lifestyle and a genetic predisposition, at certain stages it is accompanied by varicose veins.

What is venous insufficiency of the lower extremities

Venous insufficiency of the lower extremities ranks first in prevalence among vascular pathologies. Women are more likely to suffer from it, and in total, according to statistics, almost a third of the adult population is affected. When for a number of reasons, including due to increased load, the work of the venous valves that regulate the blood circulation process is disrupted, a constant outflow of blood begins in the lower extremities downward, against the upward movement, to the heart, the first symptom appears - a feeling of heaviness in the legs.

If the disease develops, the pressure on the walls of the vessels constantly increases, which leads to their thinning. Vein blockages can form, and if timely therapy is not started, trophic ulcers of the tissues surrounding the venous vessels can occur. Symptoms of varicose veins appear - swelling of the lower extremities, cramps at night, a clear venous pattern at the surface of the skin.

Symptoms

Symptoms of venous insufficiency depend on the form in which it occurs - acute (OVN) or chronic (CVI), severity, stage of the disease. OVN of the lower extremities develops rapidly, accompanied by severe pain, swelling, and the appearance of a venous pattern on the skin. The main symptoms of CVI of the lower extremities are:

systematic feeling of heaviness in the legs;
muscle cramps at night and during rest;
puffiness;
hypo- or hyperpigmentation of the skin, venous dermatitis;
trophic ulcers, dryness, redness on the skin;
dizziness, fainting.

Causes

The medical group of causes, that is, diseases and conditions due to which chronic venous insufficiency of the lower extremities develops, are diseases in which the functioning of the venous-muscular pump system is disrupted:

phlebothrombosis;
thrombophlebitis;
congenital pathologies of the vascular system;
injuries and serious injuries of the lower extremities.

There are secondary, so-called non-modifying factors that are not the cause of acute respiratory failure and chronic venous insufficiency, but are at risk, may contribute to the development of the disease or worsen the patient's condition. These include:

genetic predisposition to the disease;
gender - women suffer from CVI on average three times more often than men, due to higher levels of the hormone estrogen;
pregnancy, labor activity - the load on the venous vessels is increased, there is a change in the hormonal background in the woman's body;
elderly age;
overweight;
low physical activity;
regular heavy physical work, weight lifting.

Forms

Allocate venous insufficiency of the lower extremities of acute and chronic forms (there is also venous insufficiency of the brain). AVR is formed as a consequence of the occlusion of the deep veins of the lower extremities, during thrombosis or injury to the legs. Subcutaneous vessels are not affected. The main symptom of OVN is severe pain, which stops after the application of a cold compress, since the cold reduces the volume of blood in the vessels.

CVI, on the contrary, affects the veins located close to the surface of the skin, therefore it is accompanied by degenerative and pigmentary changes in the skin - age spots, trophic ulcers. If the treatment is delayed, the occurrence of such vascular anomalies as pyoderma, the formation of blood clots, and the pathology of ankle joint traffic becomes inevitable.

CVI classification

There is an international CEAP classification system for venous insufficiency. According to this system, there are three stages of CVI:

CVI 1 degree - accompanied by pain, swelling, convulsive syndrome, the patient is disturbed by a feeling of heaviness in the legs;
CVI grade 2 - accompanied by eczema, dermatosclerosis, hyperpigmentation;
CVI grade 3 - trophic ulcers on the skin of the lower extremities.

Diagnostics

To clarify the clinical picture of the disease, establish an accurate diagnosis and provide assistance, after an external examination, the doctor directs the patient to undergo the following tests:

Ultrasound of the lower extremities;
general analysis and biochemistry of blood;
phlebography.

Treatment of venous insufficiency of the lower extremities

Violation of the venous outflow of the lower extremities, called venous insufficiency, is treated with complex therapy, including:

elimination of risk factors;
drug therapy;
correction of the patient's physical activity with the help of therapeutic exercises;
physiotherapy;
surgical intervention;
elastic compression method.

drugs

The mechanism of treatment of chronic venous insufficiency with medicines is developed depending on the stage of development of the disease. In the first degree of CVI, sclerotherapy is used - an intravenous injection of a drug that significantly reduces blood flow in the deformed part of the vessel. During the second degree, drug therapy is used that increases the overall tone of the venous vessels and improves the processes of circulation of adjacent tissues. In this case, the main results are achieved only for 3-4 months of treatment, and the total duration of the course is 6-8 months.

At the third stage, the patient needs complex treatment of the main symptoms and complications. General spectrum drugs and topical ointments are prescribed. During the course of complex therapy, the appointment of phlebotonics, non-steroidal anti-inflammatory drugs, anticoagulants, antiplatelet agents and antihistamines is mandatory. Preparations for external use are selected from the group of drugs containing corticosteroids.

It is important to prescribe the correct physiotherapy procedures and the selection of a complex of therapeutic exercises. In most cases, they are appointed;

electrophoresis;
balneotherapy;
diadynamic current.

Trophic ulcers associated with the third stage are a very dangerous type of skin disease, fraught with a number of serious complications and infections. The patient is prescribed bed rest, long-term antibiotic therapy, regular local hygienic treatment with the use of antiseptics. To speed up the process, they recommend products containing natural plant antiseptics - propolis, sea buckthorn - and wearing medical knitwear.

Folk remedies

In the initial stages of venous insufficiency of the lower extremities and as a preventive measure to improve blood circulation and reduce pain, they resort to folk remedies. From the disease help:

infusion of horse chestnut;
chamomile oil;
alcohol tincture of fragrant rue;
tincture of wormwood silver;
compresses from a bodyak - sow thistle ordinary;
whey wraps;
alcohol tincture of Kalanchoe.

For the prevention of venous insufficiency of the lower extremities, it is important to follow a dietary diet - to refuse fried and fatty foods. It is recommended to eat foods that have anticoagulant properties:

figs;
seaweed;
onion;
tomatoes.

Compression therapy

Elastic compression treatment involves two main points - wearing compression underwear (highly recommended for pregnant women) and bandaging the lower extremities with an elastic bandage. With the help of compression therapy, a significant improvement in the condition of a patient with venous insufficiency of the lower extremities is achieved in the following ways:

reduction of puffiness;
restoration of normal operation of the muscle-valve pump;
improvement of microcirculation of tissues and hemodynamics of veins.

Bandages lose elasticity after several washes, so you should replace them on average every two to three months, and alternate with wearing compression stockings or underpants. Compression bandaging of the lower extremities is carried out according to the following rules:

produced before lifting;
legs are bandaged from the bottom up, from the ankle to the middle of the thigh;
bandaging should be tight, but pain and squeezing should not be felt.

Surgical intervention

When a patient presents at an advanced stage in the development of venous insufficiency of the lower extremities, the doctor may prescribe the following type of operation:

sclerotherapy;
laser irradiation;
phlebectomy;
abelation.

Prevention

As a prevention of venous insufficiency, risk factors are reduced by maintaining an active lifestyle, adjusting eating habits, quitting smoking and alcohol, uncomfortable shoes and tight clothing. If there is a genetic predisposition in the presence of a medical history, it is recommended to undergo a preventive ultrasound examination of the veins to detect pathological symptoms and timely treatment of venous insufficiency.

Video: Chronic venous insufficiency

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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Signs of acute and chronic venous insufficiency of the legs - causes, degrees and therapy

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

A whole army of diseases is attacking modern man. Among them are diseases of the veins of the lower extremities. Internet portals are full of information about varicose veins and how to deal with this disease. But not many people know about venous insufficiency. The term "chronic venous insufficiency (CVI)" implies a complex set of symptoms that describe certain stages of pathological changes in blood vessels and other anatomical structures of the lower extremities. Such manifestations occur with a constant, that is, chronic violation of the venous outflow from the lower extremities.

How the disease develops

Chronic venous insufficiency is a chain of pathological changes in the lower extremities, which has a certain staging and classification. The main causes of this condition are varicose veins of the lower extremities, as well as deep venous thrombosis and thrombophlebitis. If the treatment of the above diseases was not carried out on time or there was insufficient effectiveness of therapeutic measures, CVI gradually develops.

Chronic stagnation of blood in the venous system of the lower extremities leads to vasodilation and an increase in internal pressure. Such abnormal pressure also extends to the system of the smallest capillaries that supply and drain all the anatomical structures of the leg. The inner layer of capillaries is gradually damaged, which leads to malnutrition and metabolism in the lower extremities. These pathological processes are the cause of unpleasant symptoms. Such chronic insufficiency progresses gradually, has its own stages and degrees of severity. Currently, there is the following classification of CVI:

Subclinical stage - no symptoms.
Grade 1 is characterized by moderate transient symptoms.
Grade 2 reflects persistent symptoms that require a careful approach to treatment.
Grade 3 is characterized by persistent chronic changes in the structures of the lower leg.

In this article, we will try to analyze the symptom complex of each stage of venous insufficiency separately. This is necessary in order to start treatment of the disease in a timely manner and avoid possible complications.

Capillaries are gradually damaged, which leads to unpleasant symptoms.

The onset of the disease

It is most difficult to identify the subclinical stage of CVI, especially if the patient is silent about the presence of symptoms and chronic diseases of the veins of the lower extremities, however, pathological microcirculatory changes of varying degrees already occur.

Constantly increased venous pressure begins to damage the smallest capillaries, but the patient practically does not feel any discomfort. At this stage, such a symptom as swelling of the legs and feet is absent in the majority. The most common complaints with this degree of chronic venous insufficiency are moderate pain and burning symptoms in the legs with prolonged standing in an upright position.

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

Transient swelling of the legs of a mild degree that occurs at the end of the day and disappears during the night.
In the evening, patients complain of symptoms such as a feeling of heaviness, discomfort and fullness in the legs and feet.

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

The treatment of venous insufficiency of the lower extremities is optimal at this stage. In this way, disability can be prevented, an acceptable quality of life and exercise tolerance can be maintained.

At the initial stage, the patient practically does not feel discomfort.

Further scenario

In a situation where CVI treatment was not started on time, the pathological process moves to a new level. The second degree of the disease is characterized by further damage to the capillary bed. Red blood cells - erythrocytes - leave the vascular bed through the damaged walls of small vessels.

There is a deposition of the product of their degradation - hemosiderin - in the skin. This gives the skin a characteristic purple-bluish hue. Sometimes, with chronic venous insufficiency of the lower extremities, there is also hypopigmentation of the skin due to a violation of its nutrition.

Edema is permanent and does not go away even at night. At this stage, chronic insufficiency of the lymphatic system, sclerotic changes in the skin and nails join. There is eczema or itching on the skin of the legs and back of the feet.

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

With CVI of the third degree, there is a total violation of circulation in the legs. At this stage of the disease, the exchange of oxygen and nutrients is severely impaired. Trophic ulcers appear on the skin of the legs. They are open wounds on the skin. Such ulcers do not heal for a long time, they are prone to growth and infection.

Treatment of trophic ulcers is a very difficult task, because venous insufficiency is extremely severe, and the pathological process is almost impossible to stop. Sometimes the addition of a secondary infection at this stage of CVI leads to suppuration and, in extremely severe cases, even to amputation of the leg. Disability is a common occurrence with advanced CVI.

Therapy in the second stage prevents the progression of the disease, but does not cure it.

The classification of chronic venous insufficiency described above clearly explains all stages of the pathological process. It is best to start the fight against the disease in the early stages. We'll talk about this below.

How to beat the disease

Treatment of chronic venous insufficiency of the legs should be started in the early stages of the disease. It is at this stage that it is possible to break the pathological vicious circle and restore normal microcirculation and venous outflow. Consider the main therapeutic measures for CVI:

Regular use of compression stockings. Special stockings, stockings or pantyhose have a different degree of compression depending on the stage of the disease. There are models for both men and women. Such therapeutic knitwear contributes to external compression of the superficial veins of the legs, which improves the outflow of blood from them. This makes a significant contribution to the treatment of chronic venous insufficiency in its initial stages, that is, in the first degree of the disease.
Taking medications with a venotonic effect. These are herbal preparations that effectively increase the tone of the venous wall. These remedies help to get rid of unpleasant symptoms.
Minimally invasive interventions that eliminate pathologically altered veins. We are talking about sclerosis, laser coagulation or ligation of dilated vessels with incorrectly functioning valves. Such measures stop the pathological process at its initial stages.
Surgical operation to remove varicose veins. It is performed when all of the above treatment has exhausted itself.
Taking anticoagulants and antiplatelet agents to prevent recurrent thrombosis and deep vein thrombophlebitis.

Compression hosiery is effective in the first stage of the disease.

At the last stage of venous insufficiency, namely in the presence of trophic ulcers, treatment should be aimed at their healing, that is, relief of symptoms. In case of infection, therapy should be supplemented with antibacterial drugs of general and local action.

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

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Chronic venous insufficiency of the lower extremities

Chronic venous insufficiency (CVI) is a pathology caused by a violation of the outflow of blood through the veins of the lower extremities. CVI is a collective concept, it includes several diseases with a similar clinical picture: long-term varicose veins, post-thrombophlebitic syndrome, congenital anomalies of venous vessels.

According to Russian studies, as a result of detailed diagnostics, signs of CVI are detected in every second inhabitant of the country aged 20–50 years. Moreover, in approximately 15% of cases, phlebologists are faced with a decompensated form of CVI, often accompanied by trophic changes in the skin, recurrent and open venous ulcers. One of the most important problems that negatively affect the development and progression of pathology, phlebologists consider the untimely appeal of patients for medical help, as well as a long period of latent symptoms. Most patients mistakenly believe that the complex of symptoms of CVI is only a consequence of prolonged static loads or physical fatigue. Some do not realize the severity of the pathology and the seriousness of the complications that this disease can lead to.

An important point: often varicose veins of the lower extremities are confused with chronic venous insufficiency. However, the latter can also appear without visible changes in the saphenous veins, since the cause of the development of CVI is congenital and acquired pathologies that lead to impaired blood flow through the deep vein system.

Development mechanism

Normally, 90% of the blood volume flows through the deep veins, and the remaining 10% moves through the superficial vessels. Venous return is provided by a number of factors. The most important role is played by motor activity. During physical exertion, the muscles of the limbs contract, while squeezing the veins, as if “squeezing” the blood from the venous vessels. Due to gravity, the blood tends to go down, and here the valves work, directing the blood flow up to the heart. Thus, maintaining normal blood flow through the venous system of the lower extremities is possible provided:

viability of the valve apparatus,
stable tone of the venous wall,
normal physiological change in the lumen of the vessel caused by a change in body position.

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

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

Normally, some volume of lymph is discharged into the venous bed through a system of fistulas (cava-caval anastomoses) connecting the tributaries of the superior and inferior vena cava. But against the background of increased pressure in the venous system, this process is disrupted. As a result, the lymphatic system is overloaded, the outflow of lymph worsens, aggravating tissue trophic disorders and provoking the formation of trophic ulcers.

Causes of chronic venous insufficiency

There are a number of modifiable and non-modifiable factors that increase the risk of developing CVI.

Low motor activity. Lack of work of the muscular-venous pump leads to stagnation of blood and starts the pathological process.
Obesity. The risk of developing CVI increases with the degree of obesity.
genetic predisposition. The weakness of the wall of the veins, due to congenital insufficiency of the connective tissue, can provoke the development of this pathology.
Gender identity. Women suffer from CVI three times more often than men. Phlebologists (http://modernsurgeon.ru/o-tsentre/) explain this fact by a high level of estrogen hormones, increased stress caused by pregnancy and childbirth, as well as a high life expectancy compared to men.
Taking hormone-containing drugs, including hormonal contraceptives.
Age. Due to prolonged exposure to provoking factors, older people suffer from CVI much more often.
Prolonged static loads and heavy physical labor associated with professional necessity.

In some cases, chronic venous insufficiency may be the result of phlebothrombosis. The cause of the development of CVI is considered to be the so-called. phlebopathy is a condition in which a violation of the outflow of blood in the veins of the lower extremities occurs in the absence of any data objectively confirming the presence of pathology. In rare cases, the disease can develop against the background of a traumatic lesion of the veins.

Chronic venous insufficiency: symptoms

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

transient swelling;
heaviness in the legs, aggravated by prolonged standing;
night cramps in the lower extremities;
changes in the skin: hyperpigmentation, dryness, loss of skin elasticity at the level of the distal third of the leg.

Varicose veins in the initial stages of CVI are not observed in all cases. As the pathology progresses, the consequences of venous circulatory insufficiency are exacerbated. Trophic skin disorders become pronounced, trophic ulcers occur. An increase in blood volume in the venous system of the lower extremities can cause a significant deterioration in the general health of the patient. The above symptoms may be accompanied by signs of heart failure, dizziness and fainting. Due to a decrease in the volume of circulating blood, patients suffering from severe chronic venous insufficiency experience difficulties in physical and mental work.

Chronic venous insufficiency: degrees (classification)

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

grade 0. No symptoms of chronic venous insufficiency of the lower extremities. Clinicians singled out this degree, since in practice a pronounced varicose vein change can occur without any signs of CVI;
chronic venous insufficiency of the 1st degree. Patients complain of arching pains and heaviness in the legs, transient swelling, cramps at night;
chronic venous insufficiency of the lower extremities of the 2nd degree. A characteristic feature is the phenomena of fibrous degeneration of the subcutaneous tissue and skin (lipodermatosclerosis), edema (edema), hyperpigmentation (the skin becomes brown), the formation of weeping or dry eczema;
chronic venous insufficiency of the 3rd degree. At this stage, a venous trophic ulcer is observed.

Chronic venous insufficiency: stages of the disease according to the international CEAP classification system, reflecting the scale of disability:

"zero" - signs of CVI are completely absent;
"chronic venous insufficiency of the 1st degree" - the symptoms of the disease appear, while the patient is considered able-bodied, there is no need for supporting agents;
"chronic venous insufficiency of the lower extremities of the 2nd degree" - the patient is able to work for a full day, provided that supportive means are used;
"chronic venous insufficiency of the 3rd degree" - the patient is considered disabled.

Severe stages of lipodermatosclerosis or prolonged lack of therapeutic measures for the first episode of venous ulcer formation often cause non-healing and constantly recurring trophic ulcer, one of the most difficult conditions faced by people suffering from chronic venous insufficiency.

Diagnosis of chronic venous insufficiency of the lower extremities

The success of CVI treatment depends primarily on an accurate diagnosis. Multiple causes and manifestations of the disease create the need for instrumental diagnostics in addition to a medical examination. Currently, the main diagnostic method of CVI is ultrasound duplex angioscanning. The study allows us to determine the nature of venous insufficiency and localization of the affected vessels. In some cases, additional instrumental diagnostic measures may be prescribed:

radiopaque phlebography. The study is necessary for the diagnosis and choice of methods of surgical treatment. It allows assessing the anatomical and functional state of deep, superficial and perforating (connecting the first two) veins of the lower extremities, localization, extent of pathological changes;
computed tomography (CT). A highly informative method that allows visualizing the nature of the pathological process in a 3D image;
magnetic resonance angiography of the veins of the lower extremities allows you to examine the state of blood vessels, lymphatic tracts, collateral blood flow and assess the extent of the pathological process.

Since CVP often indicates the neglect of the disease, timely diagnosis and the subsequent set of therapeutic measures are extremely important for the patient.

Chronic venous insufficiency: treatment

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

Phlebologists are guided by the following principles for the treatment of chronic renal failure:

Therapy should be carried out in courses. Some patients are treated in short and episodic courses, while others require long-term and regular treatment. The average course duration is 60-75 days.
Medications should be combined with other treatments.
The treatment plan is selected strictly individually.
Achieving a positive effect of treatment is possible with the direct participation of the patient. The patient must clearly understand the essence of the disease and be aware of the consequences of non-compliance with the recommendations of the attending physician.

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

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

An obligatory condition that patients must comply with in the treatment of CVS is the correction of motor activity. The phlebologist recommends a special set of exercises that will not include heavy lifting or sudden and fast movements. Patients with CVI are shown:

Compression therapy is an integral part of the entire treatment complex for CVI. This technique allows:

eliminate swelling;
reduce the diameter of the lumen of the vein;
improve venous hemodynamics;
improve the functioning of the valve apparatus;
restore microcirculation;
improve lymphatic drainage through the lymphatic vessels.

An elastic bandage on a diseased limb should be formed by a phlebologist, since this process requires professional skills. Self-use of an elastic bandage can only aggravate the symptoms of the disease. As a rule, an elastic bandage is used in cases where short-term continuous wear is required. For long-term use, compression stockings are preferred. The attending physician will select products: tights, stockings or stockings with the desired degree of compression. Independent use of compression stockings is undesirable, since the patient will not be able to correctly select the required level of pressure of the product.

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

atherosclerosis of arterial vessels;
cardio-respiratory failure;
the presence of damage to the skin in the area of \u200b\u200bthe intended use of compression products.

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

At stage 1, against the background of CVI, varicose saphenous veins are observed. In order to eliminate this defect, sclerotherapy is prescribed. The essence of the method is the introduction of a small diameter chemical agent into the vein, which, as it were, “glues” the vessel, after which the vein completely resolves. To achieve the expected effect, it is necessary to use compression therapy. Perhaps the appointment of a short course of medication.
If chronic venous insufficiency of the 2nd degree is detected, the treatment will be aimed at improving microcirculation in the surrounding tissues and increasing venous tone. For this purpose, the phlebologist will prescribe medications. The duration of their intake and the number of courses will depend on the rate of manifestation of the visible therapeutic effect.
Chronic venous insufficiency of the 3rd degree, treatment should be aimed at combating the complications of the disease. In this case, the doctor prescribes a combination therapy, which includes general medications and topical medications. Drugs are selected depending on individual indicators and the level of neglect of the disease. As a rule, non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac), phlebotonics (Flebodia, Detralex, Vasoket), anticoagulants (Clexane), antiplatelet agents (Pentoxifylline, Trental), antihistamines (Edem, Cetrin, Lorano) are used. Phlebologists do not recommend continuing treatment in the absence of a therapeutic effect for two months. Local pharmacotherapy consists in the use of medicines (gels, ointments) with the active ingredient Heparin. This is Lyoton 1000, heparin or troxevasin ointment. To prevent the progression of trophic disorders, topical pharmaceuticals containing corticosteroids (Flucinar, Mesoderm, Polcortolone, Akortin) are prescribed. In some cases, in the presence of multiple lesions of the skin, additional treatment by a dermatologist is necessary.

Doctors pay special attention to the treatment of trophic ulcers, since these injuries are often complicated by bleeding and irreversible changes in the skin. It requires bed rest, treatment of ulcers with a special solution, the use of antiseptic agents, such as Miramistin ointment, and antibacterial therapy. The CVI treatment complex includes physiotherapy techniques. Well proven: diadynamic currents, electrophoresis and balneotherapy.

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

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

classical open operations on the saphenous veins. To perform them, several incisions are made in order to remove the affected vessels;
methods of intravascular obliteration. This includes minimally invasive methods: radiofrequency ablation (RFA) and endovenous laser ablation (EVLA). Manipulations are carried out without incisions (puncture). Under ultrasound guidance, the surgeon "closes" the diseased vessel, and does not remove it.

Surgical interventions on perforating veins:

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

In post-thrombotic disease, the following reconstructive operations are indicated:

Deep vein stenting. In 1-6% of patients with trophic ulcers, narrowing of the iliac veins is observed. Stenting significantly improves the clinical condition of patients, slows down the further progression of reflux and eliminates complex surgical intervention. The operation is carried out in a specialized vascular hospital, requires modern medical equipment and highly qualified personnel.
Reconstructive operations on deep veins. The purpose of the intervention is the formation of the valve structure in deep venous vessels. At this stage, this section is considered one of the most problematic among the entire arsenal of operational phlebology.

Photos BEFORE and AFTER CVI treatment

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

Observe active driving mode.
Avoid prolonged static loads (standing or sitting for a long time).
Regularly perform a complex of therapeutic exercises prescribed by the attending physician.
Constantly wear compression stockings recommended by a phlebologist during the day.

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

Varicose disease of the lower extremities CVI 2nd degree

Diagnosis of CVI 2nd degree

pain that worsens with prolonged standing;
"syndrome of tired legs", an uncomfortable feeling of heaviness in the legs;
swelling of the legs;
increased sweating;
the appearance of vascular patterns on the legs in the form of nets, stars;
cramps in the calf muscles, which in most cases disturb at night;
a significant change in skin color, the leg acquires a pale bluish tint;
the lower limb affected by CVI of the 2nd degree is much colder to the touch than a healthy leg;
the appearance of hyperpigmentation, which is characterized by dark spots in the lower leg;
inflammatory process of the skin.

CVI 2 degrees of the lower extremities, photo

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

CVI 2 degrees of the lower extremities, photo:

CVI 2nd degree and army

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

diagnosis of post-thrombotic varicose veins of the lower extremities;
diagnosis of varicose veins of the lower extremities with the manifestation of chronic venous insufficiency of the 2nd degree.

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

Treatment of chronic venous insufficiency of the 2nd degree

Treatment of chronic venous insufficiency of the 2nd degree must necessarily be complex. It will no longer be possible to cope with a progressive disease solely with the help of pills!

Compression underwear. Wearing medical underwear is mandatory at all stages of the disease. These can be special stockings, stockings for varicose veins on the legs or tights made of compression stockings. Models of underwear are somewhat different - they are for men and for women, they have different degrees of compression. The consultant will help you choose the right medical underwear, depending on the individual characteristics of the patient.

Medical underwear contributes to squeezing the veins, thereby improving blood flow in the legs. Phlebologists insist that compression hosiery is a mandatory component of complex therapy.

Medicines. The doctor prescribes a list of drugs with a venotonic effect. Drug therapy helps to alleviate the patient's condition, increases the tone of the vascular walls. Drugs are prescribed on an individual basis, depending on the patient's contraindications. Frequent companions of the patient are drugs Detralex and Venoruton.
Minimally invasive intervention. It refers to sparing methods of treatment that do not require serious trauma to the skin. With CVI 2 degrees can be assigned:

sclerotherapy - intravenous administration of a sclerosant substance, which allows you to restore the normal outflow of blood;
laser coagulation - elimination of blood reflux by inserting a catheter into the affected vein and exposure to laser radiation.

Surgery for CVI 2nd degree

Indications for surgical intervention:

progression of the disease, the absence of a positive result of therapeutic therapy;
reflux (abnormal blood flow);
development of trophic disorders.

Contraindications for the operation:

advanced age of the patient;
inflammatory process;
the presence of severe comorbidity.

The operation can be carried out in two ways:

Crossectomy. Through a small incision in the groin, the surgeon cuts (ligates) the great saphenous vein. The intersection is done at the level of fistulas with a deep vein.
Stripping. A medical probe is inserted through a small incision into the vein. When removing a small vein, the thinnest probe is inserted; when removing a large vein, a large probe is used. After the introduction of the probe, the surgeon completely excised the venous trunk.

The operation is dangerous with complications in the form of bleeding, lymphatic leakage, the appearance of hematomas, thrombosis.

CVI 2 degree disability

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

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Information site about varicose veins, how to treat leg veins

Venous insufficiency of the lower extremities is a fairly common problem and has a microbial code of 10. This condition occurs due to improper operation of the valves, which for one reason or another cease to close completely.

Because of this, blood flow to the heart is disrupted, and vein insufficiency appears. It is important to understand the difference between acute and chronic venous insufficiency. The first option is much less common and occurs in deep vessels. Chronic venous insufficiency is very widespread, it develops in the subcutaneous veins.

The symptoms and treatment of this disease are well understood. Another rather dangerous disease is chronic cerebral venous insufficiency. In the human brain, problems begin that are associated with blood circulation. Cerebral insufficiency requires special attention; in advanced cases, it can lead to a very serious complication.

Symptoms of venous insufficiency

Venous insufficiency has characteristic symptoms. At the initial stage, a person feels fatigue and fullness of the lower extremities. These signs begin to become larger and increase with standing for a long time. As a result of the development of the condition, convulsions and severe pain in the calf area begin.

In addition, with venous insufficiency, edema and spider veins are often observed. Similar signs are found in valvular venous insufficiency in perforating veins. It is necessary to seek help from a doctor already at the manifestation of the initial signs of the development of the disease.

Treatment of venous insufficiency of the lower extremities

To start the treatment of venous insufficiency, special groups of drugs are used. These funds normalize the tone of the veins and blood flow. Thanks to the regular use of appropriate drugs, the condition of patients improves significantly, and unpleasant and painful symptoms disappear.

It is very important that the treatment is prescribed by a doctor, an independent choice of drugs can aggravate the situation. In addition, physiotherapy is indicated for venous insufficiency of the lower extremities. Only in extreme cases, with this disease, one has to turn to injections into a vein and surgery.

Preparations

For the treatment of venous insufficiency, it is often necessary to take drugs belonging to different groups, it is this combination therapy that will give the best result. The following medications are most commonly prescribed by doctors:

Phlebotonics - Phlebodia 600, Detralex, Ginkor Fort, Venarus;
Anti-inflammatory drugs - Diclofenac, Nise;
Drugs to prevent allergies - Zodak, Promestazin;
Blood thinners - Aspirin, Dipyridamole;
Antioxidants.

A reasonable combination of the drugs presented can only be selected by a specialist. Self-medication in this case can only worsen the condition at times. In addition to tablets and capsules, topical agents help relieve swelling and pain. These include: Heparin ointment, Lyoton 1000, Indomethacin ointment, etc.

Treatment with folk remedies

Treatment of venous insufficiency of the lower extremities can be carried out using the means and methods of traditional medicine. But this should be done only after consultation with the doctor. One of the effective options that phlebology highlights is hirudotherapy.

This method involves treatment using medical leeches. When bitten, beneficial substances enter the human body that contribute to blood thinning. This helps to prevent the development of varicose veins and thrombophlebitis.

Only hirudotherapists know exactly how to treat with leeches, it is they who should be contacted for a course, the duration of which should be from 5 to 15 procedures. After each session, you need to wear compression stockings on the affected area.

A very good result is the observance of a diet that provides for the rejection of heavily fatty, fried foods, as well as the restriction of sweets. Proper nutrition will certainly improve the patient's condition. In this case, it is recommended to wear only comfortable, non-squeezing shoes.

Herbal treatment

Treatment at home with the help of various medicinal plants is very common. This can be learned in health school. Decoctions and ointments based on horse chestnut, needle roots and sweet clover are very popular.

Hazelnut leaves and bark will help to cope with chronic venous insufficiency. An infusion of them should be taken orally 3 times a day for 1/3 cup. It's pretty easy to make at home. To do this, steam a tablespoon of the plant in a glass of boiling water and let it brew a little.

Sophora flowers also help with this disease. This plant must be insisted on vodka and taken orally 1 teaspoon once a day.

Another effective medicinal plant is Kalanchoe. Alcohol compresses with its addition help to cope with pain, fatigue and swelling in the leg area in a short time. Sytin infusion is also recognized as effective.

Chronic venous insufficiency of the lower extremities 1, 2 degrees

There is a certain pathogenesis of chronic venous insufficiency. The result of treatment and prevention in this case depends entirely on how quickly the treatment was prescribed. In medicine, the following stages of development of venous insufficiency are distinguished:

Initial (grade 1) - characterized by the appearance of edema and heaviness, spider veins are also quite often formed.
Stage 2 is due to the appearance of external inflammation and a clear increase in the saphenous veins.
Venous insufficiency of the lower extremities stage 3 - is very neglected, it manifests itself when chronic venous insufficiency progresses with trophic ulcers, and sometimes atrophy.

The presented classification is generally accepted. But at the same time, the disease begins to develop even before the first degree, at which time everything happens without the manifestation of any obvious symptoms. Often this state is referred to as the zero stage.

Only a specialist can accurately determine the neglect of the disease, since venous insufficiency can be of different types. Thus, venous lymphatic insufficiency, varicose venous insufficiency, insufficiency of venous valves, post-traumatic venous insufficiency are distinguished.

Exercises for venous insufficiency of the legs video

When signs of venous insufficiency appear, as well as for preventive purposes, it is recommended to do special exercises. It consists in the impact on the lower limbs. Birch exercise will help relieve fatigue. In addition, it is useful to work with the feet and hands from a sitting position. Also, with venous insufficiency, it is recommended to do “scissors” and “bike”.

Venous insufficiency in men

Venous insufficiency affects both women and men. It can be localized not only in the region of the lower extremities, but also in the pelvic veins. Men quite often experience heavy physical exertion, which is the main reason for the development of this condition.

Phlebologists are engaged in the diagnosis of this disease. It is they who can tell how to treat this disease, both in the elderly and in adolescents. As a rule, the course includes physiotherapy exercises and massage.

photo pictures

How does venous insufficiency of the lower extremities develop? Complete step by step course.

Venotonic drugs

Venotonic drugs help improve the condition of the valves. Phlebologists are engaged in their selection. The main effective drugs are: Detralex, Phlebodia 600, Venarus, Askorutin, etc. Also, Venodiol can ensure the normalization of blood flow. During pregnancy, taking medications from this group must be agreed with the gynecologist.

All of these drugs for venous lymphatic insufficiency give a good result. But still, only a specialist can answer the question of how to be treated with one or another remedy. You should not seek advice from various thematic forums and sites on the example of Wikipedia.

Detralex: instructions for use

Detralex is prescribed for varicose veins of the lower extremities, when hemorrhoids appeared and for pelvic varicose veins in women. Take this remedy should be in the dosage indicated in the annotation. The course of taking Detralex directly depends on the disease and the stage of development, which is why it is selected individually. Only a doctor can correctly answer the question of how much to drink Detralex.

Phlebodia 600: instructions for use, price, reviews, analogues

Phlebodia 600 is a famous French venotonic. Its analogue is Detralex. The answer to the question of how they differ is quite simple. The preparations have different concentrations of diosmin in their composition. A package of Phlebodia costs about 800 rubles in Moscow, Vladivostok and Krasnoyarsk. It should be taken with venous insufficiency 1 time per day, 1 piece.

Venarus: instructions for use, price, reviews, analogues

Venarus is a Russian-made venotonic. This medicine is recommended for patients with venous insufficiency syndrome. The course of treatment with this drug should be prescribed by a phlebologist, as a rule, it lasts about 3 months, during which 2 tablets per day should be consumed.

How does it affect varicose veins

Varicose veins and chronic venous insufficiency are given to patients at the same time. As the experience of doctors shows, often venous insufficiency is considered the cause of varicose veins. To get by with a conservative method of treatment, it is definitely recommended to consult a doctor to prescribe the right treatment. According to statistics, the disease is acquired, but there are also cases of inheritance when newborns are diagnosed with problems with veins.

Phlebectomy: surgery to remove varicose veins

In cases where conservative treatment is ineffective, venous insufficiency of the lower extremities is in serious condition, you have to resort to surgery. They are carried out in specialized clinics. There are experienced doctors who know the pathogenesis of the formation of this condition.

The essence of the operation is to remove the defective vein. This surgical intervention is carried out quickly enough and does not require any long recovery period. After the operation, patients are advised to regularly wear compression underwear and undergo preventive examinations. Immediately after this procedure, patients experience a clear improvement in their condition.

Only a phlebologist should make a decision on how venous insufficiency of the lower extremities is treated. Surgical intervention is prescribed only as a last resort. At the initial stage of chronic venous insufficiency of the disease, a good result is given by conservative treatment, which is carried out using well-known and affordable venotonics, tablets, gels and ointments.

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CVI development mechanism

Blood from the lower extremities flows through deep (90%) and superficial (10%) veins. The outflow of blood from the bottom up is provided by a number of factors, the most important of which is muscle contraction during exercise. The muscle, contracting, presses on the vein. Under the influence of gravity, the blood tends to go down, but the venous valves prevent its outflow. As a result, normal blood flow through the venous system is ensured. Maintaining a constant movement of fluid against gravity becomes possible due to the viability of the valvular apparatus, the stable tone of the venous wall and the physiological change in the lumen of the veins with a change in body position.

In the case when one or more elements that ensure the normal movement of blood suffer, a pathological process is launched, consisting of several stages. The expansion of the vein below the valve leads to valvular incompetence. Due to the constant increased pressure, the vein continues to expand from the bottom up. Venous reflux joins (pathological discharge of blood from top to bottom). Blood stagnates in the vessel, presses on the wall of the vein. The permeability of the venous wall increases. The plasma through the wall of the vein begins to sweat into the surrounding tissues. The tissues swell, their nutrition is disturbed.

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, leads to an overload of the lymphatic system and a violation of the outflow of lymph. Trophic disturbances are aggravated. Trophic ulcers are formed.

Causes of CVI

Chronic venous insufficiency can occur in the following conditions:

long-term varicose veins of the lower extremities;
post-thrombophlebitic syndrome;
congenital pathology of the deep and superficial venous systems (congenital hypo- or aplasia of deep veins - Klippel-Trenaunay syndrome, congenital arteriovenous fistulas - Parke-Weber-Rubashov syndrome).

Sometimes chronic venous insufficiency develops after phlebothrombosis. In recent years, phlebopathies have been singled out as one of the causes leading to the development of CVI - conditions in which venous stasis occurs in the absence of instrumental and clinical signs of pathology of the venous system. In rare cases, chronic venous insufficiency develops after an injury.

There are a number of adverse factors that increase the risk of developing chronic venous insufficiency:

genetic predisposition. The development of pathology leads to a genetically determined deficiency of connective tissue, which causes weakness of the vascular wall due to a lack of collagen.
Female. The occurrence of chronic venous insufficiency is due to a high level of estrogen, an increased load on the venous system during pregnancy and childbirth, as well as a higher life expectancy.
Age. In older people, the likelihood of developing CVI increases as a result of prolonged exposure to adverse factors.
Taking hormonal contraceptives and other hormone-containing drugs (due to increased estrogen levels).
Lack of physical activity, obesity.
Prolonged static loads (long trips in transport, standing or sedentary work), constant lifting of weights.
Chronic constipation.

CVI classification

Currently, Russian phlebologists use the following classification of CVI:

Grade 0. There are no symptoms of chronic venous insufficiency.
Grade 1. Patients are concerned about pain in the legs, a feeling of heaviness, transient swelling, night cramps.
Grade 2. Edema becomes persistent. Hyperpigmentation, lipodermatosclerosis phenomena, dry or weeping eczema are visually determined.
Grade 3. It is characterized by the presence of an open or healed trophic ulcer.

Grade 0 was chosen by clinicians for a reason. In practice, there are cases when, with severe varicose veins, patients do not make any complaints, and symptoms of chronic venous insufficiency are completely absent. The tactics of managing such patients differs from the tactics of treating patients with a similar varicose vein transformation, accompanied by CVI of 1 or 2 degrees.

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.

CVI classification according to the CEAP system:

Clinical manifestations:

0 - visual and palpatory signs of venous disease are absent;
1 - telangiectasia;
2 - varicose veins;
3 - edema;
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 with unknown cause (EP);
secondary CVI, developed as a result of thrombosis, trauma, etc. (ES).

Anatomical classification.

Reflects the segment (deep, superficial, communicant), localization (large subcutaneous, inferior hollow) and the 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 reflux and obstruction (PR, O).

When evaluating CVI according to the CEAP system, a scoring system is used, where each symptom (pain, swelling, lameness, pigmentation, lipodermatosclerosis, ulcers, their duration, number and frequency of relapses) is estimated at 0, 1 or 2 points.

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

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

CVI symptoms

CVI can present with a variety of clinical symptoms. In the early stages, one or more symptoms appear. Patients are concerned about heaviness in the legs, aggravated after a long stay in an upright position, transient edema, night cramps. There is hyper- (rarely hypo-) pigmentation of the skin in the distal third of the lower leg, dryness and loss of elasticity of the skin of the legs. Varicose veins in the initial stage of chronic venous insufficiency do not always appear.

As CRF progresses, local circulatory failure worsens. Trophic disturbances become more pronounced. Trophic ulcers are formed. The deposition of a significant amount of blood in the lower extremities can lead to dizziness, fainting, and signs of heart failure. Due to the decrease in BCC, patients with severe chronic venous insufficiency do not tolerate physical and mental stress.

Diagnosis of CVI

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

CVI treatment

When determining the tactics of treating 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 to restore the normal functioning of the venous and lymphatic systems of the lower extremities and to prevent relapses.

General principles of CVI treatment:

Therapy should be course. Some patients are shown short or episodic courses, others - regular and long. The average course duration should be 2-2.5 months.
Taking medications must be combined with other methods of treating CVI.
Treatment for CVI should be individualized.
To achieve 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 recommendations of the doctor.

Conservative methods are of primary importance in the treatment of chronic venous insufficiency: drug therapy (phlebotropic agents) and the creation of an additional framework for veins (elastic compression). Preparations for topical 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 the pathological venous shunt and remove varicose veins (phlebectomy). About 10% of patients with chronic venous insufficiency need surgical treatment. With the development of chronic venous insufficiency against the background of varicose veins, they often resort to minimally invasive miniphlebectomy.

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Forms of venous insufficiency

This disease can be divided into the following forms:

OVN (acute venous insufficiency of the lower extremities)

The onset of acute leg failure occurs after prolonged occlusion (for example, due to strong compression) of the deep veins and the violation of blood outflow caused by this process. Acute venous insufficiency of the legs is accompanied by pain in the region of the main 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 under the influence of cold decreases. 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 OVN.

CVI (chronic venous insufficiency of the lower extremities)

It is expressed by a constant violation of blood circulation in the area of \u200b\u200bthe vessels. 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, pigmentation disorders are noticeable in patients in the form of the appearance of age spots in the area where pathological changes have already begun to appear (in the area of blood flow disturbance).

In the absence of treatment for venous insufficiency of this form, age spots will become larger, and then they can grow into soft tissues and cause trophic ulcers that are difficult to remove. The last stage of CVI is accompanied by the formation of blood clots, pyoderma - a purulent lesion of the skin due to the ingress of pyogenic cocci on any of its sections and other pathologies.

Causes

The acute form of this disease can often occur in both the elderly and younger people. Among the possible causes of AVR, acute forms of thrombosis are distinguished, as well as injuries that necessitate ligation of veins located in deep tissues.

The main causes of chronic venous insufficiency include diseases such as varicose veins and post-thrombophlebitic disease. In addition, people with a low level of mobility and overweight have an increased risk of developing CVI of the lower extremities. Lifting weights or long-term performance of work in an uncomfortable sitting (or standing) position can also be reasons for the appearance of this pathology.

The following categories of the population can be attributed to the risk group of people who have the greatest chance of developing CVI:

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 at different stages of the disease. At the initial stage of its course, the symptoms of venous insufficiency may either be absent altogether or appear to a slight extent. Patients in this case express the following complaints:

a feeling of heaviness in the legs, aggravated by prolonged standing in a “standing” position;
increased swelling;
intermittent 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 violation, on the contrary, occurs in almost all patients.

With the development of pathology, the following symptoms can be added to the above symptoms:

violation 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 gradually complement each other.

In patients with chronic venous insufficiency of the lower extremities, the volume of circulating blood increases (in the vessels located in this zone), so they usually have a hard time enduring an increased amount of physical and mental stress.

Classification

In Russia, phlebologists - experts on "veins" - adopted the following classification of CVI, structuring this disease depending on its stage:

Grade 0. No symptoms of CVI;
Grade 1. Patients complain of pain in the legs, a feeling of heaviness, periodic cramps and swelling;
Grade 2. Edema becomes more pronounced and stable, increased pigmentation is noticeable, changes in the subcutaneous tissue of a degenerative-dystrophic nature (lipodermatosclerosis or "indurated cellulite"), dry or weeping eczema may appear.
Grade 3. It is 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 that required for CVI 1 or 2 degree of therapy.

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:

There are no symptoms of the disease; on palpation (palpation), CVI also does not make itself felt.
Steady expansions of small vessels are noticeable, while the inflammatory process is not started.
There is varicose veins.
There is swelling.
Increased pigmentation of the skin is noticeable, eczema and degenerative-dystrophic changes in the subcutaneous tissue are possible.
There are symptoms listed in the previous paragraph in the presence of a healed trophic ulcer.
Requirements 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 insufficiency of veins is also established:

Grade 0. The patient is able to work in full, 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;
Grade 2. The patient is able to perform work only under the condition of treatment with prescribed drugs;
Degree 3. Complete disability.

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

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

valvular insufficiency

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

Valve insufficiency occurs when the venous valves for some reason cease to function normally. With a low quality of treatment for valvular insufficiency of the veins of the lower extremities, the patient may experience a deterioration in general well-being, a decrease in body endurance, and an increased risk of cardiovascular diseases.

Venous cerebrovascular insufficiency (VHMK)

Venous cerebrovascular insufficiency is a pathology caused by obstruction of the outflow of venous blood from the cranial cavity. With severe coughing, playing wind instruments, strong screaming, squeezing the neck and some other phenomena, this condition often occurs in an easily reversible form.

Cerebral vein insufficiency disease is a consequence of another diagnosed and currently progressing diagnosis. Its appearance is often observed in traumatic brain injuries, osteochondrosis, bronchial asthma, various brain tumors, some pathological changes in the liver, prolonged cessation of nasal breathing and other pathologies.

VNMK in many cases proceeds asymptomatically. With an increase in the deterioration of the adaptive ability of the brain to work conditions with difficult blood circulation, patients may complain of frequent dizziness, memory impairment, headaches (aggravated by moving the head in any direction), darkening of the eyes, swelling of the eyelids and redness of the eyes. In some cases, with such a disease, convulsions, fainting and epileptic seizures can be observed.

Therapy for cerebrovascular insufficiency implies relief of the symptoms of the underlying disease, but when it appears, physiotherapy, oriental massage and some other methods of non-drug therapy will not be superfluous.

Diagnosis of the disease

It is possible to diagnose chronic venous insufficiency 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 under study. In addition, with the help of this manipulation, it is possible to determine the pressure in the vessels due to the reflection of ultrasonic waves from erythrocytes.

Duplex ultrasound scanning is a research method that also allows you to establish the presence of pathologies regarding the flow of blood flow, as well as objectively assess the condition of the veins.

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

Treatment

Treatment of venous insufficiency of the lower extremities is carried out both conservatively (with the help of drugs) and surgical methods. The use of drugs without the use of surgical intervention is effective in cases where the disease has not yet passed into a deep stage. In addition, the "therapeutic" approach will be rational in preparation for surgery and during the recovery period after it.

CVI treatment is carried out by phlebotropic (venotonic) drugs belonging to the pharmacological group of angioprotectors.

Phlebotonics include the following drugs:

Phlebodia. Produced in the form of tablets. It is used to eliminate the symptoms of swelling, is used to restore normal blood circulation in the vessels;
Detralex. Tonic tablets for veins that reduce the extensibility of the walls of blood vessels;
Angistax. The drug is available in the form of capsules, gel and cream. It has a herbal composition, which includes an extract of red grape leaves. It has a venotonic effect, normalizes the movement of blood through the vessels. To increase the effectiveness of therapy, it is advisable to simultaneously use both oral and external forms of the drug;
Troxevasin. A drug that is available in the form of capsules and gel, which in most cases is preferably used simultaneously. The drug is able to relieve the inflammatory syndrome and has an antioxidant effect;
Aescusan. Drops for oral administration. The composition of the drug includes vitamin B1, which contributes to the expansion of veins, and horse chestnut extract, which has an analgesic effect caused by venous diseases.

Preparations 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 blood thinners.

For the treatment of severe CVI, in the event of trophic ulcers on the skin, antibiotics of the penicillin series and the cephalosporin group can be prescribed. Their use can save the body from sepsis and other possible serious consequences.

Rules for applying compresses

A cold compress is made and applied as follows:

Two pieces of gauze are folded several times and placed in a container with cold water or ice. 2 pieces are needed 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.
After both compresses have cooled down sufficiently, one of them is placed on the affected surface and held on it for 2 to 3 minutes. After this time, the compress is changed, and the “spare” is cooled for reuse.
The above procedure must be repeated for at least 1 hour.

After the elimination of the acute stage of inflammatory processes, the use of warming ointments that slow down blood clotting (for example, heparin) is allowed. The use of such an ointment is allowed in the form of a warm compress. For the correct imposition of such a compress, it is necessary to adhere to the following procedure:

Fold the gauze used for the compress into 3-4 layers.
Soak the used piece of gauze with an ointment with a warming effect.
Apply gauze to the affected area.
Close the impregnated gauze with a polyethylene or compressor bag.
On top of the package, it is necessary to lay out a sufficient amount of cotton wool for insulation, and it is even better to ensure that the compress is warmed with a woolen cloth. Fix 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 therapy for venous insufficiency

In especially severe cases, more radical approaches to the treatment of the disease may be required, namely, surgical intervention. In modern medicine, the following manipulations are used for these purposes:

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. Manipulation is relatively painless, local anesthesia for its implementation will be quite a sufficient method of pain relief. Used to remove veins of small diameter;
laser surgery. Manipulation in which damaged veins are irradiated with laser light from the inside, after which they are glued together and subsequently resorbed. The procedure does not require any surgical incisions. With the help of laser surgery, it is possible to remove both damaged large veins and varicose veins on the legs;
surgical removal of damaged veins. It implies the need for incisions to gain access to the damaged vein, its ligation and subsequent removal. The operation is performed only under general anesthesia. Veins of large diameter are subjected to surgical removal.

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

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HVN - What is it?

Chronic venous insufficiency of the lower extremities (CVI) is a set of certain symptoms that are caused by poor outflow from the veins of the lower extremities due to a violation of their hemodynamics.

Two main factors are involved in the pathogenesis of the development of the disease.

Firstly, this is a decrease in the diameter of the vessel and, as a result, a decrease in its transmission capacity.
Secondly, there is a violation of the mechanism that ensures the outflow of venous blood from the veins of the lower extremities.

How it looks in practice: normally, in a person, the outflow of blood from the veins of the lower extremities occurs through the system of deep and superficial veins to the heart. This flow of blood against gravity is made possible by a valve mechanism in the veins that prevents blood from flowing in the opposite direction. A certain role is played by the contraction of the muscles of the thigh and lower leg, as well as the state of the vascular wall.

If this well-established outflow system malfunctions, then venous blood, instead of rising from the veins of the legs to the heart, is delayed, causing overflow of the vessels and the appearance of various unpleasant symptoms. So, microcirculation processes are gradually disturbed, edema and trophic disorders develop.

Important! The highest venous pressure is in the lower third of the lower leg, so it is here that the first problems with venous outflow begin.

In fact, CVI is not a separate diagnosis. This is a complex of symptoms associated with disruption of the veins, which can occur both in congenital and acquired pathologies.

Causes

Causes of venous insufficiency of the lower extremities:

decrease in the diameter of the venous bed;
disruption of the valve mechanism, in case of problems with which there is a backflow of blood into the vein.

The most common cause of CVI is varicose veins and post-thrombophlebitic syndrome. In rare cases, the problem is caused by congenital vascular anomalies (fistulas, fistulas) and traumatic injuries.

In addition to these key causes, contributing risk factors for this pathology are:

Hereditary predisposition to the development of weakness of the vascular wall.
Pregnancy. In addition to hormonal changes, during this period, the load on the vessels increases, which leads to the development of varicose veins and the appearance of chronic venous insufficiency in every third woman.
Hormonal disorders and endocrine pathology.
Excessive physical activity.
Overweight and metabolic disorders.
Atherosclerosis.
Congenital anomalies of the veins.
Alcohol and smoking, which reduce the tone and elasticity of the walls of blood vessels.
Hormonal contraceptives, etc.

According to the clinical course, three stages are distinguished, first of all, it is necessary to select the appropriate therapy - the symptoms and treatment of venous insufficiency of the lower extremities depend on the stage of the disease and are determined by:

1. Stage of compensation. At this stage, the symptoms of venous insufficiency of the lower extremities remind of themselves only by cosmetic signs: vascular "asterisks" appear, varicose veins on the legs are visible, etc.

Some patients note increased fatigue in the legs and the appearance of swelling in the evenings, others do not pay attention to it. You can learn about the diagnosis and assess the degree at this stage only with the help of special studies.

2. Stage of subcompensation. At this stage, the patient develops trophic disorders that are treatable. Standard patient complaints at this stage:

pain and fatigue of the legs;
cramps and tingling in the legs;
itching of the skin;
trophic disorders (ulcer, eczema).

Even at this stage, patients most often turn to a specialist, primarily because of cosmetic defects (ulcers, varicose veins).

3. Stage of decompensation. Irreversible trophic disorders occur. The patient is disturbed by pronounced edema (elephantiasis), severe ulcers develop that cannot be treated, the color of the skin on the legs changes (purple-black), they suffer from pain, and there are problems with walking.

Important! In addition to the stage, when making a diagnosis of CVI, indicate the underlying disease that caused the development of the symptom complex, as well as the form of CVI: edematous, painful, varicose, ulcerative or mixed. Therefore, the diagnosis will sound something like this: Varicose veins. CVI stage II, edematous-painful form.

Treatment of venous insufficiency

Treatment of venous insufficiency of the lower extremities depends on its degree, form and the presence of concomitant complications. The problem is solved conservatively and surgically.

Conservative therapy consists of:

taking drugs that improve the tone of the vascular wall (phlebotonics) and the rheological properties of blood;
elimination of risk factors (weight loss, normalization of nutrition and physical activity, pregnancy planning);
physiotherapy;
prevention of the progression of the pathological process (wearing compression underwear, bandaging, exercise).

Surgical treatment is aimed at eliminating directly varicose veins. For these purposes, sclerotherapy is used (a sclerosant substance is injected subcutaneously, which causes adhesion of the walls of the vessel), as well as various operations for resection of superficially altered veins (according to Troyanov-Trendelenburg, according to Linton and others).

Complications

Most patients mistakenly believe that ugly dilated veins are the main complication of the disease, but the problem is much more serious.

Complications of CVI can be:

Trophic ulcers. These are non-healing skin defects that appear at advanced stages. Not amenable to treatment and cause excruciating pain to patients.
Thrombophlebitis - inflammation of the vein wall with the formation of blood clots (blood clots).
Pulmonary embolism. The detachment of a thrombus and its migration through the bloodstream can cause blockage of one of the branches of the pulmonary artery and lead to death.
Eczema and erysipelas.