Symptoms and treatment
What is chronic venous failure? The causes of the occurrence, diagnosis and treatment methods will analyze in the article of Dr. Hitaryan A. G., Flebogus with experience in 34 years.
Definition of the disease. Causes of the disease
Chronic venous insufficiency (HSN) - pathology arising from violations of venous blood outflow in the lower limbs. It is one of the most common diseases related to the vascular system.
Hval affects more female half of the population than men. A quarter of the inhabitants of developed countries of the world can identify this state.
Often, the helms are confused with the varicose veins of the lower extremities, which is delusion. HPV can exist without visible manifestations of the extension of the veins.
Heredity, overweight, hypodynamine, previously suffered diseases of the vascular system (or thrombosis), violation of the hormonal background and increased intra-abdominal pressure, may be causes of blood outlet disorders in the lower limbs.
In women, the development of the disease occurs more often during pregnancy and childbirth. During pregnancy, the level of progesterone and estrogen increases significantly. They weaken the walls of the veins. In addition to hormonal changes, the progression of the HSN can be associated with the displacement of venous vessels in a small pelvis, as well as with an increasing uterus. The deterioration of the venous wall states can be associated with a change in pressure in the veins, during battles during childbirth. High estrogenic background, vests of veins during childbirth are the main perpetrators of the disease.
Frequent and prolonged static loads, raising gravity lead to the beginning of the disease and its progression. Patients consider normal clinical manifestations of Hoods, associated them with fatigue and insufficient physical activity. Unfortunately, patients will defimately turn to those skilled in the first symptoms of the disease. Athletes are most often susceptible to athletes, people with excess body weight, pregnant women.
The underestimation of the severity of the disease leads, as a rule, to severe consequences: the expansion of the veins, their inflammation, thrombosis, the formation of trophic ulcers on the lower limbs (frequent complications of the Hood).
When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Clinical signs of Hood are diverse and do not depend on the progression of the disease.
The initial stage is manifested by one or immediately complex symptoms. Only the cosmetic defect "asterisk" (TeleangiTasy - Tae), as well as the emergence of discomfort, severity in the legs, increasing during the long stay on the legs, can be a reason for appealing to a specialist. Muscle spasms and skin irritation can be met less often, which can appear in varying degrees. Varicose-extended veins may not be, but, as a rule, when examined, signs of lesion of intradermal veins are detected.
Basically, the manifestation and course of the helium are reduced to the following complaints:
- the appearance of "asterisks", strengthening by the end of the day of the ethony of the feet and the heads;
- muscular spasms and feeling of running goosebumps;
- decrease in temperature and disruption of leg sensitivity;
- the appearance of pigmentation on the legs;
- discomfort and fatigue of the lower extremities.
As pregnancy develops, women begin to increase the degree of occurrence of named signs. Their appearance is reduced within a week after the birth of the child.
Often, people with hoops complain about the feeling of heat in the legs, the appearance of itching, burning and feelings of gravity. Most often, the intensity of the symptoms of the HSV increases to the second half of the day or in connection with the increase in air temperature.
The occurrence of pain in the lower limbs is due to the violation of the valves, leading to the transition of blood flow from deep veins into the surface. Due to the increase in pressure in surface veins, there is a gradual increase in pain, humanity, dryness and hyperpigmentation of the skin occurs. Primary trophic violations can cause an opening of an ulcers.
A significant amount of circulating blood (BCC) begins to delay in the lower limbs, which leads to dizziness, fainting and heart failure. Since the BCC decreases, people with severe helms do not really manage to cope with physical and mental loads.
In the soreness of the veins and redness over the skin during the period of the flow of symptoms of the Holy, there is a risk that they can precede vein thrombosis in the lower limbs.
Pathogenesis of chronic venous insufficiency
Pathogenesis helve is very specific. In a healthy person, blood outflows occurs through deep veins of the shin. Due to the joint work of a constantly shrinking and relaxing skeletal muscles and the valve apparatus, the blood is directed to the heart, where it is saturated with oxygen. In the process of this work, a smooth skeletal musculature enhances the pressure on the vein, and the valve system, which consists of closed flaps, does not allow the blood of the strength of gravity.
Because of the long existing risk factors, venous hypertension occurs, there is an expansion and protrusion of the walls of the veins. Valve flaps are diverged and cannot prevent the pathological outflow of blood. The increased blood volume is stronger than the vein wall, so Vienna expands. If you do not start treatment, Vienna will continue to expand. The walls of the vessels will begin rapidly lose their elasticity, their permeability will increase. Through the walls in the surrounding tissues, elements of blood, plasma will be released. Thus, there is a tissue ease, which is even more impoverished by their oxygen. Free radicals, inflammation mediators are accumulated in the tissues, the mechanism of activation of leukocytes is launched. It disrupts the nutrition and metabolism of tissues. The final result is the formation of "venous" trophic ulcers, which significantly reduces the quality of the patient's life.
Classification and stage of development of chronic venous insufficiency
On clinical features, the following stages of Hood are distinguished:
- 0 Stage - cosmetic defect, the appearance of Tae, which does not cause any clinical manifestations;
- I stage - swelling of the legs and stop, increasing closer in the evening;
- Stage II - pain in the course of varicose-expanded veins increasing at night. At palpation of veins can be painful;
- III stage - the constant efficiency of soft tissues, the feeling of numbness and cooling legs, the soreness increases significantly, the convulsions are joined, which are also growing at night;
- IV stage - skin changes, pigmentation, venous eczema, lipodermatosclerosis (varicose dermatitis);
- V Stage - Skin Changes indicated above, and healed ulcer. At this stage, bleeding can begin, the veins are blocked by blood closures, thrombophlebitis occurs.
- VI Stage - Skin Changes indicated above, and active ulcer.
Thrombophlebitis can only be cured by a surgical intervention.
Complications of chronic venous insufficiency
Complications of HSN include bleeding from an extended vein, thrombophlebitis and venous ulcers. All these complications arise in the later stages of the HSN with a long period of the disease.
Bleeding from extended veins may occur after traumatization or start spontaneously. The reason is the violation of the integrity of the ulcerated skin over the veins. As a rule, these veins are located in the ankle area. This zone is distinguished by very high pressure in the veins, especially in the vertical position of the body. Venous blood has a low coagulation, so the bleeding data at late diagnosis is very abundant. Emergency care lies in the immediate transfer of the patient in a horizontal position, the limbs give the sublime position and impose the gulling bandages, if there is an opportunity for elastic binting. Phlebologists can flash a bleeding vessel or glue it with special preparations.
The trophic ulcer develops in the lower third of the leg, in the zone of maximum skin disturbances. First, brown spots appear there - pigmentation. Then in the center there are whorescent seals resembling paraffin sided. This is seen as a predicable state. Even the slightest injury of this site can lead to a skin defect.
The resulting skin defect begins to increase progressively, skin inflammation begins around. There is infection of ulcers. She begins to mock, thereby the zone of inflammation increases. When maintaining the reasons that caused the formation of ulcers, it appears again and again. Therefore, the optimal tactics of treatment is the priority elimination of the causes that caused an ulcer, and the prevention of its recurrence. Conservative treatment consists in adequate elastic compression, the selection of compression knitwear for patients with trophic ulcers, using special wound coatings for various stages of inflammation of trophic ulcers.
Diagnosis of chronic venous insufficiency
It is important to know that in the treatment of any disease, the main thing is to identify it in the early stages, thereby you can prevent possible complications, minimize costs and significantly reduce the treatment time.
Conducting the diagnosis of HSN in the early stages contributes to the acceleration of treatment. Diagnosis is important to determine the stage of the disease. After a general clinical inspection, the doctor conducts duplex angiusing of the veins of the lower extremities to determine the tactics of treatment. Duplex angiosication will help assess the state of the test vessels, see the places of their essences or extensions, as well as reveal thrombosis.
For self-diagnostics, the helium is enough just to look at your feet. Symptoms such as humanity, pain and convulsions, as well as the appearance of vascular grids and veins on the legs, are "alarming call" for a hike to phlebologist.
One of the most affordable methods for diagnosing this disease is an ultrasound, the main advantage of which is a reusability of applying without risks for health, painlessness, as well as the ability to identify violations in the current work of the venous apparatus.
To obtain a better result, the survey is recommended in the afternoon. Since it is after day-to-day load on the legs, a more accurate estimate of the valve states, the vein diameter and the degree of damage to the walls can be carried out. The tactics of treatment affects the presence of a thrombus in the lumen of the veins, which leads to a blood flow violation and carries the greatest threat to the patient's life.
Treatment of chronic venous insufficiency
The methods of treating the HSN quite a lot. In specialized clinics, the main place is occupied by minimally invasive treatment methods, that is, operational interventions with minimal damage to the skin.
Endovazak Laser Coagulation (EVLK)
In developed countries, assistance using laser technology is obtained up to 40% of patients suffering from this disease. With early diagnosis, the treatment takes a little time and does not leave marks. In many clinics, a phlebological water laser is used with a wavelength of up to 1500 nm that supports radial filaments. This technology is allowed to close veins of any diameter through a small skin puncture.
The sclerotherapy method is based on the introduction of sclerosant into the lumen of the affected vessel. Thanks to this substance, Vienna is bumping into and fading completely. With a deeper arrangement of varicose veins, the Echo-sclerotherapy technique is applied. For more accurate intravenous drug administration, the procedure is performed under the control of the ultrasound. With this technique, the connective tissue is replaced, which disappears within a few months. Sclerotherapy is also used to eliminate external cosmetic manifestations of varicose veins.
The diode fluorescent sclerotherapy method is to highlight the fluorescent lamp of teleangioectasis (up to 0.4 mm) or the reticular veins (up to 2 mm), in the lumen of which a special solution is introduced.
A promising direction in aesthetic phlebology is the combined use of a diode laser and sclerotherapy - laser cryotherapy (CLACS). This method allows to eliminate reticular veins and teleangioectas without special feelings.
Conservative therapy Hood is lies in:
The patient should not worry about the choice of the method of treatment, as the phlebologist will select an individual therapy by age depending on the age and type of activity of the patient, on the form of its disease and the presence of pathologies. Usually, when contacting large phlebological centers, experts for the treatment of one patient simultaneously use many methods. For example, for the most effective and efficient treatment, the HSN performs a laser operation in combination with injection methods for the treatment of veins.
Forecast. Prevention
There are several methods that contribute to a decrease in the risk of developing pathology and stop the progression of HSN.
The greatest positive effect gives an increase in physical activity. Daily walking (preferably 2-3 km), sports walking, running, swimming, cycide ride venous pressure. If long-term orthostatic loads are characteristic of your work, then try to make 10-15 minute breaks during the working day, during which the muscles knead the legs or take a horizontal position, while the legs should be raised.
When having the adoption of hot baths, visiting the bath and saunas is strictly contraindicated, because it causes an increase in veins, their overflow and disrupts blood outflow.
Reduce the risk of strengthening SHAL symptoms allows reducing the time of staying in the sun and in solarium, due to which muscle and venous tone decreases.
In a stop of the HSV progression, there is an important role to monitor the body weight, after all, the greater the weight of a person, the greater load of the vessels of the legs. From the diet, fats, salt and sugar, all sharp and spicy should be eliminated as much as possible. The use of spicy and salty dishes causes a fluid delay in the body, fat deposition and weight gain. It is necessary to use as much as possible coarse fiber and dietary fiber.
Women are recommended as much as possible to go to the shoes on a high heel (above 4 cm). Due to the high heel, the muscles of the lower extremities can be continuously voltage, thereby increasing the load on the vein. To restore the natural outflow of blood, the legs need to give rest for a few minutes, removing shoes every 2-3 hours. Remember that choosing free, stable and comfortable shoes, you can avoid problems with vessels.
People entering the risk group of the development of this pathology should be wearing exceptionally loose clothes and socks without tight gum. For people who have a tendency to the Holy, it is recommended to wear a compression knitwear, selected by consulting Flaboball specialists.
Chronic venous insufficiency (il) is a combination of clinical manifestations resulting from a disturbance of blood outflow in the veins system. HSN includes diseases such as varicose veins, post-tombotic disease, congenital and traumatic anomalies of venous vessels.
Hood of the lower extremities is currently the most common vascular disease. In women, Hood is found three times more often than in men.
Video about chronic venous insufficiency
Causes of chronic venous insufficiency
The predisposing factors of the development of HDF include:
Heredity;
- female;
- re-pregnancy;
- excess body weight;
- insufficient physical activity;
- Heavy physical work associated with lifting weights, long stay in the standing position or sitting.
The main reason for the occurrence of the disease is the violation of the work of the muscino and venous pump. Normally, blood outflow in the lower limb area is carried out on the deep (90%) and surface veins (10%). To promote blood to the heart in veins there are valves that prevent blood movement down under the action of gravity. Also play the abbreviation of the muscles of the thigh and the tibia, which prevents the reverse current of the blood.
The worst conditions for normal blood flow occur in the vertical position of the body in the absence of active muscle contractions. Thus, blood flow occurs, increase pressure in the veins system and, as a result, their expansion. The insufficiency of the valve apparatus is formed, the valve flap is not completely closed, and an abnormal blood flow occurs from top to bottom.
This leads to an even greater increase in pressure in the veins. As a result of increased pressure, the permeability of the venous wall increases, it swells, squeezing the surrounding tissues, disrupting their nutrition. In the final in this place a trophic ulcer is formed.
Symptoms of chronic venous insufficiency
In the following signs, it is necessary to turn to a specialist with the aim of eliminating the Holy: a small severity in the legs, which arises mainly in the evening or after static load; Entrids ankles (fingers are not affected by). Edems appear in the evening (one can determine the presence of traces from the socks gum), the degree of severity depends on the duration of physical exertion. It is important that in the morning the edema is not defined. Perhaps the presence of varicosely extended veins or "vascular stars" (visible expansion of small wreaths). All these signs indicate the presence of the HSD of the first degree.
External manifestations of HSN.
Over time, intense, sawing pains in the legs, burning care; The cramps of the calf muscles that appear, as a rule, at night. Evenkers become persistent (revealed at any time of the day), the skin is pale, cold to the touch, in addition, as a result of poor blood circulation on the skin, sites of hyperpigmentation (brownish staining), lipodermatosclerosis (inflamed red skin, painful when feeling) and eczema ( Skin thinning over an extended vena, it becomes spotted, strongly itches). In this case, there is a scene of 2 degrees.
The presence of an open or healing trophic ulcer, as well as the complications of the HSN (bleeding, deep veins thrombosis or thrombophlebitis) confirms the Hood of 3 degrees.
The formation of ulcers when Hood occurs in several stages. Initially, a section of brownish skin staining appears. Over time, the center forms a seal having a whisper, lacquer, resembling a paffine. In the future, even minimal injury leads to the opening of the ulcerative defect. In case of late treatment, the sizes of ulcers increase progressively, the infection is possible.
It also distinguishes 0 degree of coal, when even a pronounced extension of the veins and "vascular stars" are not accompanied by weight in the legs, pain and edema. At this stage of the disease, treatment is also necessary.
With incorrectly or late treatment, it may bring to formidable complications, such as deep veins thrombosis (full or partial closure of the lumen of the vein thrombus) and thrombophlebitis (inflammation of the vein wall, concomitant thrombosis). At the same time, it suddenly occurs, swelling rapidly increases, which covers the entire lower limb, is accompanied by intense powdering pain. In the eyes there may be redness or scenario, painful skin sealing, and there is no connection with the preceding physical activity, there may be no varicose veins, the sections of brownish coloring of the skin and ulcers. If the thrombus breaks up, then with a blood current, it can get into the lungs and cause a severe disease - thrombomembolism of the pulmonary artery (full or partial closure of the lumen of the artery thrombus). This complication is often mortally. With suspected thrombosis of deep veins or thrombophlebitis, it is necessary to immediately lie down, give the leg to the eclipse, call the ambulance brigade. It is strictly forbidden to knead the muscles, lubricate with any ointions, step on a sore leg.
It should also be feared the injuries of the affected area, as they can lead to the development of strong bleeding. In the case of bleeding, it is necessary to bandage the foot of the harness (medical or improvised) head of the harness (medical or improvised), so much so that the bleeding stops, and immediately cause a team of ambulance. Bleeding from varicosely extended veins also relates to complications threatening life.
Symptoms of Hoods, such as pain in the lower extremities and swelling, are characteristic of a number of other diseases:
"Heart" swelling. The presence of heart disease, hypertensive disease. The swelling of the lower extremities appear at any time of the day, more often constant, always bilateral. No connection with exercise. The pain in the lower limbs is usually absent, expressed only at a significant edema. The skin in the field of edema is warm, normal coloring.
Swells with lymphideme (violation of the outflow of lymph). Also, as well as when the tie swells appear closer in the evening, are associated with exercise. Skin in the field of edema of ordinary color and temperature. With a pronounced edema process, the hip region is captured. Pain of various intensity. But there are no extended veins and ulcers. To distinguish this disease from the HSN is possible when conducting lymphography (instrumental study of the lymphatic system).
With the arthrosis of swelling and intense pains are determined only in the zone of the affected joint. The mobility of the joint is drastically limited at the beginning of the move, then, with a continuation of the movement, the mobility is somewhat improved, the pain becomes less intense. Differentiate this disease and helms will allow the ultrasound and X-ray content of the joint.
With osteochondrosis of the lumbar spine the greatest severity of pain in the popliteal yam. The pain pulling, can "shoot" in the thigh and the buttock area arises, as a rule, at night. The intensity decreases after the course of anti-inflammatory therapy. Edema is not characteristic.
To distinguish these diseases from the HSN in the state only a qualified specialist.
Diagnosis of chronic venous insufficiency
When contacting the doctor, you will be offered the following examination:
General blood analysis. In terms of erythrocytes and hemoglobin, it is possible to judge the degree of blood viscosity, according to the number of platelets, the state of the blood coagulation system is estimated, the increase in the number of leukocytes indicates the presence of inflammation.
Biochemical analysis of blood and urine. Changes in these indicators are not specific, depend on the presence and severity of concomitant diseases.
The most accurate method of diagnosing venous pathology is Uzi vessels of the lower extremitiesIn the course of which the velocity expansion sections are determined, the presence of varicose nodes, thrombov. Uzi vessels of the lower extremities should be carried out in the presence of any of the above signs of the Holy.
With dubious data, ultrasound resort to surgical methods, for example phlebography (intravenous administration of a contrast agent in order to estimate the state of the venous system).
Treatment of chronic venous insufficiency
Treatment of HSN - a complex process, the duration of which directly depends on the stage of the disease. Therapeutic measures are divided into surgical and conservative (not surgical). Despite the greatest prevalence of the disease, the share of surgical methods accounts for only 10%. Timely started treatment will allow to restore normal venous blood flow and avoid complications.
Conservative treatment of venous insufficiency includes a decrease in the severity of risk factors, physical activity recommendations, elastic compression, drugs and physiotherapy. The application of these activities in the complex provides the best result.
If possible, it is necessary to identify the risk factors for the progression of the disease, such as, for example, obesity, the reception of oral contraceptives, improper physical activity, and try to adjust them.
Also for each stage of the disease, the doctor must provide recommendations on physical exertion.
Regardless of the stage, it is recommended: as often as possible to give the legs into the sublime position, at night put a pillow at night, wearing comfortable shoes. Sports recommended walking, swimming, with Hood 0-2 stages - cycling, easy run. Physical education (except for swimming) is carried out using elastic compression. It is necessary to exclude the occupations of the types of sports, with which there is an increased probability of limbs injury and need sharp (jerky) loads on the lower limbs: football, basketball, volleyball, tennis, skiing, various types of martial arts, exercises associated with lifting weights. At home, regardless of the stage of the disease, the next set of exercises is possible.
Elastic compression is the use of elastic bandage or medical knitwear. At the same time, due to the dosed squeezing of the muscles of the lower extremities, blood outflow is improved on veins, which prevents the further expansion of the veins and the formation of thrombus. In addition, skin protection is protected from mechanical damage, the risk of ulcers is reduced. The use of elastic compression is shown at any stage of the disease.
Rules for using elastic bandages:
Elastic bandaging begins in the morning, before lifting from the bed. The bandage is applied to the bottom up with the mandatory capture of the foot, heels to the hip region. Each overlay turnover of the bandage should cover the previous half. Squeezing should not be intense, do not cause pain. In the case of "slipping" of the bandage it must be tied up.
Disadvantages when using elastic bandages:
Poorly fixed on foot;
- It is difficult to achieve the necessary squeezing of the muscles;
- After several styrics stretch.
These shortcomings are deprived of medical compression knitwear (golf, stockings, tights). Depending on the HDD stage, 3 class of compression (compression) is allocated, which must be considered when purchasing product data.
Compression knitwear does not apply if available:
Severe cardiopulmonary failure
- severe disease of the bottom limbs
- damage to the skin of the lower extremities (dermatitis, eczema, acute grinding inflammation, infected ulcer). In this case, elastic compression is carried out by a special way.
By 0-1 stages of the disease The gold standard of treatment of cosmetic defects is sclerotherapy - a method for treating extended surface veins and "vascular stars". A sclerosis is introduced into the vein (a special substance that leads to the cessation of blood flow in this vein). In the final of the Vienna, the cosmetic defect disappears.
0-1 stages for prevention, at 2-3 stages for the purpose of treatment it is necessary to use drugs. Most drugs are aimed at improving the veins, improving the nutrition of surrounding tissues. Course treatment is long, 6 or more months.
Currently applied: Detralex, cycle 3 Fort, Gincor-Fort, Troksevazin, Anvenol, Eskusan, Asklezan, Antistax, Phlebodia 600. The use of a drug, as well as a treatment diagram should be discussed with a specialist. The use of local treatment (ointment, gels) in the absence of complications (thrombophlebitis) is inappropriate.
Since the stage of the disease is characterized by the presence of an ulcer. Treatment of trophic ulcers is a complex process, including both the general and local impact. Local treatment implies the processing of the area of \u200b\u200bthe Russian Academy of Sciences by antiseptics, the use of enzymes, if necessary, is a surgical removal of dead particles. Daily - two, three-time toilet wounds using both standard drugs (dioxide, dymexide, chlorhexidine) and cooked at home (weak manganese and chamomile decoction). After machining, ointment is superimposed (Levomikol, Levosin).
Physiotherapy has an auxiliary value in chronic venous insufficiency. Used with any degree of severity of the process according to the indications. For example, diadinamic currents, electrophoresis, laser, magnetic field possess a good effect.
With good results of conservative treatment, further lifestyle correction is recommended, regular physical exertion, elastic compression. The decision to conduct a re-course of treatment is necessary in the recurrence of the disease, the emergence of complications or with a prophylactic goal.
With the ineffectiveness of conservative treatment, the issue of surgical treatment is solved. In addition, surgical treatment is necessary at:
Complication of Hood (thrombosis, thrombophlebitis, bleeding).
- The presence of long-lasting ulcers.
- pronounced cosmetic defect.
Surgical treatment consists in removing the modified veins. The volume of the operation depends on the severity of the process and complications.
Rehabilitation after the operation depends on its volume, but it is necessary to mention the general principles. The seams are finally formulated after 6 months, therefore, to avoid their discrepancy and subsequently a cosmetic defect, it is necessary to exclude a strong mechanical effect on them (the use of rude washcloths, rigid clothes). It is necessary to wash only warm, better cool water. After the operation, it is recommended to wear elastic bandages for 3 months, after which another 3 months wearing elastic healing stockings. In the future, elastic compression is used in the case of the planned "harmful" physical exertion (long-term moving, flights, a long stay on the legs, hard work). It may take the prophylactic use of drugs that improve the tone of the veins.
Prevention of chronic venous insufficiency
Currently, the prevention of Hood is of great importance. Implementation of simple events can significantly reduce the emergence of the disease of the veins of the lower extremities:
Maintaining a mobile lifestyle, alternation of static load with walking, running, swimming.
- During the rest, keep legs in a raised position.
- follow body weight
- Wear comfortable shoes with a heel to 4 cm, if necessary, use orthopedic insams.
- When using estrogenic drugs (oral contraceptives), during pregnancy in a planned order to perform ultrasound veins of the lower extremities.
- If necessary, use elastic compression and drugs.
Doctor Therapist Sirotkin E.V.
Catad_Tema Chronic Venus Diseases - Articles
Chronic venous insufficiency
Serov V.N., Zharov E.V.
FGU NTSAGIP
Chronic venous insufficiency (il), or chronic vein diseases on the MKB-10 terminology, include varicose veins, post-tombotic disease, congenital and traumatic anomalies of venous vessels.
The Hood of the lower extremities is currently the most common pathology of the human vascular system and is characterized by impaired venous outflow on the macrohereodynamic level, which lead to the disorganization of the regional microcirculation system. The emergence of this pathology in the spectrum of diseases of the human body is due to the transition of our distant ancestors to movement in a vertical position. A person is the only representative of the animal world of the planet suffering from the Holy.
Epidemiological studies show that chronic diseases of the veins are marked more than a third of Russians, and more often in women than in men. Such a high frequency of occurrence allows you to boldly call the Holy "Civilization disease". Moreover, if earlier the disease relate to the problems of persons of the older age group (more than 50 years), then at present, 10-15% of schoolchildren at the age of 12-13 reveal the first signs of venous reflux. Obviously, the development of the HSN is a process extended in time, that is, subject to the detection and treatment of the disease in the early stages, one can actually reduce the number of ill formals of the disease in time.
The encoding of all classes in the population ranges from 7 to 51.4%, and in women - 62.3%, in men - 21.8%. The quantity of high gravity and severe occurs in 10.4% (12.1% of women and 6.3 men), with the development of trophic ulcers - in 0.48% in the population. The frequency of varicose veins in pregnant women ranges from 20.0 to 50.0%, and when taking into account all forms, it reaches 70-85%.
A variety of risk factors are proposed, they include accommodation in industrialized countries, hypodynamine, female floors, the presence of helms in relatives, constipation, obesity, repeated pregnancy.
The relative risk of the development of varicose disease during pregnancy in women 30-34 years and women over 35 years is 1.6 and 4.1, respectively, compared to those in women under 29 years old. The relative risk of the development of the HSN in women who had 1 genera in history, and women who had 2 genera and more, equal to 1.2 and 3.8 compared to the risk of primariable. The presence of varicose disease in the family increases the risk of HPV to 1.6. At the same time, the bonds and body weight of the patient did not detect the patient. The risk of developing HSN during pregnancy also increases with an increase in the age of pregnant, reaching 4.0 in pregnant women older than 35 years compared to pregnant younger than 24 years.
Traditionally, it was believed that the valve insufficiency of various parts of the venous channel of the lower limbs, leading to the appearance of pathological, retrograde blood flow, which is the main factor in the damage to the microcirculatory bed, is also considered to be the basis of Pathogenesis. This theory is based on the results of a macroscopic examination of the venous system of the lower extremities, first using radiocontrase phlebography, and then with the involvement of non-invasive ultrasound methods. However, a large number of patients were revealed with complaints characteristic of coals in the absence of valve pathology. At the same time, the use of plethysmography fixed varying degrees of severity violation of the tone of the venous wall. Due to this would be laid hypothesis that the HSN is not a valve disease disease, but the pathology of the vein wall.
It has been proven that in the presence of various risk factors (genetically deterministic defects of connective tissue, change in hormonal background, long-term static loads, overheating, insufficient physical activity, etc.) and under the action of gravity in the venous capillary knee, the pressure reduced the arteriolienary gradient needed for normal Perfusion microcirculatory bed. The consequence of these processes becomes first periodic, and then constant tissue hypoxia. In addition, the constant change in the position of the body and the uneven load on the various parts of the venous channel of the lower extremities launches another little learned mechanism that called the mechanotransduction, or the shift force. This means that under the influence of constantly changing the strength and direction of pressure, there is a gradual loosening of the connective tank frame of the walls of Wesull. Violation of the normal intercellular relations of the endothelium of venous capillaries leads to the activation of genes encoding the synthesis of various adhesion molecules.
Certain changes undergo blood flow through the venous microcirculatory line. Thus, erythrocytes having a more stable and ergonomic shape, push the leukocytes to the periphery and, in the literal sense of the word, cause them to roll along the endothelial layer with already activated adhesion receptors. As a result, leukocytes stick to the endothelium Vevel and under the influence, it is not yet to the end of the well-known mechanism, they begin to infiltrate the venous wall, and then soft tissues.
Such a process with elements of aseptic inflammation captures all new parts of the venous channel of the lower extremities and even acquires generalized. Aseptic inflammation and constant remodeling of the connective tissue matrix lead to macroscopic changes in the venous bed. Moreover, there is every reason to believe that the damage to venous valves is associated with leukocyte aggression. This provision is confirmed by microscopic studies of insufficient venous valve sashs, in which their infiltration is often detected.
In the pathogenesis of the development of varicose veins, the increased uterus plays a role only in the third trimester of pregnancy, having compression on the iliac and lower veins, which causes a decrease in blood flow through the femoral veins to 50% (according to duplex mapping).
According to the hormonal theory of pathogenesis of varicose disease in pregnant women with increasing pregnancy period, progesterone products increase, reaching 5 μg / day. This leads to a decrease in the tone of the venous wall and increases its extensibility to 150.0% of the norm, returning to the initial indicators only 2-3 months after delivery. The risk of developing varicose disease increases with family predisposition, with the number of pregnancies and age.
Consequently, the basis of the Pathogenesis of the HSV lies damage to the venous wall as a result of the effects of physical (shear force) of factors leading to the synthesis of cell adhesion molecules and leukocyte activation. All this opens up prospects for preventive helical therapy with the help of drugs - venous wall protectors.
A special place among the various forms of the HSN occupies a frequently encountered varicose veins in women against the background of pregnancy. Not all experts correctly interpret this situation, the outcome of which can be a relatively favorable course without complications against the background of pregnancy and childbirth, up to the complete disappearance of the expansion of the veins in the postpartum period. But the misconception of the patient, complicated during the pregnancy itself, create a threat to the development of venous thrombosis with risk of thromboembolic complications.
The main etiological factors for the development of HSV outside pregnancy are considered to be the weakness of the vascular wall, including connective tissue and smooth muscles, dysfunction and damage to the endothelium veins, damage to venous valves, microcirculation disruption.
All listed factors are present and exacerbated during pregnancy.
The sickness of the lower hollow vein and the iliac venue of a pregnant ukroke leads to venous obstruction and, as a result, to an increase in venous capacity, accompanied by the blood of blood, which contributes to the damage of endothelial cells and does not allow to derive activated coagulation factors of the liver or affect them inhibitors from - With a small probability of mixing them with each other.
During physiological pregnancy, the walls of the vessels usually remain intact, however, the disorders listed above serve as the basis for the development of venous hypertension both in deep and in the surface system. The subsequent increase in pressure in veins leads to a violation of the balance between hydrostatic and colloid-osmotic pressure and ends with swelling of the tissues. The violation of the function of the endothelial cells of capillaries and Vull, possibly due to the venous state, the activation of leukocytes, changes in the production of nitrogen oxide during pregnancy, leads to their damage, which launches the vicious circle of pathological changes in the microcirculatory level, accompanied by increased adhesion leukocytes to the walls of the vessels, their output In the extracellular space, the deposition of fibrin in the intra, perivascular space, the release of biologically active substances.
Adhesion leukocytes is the main etiological factor in trophic lesions in patients with chronic venous hypertension, confirmed by many clinical examinations of patients outside pregnancy. However, this mechanism cannot be excluded during pregnancy. Since adhesive and migratory leukocytes cause partial obstruction of the capillary lumen and reduce its throughput, this mechanism can also contribute to the development of capillary hypoperfusion, concomitant Hood. The accumulation and activation of leukocytes in the output space is accompanied by the release of toxic metabolites of oxygen and proteolytic enzymes from cytoplasmic granules and can lead to chronic inflammation with the subsequent development of trophic disorders and venous thrombubs.
Venous dysfunction is preserved for several weeks after delivery, which indicates the effect of not only venous compression of a pregnant uterus, but also other factors. During pregnancy, the extensibility of the veins rises, and these changes are preserved in some patients within 1 month and even the year after delivery.
Pregnancy and postpartum Create favorable conditions for the formation of complications of the HSN, of which thrombosis are the most terrible. Venous thrombus are intravascular deposits consisting mainly of fibrin and erythrocytes with various numbers of platelets and leukocytes. Its formation reflects the imbalance between thrombogenic incentive and various protective mechanisms. During pregnancy, the concentration of all coagulation factors, except XI and XIII, increases, and the content of which is usually reduced. The protective mechanisms include the inactivation of activated coagulation factors inhibitor circulating in the blood.
Thrombinniced formation of fibrin increases during pregnancy, leading to hypercoagulation. During physiological pregnancy, the walls of the vessels usually remain intact. However, local damage to the endothelium of varicose veins may occur during pregnancy and childbirth through natural generics or during the cesarean section, which launches the thrombosis process. Considering the increased aggregation of erythrocytes, detected with the HSN, the endothelium dysfunction of the affected veins and other factors of the HSD, becomes clear why the Holy RF has significantly increases the risk of thrombotic complications during pregnancy.
The classification of the degree of coals is quite diverse. According to Widner, there are three forms of il:
- stem veins (large and small subcutaneous veins and their tributaries 1-2 orders);
- reticular veins - expansion and elongation of small surface veins;
- teleangioectasia.
From a practical point of view, a clinical classification is very convenient (Table 1) based on the objective symptoms of the Holy.
Table 1. Clinical classification
These include pulling, mischievous pains, gravity in the lower limbs, trophic skin disorders, convulsive twitching of the muscles of the legs and other symptoms inherent in venous dysfunction. The clinical classification is composed on ascending as the severity of the disease. Higher estimate limbs have significantly pronounced manifestations of chronic venous disease and may have some or all symptoms characteristic of a lower category of assessment.
Therapy and some of the conditions of the body (for example, pregnancy) can change clinical symptoms, and then the assessment of its state must be reinstated.
The diagnosis of HSN includes a thorough study of clinical manifestations, history data and the results of a physical examination.
The symptoms of the initial manifestations of the hoptions are diverse and nonspecific. As a rule, the reason for appealing to the doctor is a cosmetic defect (the emergence of teleangioctasis) and concern about the feeling of discomfort in the legs.
Significantly less often with the initial forms of the HSN there are night crashes and varying degrees of severity irritation of the skin. In this case, the varicose transformation of subcutaneous veins, which is a pathognomonic symptom of the Holy, is absent, although signs of the lesion of intradermal veins can be detected.
The most frequent complaints of patients with veins pathology are:
- the presence of teleangioectasis and swelling
- legs and feet, increasing in the evening;
- pain, cramps and feeling of crawling goosebumps in calf muscles;
- sensitivity impairment and slurry lower limbs;
- pigment spots on the skin of the heads;
- permanent feeling of discomfort and fatigue.
Therefore, several syndromes are distinguished, characteristic of the helical: edema, pain, convulsive, trophic disorders, secondary lesions of the skin.
Common symptoms of the disease are a feeling of gravity in the legs ("Heavy Feet" syndrome), a feeling of heat, burning, itching.
As pregnancy progressing, the frequency of occurrence of these signs increases, decreasing only for the 5-7th day of the postpartum period. Throughout pregnancy, an increase in the number of affected veins with a maximum of childbirth is observed.
Evenkers are more often formed in ankle area, and night cramps are joined. All symptoms become more pronounced by the end of the day or under the influence of heat.
The intensity of pain does not always correspond to the degree of expansion of surface veins. The pain appears when due to the insufficiency of the valves in the proof veins, the blood begins to flow from deep veins into superficial. The pressure in the legs of the legs increases, the pain gradually increases (especially in the standing position), there are edema stops, trophic disorders - dryness and hyperpigmentation of the skin, hair loss, and muscular spasms are observed at night. Over time, the Hood can be complicated by the appearance of long-lasting trophic ulcers. Often develops acute thrombophlebitis of superficial veins. There is a risk of deep veins thrombosis.
Symptoms of chronic venous insufficiency may have a different degree of severity and significantly worsen the quality of life of patients.
The hazardous consequences of chronic venous insufficiency include varicose vein extension, phlebitis (inflammation of veins walls), thrombophlebitis (clogging of the lumen of veins with inflammation) and perifelibates (inflammation of tissues along the periphery of the veins).
Among the listed subjective and objective symptoms may appear signs, often preceding thromboembolic complications: erythema of skin over veins and soreness at its move, the presence of varicose-expanded veins of the lower extremities and the perineum.
The frequency of venous thromboembolic complications during pregnancy in such women is 10.0%, 6.0% in the postpartum period.
All patients, in addition to the standard obstetric examinations, are inspected and palpation of varicose-expanded, deep and main subcutaneous veins of the lower extremities followed by their subjective assessment.
Special research methods are a mandatory component of the diagnosis of HSV. At the same time, the complexity of the diagnosis in the initial stages of the RFN determines the negative result of the traditional instrumental methods of the survey, the resolution of which is oriented towards clinically pronounced forms of HSN. All this creates objective difficulties in setting the correct diagnosis, and, accordingly, in the choice of therapeutic tactics.
For the helium, a significant decrease is characterized by a significant disappearance of symptoms with active movements in the ankle joint or during walking. In addition, even in the absence of varicose transformation, the attentive inspection of the lower extremities allows to detect the amplification of the subcutaneous venous pattern, indicating the decrease in the tone of the venous wall. Moreover, as a result of aseptic inflammation, such veins acquire hypersensitivity during palpation.
Ultrasound Doppler When examining pregnant women with venous disorders, it is carried out using sensors with frequencies of 8 MHz (rear Tibial Vienna, large and small subcutaneous veins) and 4 MHz (femoral and popliteal veins).
Doppler Research is performed in order to establish the permeability of the deep venous system, valve's consistency, localization of reflux sections in perforate veins and ousti, determining the presence and localization of thromboms.
Compression samples are used to evaluate not only deep veins, but also the viability of deep, subcutaneous and perforant vessels. Normally, during proximal compression and with distal decompression, blood flow in the veins is stopped.
Ultrasound methods of visualization of the lower limbs are performed on the machine with linear 5-10 MHz sensors. Upon duplex angiosication is determined by venomance, the nature of the venous blood flow, the presence or absence of reflux, and the diameter of the lumen of the main venous stems.
All pregnant patients with Hoods are shown monthly to determine the hemostasiogram and - twice during the postpartum period. Blood from veins are taken into a standard tube containing 0.5 ml of sodium citrate on an empty stomach within 16-18, 28-30 and 36-38 weeks of pregnancy, as well as on the 2-3rd and 5-7th day of the postpartum period. The hemostasis study includes the definition of fibrinogen, activated partial thromboplastine time, prothrombin index, coagulogram, platelet aggregation, soluble complexes of fibrin monomers and / or d-dimer. In addition, pregnant women investigate the factors responsible for reducing the coagulation properties of blood: protein C, antithrombin III, plasminogen, etc.
Differential diagnosis of HSN is carried out with the following diseases: acute thrombosis of deep veins; water of pregnant women; lymphede; chronic arterial failure; circulatory failure (ischemic heart disease, heart defects, myocarditis, cardiomyopathy, chronic pulmonary heart); kidney pathology (acute and chronic glomerulonephritis, diabetic glomerosclerosis, systemic red lupus, gestosis); liver pathology (cirrhosis, cancer); osteoarticular pathology (deforming osteoarthritis, reactive polyarthritis); idiopathic orthostatic edema.
With acute thrombosis of deep veins, swelling appears suddenly, often against the background of complete health. Patients note that in a few hours the volume of the limb increased significantly compared to the contralateral.
In the first days, the development of edema has an increasing character, accompanied by sawing pains in the limb, increased venous pattern on the hip and in the groin area on the side of the defeat. A few weeks later, the edema becomes constant and, although tends to regress, which is associated with the recitation of thrombotic masses and the partial restoration of deep veins, does not completely disappear almost never. Venous thrombosis amazes, as a rule, one limb. Often swelling covers at the same time the shin and the thigh is the so-called orofemoral venous thrombosis.
Changes in surface veins (secondary varicose extension) are developing only a few years after transferred acute thrombosis along with other SHD symptoms.
An additional criterion that distinguishes the eundle syndrome with HSN is the presence of trophic surface tissue disorders (hyperpigmentation, lipodertosclerosis, trophic ulcer), which are never found in acute venous thrombosis.
Edems of pregnant women usually appear at the end of II or the beginning of the III trimester, do not change throughout the day, often accompanied by the addition of pressure and proteinuria (with the development of gestosis). For the helms are characterized by swelling from the early terms of pregnancy, the presence of varicose veins, the lack of signs of water of pregnant or gestosis.
Lymphedhem (lymphostasis, elephantism) - impaired lymphatic outflows may have a congenital character (primary lymphedema) and manifest themselves for the first time in children's, adolescent or young age (up to 35 years). Initially, there is usually a transitional character of edema, which appears in the afternoon on the foot and legs. In some cases, the symptoms of the disease disappear for several weeks or even months. Then, at later stages, swelling becomes constant and can cover the entire limb. The patterned swelling of the foot, the varicose veins of the veins during primary lymphedeme is rare.
The secondary lymphidem is most often a consequence of repeatedly transferred grinding inflammation. At the same time, swelling, as a rule, appears only after the second or third acute episode and, once evolving, is preserved permanently. Since the grinding inflammation often occurs in patients with helms, with a secondary lymphedemy of post-infection genesis, noticeable signs of the pathology of the venous system can be revealed - varicose veins, trophic skin disorders and subcutaneous fiber.
In the presence of osteoarticular pathology, swelling with inflammatory or degenerative-dystrophic changes in the joints of the lower extremities is quite simple. It is almost always local and in the area of \u200b\u200bthe affected joint in the acute period of the disease, combined with severe pain syndrome and restriction of movements in the affected joint. With long flow and frequent exacerbations, the deformation of the surrounding tissues (pseudo-beam) becomes constant. Characteristic of patients with the articular cause of edema is the presence of flatfoot and the valgus deformation of the foot. Typically, this pathology takes place before the occurrence of pregnancy, which facilitates the differential diagnosis.
Chronic arterial insufficiency - rare pathology during pregnancy. Violations of arterial blood supply to the lower extremities may be accompanied by edema only when critical ischemia, i.e. In the terminal stage of the disease. Edema has a subpascial character, affecting only the muscular array of the leg. In case of inspection, the pallor and cooling of the skin, a decrease in the hair cover of the affected limb, the absence or a sharp weakening of the ripple of the main arteries (bertovy, poning, femoral).
Lipidema is a symmetric increase in the volume of subcutaneous fatty tissue only on the tibia, which leads to the appearance of quite characteristic outlines of this part of the limb, while the volume and shape of the thigh and the feet remain unchanged. At the same time, the edema cannot be called this state, although this is exactly how patients with patients formulate its main complaint. Palpation of the tibia in these patients quite often causes painful sensations. The etiology of this state is unknown, and most likely, we can talk about the inheritable subcutaneous fiber defect. The basis for such assumptions is that the lipid is detected only in women. A similar picture can also be observed from their relatives on the downward or upward line.
With all these states requiring differential diagnosis, ultrasound doppler and duplex angiosication make it possible to determine the state of the venous system with high accuracy and reveal the acute thrombotic damage or chronic pathology of the veins. In addition, when angioscript in the nature of the changes of subcutaneous fiber, one can judge the cause of edema. The lymphidem is characterized by visualization of channels filled with interstitial liquid. When the scanographic picture of the subcutaneous fatty fiber can be compared with the "snowstorm". These data complement the previously obtained information and help to establish, the pathology of which system (venous or lymphatic) plays a leading role in the genesis of edema syndrome.
In the treatment, the main task is to create conditions for preventing the progression of the disease, reduce the severity of the manifestations of clinical symptoms and the prevention of thromboembolic complications (thrombophlebitis, varicotromibophlebitis, deep veins thrombosis, pulmonary thrombosis), which are an indication for immediate hospitalization.
All outlined above requires effective prevention in the earliest stages of pregnancy. This means the use of compression therapy and modern phlebotropic drugs that do not have teratogenic action.
To date, the basic option for prevention in pregnant women is the use of a first-class medical compression knitwear to create a pressure of 12-17 mm Hg. Its undoubted advantages include the physiological distribution of pressure towards the foot to the upper third of the thigh. In addition, when viscating products, the anatomical features of the limb are taken into account, which ensures the stability of the bandage and the necessary comfort when wearing.
Modern knitwear have high aesthetic properties, which is of great importance for women. The use of compression therapy leads to the following effects:
- reducing edema;
- lipodermosclerosis reduction;
- reduction of veins diameter;
- an increase in venous blood flow rate;
- improving central hemodynamics;
- reduction of venous reflux;
- improving the function of venous pump;
- influence on arterial blood flow;
- improvement of microcirculation;
- increase the drainage function of the lymphatic system.
Medical compression knitwear depending on the magnitude of the pressure developed in the propelled area is divided into prophylactic (as mentioned above) and therapeutic. In therapeutic, in turn, 4 compression classes are distinguished depending on the pressure of the pressure generated in this zone. The key to the success of compression treatment is its regularity. You can not use knitwear only on occasion or only in winter, as many patients come. To wear elastic stockings or tights is better lying, without getting out of bed.
The most modern method of nonspecific pregnancy and treatment of HSN during pregnancy is the use of a special compression knitness of the 1-2th grade of compression, including hospital.
In conducted studies of the effectiveness of therapeutic knitwear of the 1-2th grade of compression during pregnancy and in the postpartum period, they revealed that its use contributes to the acceleration of venous blood flow in the lower limbs and the improvement of the subjective sensations of patients. In patients used products from therapeutic knitness of the 1-2th class of compression, a more pronounced decrease in the diameter of venous stems in the postpartum period according to the ultrasound data was noted.
Compression knitwear to patients must be used daily throughout the pregnancy and in the postpartum period, at least within 4-6 months.
The use of compression products does not cause reliable changes in the hemostasiogram, which allows them to be used during a root separation (both through natural generic paths and during cesarean section). The antitrombaembolic effect of medical compression knitwear is mainly due to the acceleration of venous blood flow, a decrease in blood state. The use of compression therapy prevents damage to blood vessels associated with their excessive stretching, eliminating one of the reasons for the development of thromboembolic complications.
The use of antithromboembolic stockings in obstetrics in pregnant women suffering from HSN reduces the risk of thromboembolic complications by 2.7 times. According to some researchers, compression knitwear improves uterine-placental blood flow.
Compression not only increases the passive ability of the muscular-venous tibia pump, but also contributes to the reinforced production of the tissue activator of plasminogen, which causes an increase in the fibrinolytic blood activity.
Almost the only contraindication to the use of compression agents are chronic binding damage to the lower limbs when a decrease in regional systolic pressure on bertic arteries is below 80 mm Hg.
In the complex of preventive measures for pregnant women should not forget about the need to maintain the perfect weight, a diet with a large amount of fiber.
The basis for the successful treatment of early forms of the HSN is not so much the relief of symptoms, how much the elimination of the main pathogenetic mechanisms caused by the development and progression of the disease, that is, one of the priorities is to eliminate venous hypertension and other mechanisms that cause endothelium damage.
A pregnant woman needs to clearly explain the essence of the disease and its possible consequences in the absence of regular treatment. General recommendations for women: protect feet from injuries, stand less; Sitting, put legs on a bench; Not combing itchy skin.
Arsenal of compression therapy means is represented not only by elastic bandages, medical knitwear, but also different equipment for variable (intermitting) compression.
One of the most important methods for the treatment of HSN is the use of local medicines. Ease of use, no system action makes them indispensable, especially in early pregnancy. Most often use heparin-containing ointments and gels that differ in efficiency and heparin content (from 100 meters to 1000 mete sodium heparin), while gels have a slightly greater efficiency compared to ointments.
The use of local means reduces the severity of such symptoms of venous insufficiency, as swelling, fatigue, severity and convulsions in the calf muscles. It should be noted that compression therapy is often combined with gel forms of heparin and do not recommend combining with ointment forms of the body component in ointments, which lengthens the suction process and increases the risk of skin infection.
Local forms of heparin have a fairly effective symptomatic effect on the subjective symptoms of HSN, but do not have a significant prophylactic effect on venous thromboembolic complications and, therefore, the use of a topical agent in the treatment of HSN may be only an addition to the main therapy.
Before drug treatment, the HSN costs many tasks, which are performed primarily on the basis of the degree of severity of clinical symptoms, but the main drug in the treatment of any forms of HSN should be a drug with a phlebotonizing effect. As the degree of degrees, the degree of helms requires an additional impact on the lymphatic system, the fight against an edema, improving the microcirculation and correction of blood rheology.
Pharmacotherapy HSD is based on the use of phleboprotectors (phlebotonics), which can be defined as drugs, normalizing the structure and function of the venous wall.
Phleboprotectors are the basis of the HSV drug therapy, regardless of its origin (varicose disease, the consequences of deep veins thrombosis, congenital anomalies, phlebopathy, etc.). It is very important that at the same time the therapeutic effect is systemic in nature and affects the venous system of both the lower extremities and other anatomical regions (the upper limbs, the retroperitoneal space, small pelvis, etc.). Due to this, some phleboprotectors are successfully used not only in phlebological practice, but also in other industries of medicine: proctology (prevention and treatment of complications of chronic hemorrhoids), ophthalmology (rehabilitation of patients who have undergone tombosis of the central veins of retina), gynecology (treatment of dysfunctional uterine bleeding, premenstrual syndrome and others).
The main indications for the use of phleboprotectors are:
- Specific syndromes and symptoms associated with Hood (swelling, feeling of gravity in the ion muscles, pain in the course of varicose veins, etc.).
- Non-specific symptoms associated with Hood (paresthesia, night cramps, reduced tolerance to static loads, etc.).
- Prevention of edema during long-term static loads (moving, flights) and under premenstrual syndrome.
An important installation for the practical application of phlebotonics is the timing of its application. Thus, with the "cyclic" edema of the lower extremities, women will have enough prescription from 10 to 28 day of the menstrual cycle, but for the treatment of patients with phenomena, the duration of the preparation of the drug is determined by clinical manifestations of the disease and can be separated from 1 to 2.5 months.
When choosing a phlebotropic drug, it is important to remember that they have different pharmacological activity and clinical efficacy against venous tone, impact on lymphotok, and also possess different bioavailability.
Most phlebotropic drugs are poorly dissolved in water and, accordingly, is not sufficiently absorbed in the gastrointestinal tract. In the case of the correct choice of the drug therapeutic effect, depending on the initial severity of the Holy, it occurs within 3-4 weeks of regular reception. Otherwise, an increase in dosage is needed or, which is preferable to change the drug.
The effect of phleboprotectors extends to many manifestations of the Holy:
- an increase in venous tone;
- reducing the permeability of the vascular wall;
- improvement of lymphatic outflow;
- anti-inflammatory action.
More than 20 different venotonic drugs are registered in Russia. The frequency of their use is determined by many factors (the severity of the Holy; prevailing syndrome - edema, pain, trophic disorders; tolerance; concomitant treatment; patient material capabilities) and constitutes 1-2% for most drugs, 26%, diosmin - 30%. The French company "Laboratory Innotek International" supplies this drug in Russia under the trade name Phlebodia 600, the international non-proprietary name is diosmin.
What explains the so high popularity of phlebodia 600? This is due to the fact that it includes the active substance diosmin granulated, which corresponds to 600 mg of diosmemin of anhydrous purified.
Phlebodia 600 drug refers to the pharmacotherapeutic group of angioprotective agents. Among its pharmacological properties it is necessary to note the fact that the drug has a phlebotizing effect (reduces vein tensile, increases the vein tone (dose-dependent effect), reduces venous stagnation), improves lymphatic drainage (increases the tone and frequency of reduction of lymphatic capillaries, increases their functional density, reduces the lymphatic Pressure), improves microcirculation (increases the resistance of capillaries (dose-dependent effect), reduces their permeability), reduces the adhesion of leukocytes to the venous wall and their migration of carbonate tissue, improves the diffusion of oxygen and perfusion in the skin fabric, has an anti-inflammatory effect. Blocks the production of free radicals, synthesis of prostaglandins and thromboxane.
When studying pharmacokinetics, it was found that the drug is quickly absorbed from the ventricular tract and is found in a plasma 2 hours after the reception, reaching a maximum concentration 5 hours after the reception. It is evenly distributed and accumulated in all layers of the walls of hollow veins and the subcutaneous veins of the lower extremities, to a lesser extent - in the kidneys, liver and lungs and other tissues. The selective accumulation of diosmin and / or its metabolites in venous vessels reaches a maximum of 9 hour after receiving and persists up to 96 hours. It is removed with the urine of 79%, with the feces - 11%, with bile - 2.4%.
The main indications for the use of the drug include varicose veins of the lower extremities, chronic lymph-venous failure of the lower extremities; hemorrhoids; Disorders of microcirculation.
Contraindications are increased sensitivity to the components of the drug, children's age (under 18).
Application during pregnancy: so far in clinical practice there were no reports of any side effects when used in pregnant women, and in experimental studies there was no teratogenic effect on the fruit.
Due to the lack of data on the penetration of the drug into breast milk during breastfeeding, its reception is not recommended.
The use of the drug is inside, Per OS. In varicose veins of the lower extremities and in the initial stage of chronic lympho-venous insufficiency (heaviness in the legs), 1 tablet per day in the morning to breakfast for 2 months is prescribed.
With severe forms of chronic lympho-venous insufficiency (swelling, pain, convulsions, etc.) - treatment is continued for 3-4 months, in the presence of trophic changes and ulcers therapy must be extended to 6 months (or more) with repeated courses through 2-3 months.
When aggravating, hemorrhoids are prescribed 2-3 tablets per day during food for 7 days, then if necessary, it is possible to continue 1 tablet 1 sow on a day for 1-2 months.
The use of the drug in the II and III trimesters of pregnancy 1 tablet 1 time per day, cancellation is made 2-3 weeks before delivery. When you pass one or several methods of the drug, it is recommended to continue its use in the usual dosage.
Side effects requiring a break in treatment are extremely rarely: more often associated with cases of increased sensitivity to the components of the drug from the gastrointestinal tract with the development of dyspeptic disorders, less often - from the central nervous system, which leads to headaches.
The symptoms of the drug overdose and the clinically significant effects of interaction with other drugs are not described.
According to experimental and clinical studies, diosmin does not have toxic, embryotoxic and mutagenic properties, well tolerated by women, has a pronounced venotonic effect. In the presence of this drug, the extensibility of varicose veins under the action of norepinephrine is approaching normal. In addition to phlebotizing properties, the drug has a pronounced positive effect on the lymphatic drainage. Increasing the frequency of peristaltics of lymphatic vessels and increasing oncotic pressure, it leads to a significant increase in lymph outflow from the affected limb.
An equally important effect on the use of the drug is to prevent migration, adhesion and leukocyte activation - an important level of pathogenesis of trophic disorders during the Holy.
The use of phlebodia-600 during pregnancy contributes to the acceleration of venous blood flow in the lower limbs, improving the subjective sensations of patients.
Currently accumulated certain scientific data on the effectiveness of phlebodia 600 in the treatment of fetoplacentage insufficiency, for the prevention of bleeding arising against the background of the Navy or after phlebectomy, which significantly expands the possibilities of its therapeutic effects in obstetrics and gynecology.
Logutova L.S. et al. (2007) In its studies to assess the influence of the drug phlebodia 600 on the state of the uterine-placental blood flow in pregnant women with placental insufficiency (PN) indicates that Mona is one of the most important problems of modern perinatology and obstetrics, which causes a high level of perinatal morbidity and mortality. The leading place in the development and progression of PN plays impairment of uterine-placental and fruit-placental hemodynamics, manifested by a violation of the state, growth and development of the fetus due to disorders of transport, trophic, endocrine and metabolic functions of the placenta.
The main causes of the Mona are violations of the circulation of maternal blood in the intervalistic space due to the combination of local hemostasis shifts on the surface of the fever and the increasing oblivion pathology of the spiral arteries, which leads to a sharp decrease in the pressure gradient in arterial, capillary and venous departments and, consequently, to a slowdown in exchange processes in a placental barrier, the emergence of local hypoxia.
Among the drugs that affect the vascular component include the angioprotective agent of Phlebodia 600. These provisions are confirmed by the results of their own studies in 95 pregnant women with Mon, the signs of which were: intrauterine slowdown in the growth of the fetus (rch) 1, 2-3 tbsp.; high indicators of the resistance of the vascular bed of placenta, umbilical umbilies and trunk vessels; structural changes in the placenta in the form of "early aging" and calcinosis; Features of the buildings of the umbilical Major.
Pregnant women were divided into two groups: in 1 65 pregnant women, 2 groups (comparison group) amounted to 30 patients. All pregnant women were a comprehensive FPN therapy, including antiagregative, antihypoxantic metabolic preparations, but the patients of 1 groups into therapy were included in the therapy, the drug Phlebodia 600, pregnant 2 groups did not receive this preparation.
The study of the uterine-placental flooding blood flow was carried out before the use of the drug phlebodia 600 to 7, 15 and 30 days from its application at 28-29, 32-37 weeks of gestation on the Ultrasonic device VOLUSON-730, equipped with a specialized sensor (RAB 4-8P). Color Doppler mapping and impulse dopplerometry of the artery of the umbilical bodies, the inflation of the fetal aortion and the placenta vessels are applied. A qualitative analysis of blood flow velocities was carried out with the definition of the systor-diastolic ratio (S / D) in the arteries of the umbilical cord, the aorta of the fetus and in the spiral arteries of the pregnant woman.
The results of comparative studies have shown that phlebodia 600 in pregnant women with placental insufficiency due to vasotonic effects improves the drainage function of intervalistic space, venous vessels of the uterus, small pelvis and lower extremities, optimizes intervalic blood flow in the placenta and in the fetus, allowing you to significantly reduce perinatal losses.
HYD and often accompanying it varicose veins are a fertile soil for the development of thrombosis, since changes in the vascular wall and slowing down blood flow serve as the most important causes of thrombosis. With appropriate changes in the adhesive-aggregation properties of uniform elements of blood and plasma levels of hemostasis (which the venous stagnation and turbulent nature of blood flow contributes) clomes arise in them. That is why the elimination of these moments contributes to the prevention of thromboembolic complications. It is important to emphasize that they are potentially preventing the cause of maternal morbidity and mortality.
Treating HSN during pregnancy is limited mainly by therapeutic measures, since surgical correction is associated with a high risk of postoperative complications and is made only in the case of the development of thromboembolic complications (thrombophlebitis proximal than the upper third of the thigh, deep veins thrombosis) after consulting a vascular surgeon and / or phlebologist.
It is known that the risk of developing thromboembolic complications (TEO) in young healthy women is 1-3 per 10,000 women. Pregnancy increases this risk of 5 times. Fortunately, the absolute risk of developing a clinically significant TEO during pregnancy or after childbirth is relatively low. However, despite low absolute figures, pulmonary artery thromboembolism is the leading cause of maternal mortality after childbirth, its detectability is 1 per 1000 genera, a deadly outcome of 1 per 100,000 genera.
The greatest risk of developing this complication is celebrated in the postpartum period. In addition, many researchers note that the frequency of deep veins thrombosis sharply (20 times) increases in the postpartum period compared to the corresponding age group of non-empty. Smoking preceding the Episodes of TEO and the hereditary forms of thrombophilia increase the risk of developing this complication in pregnant women. In the suffering of Holy patients, the frequency of thromboembolic complications increases to 10.0%.
The use of phlebodia 600 is accompanied by a significant reduction in the risk of thromboembolic complications during pregnancy, while its application is the most important part of a set of measures that include low molecular weight heparins, compression therapy, local means and gives the greatest positive effect.
The use of low-molecular weight heparins in an individually selected daily and exchange rate dose of low molecular weight heparins (DateParin of sodium, ENOCAPARIN, sodium, obverse of calcium) is accompanied by a rapid normalization of the hemostasiogram indicators and significantly increases the effectiveness of the prevention of thromboembolic complications. Their use is usually not accompanied by side effects, does not increase the risk of bleeding.
After completion of pregnancy, an improvement is usually observed (both in the damage to the limb and varicose crotch), however, in the postpartum period, it is recommended to continue the use of local and compression products within 4-6 months representing the greatest risk of thromboembolic complications. In the future, when preserving the symptoms of the Holy, a consultation of a vascular surgeon or a phlebologist is needed to select the tactics of further treatment.
In conclusion, it should be noted that modern floe-protectors are a powerful means of preventing and treating various forms of the Holy. Unfortunately, many patients are not aware of possible complications of chronic venous insufficiency and easily, following the advice of acquaintances or advertising, resort to self-medication, use ointment, creams or drugs with questionable efficiency. The active participation of the doctors of all specialties in the selection of rational pharmacotherapy helms creates real possibilities for controlling chronic venous insufficiency, which is increasingly called human civilization disease.
Literature
Venous insufficiency (HV) is a complex of clinical manifestations that develop in the human body due to a violation of blood outflow in the veins system. This ailment is one of the most common in its own way. About 15-40% of the population suffer from this insufficiency of blood circulation.
The widespread prevalence of acute and chronic venous insufficiency is caused by straightness, since because of this, the load on the vessels of the legs is constantly increasing. Most often, patients seek medical attention at the last stages of the disease. In this and lies its greatest danger. People suggest that the symptoms that have arisen, it is nothing more than the consequences of fatigue due to constant loads on their feet. The severity of pathology objectively does not evaluate any patient who has it. Most often, the venous insufficiency of the lower limbs is confused with, but these two states are not the same. The disease can also develop not only in the legs, but also in the brain.
Pathogenesis
The pathogenesis of the development of acute and chronic venous insufficiency is peculiar. With prolonged blocking of blood outflow along the vessels (the reasons for circulatory disorders can be different), the optimal setting is created to increase the pressure in the lumen of the vein.
Due to the expansion of the veins, the valve device is developing. In each vein in the human body there are valve flaps, whose work is to adjust blood circulation. If for any reason the sash will not be closed tightly, then the blood will begin not only to move up (back to heart), but also to escape down to the limbs. This will be the first symptom for the development of venous insufficiency - the feeling of constant gravity and overcrowding in the legs.
If you are not treated in a timely manner, then the pressure in the veins will gradually will only increase the walls of the vessels lose their elasticity. Their permeability will increase. Regional edema of the lower extremities will be developed. Later there will be trophic violations. They develop due to the compression of tissues that surround venous vessels, and violations of their normal nutrition.
Forms
- acute venous insufficiency (Aries). It develops sufficiently sharply, due to the ceiling of the deep veins of the legs. Accordingly, blood outflow from them is instantly violated. This syndrome develops in people of advanced and able-bodied age. Its development provoke several reasons: acute forms, as well as injuries, due to the veins of the veins, located in deep tissues. The pathological process amazes exclusively deep veins, it does not apply to superficial. The symptoms of Aries are manifested almost immediately - a person develops the edema of the legs, the skin acquires a blue shade. A distinctive feature of the presence of Aries - a vein pattern on the skin clearly visible. A person feels a strong pain toward the main vessels. You can learn pain sensations using a conventional cold compress. Its action is due to the fact that the cold contributes to a decrease in blood volume in vessels;
- chronic venous insufficiency (helve). Pathology is localized only in venous vessels located subcutaneously. It does not apply to deep. Only at first glance, it may seem easy and harmless, but in fact, due to a constant circulatory disorder, pathological changes are developed in the trophic of ankle joint. This form of insufficiency has several stages. Not the first stage on the skin in the place of blood flow disorders appear pigment stains. If the patient does not receive a timely as help to a doctor, then gradually they become several times more and germinate into soft fabrics. As a result, trophic ulcers arise (conservative way to cure them). At the last stage, swarms are formed, and other vessel abnormalities are developing.
The reasons
Venous insufficiency is most often developed at the states below:
- post-terrombophlebitic syndrome;
- varicose veins;
- congenital vessel pathologies;
- phlebotromboosis;
- limit injuries.
Negative factors under which the likelihood of the progression of venous deficiency of lower extremities increases significantly:
- preparations that in their composition contain hormones;
- genetic predisposition;
- female. In the body of a woman, estrogen levels are quite high, so they occur more often Aries and Hood. Also during pregnancy and childbirth, the load on venous vessels increases (venous insufficiency of both feet and brain can develop;
- obesity;
- weak motor activity;
- age. HDV, most likely, will develop in people of old age, since their organism has adverse factors have influenced for a longer time;
- static loads;
- chronic constipation;
- lifting weight (permanent).
At-risk groups
Lymphovenomous insufficiency develops in people in the most active period of their life - from 20 to 50 years. But only a few patients seek help to qualified doctors, as soon as they begin to feel the first symptoms of the disease. There are some groups of people whose pathology develops most often:
- athletes;
- people who have a genetic tendency to Hood;
- people with excess body weight;
- pregnant women.
Classification
The most common classification of chronic venous insufficiency is considered the most common:
- degree 0. In this case, the pronounced symptoms of the disease are absent. The patient does not notice any changes. Performance is preserved;
- degree 1. For a given degree, the appearance of the first symptoms indicating the presence of a pathological process in the body is characterized. The patient feels pain in the lower limbs, a feeling of gravity and cutting. Soon pronounced not passing swelling and convulsions appear (more pronounced at night);
- degree 2. Edems do not disappear. In case of inspection, there is an eczema, hyperpigmentation, lipodermatosclerosis;
- degree 3. Trophic ulcers are formed on the surface of the limbs. This state is most dangerous to patient health.
There is also an international classification of Aries and Hood - sEAR system.
Classification of venous insufficiency by sear
On the clinical picture:
- 0 - visual signs of the presence of the pathology of venous vessels are absent;
- 1 - Teleangectas;
- 2 - visually marked varicosely extended veins on on the legs;
- 3 - persistent swelling appear;
- 4 - Changes are manifested in skin;
- 5 - changes on the skin if there are already healed ulcers;
- 6 - Changes on the skin with fresh ulcers.
An important value is given to etiological classification, since the treatment of veins pathology depends largely on the reasons that provoked chronic insufficiency of blood circulation.
Etheological Classification:
- EU - genetic inclination;
- EP is an unknown reason;
- ES - insufficiency develops in humans due to injury, thrombosis and so on.
Anatomical classification according to the SEAR system makes it possible to display the lesion level, segment (deep, surface or communicating), as well as the localization of the pathological process (lower vein vein or large subcutaneous vein).
Classification of HSV on the SEAR system, taking into account the pathophysiological moments:
- chronic insufficiency of venous blood circulation with reflux phenomena;
- HSN with manifestations of obstruction;
- Hood combined (combination of reflux and obstruction).
The classification of acute and chronic blood circulation deficiency is used in medicinal institutions to phlebologists to determine the stage of the disease, as well as its severity. It is necessary to assign appropriate effective treatment.
Symptomatics
The symptoms of Aries are shown rapidly, since the blockage of vessels occurs very quickly. Due to the impossibility of outflow of blood from the lower extremities, the edema is formed. In the course of the vessels, the patient notes the occurrence of severe pain, which does not pass when changing the position or alone. The skin acquires a blue shade and the veins drawing appears on it. This form of the disease is more simply treated. First aid - the imposition of cold compress and admission of painkillers. Further treatment will be prescribed only phlebologist.
Symptoms of chronic form of the disease can be different. Therefore, different people have a clinical picture of chronic blood circulation deficiency may differ slightly. At the first stages of the development of the pathological process, either one or immediately a complex of symptoms is manifested:
- most often, a person begins to disturb the severity in the legs, which is significantly enhanced after a long stay in a standing position;
- education of edema on the lower limbs;
- night cramps;
- hypopigmentation or hyperpigmentation of the skin;
- skin covers lose their elasticity and become dry;
- at the later stages on the surface of the skin, trophic ulcers are formed;
- due to the deposit of a large amount of blood in her legs, a person occurs dizziness, a faint state.
If there are at least one of the above symptoms, it is recommended to immediately apply for emergency medical care to the medical institution. There, based on the primary inspection and diagnostic data, the doctor determine the severity of the disease (using the approved classification), and will also appoint a suitable course of treatment.
Diagnostics
- Uzi lower extremities. With it, it is possible to identify areas in which Viennes are expanded and blood circulation is broken. The doctor can also identify the presence of thromboms, varicose nodes. This examination should be made immediately as soon as the first symptoms of the HSD appeared;
- if the data of ultrasound is dubious, then in this case they resort to phlebography.
Treatment
Acute venous insufficiency Eliminated in several stages. During the active phase of the disease, it is necessary to impose a cold compress in the location of the pathological process. The cooled cloth is applied for two minutes, after which it is placed in ice and water capacitance and water to cool. These actions are recommended to repeat over the hour. After removal of inflammation, the second stage comes - improving blood circulation. You can use ointments, as part of which there are substances that slow down blood flow.
Il It is treated much more difficult than sharp. In determining the correct tactics of the treatment of chronic insufficiency of blood circulation, it should be clearly understood that this pathological state is a systemic process. The main goal of all therapeutic measures is the restoration of normal blood circulation in the venous system of lower extremities, as well as preventing possible recurrences.
- treatment of the disease is carried out by several courses. It all depends on the severity of the symptoms and the severity of pathology;
- treatment of venous insufficiency is selected strictly individually;
- medical therapy combines with other methods of treating the HN circulatory.
The use of synthetic drugs (phlebotropic drugs are prescribed), as well as elastic compression. Also prescribe drugs for local applications.
Surgical treatment is carried out in order to remove the pathological venous reset, as well as remove areas of varicose veins.
Chronic brainwater failure
This disease is to highlight especially, as it can develop absolutely from any person and is quite serious pathology. Chronic venous brain deficiency may occur even with singing, physical voltage, squeezing the neck too tight collar and so on. As a rule, patients have no complaints on the deterioration of the overall state. This is explained by the fact that the brain has an amazing compensatory mechanism and a developed circulatory system. Therefore, even serious difficulties of blood outflows for a long time are not manifested. This is the greatest danger of this state.
Prevention
Despite the fact that venous insufficiency is a disease laid in a person genetically, some measures can be taken, which will significantly reduce the risk of its development:
- do not overheat in the sun;
- do not wear too tight underwear and clothing (the same rule refers to the prophylaxis of coals in the brain);
- do not sit and do not stand without movement over a long period of time;
- diet;
- refusal of high heels.
The acute and chronic venous insufficiency of the brain and the lower extremities is a complex and insidious disease that sometimes flows completely asymptomatic and makes itself felt at the last stages. The consequences can be very hard, right up to thromboembolism. Therefore, if a person feels a constant weight in his legs and in the evening he appears swelling, you should immediately visit the doctor to exclude venous insufficiency or its confirmation.
The venous deficiency of the lower extremities is a fairly common problem and has a code on the ICD 10. This state occurs due to improper operation of the valves, which for one reason or another cease to fully close.
Because of this, blood flow to the heart is disturbed, and there is insufficiency of veins. It is important to understand what the sharp and chronic venous insufficiency is different. The first option is occurring much less and occurs in deep vessels. Chronic venous insufficiency is very widespread, it develops in subcutaneous veins.
Symptoms and treatment of this disease are well studied. Another rather dangerous disease is chronic cerebral venous insufficiency. In the human brain, problems are begins to circulate. Cerebral insufficiency requires special attention, in the running options, it can travel to a very serious complication.
Symptoms of venous insufficiency
Venous insufficiency has characteristic symptoms. At the initial stage, a person feels fatigue and cutting the lower extremities. These signs start becoming more and increase with a long stay standing. As a result of the development of the state, convulsions and severe pain in the field of ICR begin.
In addition, in venous insufficiency, swelling and vascular stars are often observed. Such signs are found at valve venous insufficiency in perforate veins. You need to seek for help with a doctor when the initial signs of the development of the disease are manifested.
Treatment of venous lack of lower extremities
For the start of treatment of venous insufficiency, special groups of drugs are used. These tools lead to the norm of the tone of the veins and blood flow. Due to the regular use of the appropriate drugs, the condition of patients is significantly improved, and unpleasant and painful symptoms leave.
It is very important that the treatment was appointed by a doctor, an independent choice of drugs can aggravate the situation. In addition, physiotherapy is shown in the venous deficiency of the lower extremities. Only in extreme cases with a given disease, it is necessary to turn to injections in Vienna and Surgery.
Preparations
For the treatment of venous insufficiency, it is often necessary to take drugs related to various groups, it is such combination therapy that will give the best result. The following medicines doctors prescribe most often:
- Phlebotonics - Phlebodia 600, Detralex, Ginkor Fort, Venarar;
- Anti-inflammatory means - diclofenak, nail;
- Preparations for preventing allergy - zoda, promressacine;
- Preparations for blood dilution - aspirin, dipyridamol;
- Antioxidants.
A reasonable combination of presented preparations can only pick up a specialist. Self-medication in this case can only deteriorate a state. In addition to tablets and capsules help remove swelling and pains for outdoor use. These include: heparin ointment, Lyton 1000, Indometackic 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 it should be done only after agreeing with the doctor. One of the effective options that the phlebology distinguishes is recognized as hirudotherapy.
This method provides for treatment using medical leeches. In the bite in the human body, useful substances that contribute to the discharge of blood are falling. This allows you to prevent the development of varicose veins and thrombophlebitis.
How to treat with leeches only the hirudotherapists know exactly about them, it is necessary to appeal to the course, the duration of which should be from 5 to 15 procedures. After each session, you need to wear a compression knitwear on the affected place.
A very good result gives a diet, which provides for the refusal of serious fatty, fried food, as well as the restriction of the sweet. Proper nutrition will certainly improve the patient's condition. It is recommended to wear only convenient, not squeezing footwear.
Treatment of herbs
Treatment is very common at home with various medicinal plants. This can be learned in school health. Raisters and ointments based on horse chestnut, the roots of the Ilitics and the Donoka are very popular.
Credit with chronic venous insufficiency will help the leaves and bark of the forest walnut. Infusion of them should be taken inside 3 times a day for 1/3 cup. Make it quite just at home. To do this, shove the tablespoon of the plant in the glass of boiling water and give a little broken.
Flowers Sofa also help with this disease. This plant must be insisted on vodka and take inward 1 teaspoon once a day.
Another effective medicinal plant is Calanchoe. Alcohol compresses with its addition help in a short time to cope with pain, fatigue and edema in the foot zone. Also effective recognized infusion of sint.
Chronic venous lack of lower extremities 1, 2 degrees
There is a certain pathogenesis of chronic venous insufficiency. The result of treatment and prevention in this case entirely depends on how quickly treatment was appointed. In medicine, the following stages of development of venous insufficiency are distinguished:
- The initial (1 degree) is characterized by the appearance of edema and severity, and vascular stars are often formed quite often.
- The stage 2 is due to the emergence of external inflammation and an explicit increase in subcutaneous veins.
- The venous deficiency of the lower extremities 3 is very launched, it manifests itself when chronic venous insufficiency is progressing with trophic ulcers, and sometimes atrophy.
The classification presented is generally recognized. But at the same time, the disease begins to develop even until the first degree, at this time everything happens without the manifestation of any obvious symptoms. Often this state is referred to zero.
Only a specialist can accurately determine the nearestness of the disease, since venous insufficiency may be of different species. This is how venous lymphatic failure, varicose venous insufficiency, insufficiency of venous valves, post-traumatic venous failure.
Exercises in venous failure video
When signs of venous insufficiency appear, and also in preventive purposes it is recommended to do a special gymnastics. It consists in exposure to the lower limbs. Remove fatigue will help the exercise birch. In addition, it is useful to work footsteps and hands from the sitting position. Also, in venous insufficiency, it is recommended to do "scissors" and "bike".
Venous insufficiency in men
Venous insufficiency suffer from both women and men. It can be localized not only in the field of lower extremities, but also in pelvic veins. Men often experience heavy physical exertion, which is the main reason for the development of this state.
The diagnosis of this disease is engaged in phlebologists. They can tell how to treat this disease, both in the elderly and in adolescents. As a rule, the course includes therapeutic physical culture and massage.
Photo Pictures
How the venous insufficiency of the lower extremities is developing. Full course on steps.
Venotonizing drugs
Venetonic drugs contribute to improving the valve status. Their selection is engaged in doctors - phlebologists. The main efficient preparations are: Detralex, Phlebodia 600, Venarar, Askorutin, etc. Also Venodyiool will be able to provide normalization of blood flow. During pregnancy, drugs from this group must be coordinated with a gynecologist.
All listed drugs with venous lymphatic failure give a good result. But still, only a specialist can be answered about how to be treated in one way or another. Do not seek advice on various thematic forums and sites on the example of Wikipedia.
Detralex: Application Instructions
Detralex is prescribed in the varicose veins of the lower extremities, when hemorrhoids appeared and with a varicosemost pelvis in women. Take this tool in the dosage indicated in the annotation. The detection rate directly depends on the disease and stage of development, which is why it is selected individually. Competently answer the question of how much drinking Dellalex can only doctor.
Phlebodia 600: Instructions for use, price, reviews, analogues
Phlebodia 600 is a famous French venotonic. Its analogue is Detralex. To the question than they differ, it's easy enough to answer. Preparations have a different concentration of diosmin in its composition. Packaging phlebodia costs about 800 rubles in Moscow, Vladivostok and Krasnoyarsk. It should take it in venous insufficiency 1 time per day for 1 piece.
Venarus: Instructions for use, price, reviews, analogues
Venarus - Russian production vetonik. This medicine is recommended for patients with venous insufficiency syndrome. The course of treatment with this drug must appoint phlebologist, as a rule, it lasts about 3 months, during which 2 tablets per day should be consumed.
How affects varicose veins
Varicose veins and chronic venous insufficiency are patients at the same time. As the experience of doctors shows, often venous insufficiency is considered to be the cause of varicose veins. To cost the conservative method of treatment, it is necessarily recommended to take advice from a doctor to appoint proper treatment. According to statistics, the disease is acquired, but there are also cases of inheritance when newborns are diagnosed with issues with veins.
Phlebectomy: Operation to remove varicose veins
In cases where conservative treatment is ineffective, the venous deficiency of the lower limbs is in serious condition, have to resort to the operation. Conduct them in specialized clinics. There are experienced doctors who know the pathogenesis of the formation of this state.
The essence of the operation is to remove the defective vein. This surgical intervention is carried out quite quickly and does not require any long-term reduction period. After the operation, patients are advised to regularly wear compression linens and prophylactic inspections. Immediately after this procedure, patients have an obvious improvement in the state.
Decide on how the venous insufficiency of the lower limbs is treated, only a phlebologist must only. Operational intervention is appointed only in the extreme outcome. At the initial stage of chronic venous failure, a good result gives conservative treatment, which is carried out using well-known and affordable ventilation, tablets, gels and ointments.
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The mechanism of development of RyD.
Blood from the lower extremities flows through deep (90%) and superficial (10%) veins. Blood outflow from the bottom upwards provides a number of factors that are the most important of which is the reduction of muscles during exercise. Muscle, shrinking, presses to Vienna. Under the action of gravity, blood tends down, but the venous valves are prevented by its reverse outflow. The result is a normal blood flow according to the venous system. The preservation of a permanent movement of liquid against gravity becomes possible, due to the consistency of the valve apparatus, a stable tone of the venous wall and the physiological change in the lumen of the veins when changing the position of the body.
In the case when one or more elements are suffering, providing a normal blood flow, a pathological process is launched, consisting of several stages. The extension of the vein below the valve leads to valve insolvency. Due to the constant high pressure of Vienna continues to expand from the bottom up. A venous reflux is joined (a pathological discharge of blood from top to bottom). Blood is stirred in a vessel, presses on the wall of Vienna. The permeability of the venous wall increases. Plasma through the wall of the vein begins to pass into the surrounding fabrics. Fabrics swell, their nutrition is broken.
The insufficiency of blood circulation leads to accumulation in small vessels of tissue metabolites, local blood concentration, activation of macotophagus and leukocytes, increase the number of lysosomal enzymes, free radicals and local inflammation mediators. Normally, part of the lymph is reset through the anastomoses into the venous system. Increased pressure in the venous bed violates this process, leads to overloading of the lymphatic system and violation of the outflow of lymph. Trophy disorders are exacerbated. Trophic ulcers are formed.
Causes of Hyd.
Chronic venous insufficiency may occur in the following states:
- long-term varicose veins of the lower extremities;
- post-tomboflectric syndrome;
- congenital pathology of deep and surface venous systems (congenital hypo- or aplasia of deep veins - Clippel-Trenne syndrome, congenital arteriovenous fistula - Syndrome Park-Weber-Rubashov).
Sometimes chronic venous insufficiency develops after transferred phlebotromability. In recent years, phlebopathy - conditions in which venous stagnation occurs in the absence of tool and clinical signs of the pathology of the venous system. In rare cases, chronic venous insufficiency develops after injuries.
There are a number of adverse factors in which the risk of chronic venous insufficiency is increasing:
- Genetic predisposition. The development of pathology gives genetically determined insufficiency of connective tissue, which becomes the cause of the weakness of the vascular wall due to the lack of collagen.
- Female. The emergence of chronic venous insufficiency is due to a high level of estrogen, an increased load on the venous system during the period of pregnancy and childbirth, as well as a higher life expectancy.
- Age. In people of the older generation, the likelihood of the development of HDF increases as a result of the long-term exposure of adverse factors.
- Receiving hormonal contraceptives and other hormone-containing drugs (due to raising estrogen levels).
- Insufficient motor activity, obesity.
- Long static loads (long trips in transport, standing or sitting), constant lifting weight.
- Chronic constipation.
Holy classification
Currently, Russian phlebologists use the following classification of HSN:
- Degree 0. There are no symptoms of chronic venous insufficiency.
- Degree 1. Patients are worried about pain in the legs, a feeling of gravity, transient swelling, night cramps.
- Degree 2. Evenkers become persistent. It is visually determined by hyperpigmentation, lipodermatosclerosis phenomena, dry or mocking eczema.
- Degree 3. It is characterized by the presence of an open or healing trophic ulcer.
The degree of 0 was allocated by clinicians not by chance. In practice, there are cases when, with pronounced varicose veins, patients do not complaints, and the symptoms of chronic venous insufficiency are completely absent. The tactics of maintaining such patients differs from the tactics of treatment of patients with similar varicose veins transformation, accompanied by coolant 1 or 2 degrees.
There is an international classification of chronic venous insufficiency (CEAP system), taking into account etiological, clinical, pathophysiological and anatomy-morphological manifestations of HSN.
Classification of the CEAP System:
Clinical manifestations:
- 0 - Visual and palpator signs of veins are absent;
- 1 - teleangioectas;
- 2 - varicoserably extended veins;
- 3 - swelling;
- 4 - skin changes (hyperpigmentation, lipodermatosclerosis, venous eczema);
- 5 - skin changes in the presence of healed ulcers;
- 6 - Skin Changes in the presence of fresh ulcers.
Etheological Classification:
- the cause of the Holy is congenital pathology (EC);
- primary helium with an unknown cause (EP);
- secondary helms developed due to thrombosis, injury, etc. (ES).
Anatomical classification.
Reflects the segment (deep, surface, communicating), localization (large subcutaneous, lower hollow) and the level of lesion.
Classification, taking into account the pathophysiological aspects of the Holy:
- Helms with reflux phenomena (PR);
- Helms with obstruction phenomena (PO);
- Hood with reflux and obstruction phenomena (PR, O).
When evaluating the HSN on the CEAP system, a system of points is used, where each characteristic (pain, swelling, chromotype, pigmentation, lipodertosclerosis, ulcers, their duration, number and frequency of recurrences) are estimated at 0, 1 or 2 points.
Within the framework of the CEAP system, the ability to reduce disability is also used, according to which:
- 0 - complete absence of symptoms;
- 1 - there are symptoms of the HSN, the patient is able-bodied and does not need support;
- 2 - the patient can work a full day only if supporting funds uses;
- 3 - the patient is disabled, even if the support means uses.
Symptoms Hood
HIV can manifest itself a variety of clinical symptoms. In the early stages one or more symptoms appear. Patients are bothering the severity in the legs, increasing after a long stay in a vertical position, transient swelling, night cramps. It is observed hyper- (less often - hypo) pigmentation of the skin in the distal third of the leg, dryness and loss of the elasticity of the skin of the shins. Varicious extended veins in the initial stage of chronic venous insufficiency appear not always.
As CPN progresses, the local insufficiency of blood circulation is exacerbated. Trophy disorders become more pronounced. Trophic ulcers are formed. The deposit of a significant amount of blood in the lower extremities can lead to dizziness, fainting, the appearance of signs of heart failure. Due to the decrease in the BCC, patients with severe chronic venous insufficiency poorly tolerate physical and mental loads.
Diagnostics Hood
The diagnosis is exhibited on the basis of anamnestic data, patient complaints, the results of an objective and instrumental study. The conclusion of the degree of violation of venous outflow is made on the basis of the WFDG of the lower limbs and duplex angiosication. In some cases, X-ray system (phlebography) is made to clarify the cause of CPN.
Treating Hood
When determining the tactics of the treatment of chronic venous insufficiency, it should be clearly understood that the HSD is a systemic pathological process that cannot be eliminated, removing one or more surface varicose veins. The purpose of therapy is to restore the normal operation of the venous and lymphatic system of the lower limbs and the prevention of relapses.
General Principles of Hood Treatment:
- Therapy should be a course. One patients show short or episodic courses, others - regular and long. The average duration of the course should be 2-2.5 months.
- Reception of drugs It is necessary to combine with other methods of treatment of HSN.
- Treatment with HSN should be selected individually.
- To achieve good results, the patient's active participation is necessary. The patient must understand the essence of his illness and the consequences of deviations from the recommendations of the doctor.
Conservative techniques are the main importance in the process of treatment with therug therapy (phlebotrobial means) and the creation of an additional framework for veins (elastic compression). Preparations for local applications: Wound coatings, ointments, creams, antiseptics and creams are prescribed if there are appropriate clinical manifestations. In some cases, corticosteroid preparations are shown.
Surgical treatment is carried out to eliminate the pathological venous reset and removal of varicose vein extended veins (phlebectomy). In operational treatment requires about 10% of patients with chronic venous insufficiency. With the development of the HSN against the background of varicose veins, it is often resorted to a minimally invasive miniflebectomy.
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Forms of venous insufficiency
This disease can be divided into the following forms:
- Aries (acute venous lack of lower extremities)
The occurrence of acute failure of legs occurs after a long overlap (for example, due to severe squeezing) of deep veins and caused by this process of blood outlet disorders. Acute venous failure of legs is accompanied by pain in the field of main vessels, which disappears when applied to it cold compress.
Such a phenomenon can be explained by the fact that the volume of blood in the vessels under the influence of cold decreases. In addition to painful sensations, swelling of feet is also possible, as a result of which skin covers sometimes take a blue tint. Veins located superficially cannot be affected by Aries.
- HSN (chronic venous lack of lower extremities)
It is expressed by a constant impairment of blood circulation in the region of the vessels. The disease in this form can be accompanied by the development of pathological changes in the process of cellular nutrition of an ankle joint. Holy, depending on the degree of its flow, can be divided into several stages. At the initial stage of the disease in patients, impairment of pigmentation in the form of pigment spots in the zone where pathological changes have already begun to appear (in the zone of blood flow).
In the absence of treatment of venous insufficiency of this form, pigment stains will become more and more, and then they can germinate in soft tissues and cause trophic ulcers, severely deleted. The last stage of the HDN is accompanied by the formation of blood clots, the pyoderma - purulent lesion of the skin due to hitting any of its sections of the glottering Cockkops and other pathologies.
Causes of occurrence
The acute form of this disease can often occur both in the elderly and people have younger. Among the possible causes of the emergence of Aries, acute forms of thrombosis are distinguished, as well as injuries that cause the need to dress veins located in deep tissues.
The main reasons for the occurrence of HSN include diseases such as varicose veins and post-terromboflectic disease. In addition, people with low mobility and overweight have an increased risk of developing the lower limbs. Lifting weights or long-term execution of work in an uncomfortable sitting (or standing) position can also be occasions for the appearance of this pathology.
The risk group of people with the greatest chances of the occurrence of HSN include the following categories of the population:
- Pregnant and nursing women;
- Patients receiving hormonal drugs (including women using oral hormonal contraceptives);
- Elderly people;
- Teenagers (helms at this age may appear due to the hormonal restructuring of the body).
Symptoms
Hyd is distinguished by different symptoms at different stages of the disease. At the initial stage of its flow, the symptoms of venous insufficiency can either not be absent, or to appear in a slight degree. Patients in this case express the following complaints:
- the feeling of gravity in the legs, amplifying with a long stay in the "standing" position;
- increased swelling;
- periodically short-term cramps, usually coming at night;
- increased pigmentation of the skin in the zone remote from the shin.
At the first stages of this disease, the varicose veins is rather an exception than the rule, but sometimes it can also appear. In the deeper stages of the Holy, such a violation, on the contrary, is found almost in all patients.
When developing pathology, the following symptoms can be added to the above:
- violation of the ability of the circulatory system to deliver blood to the 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 on any of the vascular sites;
- the emergence of signs of heart failure.
Usually, with the disease, "venous insufficiency" symptoms appear not simultaneously, but complement each other gradually.
In patients with the cooler of the lower extremities, the volume of circulating blood increases (in vessels located in this zone), so they are usually hardly tolerated by an increased volume of physical and mental loads.
Classification
In Russia, phlebores - specialists "on veins" - adopted the following classification of HSV, structuring this disease, depending on its stage:
- Degree 0. The absence of symptoms of HSN;
- Degree 1. Patients complain of pain in the legs, feeling of gravity, periodic cramps and swelling;
- Degree 2. Edections become more pronounced and stable, increased pigmentation, changes in the subcutaneous fiber of degenerative-dystrophic nature (lipodermatosclerosis or "indurative cellulite"), possibly the appearance of dry or wet eczema.
- Degree 3. It is expressed by the appearance of a patient with an open or healing trophic ulcer.
The "zero" degree was marked by Russian specialists in order to properly determine the treatment of symptoms of chronic venous insufficiency of the lower extremities, as well as the disease itself. In this case, it will differ from the need therapy required with the weld 1 or 2.
International classification of venous diseases of the lower extremities
In medical practice, another structuring of venous diseases, which is called CEAP and is international. It implies the "symptomatic" separation of the HSN by the following signs:
- The symptoms of the disease is absent, when palpation (feeling), the helium also does not allow himself to know.
- Sustainable expansions of small vessels are noticeable, the inflammatory process is not launched.
- There is a varicose vein extension.
- There is a swelling.
- Increased pigmentation of the skin is noticeable, the appearance of eczema and degenerative-dystrophic changes in subcutaneous fiber is possible.
- There are listed symptoms listed in the previous paragraph in the presence of healing trophic ulcers.
- Requirements are similar to the previous paragraph, but under the condition of fresh trophic ulcers.
Each of the listed features in this classification is considered separately, and, depending on the degree of manifestation, it is set to the corresponding score - "0", "1" or "2".
Under the auspices of this classification also establishes the degree of disability due to vein failure:
- Degree 0. The patient is able to be able to fully, there is no symptomatic disease, the patient in special therapy does not need;
- Degree 1. The patient has some SHAL symptoms, but does not have any disability. Special treatment such patients also do not require;
- Degree 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, relying on which boys were classified for 3 types:
- Hood is a congenital disease (EC).
- primary Holy, the cause of the origin of which is unknown (EP).
- secondary helms with the identified cause of occurrence.
Valve insufficiency
Valve insufficiency of the veins 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 inverse blood movement.
Valve insufficiency occurs in cases where the venous valves for some reason cease to fulfill their functions normally. With low quality treatment of the valve insufficiency of the lower limbs, the patient may deteriorate in general well-being, a decrease in the endurance of the organism, as well as an increase in the risk of cardiovascular diseases.
Venous insufficiency of cerebral circulation (ONMK)
Venous insufficiency of cerebral circulation - pathology due to the difficulty of the outflow of venous blood from the skull cavity. With a heavy cough, the game on wind instruments, a strong cry, squeezing the neck and some other phenomena such a state is often found in an easily-impaired form.
The disease of the insufficiency of the brain veins is a consequence of the other diagnosis of the diagnosis. Its appearance is often observed in crank-brain injuries, osteochondrosis, bronchial asthma, various brain tumors, some pathological changes in the liver, long-term cessation of nasal respiration and other pathologies.
ONMK in many cases proceeds asymptomatic. With the increasing deterioration of the adaptation ability of the brain to the conditions of work with difficulty blood circulation, patients can complain about frequent dizziness, memory deterioration, headaches (amplifying when moving the head in some direction), darkening in the eyes, appearance of the eyelidity and redness of the eyes. In some cases, with such a disease, cramps, fainting and epileptic seizures may be observed.
Therapy of the insufficiency of the brain circulation implies the relief of the symptoms of the underlying disease, but when it appears, there will be no superfluous physiotherapy, oriental massage and some other methods of irritable therapy.
Diagnosis of the disease
Diagnose chronic vein failure is possible with the help of ultrasonic methods - Doppler ultrasound research and duplex ultrasound scanning.
Doppler ultrasound examination 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, using this manipulation, it is possible to define pressure in vessels due to the reflection of ultrasonic waves from red blood cells.
Duplex ultrasound scanning is a study method that can also establish pathologies relative to the flow of blood flow, as well as objectively assess the state of the veins.
To establish the cause of origin, X-ray diagnostic methods are used, for example, phlebography. Phlebography is carried out in the following way: a contrast agent is introduced into the veined under study, after which it is considered by radiography.
Treatment
Treatment of venous deficiency of the lower limbs is carried out both conservative (with the help of drugs) and surgical methods. The use of medicines without the use of operational intervention is effective in cases where the disease has not yet passed into the deep stage. In addition, the "therapeutic" approach will be rational in preparation for operations and during the recovery period after it.
Hyd treatment is carried out by phlebotropic (veotonic) drugs belonging to the pharmacological group of angioprotectors.
The following drugs can be attributed to phlebotonics:
- Phlebodia. Produced in the form of tablets. It is used to eliminate swelling symptoms, is used to restore normal blood circulation in vessels;
- Detralex. Toning tablets for veins that reduce the tensile walls of the vessels;
- Angistax. The drug manufactured in the form of capsules, gel and cream. It has a vegetable composition, which includes the extract of the leaves of red grapes. It has a venotonic effect, normalizes blood flow through vessels. To increase the effectiveness of therapy, it is advisable to simultaneously use both oral and outer form of the drug;
- Troksevazin. The drug produced in the form of capsules and gel, which in most cases is preferably used simultaneously. The drug is capable of removing inflammatory syndrome and has an antioxidant effect;
- Eskusan. Drops for reception inside. The preparation includes vitamin B1, which contributes to the expansion of the veins, and the extract of horse chestnut, which has an anesthetic effect caused by venous diseases.
Preparations for the treatment of venous lack of lower limbs must be taken under the control of the attending physician to prevent the development of the disease.
In addition to phlebotonics, if necessary, the doctor may prescribe non-steroidal anti-inflammatory agents, such as meloxico and diclofenac, as well as drugs that dilute blood.
For the treatment of severe hydroform, in the occurrence of trophic ulcers on the skin, antibiotics of the penicillin row and group of cephalosporins can be prescribed. Their use can protect the body from sepsis and other possible severe consequences.
Compressions overlay rules
Cold compress is manufactured and superimposed as follows:
- Two pieces of gauze folded several times and fit into a container with cold water or ice. 2 pieces are necessary for continuous therapy - so far one piece of gauze is superimposed on the inflamed area in the form of a compression, the second is cooled at that time.
- After both compresses have been cooled enough, one of them is placed on the affected surface and is held on it for 2 to 3 minutes. After this time, the compress is changing, and the "spare" is cooled to reuse.
- The above procedure must be repeated at least for 1 hour.
After eliminating the acute stage of inflammatory processes, it is allowed to use warming ointments that slow down blood clotting (for example, heparin). The use of such ointments is permitted in the form of warm compress. To properly impose such a compression, you must follow the following procedures:
- Fold the gauze used for the compress, in 3-4 layers.
- Impust the used piece of gauze with a warming effect.
- Enter gauze to the affected area.
- Close soaked with gauze with a polyethylene or compressor package.
- From above, you must lay out in sufficient cotton wool for insulation, and even better to ensure the insulation of the compress wool cloth. Fix the bandage ready-made compress. Leave it overnight.
In the morning, the footage, subjected to compression therapy, must be treated with alcohol.
Radical methods of venous insufficiency therapy
In particularly severe cases, more radical approaches to the treatment of the disease may also be required, namely, operational intervention. In modern medicine, the following manipulations are used for these purposes:
- sclerotherapy. The procedure in which a special preparation is introduced into the lumen of the vessel, gluing its walls and causing subsequent absorption of damaged veins. Manipulation is relatively painless, local anesthesia for it will be quite a sufficient way of anesthesia. Used to remove the veins of a small diameter;
- laser surgery. The manipulation in which the damaged veins is exposed to laser light from the inside, after which they are bonding and subsequent absorption. The procedure does not require surgical cuts. With laser surgery, you can remove both damaged large veins and varicose mesh on the legs;
- surgical removal of damaged veins. It implies the need for cuts to gain access to a damaged vein, its ties and subsequent removal. The operation is carried out only under general anesthesia. Surgical removal subjected to veins of large diameter.
Timely appeal to the doctor will avoid the need for the described manipulations, and possibly completely cured this pathology.
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Il - what is it?
Chronic venous deficiency of the lower extremities (coal) is a combination of certain symptoms, which are due to a poor outflow from the veins of the lower extremities due to the violation of their hemodynamics.
Two main factor participate in the pathogenesis of the development of the disease.
- First, it is a decrease in the diameter of the vessel and, as a result, a decrease in its ability.
- Secondly, there is a violation of the mechanism, which ensures the outflow of venous blood from the veins of the lower limbs.
As it looks in practice: Normally, the human outflow from the veins of the lower extremities occurs through the deep and surface vein system to the heart. Such a blood flow against the action of gravity becomes possible due to the valve mechanism in veins, which do not give blood to flow in the opposite direction. A certain role is played by the reduction of the muscles of the hip and the legs, as well as the state of the vascular wall.
If it fails to work in this established outflow system, the venous blood is instead of climbing the legs to the heart, it is delayed, causes overflow of vessels and the appearance of various unpleasant symptoms. So, the processes of microcirculation are gradually violated, edema develops and trophic violations.
Important! The highest venous pressure in the lower third of the leg, so it is here that the first problems with the venous outflow begin.
In fact, the HPN is not a separate diagnosis. This is a complex of symptoms associated with the violation of the work of the veins, which can occur both in congenital and for acquired pathology.
Causes of occurrence
Causes of venous deficiency of lower extremities:
- reduction of the diameter of the venous bed;
- violation of the valve mechanism, with problems with which the reverse blood casting in Vienna takes place.
Most often, varicose disease and post-loboflebic syndrome becomes the cause of the Hood. In rare cases, the problem cause congenital abnormal vessels (fistulas, fistulas) and traumatic damage.
In addition to these key reasons that contribute to the risk factors of this pathology are considered:
- Hereditary predisposition to the development of the weakness of the vascular wall.
- Pregnancy. In addition to hormonal perestroika, during this period, the load on the vessels increases, which leads to the development of varicose and the emergence of chronic venous insufficiency in every third woman.
- Hormonal disorders and endocrine pathology.
- Excessive physical exertion.
- Overweight and exchange disorders.
- Atherosclerosis.
- Congenital veins anomalies.
- Alcohol and smoking that reduce the tone and elasticity of the walls of the vessels.
- Hormonal contraceptives, etc.
For clinical flow, three stages are distinguished, first of all, it is necessary to select the appropriate therapy - symptoms and treatment of venous deficiency of the lower extremities depend on the stage of the disease and are determined:
1. Compensation Stage. At this stage, the symptoms of the venous insufficiency of the lower extremities are reminded of themselves only with cosmetic signs: vascular "stars" appear, varicose veins are visible on the legs, etc.
Some patients celebrate increased fatigue in the legs and the appearance of edema in the evenings, others do not pay attention to it. To learn about the diagnosis and evaluate the degree at this stage, you can only with the help of special research.
2. Stage of subcompensation. At this stage, a patient appears trophic disorders that can be treated. Standard patient complaints at this stage:
- pain and fast fatigue feet;
- cramps and tingling in the legs;
- itching skin;
- trophic disorders (ulcer, eczema).
Even at this stage, patients most often turn to a specialist, primarily due to cosmetic defects (ulcers, varicose veins).
3. Stage of decompensation. There are irreversible trophic disorders. The patient is worried about pronounced swelling (elephant), severe ulcers are developing, which are not amenable to treatment, the skin color changes on the legs (bugbero-black), torment pain, problems with walking arise.
Important! In addition to the stage, when formulating the diagnosis of HSN, the main disease is indicated that caused the development of the symptom complex, as well as the shape of the coal: edema, pain, varicose, ulcerative or mixed. Therefore, the diagnosis will sound like this: varicose disease. Holy II stage, edema-pain.
Treatment of venous insufficiency
Treatment of venous insufficiency of the lower limbs depends on its degree, the form and availability of related complications. The problem is solved by conservative and surgical path.
Conservative therapy consists of:
- reception of drugs that improve the tone of the vascular wall (phlebotonic) and the rheological properties of blood;
- elimination of risk factors (decrease in body weight, nutritionalization and physical activity, pregnancy planning);
- physipesis;
- prevention of the progression of the pathological process (wearing compression linen, binting, charging).
Operational treatment is aimed at eliminating directly varicose veins. For these purposes, sclerotherapy is used (subcutaneously introduced substance-sclerosis, which causes the sticking of the vessel walls), as well as various operations on resection of superficially modified veins (along Trojanov-Trendelenburg, Linton and others).
Complications
Most patients mistakenly believe that ugly extended veins are the main complication of the disease, but the problem is much more serious.
Complication of helms can be:
- Trophic ulcers. These are non-kind of skin defects that appear on running stages. Do not treat and deliver painful pain patients.
- Thrombophlebitis is inflammation of the veins wall with the formation of blood clots (blood clots).
- Pulmonary embolism. The tomb of the thrombus and the migration of it in the bloodstream can cause the blockage of one of the branches of the pulmonary artery and lead to a fatal outcome.
- Eczema and grinding inflammation.
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