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July 2, 2012
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Venous insufficiency is an illness which develops at the person as an effect of insufficiency of valves of deep veins. This illness meets today very often, but in most cases the illness a long time progresses unnoticed. As the medical statistics testifies, about 60% of people of working-age suffer from chronic venous insufficiency. But only the tenth part of patients take a course of adequate therapy of this disease. Generally with this problem patients address therapists. Therefore it is very important that the specialist established the correct diagnosis.
Reasons of venous insufficiency
In view of the fact that development of venous insufficiency is directly connected with bipedalism, most often at people chronic venous insufficiency of the lower extremities is shown.
A number of features of life of modern people is the global reasons of development of venous insufficiency. First of all, it is a total hypodynamia, continuous stay in a pose sitting or standing in the course of daily work. Besides, certain inborn features of the hormonal status and vascular system are causes of illness that provokes deterioration in venous outflow of blood. Development of chronic venous insufficiency often turns out to be consequence of the same factors which provoke manifestation at the person of a varicosity, and also a deep vein thrombosis of legs.
It is important to consider that provocative factors of development of venous insufficiency is smoking, and also pregnancy. Existence at close relatives of a varicosity has to guard also.
With age at the person the risk increases to ache with venous insufficiency: it most often develops at people who already were 50 years old. The illness is more often diagnosed for women.
Mechanism of development of venous insufficiency
Venous valves are both in deep, and in superficial veins. If at the patient the deep vein thrombosis develops, then there is an obstruction of their gleam. And if after a while the gleam is recovered in view of process of a rekanalization. But if the gleam of veins is recovered, then their valves are not subject to recovery. As a result elasticity of veins is lost, their fibrosis develops. And owing to destruction of valves of veins at the patient the normal blood stream stops.
Gradually at the patient chronic venous insufficiency develops. If there is a damage of valves of deep veins of legs, then the retrograde blood flow in veins occurs freely as the main function of valves – to interfere with a retrograde blood flow on veins of legs. As a result, blood pressure increases, and plasma passes through venous walls in fabric which surround vessels. Fabrics gradually become more dense that promotes squeezing of small vessels in anklebones, a shin. Ischemia owing to which the patient has trophic ulcers which are considered as one of the main symptoms of venous insufficiency is result of such process.
Symptoms of venous insufficiency
Statistically, from the subcompensated and dekompensirovanny form of chronic venous insufficiency every seventh person in the world suffers approximately. At chronic venous insufficiency actually at the person venolimfatichesky insufficiency as owing to strengthening of venous pressure also load of absorbent vessels strongly increases develops.
Venous insufficiency can be shown differently. As a rule, the person complains of pain in legs, constant feeling of weight, evening hypostases of legs which disappear in the morning. At venous insufficiency to the patient his usual footwear as puffiness is noted becomes gradually small. At night spasms can disturb the patient. Also skin color on a shin changes, skin becomes not such elastic as before. Varicose veins are looked through though at initial stages of an illness they can not be shown. Besides, the patient feels constant fatigue, concern.
Stages of venous insufficiency
It is accepted to distinguish three various stages of chronic venous insufficiency. It is a stage of compensation, subcompensation and decompensation. At the first stage of a disease at the person exclusively cosmetic defect is shown, that is varicose veins and teleangiectasias are looked through. To diagnose a disease at this stage, tool methods of research are applied, and also special tests are carried out. Such tests allow to estimate a condition of valves, passability of deep veins. Besides, in the course of diagnosis of this disease the flebomanometriya, a flebografiya, ultrasonic scanning is used.
At the second stage of a disease (subcompensation) at the person the trophic frustration having reversible character at this stage are already shown. At this stage the patient complains of constant pain, display of spasms of legs, strong fatigue, a skin itch. Sometimes there is a pigmentation of integuments, eczema can develop. Many patients at a stage of subcompensation see doctors with complaints to cosmetic defects as they at this stage of change a condition of vessels are already noticeable.
At the third stage of venous insufficiency (decompensation) trophic disturbances of irreversible character take place. The person suffers from manifestation of elephantiasis, trophic ulcers. At the same time in the anamnesis of the patient thrombophlebitis of deep veins, varicosity, TELA can appear.
Also four different forms of venous insufficiency are allocated: varicose, edematous and painful, ulcer and mixed. At everyone forms characteristic symptoms of venous insufficiency are shown as the general, and.
Complications of chronic venous insufficiency
The most often shown complications at chronic venous insufficiency are disturbances of a trophicity of tissues of shin which have the progressing character. Hyperpegmentation which progresses to deep trophic ulcers after a while is initially shown. Except local complications the disease provokes distantny reactions. Because in veins of legs the volume of the circulating blood becomes less, at the patient with chronic venous insufficiency heart failure can be shown. Existence in an organism of decomposition products of fabrics provokes allergic reactions which become the reason of dermatitis, venous eczema.
Diagnosis of chronic venous insufficiency
In the course of diagnosis of a disease the doctor is guided by the fact that venous insufficiency actually is a symptom complex which is based on insufficiency of the valve and a vascular wall in superficial and deep veins of legs. In the course of diagnosis it is important to define what stage of a disease at the moment takes place at the patient.
Besides, in the course of establishment of the diagnosis the form of chronic venous insufficiency is defined. Initially the specialist pays attention to existence of some symptoms of a disease: hypostases of legs, characteristic pain, night spasms in gastrocnemius muscles, existence of pigmentation in the lower part of a shin, and also eczemas, dermatitis and trophic ulcers.
Generally at diagnosis ultrasonic methods of inspection are applied: duplex ultrasonic scanning, Doppler ultrasonography. To specify the reasons of manifestation of chronic venous insufficiency, carrying out a flebografiya is possible.
Treatment of chronic venous insufficiency
Today treatment of venous insufficiency is made using methods which are appointed also at other diseases of vessels — varicosity, a posttromboflebitichesky syndrome.
The purpose of therapy of this illness is, first of all, recovery of a blood-groove in veins. As a result, also lymph current is recovered, trophic changes of reversible character disappear. Actively use of both conservative, and surgical methods of treatment of venous insufficiency practices.
Conservative therapy of venous insufficiency consists in use of a number of physical methods, and also medicines. At complex use of these means the effect of treatment will be the highest. Besides, it is important to define what risk factors directly influencing progressing of an illness take place in each case. It can be pregnancy, increase in body weight, specific loadings on a workplace. Each patient has to understand about a possibility of further progress of chronic venous insufficiency and take measures for the prevention of this process.
In order that the surgery was not necessary at venous insufficiency of the lower extremities and further, it is important to follow all rules of prevention of further development of venous insufficiency, to apply compression therapy. The compression is carried out by means of bandaging of extremities by elastic bandage, wearing special compression stockings. The compression jersey should be chosen only after consultation with the doctor as there are four classes of such jersey.
The course of treatment medicamentous flebotropny drugs is not less important. Treatment by such means can facilitate a condition of the patient considerably. For drug treatment of chronic venous insufficiency drugs of bioflavonoids are in most cases appointed. Their action is especially effective at early stages of an illness. Even if accepts such drugs of the patient throughout the long period, they do not exert a negative impact on an organism. If treatment is carried out on compensation stages, then a therapy course by such drugs last from one to two months and 2-3 times a year repeat. At subcompensation stage duration of a course of treatment increases about four months. The third stage of venous insufficiency is treated by means of a semi-annual course of administration of drugs of bioflavonoids then the dose decreases half.
Today most often treatment of this disease is carried out using drugs on the basis of diosmin and hesperidin. They are most effective at simultaneous use. Besides, diosmin is used also for prevention of venous insufficiency.
Now resort to operational methods of treatment of venous insufficiency only in 10% of cases as conservative methods of treatment can improve considerably quality of life of the patient in most cases. However very often surgical treatment is demanded by those patients, it is important to them to eliminate cosmetic defect — varicose expanded veins.
There are several often applied operational methods of therapy of venous insufficiency. So, carrying out removal of a conglomerate of varicose veins, bandagings of the place where the saphena of a hip falls into a femoral vein is possible. According to other technique, in a shin the section is carried out, and bandaging of perforantny veins is made. Such operation is performed if insufficiency of valves of perforantny veins is diagnosed for the patient.
Carrying out so-called operation of Bebkok consists in carrying out a section at the beginning of a hip saphena. After that enter a probe with the roundish termination into a varicose vein. Its end is removed in a knee together with the recorded vein.
At development in the patient with venous insufficiency of a varicosity sclerotherapy is sometimes applied. Such technique was used for treatment in ancient times. The technique consists in introduction to a vein of special substance which promotes chemical impact on walls of a vein to both the subsequent their adhesion and fusion. But manifestation of palindromias, tromboembolic episodes is characteristic of this method. Sclerotherapy is appointed in the presence at sick varicosity of veins of small and medium caliber. Procedure is carried out with use of local anesthesia.
Also for treatment of chronic venous insufficiency use of laser surgery, endoscopic removal of varicose veins practices. Only the specialist after detailed research and establishment of the diagnosis has to offer a technique of treatment.
Prevention of chronic venous insufficiency
To prevent development of chronic venous insufficiency, it is necessary not to allow displays of those diseases which provoke its progressing further. Methods of prevention of such illnesses assume use of compression jersey, everyday physical activity with adequate loadings, periodic sublime position of legs, and also regular breaks during the long work sitting or standing. In a break it is necessary to do warm-up or some time to take extremities in the sublime weakened situation. It is in certain cases reasonable to accept a rate of flebotropny drugs periodically. For avoiding of problems with vessels it is always necessary to choose only convenient, free and steady footwear. Women should not wear constantly shoes on very high heel.
Section: Diseases of vessels