Chronic venous insufficiency
VASCULAR SURGERY – EURODOCTOR.RU – 2007
What is venous insufficiency?
Venous insufficiency – a disease caused by lack of deep vein valves. The disease is very common and familiar to many people, however, suffers from lack of attention, both from the patient and, until recently, by the medicine, has emerged as retribution for human bipedalism. Features of modern life – lack of exercise, prolonged sitting and standing at work, as well as some features of congenital vascular and hormonal problems lead to venous outflow of blood.
The main substrate of chronic venous insufficiency is, as mentioned above, the lack of venous valves. Valves are available in the deep veins, and in the surface. In deep vein thrombosis of lower extremities of their lumen blocked. However, over time, their clearance is restored. This is due to the so-called recanalization. However, after the restoration of the lumen of the vein is no restoration of their valves. Veins become inelastic, comes to fibrosis. The valves of veins are destroyed and the normal blood flow stops.
As you know, the valves prevent the backflow of blood through the veins of the legs. With their failure develops so-called post-trombophlebitic syndrome, and as its main manifestation – venous insufficiency. Its manifestations are diverse. What appears CVI? Symptoms varied with the presence of only one symptom or several. Patients were concerned about pain, heaviness, swelling in the evenings, going in the morning, night cramps, change in color of the skin in the lower third of the leg and loss of elasticity of the skin, the presence of varicose veins. The latter feature does not always appear in the initial stages of the disease.
What are the causes of chronic venous insufficiency?
The mechanism of chronic venous insufficiency is the following. Damaged valves of deep veins of the legs can not prevent reverse blood flow in them. This leads to a significant increase in blood pressure. The result is that the liquid part of blood – plasma – begins to "propotevat" through the walls of the veins into the surrounding tissue. This leads to swelling and compaction fabrics. Swelling of the skin squeezes tiny blood vessels in the leg. Especially the ankles. This leads to ischemia, resulting in sores appear – one of the main signs of venous insufficiency. For chronic venous insufficiency can lead the factors that contribute to the development of varicose veins of the legs (primary or secondary), thrombosis of deep veins of the legs, as well as the primary valve insufficiency of the deep veins of the lower extremities.
Diagnosis of chronic venous insufficiency
Diagnosis of chronic venous insufficiency is primarily based on the ultrasonic diagnostic methods. That the following methods:
- Doppler ultrasound
- Duplex ultrasound scanning
In addition, for further clarification causes of chronic venous insufficiency can be applied X-ray methods such as phlebography.
How does chronic venous insufficiency?
The main manifestation of chronic venous insufficiency include:
- Swelling of the lower extremities
- Dull arching pain aggravated by prolonged standing and decreasing at rest
- Cramps in the calves at night
- Pigmentation of the skin in the lower part of leg
- Dermatitis, eczema
- Trophic ulcers, mainly in the ankles
Treatment of chronic venous insufficiency
Treatment of venous insufficiency is virtually the same events, which are used in postthrombotic syndrome and varicose veins.
Here are the methods of treatment:
- Compression therapy is used as varicose veins and postthrombotic syndrome and chronic venous insufficiency. To apply compression therapy elastic bandages, but most of the special compression stockings. Depending on the pressure generated by it is divided into four classes. The action of compression hosiery is based on the fact that when the superficial veins are compressed feet, the outflow of blood from the deep veins in the superficial venous system becomes impossible.
- Sclerotherapy. This method of treating varicose veins is known from the time of Hippocrates. At one time in our country this method has been unfairly rejected. But abroad, this method has been successfully developed and applied. Method is considered the founder of John Fegan. His technique of sclerotherapy has been known since 1967. This technique is also known as compression sclerotherapy. The method consists in the fact that the vein entered the special substance that irritates the inner wall of the vein leading to her chemical burns. This leads to adhesion of the walls of veins and imperforate. At the present time vachestve these drugs – sclerosants – used fibroveyn, and ethoxysclerol trombovar. After the introduction of sclerosant into the vein, it is compressed latex pillow, after which the bandages. Thus all of the vein sclerotherapy. As a result, the lower limb is bandaged. Instead, the bandage is now increasingly applied compression stockings. Compression of veins can be extended to three months. It should be noted that this method is not without drawbacks, namely, it does not guarantee against recurrence of varicose veins.
- Surgical methods. Troyanov-Trendelenburg operation – the technique is ligation of the confluence of saphenous vein femoral vein in the thigh, as well as the removal of the conglomerate varicose veins. To do this in the hip area of the entire length of the varicose vein is cut.
Operation and Kokketa Linton – is a technique that is carried out in a cut leg, and tied perforating veins. At the same time during surgery, they tied Linton tied for fascia, and when the operation Kokketa – over the fascia. This operation is effective for valve insufficiency of perforating veins, the so-called postthrombotic syndrome. Currently, these operations are modified so that the ligation of these veins is performed with a minimal incision. This so-called technique of remote cross perforators. In addition, for this purpose used an endoscopic technique. This so-called minimally invasive technique.
Operation Babcock – is that in the early saphenous vein thigh incision. Provided saphenous varicose Vienna. In the lumen of the vein is introduced flexible probe, the other end of which is derived from the other end of varicose veins in the knee. At the end of the probe has a rounded education. Vienna is fixed to it and displays the probe. Currently applied methods of stripping and miniflebektomy, which are essentially modifications of the Babcock operations, but instead of using a thick section of a puncture, after which practically no scar remains.
Prevention of chronic venous insufficiency
Prevention of venous insufficiency is the prevention of diseases that cause its development. One of the important methods of preventing this is to wear compression hosiery.
CARDIOVASCULAR SURGERY in MC Imedical – ISRAEL
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CLINIC CARDIOVASCULAR SURGERY NIDERBERG – GERMANY
CENTER FOR CARDIOVASCULAR MEDICINE SURGERY JSC – MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
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