Venous insufficiency is called a circulatory disturbance in the veins, which is accompanied by pronounced symptoms. This disease is associated with genetics and an inactive lifestyle, and at a certain stage is accompanied by varicose veins. In the article, we will examine this disease in more detail and learn about the classification of chronic venous insufficiency.
What it is
Pathology takes the first place in prevalence among all vascular diseases, most often it affects women. Also, according to statistics, one third of the entire adult population is affected by this disease. A feeling of heaviness in the legs is the first symptom that appears in connection with a malfunction of the valves of the venous valves that regulate the blood circulation. At this point, blood flow starts down, instead of moving up, to the heart.
With the development of the disease, pressure increases on the walls of the vessels, which leads to their thinning. As a result, blockages of the veins are formed. And if left untreated, trophic ulcers appear on the surrounding tissues. According to the classification of CVI, the first signs of varicose expansion are swelling of the legs, cramps in the evening, a clear pattern of veins on the surface of the skin.
Forms
In medicine, two forms of venous insufficiency are distinguished: acute and chronic. CVI affects the veins that are close to the surface of the skin; therefore, age spots or ulcers may appear. OVN is formed as a result of blockage of the deep veins of the lower extremities when a leg is injured or during thrombosis, while vessels that are close to the skin surface are not affected. The main sign of OVN is considered to be severe pain, which disappears if a cold compress is applied.
Causes
The main factors for the development of CVI are considered:
- heredity;
- repeated pregnancies and childbirth;
- heavy physical labor;
- female;
- inactive lifestyle;
- prolonged stay in a standing or sitting position;
- excess weight.
It was revealed that pathology occurs when the muscular-venous pump is disturbed. Normally, blood in the lower extremities moves through the system of deep and superficial veins. For the movement of blood flow to the heart muscle in the veins there are valves, they do not allow blood to move down.
The worst conditions for normal blood circulation are: vertical body position and the absence of muscle contractions. In this case, the blood stagnates, the pressure rises, and the vessels expand. Thus, the pathology of the valve apparatus is formed, it does not completely close its valves, thereby causing an abnormal blood flow down.
This contributes to increased pressure in the veins. After that, the permeability of the walls of the vessels increases, the vein swells, squeezes adjacent tissues, thereby disrupting their nutrition. As a result, a trophic ulcer appears in this place.
Signs
According to the classification of CVI, the signs of the disease depend on the form, severity and stage. The main symptoms are:
- heaviness in the legs;
- muscle cramps during rest and at night;
- swelling of the legs;
- increased skin pigmentation;
- dryness;
- redness
- Dizziness
- trophic ulcers;
- venous dermatitis;
- pre-syncope.
CEAR classification of CVI
CEAP classification is divided into four groups, each of which is indicated by a letter of the Latin alphabet: C, E, A and P. These values are decrypted:
- C - clinical. The clinical picture of the disease.
- E - etiological. Etiology, allows you to know the primary or secondary disease.
- A - anatomical. Indicates the localization of the disease and the level of damage.
- P - pathophysiological. Pathophysiology, indicates the degree of progression.
Clinical manifestations have a classification of CVI according to degree:
- 0 - no visual symptoms.
- 1 - spider veins appear, veins are visible on the surface of the skin.
- 2 - varicose veins begin to develop, not only small, but also large veins are visible on the surface. Mumps may appear on the skin.
- 3 - pain and swelling are added to all the symptoms.
- 4 - skin changes, pigmentation, ulcers.
- 5 - all that is in the previous paragraph, but the ulcers heal.
- 6 - ulcers become open and do not heal.
Etiology (classification of CVI according to CEAP):
- Ec. The disease is congenital, the first symptoms in this case appear in childhood.
- Ep. Primary disease, no cause identified.
- Es. Secondary CVI, developed due to a blood clot, trauma, etc.
- En. The reason is unknown.
Anatomical group:
- AS - veins on the surface of the skin;
- AD - deep veins;
- AR - perforating veins of the thigh and / or lower leg;
- An - no change.
Depending on where the disease is located, the specialist selects the desired treatment.
Pathophysiology:
- Pr - reflux.
- Po - vascular occlusion.
- Pr, o - a combination of occlusion and reflux.
- Pn - no violations.
Consider an example of decoding the classification of CVI according to CEAP. C2, S, Ep, As, p, Pr, 2, 18 means: varicose veins with symptoms, primary disease. Reflux through a large saphenous vein on the thigh and perforating vein of the lower leg.
Classification of CVI according to Savelyev
Another type of classification created by Russian scientists: Savelyev, Yablokov and Kiriyenko. According to her, there are three degrees:
- 0 degree - there are no signs of the disease.
- Grade 1 - the first symptoms appear: swelling and heaviness in the legs.
- 2 degree - swelling, increased pigmentation, eczema.
- Grade 3 - trophic ulcers.
Complications: bleeding, thrombophlebitis, trophic ulcer (indicating localization and stage of the process).
Treatment
Depending on the classification of CVI of the lower extremities, complex therapy is prescribed, which may include the following types of treatment:
- physiotherapy;
- the use of drugs;
- medical gymnastics;
- surgical intervention;
- compression therapy.
Initially, the specialist finds out the risk factors for the progression of the disease, such as overweight, improper physical activity, taking birth control pills, and gives recommendations for correcting them.
Regardless of the degree recommended:
- often keep your legs in an elevated position, put a pillow under your feet at night;
- choose comfortable shoes;
- walk more;
- of sports, swimming is recommended;
- with chronic venous insufficiency from 0 to 2 stages - easy running, cycling;
- during sports, in addition to swimming, apply elastic compression;
- engage in therapeutic exercises;
- exclude sports such as football, volleyball, basketball, tennis, downhill skiing, martial arts, weight lifting.
Elastic compression - the use of an elastic bandage and medical knitwear. Due to squeezing the muscles of the legs, blood circulation improves, which complicates the further development of vein expansion. This type of treatment can be used at any stage of the disease.
Physiotherapy is an auxiliary element in the treatment of CVI. It is used at any stage of the disease. Electrophoresis, a laser, diadynamic currents, and a magnetic field have proven themselves well.
With the positive results of conservative methods of treatment, the patient is recommended further correction of lifestyle, constant physical activity and elastic compression. A second course is carried out in case of a recurrence of the disease, complications or for prevention.
If drug treatment did not bring positive results, the question of surgical intervention is being resolved. In addition, surgery is necessary for complications such as thrombosis, thrombophlebitis, bleeding, ulcers, as well as severe cosmetic defect.
During the operation, the changed veins are removed. The volume of surgery depends on the complications and severity of CVI. After surgery, seams are formed within six months, so it is necessary to exclude the use of coarse washcloths and tight clothes for this period, this can lead to seam discrepancy and a cosmetic defect. You can only take a shower in warm or cool water, and also wear elastic bandages or stockings.
Prevention
Prevention of CVI is a series of simple actions that help reduce the risk of a disease:
- maintaining an active lifestyle;
- walking, jogging or swimming;
- weight control;
- comfortable shoes, if necessary, you can use orthopedic insoles;
- during pregnancy, ultrasound of the veins of the lower extremities is recommended.
If there are disturbing symptoms, the best option is to see a doctor. According to the classification of CVI, he will be able to determine the degree of the disease and prescribe a course of treatment.