Venous insufficiency is a violation of blood circulation 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 consider this disease in more detail and learn about the classification of chronic venous insufficiency.
What is this
Pathology ranks first in prevalence among all vascular diseases, most often women are affected by it. 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 due to a malfunction of the venous valves that regulate the blood circulation process. At this point, blood begins to flow downward instead of upward to the heart.
With the development of the disease, pressure increases on the walls of blood vessels, which leads to their thinning. This results in blockagesveins. And if they are not treated, trophic ulcers appear on the surrounding tissues. According to the CVI classification, the first signs of varicose veins are swelling of the legs, cramps in the evening, a clear pattern of veins on the surface of the skin.
Shapes
In medicine, there are two forms of venous insufficiency: acute and chronic. CVI affects the veins that are close to the surface of the skin, and therefore pigment spots or ulcers may appear. OVN, on the other hand, is formed due to blockage of the deep veins of the lower extremities when a leg injury is received or during thrombosis, while the vessels that are close to the surface of the skin are not affected. The main symptom of ALS is severe pain that disappears if a cold compress is applied.
Reasons
The main factors in the development of CVI are:
- heredity;
- repeated pregnancies and births;
- hard physical labor;
- female;
- inactive lifestyle;
- prolonged standing or sitting position;
- overweight.
It was revealed that the pathology occurs when the functioning of the musculo-venous pump is disturbed. Normally, blood in the lower extremities moves through the system of deep and superficial veins. Veins have valves to allow blood flow to the heart muscle, they prevent blood from moving down.
The worst conditions for normal blood circulation are: the vertical position of the body and the absence of muscle contractions. In this case, the bloodstagnates, the pressure rises, and the vessels dilate. Thus, the pathology of the valvular apparatus is formed, it does not completely close its valves, thereby causing an abnormal downward flow of blood.
It increases the pressure in the veins. After that, the permeability of the vessel walls increases, the vein swells, compresses neighboring 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;
- dry;
- redness;
- dizziness;
- trophic ulcers;
- venous dermatitis;
- pre-fainting.
CVI classification by CEAR
CEAP classification is divided into four groups, each of which is designated by a letter of the Latin alphabet: C, E, A and P. These values are deciphered:
- C – clinical. Clinical picture of the disease.
- E – etiological. Etiology, allows you to know the primary or secondary disease.
- A – anatomical. Indicates the location of the disease and the level of damage.
- P - pathophysiological. Pathophysiology, indicates the degree of progression.
Clinical manifestations are classified by degree of CVI:
- 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. Skin bumps may appear.
- 3 - Pain and swelling are added to all symptoms.
- 4 - skin changes, pigmentation, ulcers.
- 5 - everything in the previous paragraph, but the ulcers heal.
- 6 - ulcers become open and do not heal.
Etiology (CEAP CVI classification):
- Ec. The disease is congenital, the first symptoms in this case appear in childhood.
- Ep. Primary disease, cause unknown.
- Es. Secondary CVI due to a blood clot, trauma, etc.
- En. Reason unknown.
Anatomical group:
- AS - veins on the surface of the skin;
- AD - deep veins;
- AP - perforating veins of the thigh and/or lower leg;
- An - no change.
Depending on where the disease is localized, the specialist selects the right treatment.
Pathophysiology:
- Pr - reflux.
- Po - vascular occlusion.
- Pr, oh - a combination of occlusion and reflux.
- Pn - no violations.
Let's consider an example of deciphering the classification of CVI according to CEAR. C2, S, Ep, As, p, Pr, 2, 18 means: symptomatic varicose veins, primary disease. Reflux in the great saphenous vein of the thigh and perforator vein of the leg.
Classification of CVIaccording to Savelyev
Another type of classification created by Russian scientists: Savelyev, Yablokov and Kiriyenko. According to her, there are three degrees:
- 0 degree - no signs of disease.
- 1 degree - the first symptoms appear: swelling and heaviness in the legs.
- 2 degree - puffiness, increased pigmentation, eczema.
- 3 degree - trophic ulcers.
Complications: bleeding, thrombophlebitis, trophic ulcer (indicating the location 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;
- drug use;
- therapeutic gymnastics;
- surgery;
- 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 their adjustment.
Regardless of degree recommended:
- keep your feet elevated often, put a pillow under your feet at night;
- choose comfortable shoes;
- walk more;
- swimming recommended sports;
- for chronic venous insufficiency from 0 to 2 stages - easy running, cycling;
- when doing sports other than swimming, apply elastic compression;
- do medicalgymnastics;
- eliminate sports such as football, volleyball, basketball, tennis, alpine skiing, martial arts, weight lifting.
Elastic compression - the use of an elastic bandage and medical stockings. By squeezing the muscles of the legs, blood circulation improves, which makes it difficult for the further development of varicose veins. 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, laser, diadynamic currents, magnetic field have proven themselves well.
With positive results of conservative methods of treatment, the patient is recommended to 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 medical treatment has not brought positive results, the issue of surgical intervention is being decided. In addition, surgery is necessary for complications such as thrombosis, thrombophlebitis, bleeding, ulcers, as well as for a pronounced cosmetic defect.
During the operation, modified veins are removed. The volume of the operation depends on the complications and severity of CVI. After surgery, sutures are formed within six months, so it is necessary to exclude the use of coarse washcloths and hard clothing for this period, this can lead to divergence of sutures and a cosmetic defect. You can take a shower only in warm or coolwater, and wear elastic bandages or stockings.
Prevention
Prevention of CVI is a series of simple actions that help reduce the risk of the disease:
- maintaining an active lifestyle;
- walking, running 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.
When anxiety symptoms appear, the best option is to see a doctor. He, according to the classification of CVI, will be able to determine the degree of the disease and prescribe a course of treatment.
