Chronic venous insufficiency – causes, symptoms, complications, treatment
Chronic venous insufficiency is a condition caused by a dysfunction of the superficial or deep venous system, or both. Dysfunction is given by the incontinence of venous valves associated or not with venous obstruction.
Varicose veins are a cause of deep venous insufficiency and are characterized by a pathological dilatation of one or more superficial veins. Varicose veins affect 30-60% of the general population.
Main causes are: age (prevalence increases with age), obesity, pregnancy, contraceptives and hormone replacement therapy is controversial, genetics. Venous blood return is aided by continence of the venous valves, adjacent artery pressure, muscle pump, pressing the foot arch, thoracic negative pressure on breathing. In case of varicose veins there is an incontinence or damaged of the valves with stagnant blood, venous dilation and subsequent thrombosis with worsening incontinence (to destroy valves). Local it will be activated an inflammatory process.
Varicose veins, most commonly, are essential and affect women. Secondary varicose veins occur after phlebitis by destroying the valvular system or can be congenital (agenesis of the deep veins) or may also be caused by a compression of a pelvic tumor.
Signs and symptoms: embarrassment (varicose veins are unsightly), feeling of heaviness, of press, of standing fatigue. Restless legs syndrome: tingling in the legs that cause the patient to move them so that they disappear. Effort myalgia may occur within a venous claudication (rare phenomenon that occurs a few weeks after a venous thrombosis).
On physical examination will be inspected the varices: size, number, location. Local may be present a nonspecific edema but is usually correlated with the feeling of heavy legs. Evaluation of valvular incontinence is done using the Schwartz technique (vibration transmission along a varicose trajectory) and Trendelenburg test. Also, it will be palpated the distal arterial pulses.
Examination of the veins is completed by achieving a Doppler ultrasound of the lower limbs (preoperative, if an ulcer is present, confirmation of thrombosis).
Superficial phlebitis – pain, redness of an endured venous package. Doppler ultrasound will confirm the location and the treatment will consist of administration of oral or topical NSAIDs and alcohol compresses.
Ruptured varices with hemorrhage – the member will be picked up and will be applied a compressive dressing.
Complications of the skin: itchy eczema (scaly reddish lesion), ocra dermatitis (brown staining of the skin), Kilian white atrophy (reflects non-vascularised areas), varicosities (dilatation of the sub-papillary venous plexus ), chronic hypodermitis (lower leg skin is endured, painless and is due to a prolonged inflammation), varicose ulcers (single, large, smooth, usually located at the internal malleolus and do not hurts).
General measures: will be corrected favoring factors (weight loss, avoid a prolonged standing, avoid contraceptives) will be resumed walking, before lifting from the bed it will be applied elastic content (sock or tape) and the tetanus vaccine will be done.
Medical treatment: venous tonic (least efficient, used in case of heavy legs sensation, pain and restless legs), strips of contention, crenotherapy (thermal cures), varicose veins can be sclerosed with physical agents or laser.
Surgical treatment: internal saphenous vein stripping and perforating veins ligation with preoperative preventive anticoagulation.