What is chronic venous insufficiency?
Arteries (Arteries)carry oxygen-rich blood from the heart to other parts of the body, while Veins (veins) They carry deoxygenated blood back to the heart. If your leg veins cannot carry enough blood to your heart, you have Chronic Venous Insufficiency. Chronic venous insufficiency is sometimes also called chronic venous disease(CVD). You have three types of veins: superficial veins, which lie close to the skin, and deep veins, which are located between muscle groups, and connect to the largest vein in the body, called the vena cava, which goes directly to the heart. Perforating veins connect superficial veins to deep veins.
The veins in your leg veins have to carry blood to the heart against gravity. Your leg muscles compress the deep veins, helping blood return to the heart. Unidirectional valves in your veins ensure that blood flows in the correct direction. When your leg muscles relax, the valves in the veins close. This prevents blood from flowing back. All these processes that allow blood to go back to the heart are called venous pump.
The venous pump works well when you walk and the leg muscles contract. But especially when you sit or stand for long periods of time, blood in your leg veins can accumulate and blood pressure in this area increases. Deep veins and perforating veins can usually withstand increased pressure for short periods of time. However, when sitting or standing for a long time, the vein walls can expand because they are flexible. Over time, this causes the vascular walls to weaken, vein valves to be damaged, and chronic venous insufficiency in susceptible people.
What are the symptoms?
If you have chronic venous insufficiency. , your ankle may swell and you may feel stiffness in your calves. You may feel pain, fatigue and restlessness in your legs. You may feel leg pain while walking or immediately after standing.
Chronic venous insufficiency may occur with varicose veins. Varicose veins are swollen veins that you can see through the skin. It often has a blue, fluffy and curled appearance. Large varicose veins may cause skin changes such as rash, redness and tenderness. Swelling may occur in the leg due to the pressure of blood accumulating in the veins.
Your lymphatic system can produce more fluid called lymph to tolerate chronic venous insufficiency. Your leg tissues absorb some of this fluid, so swelling of the leg may become easier.
Causes of chronic venous insufficiency?
Family history of varicose veins, excess weight, pregnancy, exercise. Doing so, smoking, sitting or standing for long periods of time are factors that increase the risk of chronic venous insufficiency. Although chronic venous insufficiency can occur in anyone, your age and gender may be factors that facilitate the development of chronic venous insufficiency; Chronic venous insufficiency is more common in women over 50 years of age. If the blood pressure in your leg veins remains higher than normal for a long time, chronic venous insufficiency will develop. In diseases such as Deep Vein Thrombosis (DVT) and Phlebitis, which are among the causes of chronic venous insufficiency, the reason for the elevated pressure in the venous vessels is the obstruction of the free flow in the veins. It occurs after rest.
Apart from this, we can list the reasons that may cause DVT as follows.
After major surgeries
- Trauma (injuries, especially leg and hip fractures)
- Long-term journeys
- Presence of intravenous devices
- Blood clotting diseases
- Cancer and cancer treatment
Pregnancy (due to hormonal changes)
Use of medications such as birth control pills containing estrogen
–DVT occurs when a blood clot called thrombus blocks blood flow in deep or perforating veins. The increase in venous blood pressure caused by blood trying to pass through the blocked vein causes excessive load on the valves. Vein valves that cannot function properly are called incompetent. Because they become enlarged, they cannot function effectively, and these inadequate valves contribute to chronic venous insufficiency. The clot formed in deep vein thrombosis blocks blood flow in the vein. In addition, this clot may break off from its location and mix with the blood flow, creating blockage in the vessels of other organs. The most commonly affected area is the pulmonary artery and lung infarction may occur. can. For this reason, deep vein thrombosis is a very serious condition that requires urgent medical intervention. When symptoms such as pain in the leg that occurs when walking, sudden severe pain, color change compared to the other side, difference in diameter, temperature and color, and non-healing wounds on the toes are observed, vascular occlusion is detected. The patient should be examined and treatment planned accordingly. In the treatment of acute DVT, clot-dissolving and stabilizing drugs and stockings that apply pressure to the legs are generally used.
– Plebitis is seen with swelling and inflammation of the superficial vein. This inflammation may cause blood clot formation and therefore the development of DVT.
What tests should be performed?
First of all, your current general health condition, previous diseases and symptoms should be evaluated. You should talk to your doctor. Next, your doctor will perform a physical examination. Your doctor may measure your leg blood pressure and leg circumference. It can control your varicose veins. Duplex ultrasound or venogram may be requested to confirm the diagnosis of chronic venous insufficiency. Doppler ultrasound is a painless procedure and uses sound waves that humans cannot hear. Doppler ultrasound allows your doctor to see the blood flow rate and structure of the veins. Venogram is an x-ray technique that allows your doctor to see the anatomy of the veins. During this test, your doctor gives a contrast dye through a needle that will allow your veins to be seen on film.
Treatment of chronic venous insufficiency?
Chronic venous insufficiency is a serious health risk. not accepted. Your doctor focuses more on pain and other patient complaints.
Medical Treatment
If there is a risk of recurrent thrombosis, life-long anticoagulant drug treatment is required. Although the administration of drugs that increase venous tone and reduce edema provides improvement in symptoms, it does not correct the underlying cause. In cases of mild chronic venous insufficiency, your doctor may recommend a compression bandage. It is done with compression stockings and elastic bandages to compress the vein and prevent blood from flowing back. In this way, compression stockings often improve skin sensitivity and prevent it from getting worse. Compress every day for the rest of your life You may need to wear socks.
You can prevent leg swelling and other symptoms by lifting your legs from time to time to reduce the pressure in the veins and by not standing still for long periods of time. When you have to stand for a long time, you should maintain blood flow by contracting your leg muscles from time to time. At the same time, you can improve the symptoms of chronic venous insufficiency by maintaining your ideal body weight or losing excess weight if you are overweight.
More serious cases of chronic venous insufficiency can be treated with surgical methods. Less than 10% of people with chronic venous insufficiency need surgery to fix the problems.
Surgical Treatment
For larger problems, your surgeon will may perform bypass surgery to treat chronic venous insufficiency. For example, your surgeon may use a removed or artificial vein, called a graft, to connect it to a vein affected by chronic venous insufficiency to help blood flow. Many surgeons can do this with a small incision. Although there is a small risk of DVT and infection from the incision site, this bypass operation, which is generally performed on the leg veins, is safe. However, your doctor will only recommend this procedure in very serious cases.
In some cases, the surgeon may find it necessary to repair the valves in the vein. In valve repair, your surgeon may shorten the valves in the vein to correct the valve functions. After making a small incision in your skin, your surgeon makes an incision in the affected vein. Your surgeon will then crimp the lids. He can place a cuff around the affected vein that supports the vein wall, thus ensuring the continuation of valve functions.
Your Cardiovascular Surgeon will help you choose the most appropriate treatment according to your situation.
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