Chronic venous insufficiency, a cause of leg swelling

Chronic venous insufficiency is a cause of leg edema that is rarely known. When severe complications, blood stasis in the veins of the veins forms blood clots, drifting to the heart causes pulmonary artery embolism that can be fatal.

Chronic venous insufficiency of the lower extremities is a venous condition of the lower extremities including the deep vein system, located in the muscle and shallow venous system located just below the skin is stretched, the venous valve system is reduced function . This condition leads to a hemodynamic disorder that causes blood to stagnate in the veins and return to the heart.

The large amount of blood in the vein causes swelling of the legs, the formation of blood clots in the veins and if the treatment is not good, blood clots can float along the bloodstream to the heart and cause a pulmonary embolism causing a Complications can lead to death for patients.

In advanced countries such as Europe and the United States etc. venous pathology is a very common disease. According to statistics in France, chronic venous insufficiency accounts for 1% of men and 4.5% of women in adulthood. In which more than 70% are women and about 35% in working people.

In Vietnam, so far there has not been a complete statistics on this disease. However, according to health experts' predictions, it will increase with the development of the economy and change the lifestyle in our country.

According to a multi-center research statistics initiated by Ho Chi Minh City University of Medicine and Pharmacy: Most 77.6% patients did not know about the previous venous disease.

This speaks of the situation of venous pathology in our country, in which most patients are less interested, afraid to go to the doctor, the doctor overlooks and misses the symptoms. Of which 91.3% of untreated patients and 8.7% of patients were treated incorrectly, mainly using medicines to treat symptoms such as aspirin, diuretic or Oriental medicines.

Depending on the location and causes of lesions, varicose veins of the lower limbs are divided into 4 groups:

Chronic venous insufficiency is a cause of leg edema that is rarely known.In the photo: BS.Nguyen Hoai Nam is examining a patient with varicose veins.(Photo: H.Cat)

- Primary varicose veins or idiopathic varicose veins: in this group, the veins are initially dilated and elongated then the venous valves gradually lose their function.

- Secondary varicose veins, often caused by phlebitis: In this group, the venous valves lose their previous function, then the new veins are stretched and elongated.

- Varicose veins in pregnant women, due to the effect of female sexual hormones and compression of the uterus is enlarged during pregnancy.

- Congenital varicose veins, an abnormal cause of the vein wall causing deep venous congestion and venous motion (mixed hemangioma).

Complications of varicose veins:

- The first is the complications of hemodynamic disorders: swollen leg of the patient, symptoms of pain in the back of the legs, night cramps.

- More severe, the patient may have thrombophlebitis, hot legs, redness, prominent veins and stiff inflammation.

- The final stage can progress to a state of enlargement of the entire vein system, very large varicose veins, circulatory stasis and nutritional disorders of the lower leg skin causing ulcers, infections that are difficult to control. treatment.

- A very severe and often frequent complication of chronic lower extremity varicose is the formation of blood clots in the vein. The embolism can be separated from the vein wall, go to the heart and cause pulmonary embolism, a very serious complication that can lead to death if not timely emergency.

The danger elements:

- In fact, not everyone is likely to have this disease, only some people in the high-risk group are prone to it. Genetics is a common denominator for these patients, hereditary more susceptible to disease than others, due to changes in enzymes in connective tissue.

- Women often suffer more than men due to the effects of female hormones, fetal up to the vein wall, due to long standing in some special careers such as sales, weaver, low muscle mass or shoes suitable.

- Excessive weight gain is also a risk factor because the force exerted from the front to suck blood is reduced and centrifugal reflux currents arise due to increased pressure from the abdomen.

- Contraceptives due to hormonal use should also be a risk factor such as pregnancy.

- Surgery may cause venous thromboembolism complications and most phlebitis is minor urinary surgery such as surgery in obstetrics and urology, other procedures such as castings, long immobilization in fractures . However, recently the importance of this risk factor has diminished.

- People who eat under a high-fiber, low-fiber diet or constipation are also prone to varicose veins.

How to diagnose?

The diagnosis of diagnosis is mainly based on clinical examination including seeing veins that are stretched, twisted, skin discolored, nutritional disorders, ulcers and the appearance of hemangiomas.

Touch to know the hardness of the software, especially the pre-tibial area, compare both sides. In addition, it is possible to touch a hard vein, edema, embolism and determine the temperature of the skin.

Finally, the diagnosis was determined by vascular color Doppler ultrasound, which allowed the determination of hemodynamic disorders, venous valve status, varicose veins and embolism. In the heart of the circuit from which to have the right treatment attitude.

Color Doppler ultrasound is a non-invasive, very safe diagnostic method that delivers immediate results with an accuracy of 95-99%. Intravenous Doppler ultrasound allows visualization of stretched vein, venous valves with impaired function and whether a blood clot forms in the vein.

Treatment of chronic venous insufficiency

There are many main therapies to control or stop reflux, remove reflux from branch veins and from connected circuits, ultimately preventing the overflow of interstitial tissue from the fluid from the micrographs. .

- Prevention : This method is to stop reflux and make the forces acting on the vein flow better.

Includes: High leg when lying down, exercise more strongly, avoid standing or sitting for long, wear tights or wrap your legs with elastic bandage, correct foot position for deformities, avoid obesity, practice breathing deep, eat a diet high in fiber to avoid constipation .

The pressure bandage restores the differential pressure between the shallow and deep vein systems through the piercing system, reducing the diameter of the vein to increase the ability to transport when resting and exertion.

- Medical treatment with vascular durable drugs such as Daflon, Rutin C, Veinamitol . But most of them only work in the early stages of varicose veins. Some specialist physicians also apply topical fibrous injections with drugs that cause vascular fibrosis.

- Surgery with two main methods: Relaxed shallow vein removal is called the Stripping method with a specialized device that allows the removal of veins as we make chicken beds and Chivas method to get veins stretching of the piercing system, this is a fairly thorough treatment with the lowest recurrence rate.

- In addition, people now apply cooling method with liquid nitrogen negative 90 degrees C to block the venous heart through a catheter in the vein, however this method gives a relatively high recurrence rate to 30 % cases.

With a chronic disease, the success of treatment depends on many factors. The most important of which is the accurate diagnosis and effective treatment, but also depends on the patient's understanding of disease status and compliance with treatment and abstinence problems in treatment.

According to vein experts in the world, the likelihood of recurrence of chronic venous insufficiency is quite high, up to 30%.

The main reason is that patients who do not strictly follow the rules of treatment such as not taking the prescribed medication, do not wear medical socks because they feel entangled when operating, do not change the regime. Working and diet rich in low fiber carbohydrates . and not participating in sports activities.

Associate Prof. Dr. Nguyen Hoai Nam - Ho Chi Minh City University of Medicine and Pharmacy