management of chronic venous insufficiency

Introduction

I write this blog for people who work a long time either standing or sitting, for those who complain of cramps at night or people who have pain in their legs after a day of work, so they can recognize the symptoms of Chronic venous insufficiency in the lower limbs and what behaviors they can perform to alleviate symptoms.

What is chronic venous insufficiency (CVI)?

Chronic venous insufficiency is the inability of the veins to fulfill their task of returning the blood from the extremities to the heart, which leads to the accumulation of blood and dilatation of the veins. the causes are multifactorial and can appear in up to 25-40% of the population.

Why does CVI occur?

It is the union of various factors among them:
I. Increased pressure within the veins
II. Alteration of the valves within the veins
III. The presence of weaknesses in the wall of the veins
IV. Damages due to thrombosis (Not for all cases)
V. Presence of inflammation due to accumulation of blood in the veins

Not all of them have to be present, but together they seem to participate in the accumulation of blood in the veins of the lower limbs, which causes them to dilate and thus become damaged.

What are the risk factors for CVI?

Risk factors are all those behaviors or conditions that may increase the risk of suffering a disease, particularly in the case of CVI, they are:
The older have more risk
Sedentary lifestyle
Smoking
Pregnancies
Prolonged times in standing
The obesity
The constipation
Family history of CVI (Does not apply to all people)

What symptoms can we expect?

CVI can present without any pain or discomfort in the lower limbs (asymptomatic) or may be some of the following sympotoms:
Varicose veins of various sizes from small ones such as telangiectasias (known as “spider veins”) to larger veins over 1 cm in diameter.
Feeling of heaviness
Evening edema (bilateral leg swelling in the evening hours)
Pain in the legs
Night cramps
Pruritus (Itching)
Skin changes such as hyperpigmentation (presence of dark spots on the affected limb)
Bleeding from varicose veins
Ulcer in the distal portion of the inside of the leg (it is the complication that produces the most disability)

What can I do to improve my symptoms?

Once the diagnosis of CVI has been made by your family doctor, a series of measures can be taken to prevent the progression of the disease and improve symptoms:
Compression stockings are the first choice, even in cases of ulcer. They can be used during the day.
Improve constipation (Check out our constipation blog to find out how to help you)
Lose weight (if you are overweight)
Perform aerobic exercise
Keep the skin of the legs well hydrated (can be with vaseline or moisturizer)
Perform massages from the foot to the knee.
Taking cold showers
Whenever possible, do your best to keep your lower extremities elevated.

In addition to the measures recommended above, there are certain medications and therapies that can help reduce symptoms and treat smaller veins, however, the formulation of these should be carried out by your famyily doctor.
In the case of large veins, the only possible management is surgical and it should be indicated by your family doctor.

What is the ulcer stage?

Once the ulcer appears, the person cannot be operated on until it closes. Sometimes these ulcers can take a long time to close, so it is advisable to do everything possible not to reach this point.

Bibliografía

González, E., & Sánchez, S. (1998). Enfermedad vascular periférica: Problemas venosos de miembros inferiores. Estudio de la incapacidad laboral por enfermedades cardiocirculatorias, 173-182
Santler, B., & Goerge, T. (2017). Chronic venous insufficiency–a review of pathophysiology, diagnosis, and treatment. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 15(5), 538-556
Prevención, D., & Crónica, T. D. L. I. V. (2013). Guía de Práctica Clínica. GPC), MASP, 4
Youn, Y. J., & Lee, J. (2019). Chronic venous insufficiency and varicose veins of the lower extremities. The Korean journal of internal medicine, 34(2), 269
SPIRIDON, M., & CORDUNEANU, D. (2017). Chronic venous insufficiency: a frequently underdiagnosed and undertreated pathology. Mædica, 12(1), 59.

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