Chronic venous disease, insufficiency: What are its causes and symptoms?

Chronic venous disease includes a wide range of diseases that affect the veins and last for a long time. These are mainly diseases of the veins of the lower extremities.

You may also come across: chronic venous disease of the lower extremities.

Today, it is one of the most common problems, also because its development supports a modern lifestyle.

The fact is, however, that a relatively large percentage of people underestimate it and neglect its treatment. Alternatively, instead of professional treatment, it treats itself.

Chronic venous disease has a long history and is progressive. 

What does that mean?

It worsens over time, and can result in chronic venous insufficiency. In addition to the aesthetic problem in the form of an ulcer, it also groups other difficulties.

Chronic venous insufficiency  ≠ chronic venous disease .

About chronic venous insufficiency speak of, abbreviated CHVI, when it meets one condition.

The condition for the evaluation of CHVI is:

Presence of increased venous pressure. 

≠

Chronic venous disease, abbreviated as CHVO, combines all diseases or anomalies that affect the veins in the long term.

The disease is said to affect: 
half  to two-thirds of the population of developed countries.

Women are affected in a 2: 1 ratio compared to the male population.

Men neglect this disease more. Women are more careful about the aesthetic aspect. But in many cases, they self-heal, which has a negative impact.

Progressive nature means that CHVO worsens over time and can go as far as CHVI with all its negative and serious manifestations. 

Therefore, early detection of vein problems and early +  professional treatment is important.

Brief information about veins in brief

The vessels that carry blood back to the heart are called the veins. 

The veins collect deoxygenated blood from the whole body. This also applies to the lower limbs. However, gravity impairs the return of blood from this place of the human body.

Auxiliary mechanisms have been developed for better blood flow from the legs, such as a muscle pump or a valve system.

The muscle pump is actually the muscles of the lower limbs, such as those in the forelegs - the muscles of the calf. Their movement compresses the veins, which helps to push the blood towards the higher parts.

Plus ...

The veins of the lower limbs contain valves. Like heart valves, their job is to direct blood flow. Closing the valve does not return blood to the lower part of the vascular bed.

In the lower limbs we recognize three systems of veins, namely:

1. superficial veins
2. deep venous system
3. connecting cores

The superficial veins  (1.) are placed closer to the body surface. They collect blood from tissues. 

The connecting cores (3.) connect the cores placed on the surface and those in-depth.

The system of deep veins (2.) includes larger veins, which run together with the arteries and are in their immediate vicinity.

This placement of deep veins is also important.

Arteries, unlike veins, contain a strong muscle layer. These muscles in the arterial wall are involved in the flow of blood. 

The contraction of the arterial wall also helps in the flow of blood in deeply laid veins.

Want to know more  about chronic venous disease? 
What causes it?
How does it manifest itself?
And what is important in its prevention and treatment?
Read on  to us .

What is chronic venous disease

The definition defines it as a broad term for all diseases and anomalies of the venous system that occur chronically. It is also one of the long-term inflammatory diseases of the veins.

But what is it all about?

The basis of the problem must be sought at the microscopic level.

It is a leukocyte-endothelial interaction. Thus, the action between white blood cells (leukocytes) and the inner lining of the vessel wall (endothelium).

White blood bodies exaggerately attach to the inner wall of the veins, which results in its gradual weakening or even damage.

The vascular wall destroyed in this way does not fulfill its function sufficiently, which gradually begins to manifest itself. The veins lose their strength, shape and are more easily permeable to fluid.

As a result of the whole cascade of disease changes, characteristic difficulties are associated. These do not end with swelling or pain in the legs.

The cause is a long-term progressive process that takes place at the microscopic level. It involves several complex mechanisms. 

The development of CHVO and CHVI is caused by disease processes:

1. blood reflux - venous reflux, in case of impaired venous valve function
   • disturbed blood flow - backflow
     • the blood is not sufficiently pushed higher, but is pushed by gravity back, into the lower parts of the vessel
   • accumulation of blood in the legs
2. vascular obstruction - an obstruction in the flow of blood, such as thrombosis
3. muscle pump disorder - dysfunction of calf muscles in neurological diseases
4. combination of several

Among all the mechanisms, it is necessary to mention, for example:

• increased pressure in the veins
• venous valve damage
• decreased venous tone 
• increased permeability of capillaries - the smallest vessels 
• increased blood density
• swelling of the tissue
• excessive leukocyte action on the vein wall
• thrombosis, ie the formation of blood clots

By joint action occurs:

Venous blood
flow deteriorates,  ie the backflow of blood from the legs 
+
slows down the flow of blood in the veins and capillaries 
+ 
increases the pressure in the veins
+ 
blood accumulates in the lower limbs 
+ 
leukocytes are deposited on the vascular wall  
+ 
an inflammatory reaction develops 
+ 
thrombosis progresses 
+ 
the vascular wall is damaged 
+ 
the venous valves are destroyed 
+ 
the blood circulation deteriorates
+ the
difficulties progress. 

A number of disease changes follow each other, which worsens the condition of veins and tissues.

How does Prof. MUDr. Viera Stvrtinova, CSc. compare in her presentation CHVO: 
What was before?
An egg or a hen? 

In chronic venous disease, the division into primary and secondary form is given.

Primary disease accounts for 70 to 90 % of all cases. 
The exact cause of this form of PGI is unknown.

A ...

The secondary form arises as a result of another pathological event. Examples are injury,  post-thrombotic syndrome, phlebothrombosis, cancer, vascular malformations and others.

Plus, there is an innate form among the causes.

Thus, the cause and initial factor of chronic venous disease may not be known. 
But ... 
Several factors are involved in its development.

The SPA has a multifactorial origin.
+ 
Different factors support each other. 

You ask: Who is at risk of chronic venous disease?

Risk factors in the development of protected areas are:

• age, with an increased risk, especially in people over 65 years of age
• hereditary and genetic predisposition, such as diseases in relatives
  • Varicose veins
  • venous thrombosis, thromboembolism
  • forearm ulcer
  • blood clotting disorders
• female gender
  • hormonal changes mainly during the period of menopause - transition
  • pregnancy and multiple births
  • hormonal contraceptives
  • hormonal treatment
• venous thrombosis in the past and its insufficient treatment
• obesity and overweight
• injury
• greater body height
• lack of exercise
  • sedentary lifestyle
  • sedentary work
  • work standing without movement
  • long sitting on the toilet
• disproportionate muscle load
• tight clothing and high heels, unsuitable shoes
• traffic jam
• lack of fiber in the diet and poor eating habits
• hot environment
• smoking
• long travel
• walking on city pavement

PGI is associated with other disease states. If it is neglected, there is a risk of deteriorating health and the risk of developing complications.

Read about therefore: Diseases of 
chronic venous insufficiency
Deep venous thrombosis
Thrombophlebitis
Thromboembolic disease

These risk factors are also divided into uncontrollable and influenceable from a practical point of view.

To a group of uncontrollable know their efforts work. This includes, for example, age, gender or hereditary and genetic factors.

Vice versa.

We can change influenceable risk factors through our efforts. Examples are overweight and obesity, lack of exercise, smoking or a generally unsuitable lifestyle.

When preventing or exacerbating the disease, it is important to evaluate the risk factors present.
Their elimination follows.
This effort is the basis for success in averting the progress of difficulties.

Manifestations of the disease are divided into subjective and objective.

Subjective are those felt by the affected person. He describes them to the doctor.

They are objectively visible from the outside and can be observed. The doctor can examine them.

The table shows the subjective and objective manifestations of the PLA

Diagnosis takes place on several levels. In doing so, it combines several investigative methods.

Investigation methods:

• medical history - the patient tells the doctor his subjective difficulties, which he feels
  • the doctor detects previous diseases such as thrombosis, inflammation of the veins, the presence of other diseases
  • family occurrence or genetic predisposition is determined
• clinical examination - a doctor examines a person
  • the condition of his lower limbs
  • standing or lying examination
  • clinical trials - Schwartz test, Trendelenburg test
• non-invasive methods
  • ultrasound - SONO examination, duplex sonography, Doppler USG
  • phlebography, CT, MRI
  • plethysmography
  • VeinViewer - projection of the venous system on the skin with an infrared camera
• invasive approach
  • measurement of venous blood pressure
  • contrast X-ray phlebography
  • CT venography
  • isotopic examination
• microcirculation assessment

The investigation methods also proceed in that order.

During diagnosis, the condition is evaluated according to the CEAP classification.

CEAP stands for Clinical Ethiology Anatomy Pathophysiology, meaning that it is an evaluation of a CHVO according to clinical symptoms, cause, anatomical location and pathophysiology.

The classification was established in 1994 in the Hawaiian Islands by the American Venous Forum.

CEAP classification in the table

The course of the disease may be unrecognized in the initial stage and the disease is asymptomatic.

Chronic venous disease is long-term and progressive. This means that it develops over time and the manifestations of the disease increase. 

Alternatively, slight dilation of the skin vessels is present. And in the form of blue-violet spider-shaped, filamentous, whiting veins. 

The opposite is the presence of large dilated varicose veins, or varices.

However, the presence of small or large vasodilation may not indicate the severity of the condition of the deep vein system.

The aesthetic problem is only one side of the disease.

Of the subjective difficulties, it is possible that increased fatigue of the lower limbs or a feeling of heavy legs is the first to appear. 

Later, nocturnal pain or muscle cramps develop. Increasing the intensity of difficulties both at night and during the day suggests the progression of the disease.

Therefore, a professional examination is required.

The return of blood from the lower limbs gradually deteriorates, in addition to macrocirculation, microcirculation is also disrupted at the level of the smallest vessels - capillaries, where metabolism occurs.

Blood circulation is limited at the level of the vessels themselves, the surrounding tissue and skin. 

Skin changes are also associated, which, in addition to changes in skin pigmentation and color, can lead to skin defects. This is called a forearm ulcer.

What is a forearm ulcer?

It is a skin defect that reaches deep, has an irregular shape and the shape of a circular wound.

A chronic wound that is difficult to heal and heal.

Its symptoms are:

• deep defect
• extensive skin damage
• circular shape
• irregular edges
• the presence of exudation, i.e. inflammatory effusion
  • so-called wound wetting
• coated defect base
• swelling of the limb

People often come to the doctor with an ulcer present, which can be healed, but also in the active stage.

It most often arises due to chronic venous insufficiency.