Treatment of chronic venous insufficiency of the lower limbs

Treatment of chronic venous insufficiency of the lower limbs

Krzysztof Witkowski, M.D. (vascular surgeon)

Chronic venous insufficiency, due to its growing incidence, is starting to be recognised as a lifestyle disease. According to clinical studies, approximately 48% of the adult Polish population is affected by this condition. A number of problems that occur as a result of this disease are generated by the pressure in the superficial vein system and gene mutation, which leads to defects in the walls of the veins, then their widening and the formation of varicose veins.

The most serious complication of chronic venous insufficiency is deep vein thrombosis, which may lead to pulmonary hypertension, or, in an extreme case, to the sudden death of a patient due to massive pulmonary embolism. Another very troublesome complication is hard to heal trophic ulcers of the leg, occurring in about 1.5% to 2.5% of adult Poles.

In addition to clinical examination, patients suffering from diseases occurring in the limb venous system area require an ultrasound of the arteries of the lower limbs with a Doppler machine to assess the extent of the changes in the arteries and impaired blood flow. The ankle – arm measurement is recommended. A score below 0.7 is a contraindication for compression treatment.

In undergoing assessment to qualify for the compression treatment, an ultrasound of the venous system should be performed in order to evaluate the patency and efficiency of the deep venous system.

Patients whose work requires spending a lot of time in a sitting position, regardless of existing varicose veins, should consider the use of compression therapy, while the degree of compression requires assessment by a vascular surgeon.

Thromboprophylaxis should be considered in patients with risk factors for deep vein thrombosis of the lower limbs, traveling by plane or car for longer than 4 hours. Currently, based on extensive international research, statistically no relationship was found between the use of low molecular weight heparins and the incidence of deep vein thrombosis of the lower limbs in patients with no risk factors for venous thromboembolism. The best method of prevention is therefore compression therapy, to protect against the onset of the so-called economy class syndrome.

A very important issue is the use of the compression treatment in pregnant women. In the case of varicose veins or chronic venous insufficiency it is recommended to use prophylactic compression therapy, and to absolutely avoid the use of currently widely advertised and available without a prescription preparations "enhancing venous efficiency and preventing venous thrombosis." These substances did not undergo clinical studies in pregnant women, which is a strong contraindication for ethical reasons. Their effects on the developing foetus are not known. In this situation as well compression therapy is recommended for the prevention of venous thromboembolism. In most cases, surgery is contraindicated.

There are two ways to perform the varicose vein treatment:

  1. Surgery –A surgical treatment – by reducing the volume of the superficial venous system, thus improving venous blood outflow, thereby reducing the possibility of venous thrombosis;
  2. Compression therapy – same result but without undergoing a surgical procedure. This method is used more often due to existing contraindications, pregnancy, or lack of consent to surgery.

Compression therapy is also used as a complementary method after the performance of varicose vein surgery, both by conventional and minimally-invasive methods, as well as sclerotherapy. Another indication for the use of compression therapy is lymph node swelling. In these cases we apply more pressure than in venous disease and varicose veins. Gradual compression is used in these cases. Compression therapy also significantly accelerates the healing process of ulcers.

The medical compression products by the Swiss company SIGVARIS are currently available at the Damian Medical Centre. They are characterized by high quality and the ability to maintain the parameters of compression over a standard period of six months. It is very important that, prior to purchase, the patient’s limbs are accurately measured by the nursing staff trained by SIGVARIS. The patient also receives information on how to use, wash and store the compression product.

 

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