What is Chronic Venous Insufficiency?

Factors that promote venous thrombosis include: venous stasis, vascular injury, and hypercoagulable state. Many clinical factors related to the above three aspects lead to venous thrombosis evenly and objectively. The common ones are as follows:

Chronic venous insufficiency

Deep venous thrombosis: It is mainly caused by the foreign blood and hypercoagulable state, so the thrombus and the wall of the thrombus only have slight adhesion, and it is easy to fall off and become a emboli to form a pulmonary embolism. At the same time, deep venous thrombosis makes the blood return significantly affected. Causes distal tissue edema and hypoxia, resulting in chronic venous insufficiency syndrome.

Affected area

whole body

Related diseases

Acute myocardial infarction. Superior mesenteric venous thrombosis. Dispersive intravascular coagulation stroke. Fracture of lower extremity deep venous thrombosis. Upper extremity deep venous thrombosis. Neonatal renal vein thrombosis. Mesenteric venous thrombosis. Gynecological and venous thrombosis. Acute superior mesenteric venous thrombosis. Thrombosis Intracranial venous thrombosis Capillary or venous thrombosis Portal vein thrombosis Lower extremity venous thrombosis Pediatric renal vein thrombosis Vascular injury

Affiliated Department

Other departments

Related symptoms

Nodular venous return disorder venous blood flow retardation venous thrombosis chronic venous insufficiency

Factors that promote venous thrombosis include: venous stasis, vascular injury, and hypercoagulable state. Many clinical factors related to the above three aspects lead to venous thrombosis evenly and objectively. The common ones are as follows:

surgery: especially surgery in orthopedics, thoracic cavity, abdominal cavity and urogenital system;

tumor: pancreatic, lung, gonad, breast and urinary tract malignant tumors;

Trauma: especially fracture of spine, pelvis and lower limbs;

Long-term bed rest: such as acute myocardial infarction, stroke, after surgery;

the effects of pregnancy and estrogen;

hypercoagulable state: lack of antithrombin III, C protein or S protein, circulating lupus anticoagulants, myeloproliferative diseases, dysfibrinemia, disseminated intravascular coagulation (DIC);

Sacral phlebitis and venous interventional diagnosis or treatment lead to venous injury. The mechanism of venous thrombosis caused by the above-mentioned various causes is not singular, but it is often a combination of factors. For example, in addition to the local vein damage caused by surgery, long-term bed rest after surgery causes venous blood stasis; after major surgery, the blood is in a hypercoagulable state .

The diagnosis of deep vein thrombosis is generally not difficult. The following diagnostic methods can be used:

1. Venous pressure measurement: The venous pressure of the affected limb is elevated, indicating that the proximal cardiac vein is blocked at the lateral pressure;

2. Ultrasound: Two-dimensional ultrasound imaging can directly see the thrombus in the large vein. With Doppler to measure the blood flow velocity in the vein, and observe whether the normal response of breathing and compression action exists. The positive rate of this type of diagnosis for proximal deep venous thrombosis can reach 95%; the diagnostic sensitivity for distal patients is only 50% -70%, but the specificity can reach 95%.

3. Radionuclide inspection: 125I fibrinogen scan is used for diagnosis of this disease. In contrast to the ultrasound examination, the detection rate of deep vein thrombosis in the gastrocnemius muscle can be as high as 90%, but the specificity of the diagnosis of near deep vein thrombosis is poor. The main disadvantage of this test is that after the radionuclide injection, a lag of 48-72 hours is required to show the effect.

4. Impedance plethysmography (IPG) and venous angiography (PRG): The former uses skin electrodes, while the latter uses inflatable cuffs to measure changes in venous volume under physiological changes. When the vein is blocked, the amplitude of the volume wave caused by breathing and sleeve filling and deflation is small. The positive rate of this type of test for the formation of proximal deep vein snow mountains can reach 90%, and the diagnostic sensitivity for distal patients is significantly reduced.

5. Deep vein angiography Inject contrast medium from the superficial vein of the foot, and use a pressure band at the proximal end, it is easy for the contrast medium to directly enter the deep vein system. If venous filling defects occur, stereotypes and localization diagnosis can be made. Superficial venous thrombosis is easier to diagnose, and local symptoms and signs are more obvious.

Differential diagnosis of chronic venous insufficiency:

1. Venous reflux disorder: The process of the systemic venous tube transporting blood back to the right atrium. The blood volume of the systemic venous system is large, accounting for more than half of the total blood. Veins easily expand and contract, so they play a role in blood storage. Vein contraction and relaxation can effectively regulate return blood volume and cardiac output, so that the circulation function can adapt to the needs of the body in various physiological states. The basic force of venous return is the pressure difference between the small vein (also known as the peripheral vein) and the vena cava or right atrium (also known as the central vein). Elevated venous pressure or decreased vena cava pressure are beneficial to venous return. Because the venous tube wall is thin and the venous pressure is low, venous return is also affected by external forces such as the squeezing effect of muscle contraction, breathing movement, gravity and so on. When the above factors prevent venous return, the body will show various manifestations.

2. Venous blood flow stagnation: Venous blood flow stagnation: Thrombophlebitis is a venous vascular disease characterized by intracavitary thrombosis secondary to acute non-purulent phlebitis, and the skin in the superficial venous area is red and swollen, and it is involved Sexual pain, palpable strips or nodules can be felt, and venous blood flow is sluggish.

The diagnosis of deep vein thrombosis is generally not difficult. The following diagnostic methods can be used:

1. Venous pressure measurement: The venous pressure of the affected limb is elevated, indicating that the proximal cardiac vein is blocked at the lateral pressure;

2. Ultrasound: Two-dimensional ultrasound imaging can directly see the thrombus in the large vein. With Doppler to measure the blood flow velocity in the vein, and observe whether the normal response of breathing and compression action exists. The positive rate of this type of diagnosis for proximal deep venous thrombosis can reach 95%; the diagnostic sensitivity for distal patients is only 50% -70%, but the specificity can reach 95%.

3. Radionuclide inspection: 125I fibrinogen scan is used for diagnosis of this disease. In contrast to the ultrasound examination, the detection rate of deep vein thrombosis in the gastrocnemius muscle can be as high as 90%, but the specificity of the diagnosis of near deep vein thrombosis is poor. The main disadvantage of this test is that after the radionuclide injection, a lag of 48-72 hours is required to show the effect.

4. Impedance plethysmography (IPG) and venous angiography (PRG): The former uses skin electrodes, while the latter uses inflatable cuffs to measure changes in venous volume under physiological changes. When the vein is blocked, the amplitude of the volume wave caused by breathing and sleeve filling and deflation is small. The positive rate of this type of test for the formation of proximal deep vein snow mountains can reach 90%, and the diagnostic sensitivity for distal patients is significantly reduced.

5. Deep vein angiography Inject contrast medium from the superficial vein of the foot, and use a pressure band at the proximal end, it is easy for the contrast medium to directly enter the deep vein system. If venous filling defects occur, stereotypes and localization diagnosis can be made. Superficial venous thrombosis is easier to diagnose, and local symptoms and signs are more obvious.

Focusing on the serious threat of pulmonary embolism, all high-risk patients with deep venous thrombosis should be prevented in advance. Femoral head fractures, large orthopedic or pelvic surgery, and middle and old people with risk factors such as increased blood viscosity are mostly prevented with low-dose heparin before undergoing surgery for more than 1 hour. Heparin 5000U was injected subcutaneously 2 hours before the operation and every 8-12 hours thereafter until the patient got up and moved. The treatment of acute myocardial infarction with heparin is also beneficial for the prevention of venous thrombosis. Warfarin and other similar drugs are also available. Dextran 40 is available for those who have a bleeding tendency.

Aspirin and other antiplatelet drugs have no preventive effect. For those with obvious anticoagulation contraindications, conservative prevention methods should be adopted, including early wake-up activities and wearing elastic stockings. Compression of the gastrocnemius with regular inflation is also effective, but it is difficult for patients to accept.

Deep venous thrombosisDeep venous thrombosis is valued clinically due to its severe fatal complication-pulmonary embolism, and the legacy of chronic venous insufficiency syndrome.