Chronic venous disease

what is chronic venous disease

1. CHRONIC VENOUS DISEASE Tamer elmoghazy 2/17/2014 Pharmaceuitcal Scientific Associatio 1

2. Overview Chronic venous disease is a common disorder that affects the veins of the legs. These veins carry blood from the legs to the heart. Normal veins have a series of valves that open and close to direct blood flow from the surface of the legs to the deep veins and back to the heart; the valves also control the pressure in smaller veins on the legs' surface . If the valves within the veins fail to work properly, blood can flow backwards in the veins and pool in the legs . 2/17/2014 Pharmaceuitcal Scientific Associatio 2

3. The pooled blood can increase pressure in the veins. This can cause problems that are mild (such as leg heaviness, aching, dilated or unsightly veins) or severe (such as swelling, skin color changes, skin rash on the leg, recurrent skin infections and chronic ulcers). People who develop these more severe symptoms are said to have chronic venous insufficiency. Overview 2/17/2014 Pharmaceuitcal Scientific Associatio 3

4. The venous system I n the lower limbs is made up of a number of complex anatomical structures, including principally: The deep venous system (90% of the total system) (read more...) The superficial venous system (10% of the total system) (read more...) Perforating veins, which cross the aponeurosis to link deep and superficial veins The veins of the foot, which form a complex network create a genuine blood reservoir. 2/17/2014 Pharmaceuitcal Scientific Associatio 4

5. The veins H ave a tubular structure with a thinner, more supple muscle layer than the arteries . They are equipped with flaps to prevent reverse blood flow, called  venous valves 2/17/2014 Pharmaceuitcal Scientific Associatio 5

6. Physiology of the venous system in the lower limbs The main purpose of the venous system within the general circulation, is to carry oxygen-depleted blood rich in cell metabolism waste back to the heart . It is within the legs that the stresses are the greatest and the specific characteristics of the venous system are the most important, since the venous system must move blood against the force of gravity in the standing position . 2/17/2014 Pharmaceuitcal Scientific Associatio 6

7. A combination of two main actions ensures venous return in the lower limbs : Firstly, the presence of mobile anti-reflux valves and the resistance of the vein walls allowing the blood to move in one direction only : from the superficial to towards the deep venous system and from the feet to the heart . Secondly, a pump mechanism which activates and maintains the blood flow through the veins. Physiology of the venous system in the lower limbs 2/17/2014 Pharmaceuitcal Scientific Associatio 7

8. The anti-reflux valves allow fluid to circulate in one direction only, making it possible to maintain the normal direction of venous blood flow, even in the absence of pressure – or in the event of negative pressure – and thereby prevent backflow of the blood . Normal blood flow is directed from the superficial towards the deep system and from the most distal part of the body towards the heart. Physiology of the venous system in the lower limbs 2/17/2014 Pharmaceuitcal Scientific Associatio 8

9. The pump mechanism mainly results from a combination of different forces : The stimulation of the venous system of the  foot. The  muscle pump , more specifically, the muscles of the calf (leading to alternate opening and closing of the valves): which is the main driving force behind the pump mechanism, The beating of the heart and the negative pressure due to the phenomenon of aspiration from the abdominal cavity that occurs during deep breathing. Physiology of the venous system in the lower limbs 2/17/2014 Pharmaceuitcal Scientific Associatio 9

10. When walking, all these mechanisms work together to ensure good venous return . Conversely, at rest, the stimulation of the venous network of the foot and calf-muscle pump is absent. Only the impact of the heart and respiratory movements on the venous system is present. Physiology of the venous system in the lower limbs 2/17/2014 Pharmaceuitcal Scientific Associatio 10

11. Chronic venous disease in the lower limbs The term  Chronic Venous Disease  (CVD) covers all the signs relating to functional or physical impairment of the venous system in the lower limbs. It is caused by valve insufficiency with or without associated venous obstruction, affecting both the superficial and deep venous systems, and has a chronic course. 2/17/2014 Pharmaceuitcal Scientific Associatio 11

12. Origin of the chronic venous disease Malfunction of the venous system can be  primary  (in almost 90% of cases) or  secondary  (approximately 10% of cases of chronic venous insufficiency). Sooner or later, it leads to progressive  chronic venous disease  (CVD), which affects between 11 to 24% of the population in industrialised countries, with a clear predominance among women (male-female ratio = 1/3). It is called primary when the impairment is not a consequence of another disease.  Conversely , the CVD is termed secondary when it is consecutive to another disease,  primarily deep vein thrombosis (DVT). This is then called post-thrombotic syndrome or disease (also called post- phlebitic syndrome).(expert's view by Jean-Patrick Benigni , MD, General Secretary of the French Society of Phlebology, Paris - France...)  2/17/2014 Pharmaceuitcal Scientific Associatio 12

13. Risk Factors Varicose veins occur more often in women than men. especially during pregnancy (starting in the first trimester). during the last 14 days of the menstrual cycle, and in people who have a job for which they must stand for long periods of time. 2/17/2014 Pharmaceuitcal Scientific Associatio 13

14. refers to other chronic conditions related to or caused by veins that become diseased or abnormal. These problems can include: Varicose veins and spider veins Leg Swelling and Leg Pain Chronic venous insufficiency Leg skin changes Leg ulcers Phlebitis Vascular Malformations Chronic venous disease (CVD) 2/17/2014 Pharmaceuitcal Scientific Associatio 14

15. Pathophysiology of the chronic venous disease Chronic venous disease is undoubtedly a multifactorial disease. No main cause has been demonstrated. It is not possible, therefore, to rank the primary physical or biological changes in order of importance. 2/17/2014 Pharmaceuitcal Scientific Associatio 15

16. Valve insufficiency This may be quantitative or qualitative quantitative in the event of congenital insufficiency in terms of valve numbers or massive destruction due to venous thrombosis qualitative as a result of a valve being torn or due to permeability of the valve Pathophysiology of the chronic venous disease 2/17/2014 Pharmaceuitcal Scientific Associatio 16

17. Venous wall damage. Damage to the venous wall seems to be more common than valve damage . The wall becomes thinner at the level of the valve. The vein is dilated and pushes the valve cusps apart, compromising their impermeability. This wall damage may be related to damage to the innermost layer of the vein: the endothelium.  The exact causes leading to the development of Chronic Venous Disease are not clearly known, Pathophysiology of the chronic venous disease 2/17/2014 Pharmaceuitcal Scientific Associatio 17

18. The following factors play a role: Hereditary factors, sedentary lifestyle, age, Deficiency of the muscle and joint pump Female sex hormones, enzymatic factors, Sequestration of leukocytes and their adhesion to the endothelium Microcirculatory problems Defective vasoconstriction in the standing position Hypercoagulability of blood in the event of a thrombosis Damage to valves and the venous wall under the influence of one or more of the above factors will lead to impairment of the venous network of the lower limbs. It causes venous hypertension which can lead to a chronic venous disease with tissue decompensation: chronic venous insufficiency. Paradoxically, we do not know why some people develop microcirculatory and tissue decompensation while others tolerate major venous hypertension very well. Pathophysiology of the chronic venous disease 2/17/2014 Pharmaceuitcal Scientific Associatio 18

19. Venous hypertension: the cause of chronic venous insufficiency  Visible morphological changes As a result of this excessive pressure and defective peripheral vasoconstriction, the venous wall gradually stretches. Varicose veins appear.  Tissue changes This excessive pressure can lead to tissue compensation and the development of true chronic venous insufficiency with repercussions for the tissue surrounding the varicose vein. The permeability of the affected vein is increased. The leg swells; this is the oedema stage. To begin with, this oedema regresses when the person lies down or raises the leg, but it gradually becomes permanent. This is the start of tissue manifestations. Tissue manifestations are self-sustaining (stasis, extravasation, interstitial flooding and local ischaemia ) and mutually exacerbate one another. Without appropriate management, this vicious circle progresses and the CVD becomes more and more severe.  Altered cellular exchanges and the consequences of this Tissue manifestations lead to impaired cellular exchanges. Pathophysiology of the chronic venous disease 2/17/2014 Pharmaceuitcal Scientific Associatio 19

20. CHRONIC VENOUS DISEASE CAUSES Any problem that increases pressure in the veins in the legs can stretch the veins . This can damage the valves, which leads to even higher pressures and worsened vein function, and can eventually lead to chronic venous disease . 2/17/2014 Pharmaceuitcal Scientific Associatio 20

21. The pressure inside the veins can increase for a number of reasons, including : A clot inside a vein – A clot will block blood flow through the vein and cause pressure to build up. Often this causes permanent damage to the vein or valves, even after the clot has dissolved . Leg injury or surgery – Injury or surgery that blocks the flow of blood through a vein can increase pressure.   CHRONIC VENOUS DISEASE CAUSES 2/17/2014 Pharmaceuitcal Scientific Associatio 21

22. Excess weight or weight gain – The added weight of pregnancy or obesity can increase pressure in the veins of the legs, and damage the veins and valves . Standing or sitting for too long – Standing or sitting for prolonged periods without walking can decrease the movement of blood out of the legs and lead to increased pressure in the veins and pooling of blood. That’s because the muscles in the legs play an important role in the circulation of blood, acting as a pump to move blood from the legs back to the heart. CHRONIC VENOUS DISEASE CAUSES 2/17/2014 Pharmaceuitcal Scientific Associatio 22

23. CHRONIC VENOUS DISEASE DIAGNOSIS Doctors can diagnose chronic venous disease by examining a person and asking about symptoms of the disorder, such as the presence of varicose veins, swelling in the legs, skin changes, or skin ulcers . They often also do additional testing, such as an ultrasound, to look at vein valve function and to identify if the problem is located in the superficial veins or the deep veins. 2/17/2014 Pharmaceuitcal Scientific Associatio 23

24.  CEAP ( Clinical- Etiological-Anatomical-Pathophysiological) classification. 2/17/2014 Pharmaceuitcal Scientific Associatio 24

25. CHRONIC VENOUS DISEASE SYMPTOMS Chronic venous disease can cause painless widened veins, skin irritation, skin rash, skin discoloration, itching, swelling, and skin ulcers. The legs may feel heavy, tired, or achy, usually at the end of the day or after prolonged standing. 2/17/2014 Pharmaceuitcal Scientific Associatio 25

26. Dilated veins   :  The most frequent feature of venous disease is widening (dilation) of the veins . Dilated veins may appear as thin blue flares, often called spider veins , or much wider, twisted veins, called varicose veins that bulge on the surface CHRONIC VENOUS DISEASE SYMPTOMS 2/17/2014 Pharmaceuitcal Scientific Associatio 26

27. Swelling   : Long-standing chronic venous disease can cause swelling (edema) in the ankles and lower legs . Sometimes this swelling is evident only at the end of the day; other times it is present all the time. Swelling often decreases with leg elevation, so it may be less prominent in the morning . The area around the ankle bones is often the first place that swelling is seen. However, swelling can be caused by conditions other than chronic venous disease, so this problem should be evaluated to determine the cause . CHRONIC VENOUS DISEASE SYMPTOMS 2/17/2014 Pharmaceuitcal Scientific Associatio 27

28. Complications Left untreated, varicose veins can expected to enlarge and worsen. As a result, the symptoms will become more severe. Additional health problems can result. These include : Severe venous insufficiency, a severe pooling of blood in the veins that slows the return of blood to the heart. This can lead to condition can cause deep vein thrombosis and pulmonary embolism. Sores or skin ulcers. Ongoing irritation, swelling and painful rashes on the legs. 2/17/2014 Pharmaceuitcal Scientific Associatio 28

29. CHRONIC VENOUS DISEASE MANAGEMENT Treatment of chronic venous disease is focused on reducing symptoms. Such as swelling, treating skin problems, and preventing and treating ulcers. 2/17/2014 Pharmaceuitcal Scientific Associatio 29

30. Leg elevation   Simply elevating the legs above heart level for 30 minutes three or four times per day can reduce swelling and improve blood flow in the veins. Improving blood flow can speed healing of venous ulcers. However, it may not be practical for some people to elevate their legs several times per day . Leg elevation alone may be the only treatment needed for people with mild chronic venous disease, but additional treatments are usually needed in more severe cases. 2/17/2014 Pharmaceuitcal Scientific Associatio 30

31. Exercises   Foot and ankle exercises are often recommended to reduce symptoms. Pointing the feet down and up (movement from the ankle) several times throughout the day can help to move blood from the legs and back to the heart. This may be especially helpful for people who sit or stand for long periods of time. Walking is a good exercise for the calf muscle pump. People with chronic venous disease who walk less than 10 minutes a day have a greater risk for developing venous ulcers than those who are more physically active.  2/17/2014 Pharmaceuitcal Scientific Associatio 31

32. Compression therapy  Most experts consider compression therapy to be an essential treatment for chronic venous disease . Compression stockings are recommended for most people with chronic venous disease. People with more severe symptoms, such as venous ulcers, often need treatment with compression bandages. 2/17/2014 Pharmaceuitcal Scientific Associatio 32

33. Compression stockings   Compression stockings gently compress the legs, and may improve blood flow in the veins by preventing backward flow of blood . Effective compression stockings apply the greatest amount of pressure at the ankle and gradually decrease the pressure up the leg. These stockings are available with varying degrees of compression . Stockings are available in several styles, including knee-high, thigh-high, and pantyhose with open or closed toes. Knee-high stockings are sufficient for most people. Some people experience skin irritation or pain, especially with initial use of compression stockings, which can be related to improper fit. The following figures show tips for using compression stockings. 2/17/2014 Pharmaceuitcal Scientific Associatio 33

34. Intermittent pneumatic compression pumps Standard compression stockings may be less effective or difficult to use if you are very overweight or have a lot of swelling. An alternative approach is the use of intermittent pneumatic compression (IPC) pumps . These devices consist of flexible plastic sleeves that encircle the lower leg. Air chambers lining these plastic sleeves periodically inflate, compress the leg, and then deflate. These are generally used for four hours per day . Similar to compression stockings, IPC pumps may be painful for some people, particularly with initial use, but this improves as swelling is reduced with treatment. 2/17/2014 Pharmaceuitcal Scientific Associatio 34

35. Compression bandages  People with severe symptoms, like ulcers, may need to be treated with compression bandages. Compression bandages look similar to a soft cast, and are applied on the leg by an experienced nurse or doctor. Topical medicines may be applied to the skin, and if ulcers are present, they may be covered with special dressings before compression bandages are put on . The bandages are usually changed once or twice a week and must stay dry. A cast bag or other plastic bag can be placed over the compression bandage to keep it dry while showering. If you have compression bandages and they get wet, you should contact your doctor to have them changed . 2/17/2014 Pharmaceuitcal Scientific Associatio 35

36. Dressings  Ulcers are usually covered with special dressings before putting on compression stockings or compression bandages. Dressings are important to help ulcers heal. They are used to absorb fluid oozing out of the wound, reduce pain, control odor, remove dead or infected cells, and help new skin cells to grow . There are several types of dressing material used for venous ulcers. The type and frequency of dressings is determined by the size of the ulcer, amount of drainage, and other factors. 2/17/2014 Pharmaceuitcal Scientific Associatio 36

37. Medications A variety of medications have been used for chronic venous disease and venous ulcers . Aspirin (300 to 325 mg/day) may speed the healing of ulcers . Antibiotics are only recommended when there is an infection . Horse chestnut seed extract reduces swelling and leg size in people with chronic venous disease. It may be recommended for people who cannot tolerate compression therapy, usually at a dose of 300 mg twice daily. Horse chestnut seed extract is available as a dietary supplement and does not require a prescription. However, its production is not regulated, and the dose may vary from one pill or bottle to another. 2/17/2014 Pharmaceuitcal Scientific Associatio 37

38. Treatment There are several procedures that can be used alone or in combination to treat varicose veins. These include : Sclero -therapy. Microsclero -therapy. Laser surgery. Surgical vein stripping. Endo-venous thermal ablation. Coil embolization. Ambulatory phlebectomy . Endoscopic perforator vein surgery. 2/17/2014 Pharmaceuitcal Scientific Associatio 38

39. Hydroxyethylrutoside is a prescription medication available in Europe that can reduce leg volume, swelling, and other symptoms . The skin irritation caused by chronic venous disease, called stasis dermatitis, usually gets better with the use of moisturizers. Sometimes, a steroid cream or ointment is needed to help with itching and inflammation . Other creams and ointments, anti-itch products, and scented lotions should be avoided because there is a risk of developing an allergic rash (contact dermatitis) from these products. Treatment 2/17/2014 Pharmaceuitcal Scientific Associatio 39

40. Medical treatment MPFF. Eiscin . Oxerutinum 500mg. ..\Downloads\ Daflon 500 - Journey into the viens.mp4

41. When is surgical treatment necessary? For the less than 10 percent of patients who require surgical treatment, the options include vein ligation and stripping, microincision /ambulatory phlebectomy , and bypass surgery. Here is a brief review of each of these techniques. Your doctor can recommend the treatment that is most appropriate for you.

42. Sclerotherapy In which a doctor injects the veins with a solution that causes the vein to close and the blood is then directed through healthier veins. This is a common treatment option, but may require multiple treatments. It is useful for treating small and medium sized varicose veins. 2/17/2014 Pharmaceuitcal Scientific Associatio 42

43. Microsclerotherapy which is similar to sclerotherapy , but uses different solutions and injection techniques . It is especially effective in treating spider veins. 2/17/2014 Pharmaceuitcal Scientific Associatio 43

44. Laser surgery in which the heat from a laser beam destroys spider vein, but does not harm the skin . It is usually less effective than sclerotherapy for varicose veins in the legs . It also causes side effects, such as bruising, blistering and discoloration. 2/17/2014 Pharmaceuitcal Scientific Associatio 44

45. Surgical vein stripping In which the varicose vein is removed through small incisions at the groin, knee and ankle . This is an option for treating larger varicose veins. 2/17/2014 Pharmaceuitcal Scientific Associatio 45

46. Endovenous thermal ablation I n which a thin tube (catheter) is inserted into the vein. Then , the surgeon applies heat through the tube, causing the vein to collapse. A scar results and the blood is forced through nearby healthy veins. This procedure is also used to treat larger varicose veins. 2/17/2014 Pharmaceuitcal Scientific Associatio 46

47. Coil embolization in which a catheter is first places into a large vein in the leg or calf; then, a small coil is inserted into the catheter and guided into the vein; alcohol is then injected. The alcohol is an irritant to the vein lining and causes it to close and scar. Again, the blood is rerouted to nearby health veins. This procedure requires local anesthesia. 2/17/2014 Pharmaceuitcal Scientific Associatio 47

48. Ambulatory phlebectomy   In which the doctor removes larger varicose veins in the legs through a series of tiny skin punctures (holes ). Local anesthesia is used. There is usually little scarring. 2/17/2014 Pharmaceuitcal Scientific Associatio 48

49. Endoscopic perforator vein surgery W hich is used for advanced varicose veins that have caused leg ulcers . The doctor makes a small incision and inserts a thin video camera to see and then close veins near the skin that lead to the deep veins in the legs. 2/17/2014 Pharmaceuitcal Scientific Associatio 49