Vital Health laboratory

Venous problems

It is common to hear the term "heavy legs". What is less well known is that this is only one of many symptoms of what is known as chronic venous insufficiency, other frequently encountered symptoms being pain, heat, oedema, cramps, burning, itching, skin disorders. Chronic venous insufficiency is a common disease, not as benign as we are used to thinking.

 

In France, about 20 million people suffer from it. Of course, the stages of this disease can be very diverse. Some stages can lead to a deterioration in the quality of life. Chronic venous insufficiency also has an economic impact estimated at between 1 and 3% of the health budget in industrialised countries.

Risk factors

Age, of course, due to increasing weakness of the venous walls, but also due to the duration of exposure to other risk factors.

 

A family history of chronic venous insufficiency should also be considered:

Risk factors for venous insufficiency

Prolonged standing , especially in the workplace, or sitting with legs hanging down for several hours should be avoided.

 

Obesity, pregnancy, hormonal disturbances are all risk factors for chronic venous disease. Low-impact sports such as walking, cycling, swimming and gymnastics should be favoured over high-impact or jumping sports.

 

Prolonged exposure to heat, such as standing on a beach without cooling your legs, regularly visiting saunas or steam rooms, or regularly taking hot baths are all situations that should be avoided.

Females also appear to be at greater risk, probably due in part to hormonal factors.

Pathophysiology

Anatomy

90% of the venous return of the lower limbs is done by the deep veins, satellites of the bones.

10% is through the superficial network (saphenous veins and their branches).

Communication systems between these two networks exist (perforating veins, saphenous veins, communicating veins). These veins contain valves, a system of anti-gravity valves which prevent the blood from flowing back downwards despite its weight.

Role of the veins

In the lower limbs, the tissues (bones, muscles, tendons, skin, etc.) require oxygen from the heart and lungs via the arteries. Once used by these different organs and structures, the blood is deprived of oxygen and must return to the heart and lungs to recover it again. This is the role of the venous system.

Pathophysiology

As in the entire circulatory system, there is a certain pressure in the veins. When standing still, this pressure is 80 mmHg at the ankle. When walking, it is about 30 mmHg. This highlights the significant impact of physical activity on the venous system.

 

 

Four return pumps are identified:

- The Lejars plantar venous sole under the foot contracts with each step on the ground.

- By contracting the calf muscles, the venous return is boosted.

- The contraction of the diaphragm during breathing movements.

- The heart "pump" which, because of its function, draws venous blood towards it.

 

All studies agree in explaining the symptomatology of chronic venous insufficiency as a result of prolonged venous hyperpressure, which is itself responsible for chronic inflammation developing an alteration of the microcirculation and, in the ultimate stage, trophic disorders (skin suffering). This alteration of the microcirculation particularly explains the role of VEINAVITAL in the management of chronic venous disease;

 

 

There are three possible causes of this overpressure:

- Varicose disease (varicose veins and microangiopathy)

- Post-thrombotic syndrome

- Functional venous insufficiency

Etiology

Varicose vein disease

According to the WHO, the definition of a varicose vein is a vein with a diameter greater than 3 millimetres in the upright position (procubitus), with an often (but not always) tortuous course that does not allow for a correct return of blood to the heart (notion of reflux in echo-Doppler)

In order to be treated, varicose veins must first be classified according to existing classifications. The most common is the CEAP classification. 

 

Several criteria are used:

- Clinical (clinical examination, territory, diameter appearance)

- Etiological(essential or secondary, notion of risk factors)

- Anatomical (territory, deep or superficial vein, etc.) 

- Pathophysiological (congenital malformation, post-thrombotic syndrome...)

 

These varicose veins should be distinguished from :

- Telangiectasias or varicosities which are small bluish or purple veins in a network, less than one millimetre in diameter, with no pathological consonance

- Reticular veins which are small veins in a subcutaneous network of 1 to 3mm in diameter, again without pathological impact.

 

Not all visible veins are necessarily varicose (sportsmen, slim people, lipodystrophy linked to certain treatments).

Post-thrombotic syndrome

This results in the classic symptoms of chronic venous insufficiency which often follow, in a delayed manner, a thrombosis (phlebitis) due to the destruction of the internal structure of the veins (valves) by the initial clot (thrombus) or by a persistent partial or total obstruction (sequelae thrombus)

Functional venous insufficiency

This situation is somewhat paradoxical because it occurs in subjects who have healthy veins but who are not stimulated (deficiency of the calf muscles, collapsed or hollow arch of the foot, abnormality of the function of the ankle or knee hindering normal walking, dysfunction of the cardio-respiratory contraction.

Rare causes

A venous compression may hinder the return of blood from the legs to the heart (tumours, ganglions, Cockett's syndrome, etc.).

Clinical impacts of chronic venous insufficiency

1st phase

The first thing to know is that they are numerous and non-specific; patients often describe heaviness, more rarely pain. Cramps and itching are also usually described. These signs are more likely to occur at the end of the day or in the heat of the day, during static positions. The impact of pregnancy, contraception, menstrual periods and certain hormonal anomalies should not be overlooked.

It is even more likely to be of venous origin if these signs improve in the cold, in a lying position (decubitus), when walking, with suitable herbal treatments or with the wearing of a medical compression device (compression stockings).

More advanced stages

- Edema mainly in the evening (end of the day), at first regressing with rest, then progressively more frequent or even permanent, and may affect the lymphatic system.

- corona phlebectatica (small blue spider veins of the ankles)

- ochre dermatitis (brownish skin lesion)

- eczema (known as varicose eczema)

- dermo-hypodermatitis (sclerotic and calf-covering appearance)

- white atrophy

- varicose ulcer

Support

Limiting stasis and hyperpressure

Healthy living rules

- limit trampling and sedentary, static situations

- avoid standing still for long periods of time, sitting with legs hanging down

- regular walking recommended

- fight against excess weight

- avoid prolonged heat (direct exposure, sauna, hammam, hot bath, floor heating, etc.)

- Raising the foot of the bed by 5 to 7 cm

- avoid sports with strong impacts on the ground such as tennis, basketball, jogging, dancing

Wearing medical compression stockings

Unfortunately, only 30% of patients suffering from venous insufficiency comply with this treatment, making it less effective than it should be in theory, and often ill-adapted (materials not suitable for patients, incorrect measurements, skin intolerance to components).


Protecting the microcirculation

The above measures (lifestyle rules, medical compression) have an impact on the protection of microvessels but not everything can be implemented in terms of lifestyle and as we have seen medical elastic compression is far from being worn as it should be and this treatment is only effective if it is observed regularly. 

It is therefore essential to strengthen microcirculation, in particular by using plants which have been recognised as effective in this area since the dawn of time and which more recently have proved their effectiveness through numerous studies. 

Due to its composition, VEINAVITAL has a role in limiting the inflammatory component of the venous wall, in protecting the tone of the vessel wall, and has an impact on the decongestion of the capillaries, thus acting directly on the progression of chronic venous insufficiency since, as we have seen, the symptomatology is essentially linked to the hyperpressure induced in the microvessels.

Specific treatments

In the case of large varicose veins, to limit the stasis they cause, they should be removed either surgically (stripping, thermal probes -LASER or radiofrequency-) or chemically by injections of a sclerosing product (sclerotherapy).

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