In the lower limb there are two venous systems (deep and superficial), connected by veins perforators. These veins, which are the result of the più the obvious aesthetic problems, are: on the ankle (where they put in communication the saphenous vein on the inside with the deep veins of the lower leg), above the calf (muscle perforators).
All the veins are equipped with valves, which have the task of promoting the venous return. The venous flow back is made functional besides the pressure gradient, created by the heart pump, the muscle pump and the foot). The microcirculation and the lymphatic also contributes to the normal physiology of the leg.
venous disorders can be caused by: inflammation, stasis, coagulation problems. When the inflammatory component is prevalent, we speak of thrombophlebitis.
In the cases where you do not see the component in question is inflammatory, you configure the concept of flebotrombosi. The two pathological events are difficult to distinguish.
venous disorders superficial
Phlebitis migrants are one of the forms più common phlebitis, have the characteristic of interest and small parts, venous often disappear spontaneously, only to reappear elsewhere.Superficial venous thrombosis: are caused by a thrombus formation to an abnormal platelet aggregation.
Therapy thrombosis superficial
The therapy of the thrombosis has two addresses therapeutic in relation to the presence of the inflammatory component.
In the presence of inflammation: anti-inflammatory for topical use and systemic (Ketoprofen, Phenylbutazone, Benzidamina…), antibiotic therapy in the presence of bacterial complications.
Without inflammation: calcium Heparin, eparinoidi for topical use.Diseases, deep vein
The deep vein thrombosis is characterized by the occlusion of a deep vein by a thrombus. Clot formation is favored by the venous stasis. The blood due to stasis and clotting initially in close proximityà of the sinuses valve (special valve pocket that promote venous return). The estimation of this disease is made in most cases with the following diagnostic tools:
Doppler: to detect the presence of venous stasis, thanks to the properties and categories of an ultrasonic signal, which vary their noise depending on the speedà of the blood flow.
Phlebography: è the più reliable but canò give rise to allergic manifestations for the presence of the Iodine in the contrast medium. The infusion of the liquid diagnostic, in the tract of the vein to be examined, is followed by an x-ray.
venous thromboembolism is the third cardiovascular disease for dissemination after the heart attack and stroke. Può cause serious consequences: pulmonary embolism, gangrene venous.
Therapy thrombosis deep
The therapy of thrombosis, deep può be both pharmacology is surgical.
drug Therapy: is based mainly on the use of heparin (which has the propertiesà to block the thrombotic process by preventing the extension of the disease), and thrombolytic drugs (Urokinase, Streptokinase, which are special substances that cause the disintegration of thrombi, but cause possible increases in blood-pressure and emoraggie).
surgical Therapy: thrombectomy (introduction, into the vein to be treated, a catheter Fogarty through which it is possible to eliminate the thrombus, this particular catheter will damage irreversibly the valve system), ligation venous (consists of a particular ligation of the vein to be treated, which allows a normal venous outflow, preventing at the same time the passage of large fragments, thrombotic), fasciotomia (special skin incisions with which you try to reduce the swelling).VARICOSE veins
You define varicose veins are those veins that have undergone a process of expansion and elongation. The causes may be:
Essential: when you depend on a malfunction or alteration localized to the vein wall.
Secondary: due to obstruction of the deep venous system, inheritance, neoplastic disease.Varicose veins essential
The appearance of varicose veins is caused by the breaking of the delicate balance that is established between the venous wall, valves, pressure endovasale. The main factors predisponesti are: hereditary, abnormalities, congenital. These factors may become decisive when you add up situations physiological such as pregnancy, obesityà, sedentarietà, heat, alterations, orthopedic (flat feet, dislocation of the hip), ethyl, senilità.
varicose veins more common are:
Of the saphenous vein (varicose of a cyclist), is typical of those who practice some of the sport. They are caused by an alteration of a vein piercing. These varicose veins can be isolated or present in both legs.
Edema of the ankle: with a pigmentation of the skin, which canò to have degenerated into a varicose syndrome.Therapy of varicose veins essential
The main treatment is surgical. The technical più used is that called “Stripper”. It consists in isolating the saphenous vein to be removed with a ligature and then tearing it with a special catheter with olive oil. In applying this technique it is necessary to pay great attention to the condition of the veins piercing, which must be in perfect condition worth profuse bleeding. In less severe cases, and più localized può be used therapy is sclerotherapy, which consists in the introduction of the particular drugs that cause the closure of the veins at particular points, in order to reduce the overhead. The alternative to surgical therapy is only the elastic compression (the wearing of special elastic stockings).Varicose veins are the secondary
Are varicose veins caused by an obstruction of the deep venous system. The clinical signs more obvious ones are: edema of the ankle, stasis, venous hypertension, eczema, ulcer. The superficial veins, because of increased flow, tend to dilate causing an alteration valvular fatal.Diagnosis
The diagnosis of this pathology relies on both the use of the Doppler is of the manoeuvre Pethers, which consists in observing the possible increase of the venous dilation, after walking the patient with the application of two tourniquets placed in particular points of the leg.Therapy
The therapies used are:
Elasto-compression: application of special elastic stockings, compression is particularly high, which can increase the speedà flow and decrease stasis. This therapy può be used as a preventive measure.
Medical: you are using medications that increase the venous tone and decrease the permeabilità (eparinoidi, diosmin, rutosidea), or that reduce the edema (diuretics).
Surgical: is used in the cases più serious, consists in the ligation of the perforators. In some cases, the binding of può be replaced by the therapy sclerosant.
After the exhaustive reading of the “Pathologies of the lower limbs”, I would like to highlight all the possible strategies that can be implemented to prevent or reduce such problems.Hygienic norms
weight loss: to read “How to lose weight without illusion”, the “Chitosan”.
Exercise daily: walk at fast pace for at least 30 minutes per day. Always remember the rule of 12, the foot pump and the muscles come into action only after the twelve steps, so if you need to move to do any activity; it would be necessary to comply with this simple rule.
the Correct elevation of the arts of the night: it is necessary to raise the foot of your bed at least 8 cm.
Products topical use
Antibiotics, if there is the presence of an ulcer.
Eparinoidi (Lioton, Reparil…), thrombosis without inflammation.
anti-Inflammatory drugs (Lifetime, Feldene, Voltaren…), thrombosis with inflammation.Compression
the Use of stockings or socks are elastic, with a compression of at least 70 denier (13-17 mm/Hg). Anyone who works in the upright position must have the foresight to wear clogs anatomical wood.
Può be useful the use of drugs flebotonici to reduce the permeabilità the capillary tube and increase the venous tone. Recommended drugs: diosmin (Daflon, Arvenum, Venosmine), centella asiatica (Centellase, gotu Kola complex, gotu kola (Centella asiatica Pharbenia), rutosidea (Venoruton, Essaven),
If the normal therapies, hygiene do not have any positive feedback is advisable to do a thorough check-up by an experienced angiologist.
Dr: Cesare Augusto De Silvestri
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Page updated on 22/5/2005