what is chronic venous disease

1. 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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
2

3. OVERVIEW
•
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
3

4. THE VENOUS SYSTEM
•
In the lower limbs is made up of a number of
complex anatomical structures, including principally:
1. The deep venous system (90% of the total
system) (read more...)
2. The superficial venous system (10% of the total
system) (read more...)
3. Perforating veins, which cross the aponeurosis
to link deep and superficial veins
4. The veins of the foot, which form a complex
network create a genuine blood reservoir.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
4

5. THE VEINS
• Have 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
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 oxygendepleted 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 .
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
6

7. PHYSIOLOGY OF THE VENOUS SYSTEM IN THE LOWER LIMBS
•
A combination of two main actions ensures venous
return in the lower limbs:
1. 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.
2. Secondly, a pump mechanism which activates and
maintains the blood flow through the veins.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
7

8. PHYSIOLOGY OF THE VENOUS SYSTEM IN THE LOWER LIMBS
•
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
8

9. PHYSIOLOGY OF THE VENOUS SYSTEM IN THE LOWER LIMBS
•
The pump mechanism mainly results from a combination of different forces:
1. The stimulation of the venous system of the foot.
2. 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,
3. The beating of the heart and the negative pressure due to the
phenomenon of aspiration from the abdominal cavity that occurs
during deep breathing.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
9

10. PHYSIOLOGY OF THE VENOUS SYSTEM IN THE LOWER LIMBS
•
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.
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.
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 JeanPatrick Benigni, MD, General Secretary of the French Society of Phlebology, Paris France...)
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
13

14. CHRONIC VENOUS DISEASE (CVD)
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
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
15

16. PATHOPHYSIOLOGY OF THE CHRONIC VENOUS DISEASE
Valve insufficiency
•
This may be quantitative or qualitative
1. quantitative in the event of congenital insufficiency in terms of valve numbers
or massive destruction due to venous thrombosis
2. qualitative as a result of a valve being torn or due to permeability of the valve
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
16

17. PATHOPHYSIOLOGY OF THE CHRONIC VENOUS DISEASE
•
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,
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
17

18. PATHOPHYSIOLOGY OF THE CHRONIC VENOUS DISEASE
•
The following factors play a role:
1.
Hereditary factors, sedentary lifestyle, age,
2.
Deficiency of the muscle and joint pump
3.
Female sex hormones, enzymatic factors,
4.
Sequestration of leukocytes and their adhesion to the endothelium
5.
Microcirculatory problems
6.
Defective vasoconstriction in the standing position
7.
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
18

19. PATHOPHYSIOLOGY OF THE CHRONIC VENOUS DISEASE
•
•
•
•
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.
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
20

21. CHRONIC VENOUS DISEASE CAUSES
•
The pressure inside the veins can increase for a number of reasons, including:
o 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.
o Leg injury or surgery – Injury or surgery that blocks the flow of
blood through a vein can increase pressure.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
21

22. CHRONIC VENOUS DISEASE CAUSES
o 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.
o 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.
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
23

24. CEAP
(Clinical- Etiological-Anatomical-Pathophysiological)
classification.
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
25

26. CHRONIC VENOUS DISEASE SYMPTOMS
• 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
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
26

27. CHRONIC VENOUS DISEASE SYMPTOMS
•
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.
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:
1. 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.
2. Sores or skin ulcers.
3. Ongoing irritation, swelling and painful rashes on the legs.
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.
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.
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.
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.
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.
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.
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.
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.
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
37

38. TREATMENT
•
There are several procedures that can be used alone or in combination to
treat varicose veins.
•
These include:
1. Sclero-therapy.
2. Microsclero-therapy.
3. Laser surgery.
4. Surgical vein stripping.
5. Endo-venous thermal ablation.
6. Coil embolization.
7. Ambulatory phlebectomy.
8. Endoscopic perforator vein surgery.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
38

39. TREATMENT
•
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
39

40. MEDICAL TREATMENT
1. MPFF.
2. Eiscin.
3. Oxerutinum 500mg.
4. ..DownloadsDaflon 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.
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.
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.
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
45

46. ENDOVENOUS THERMAL ABLATION
• In 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.
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.
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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
48

49. ENDOSCOPIC PERFORATOR VEIN SURGERY
• Which 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.
PHARMACEUITCAL SCIENTIFIC ASSOCIATIO
49