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The superior vena cava and its tributaries. Traumatic injury; Occlusion; Padget-Shreter's syndrome (thrombosis of profound veins of extremity) and postthrombophlebiti\c syndrome of upper extremities; Syndrome of superior vena cava. Congenital diseases (angiodysplasia)
Inferior vena cava Postthrombophlebitic syndrome: superficial veins; Acute thrombophlebitis: profound veins of lower superficial veins of lower extremities; extremities; profound veins of lower ileofemoral veins; extremities; the trunk of inferior vena ileofemoral veins; cava. venous gangrene (blue Primary varicose dialtion of phlegmasia); superficial veins of lower the trunk of inferior vena extremities; cava: Congenital diseases embolism of pulmonary (angiodysplasia) artery. Traumatic injury.
Chronic venous insufficiency is mainly caused diseases: varicose disease of lower extremities postthrombophlebitic disease angiodysplasia
Varicose disease
Varicose disease of subcutaneous veins is their irreversible dilation and elongation occurring due to crude pathological change of venous walls and valvular apparatus.
Postthrombophlebitic disease
Postthrombophlebitic disease a complex of symptoms developing due to thrombosis of profound veins.
0 - no symptoms; 1 - heavy feet syndrome; 2 - intermittent edema; 3 - persistent edema, hyper- or hypopigmentation, lipodermatosclerosis, eczema; 4 - venous ulcer.
Complain
of fatigue, the heavy feeling and enlargement of feet, spasms of gastrocnemius muscle, paresthesia, edema of shins and feet.
2.
Edema
Edema usually develops by nighttime after walking or prolonged standing and disappears after a night's rest.
Hemosiderosis skin
Skin pigmentation develops in the lower third of the shin; it is more pronounced above the inner ankle; the skin is less elastic, it becomes dry, shiny, vulnerable, fused with sclerotically degenerated fat.
Trophic ulcer
Ulcers caused by venous circulation disorder typically develop on the inner surface of lower third of shin, above the ankle. The ulcers are usually single, flat, with an even bottom; their borders are irregular, abrupt; the discharge is scarce, serous or purulent. If infection develops, ulcers become painful. Around the ulcer hemosiderosis and induration of subcutaneous fat develop.
Trendelenburg-Trojanov's test.
The patient lying on his back raises one leg. When blood has drained from superficial veins, the greater subcutaneous vein is compressed in the place where it joins the femoral vein and keeping the finger there the patient is asked to rise. If venous trunks swell quickly when the finger is removed, we can conclude that the ostial valve is incompetent.
Hackenbruch's test.
Place your hand on the thigh where the greater subcutaneous vein joins the femoral vein and ask the patient to cough. You can feel throbs over the vein which points to incompetence of ostial valve.
Scheins' test.
The patient is placed on the back, his legs are raised. After draining of superficial veins three tourniquets are applied. The patient is asked to rise. A quick swelling of the veins between the tourniquets points to an incompetent perforating vein in this place.
Pratt-I test
Measure the circumference of the patient's shin, ask him to lie on his back, drain the veins by stroking them along their course. Apply elastic bandage to the legs. The patient is asked to walk for 10 min. If pains develop, it points to affection of profound veins. Enlarged circumference of the shin after walking points to impatency of profound veins.
Loevenberg's test
The cuff of Rivarocci machine is applied to the lower third of shin and air is slowly pumped into it. If sharp pains develop when the pressure in the cuff rises to 150 mm Hg, it is characteristic of thrombophlebitis of profound veins.
Homans' sign
Pains in gastrocnemius muscle upon dorsal flexing of the foot is characteristic of thrombophlebitis of profound veins of the extremity.
Moses' sign
Pains in the shin upon anteriorposterior compression
Duplex scanning
Contrast-dye radiophlebography
In distal phlebography the radiopaque substance is injected into the dorsal vein of foot while a tourniquet is applied to the lower third of shin. In proximal phlebography the radiopaque substance is injected directly into the femoral vein by puncturing.
The therapeutic effect of compression treatment is determined by the following mechanism of action:
decrease of pathologic venous "capacity" of lower extremities; functional improvement of the insufficient valvular apparatus; increased resorbtion of tissue fluid in the venous part of capillary; its decreased filtration in the arterial part; increased fibrinolytic activity of blood.
hlebotropic drugs
detralex, ginkor-fort, troxevasin, escusan, calcium dobesilan (doxium).
Rheologic hemocorrectors
acetylcalicylic acid, dipiridamol, pentoxyphylline, low-molecular dextranes (rheopolyglucine, rheomacrodex, rheogluman and so on)
Indirect anticoagulants.
This category includes derivatives of coumarine and fenindione. They do not affect coagulation upon direct connection with blood; they decrease blood clotting by inhibiting the synthesis of vitamin K-dependent procoagulants (factors II, VII, IX, X). The initial dose of feniline (fenindione derivative) is 0.12-0.18 g (3 times a day), on the second day the dose is 0.09-0.15 g, and afterwards - 0.03-0.06 g a day depending on the prothrombin level in blood. The effectiveness of treatment is checked with the help of prothrombin index which should decrease to 50%.
Phlebosclerosing treatment
This method consists in introduction of sclerosing substances (fibrovein, thrombovar, etoxisclerol) into the varicose veins.