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VARICOSITY Latin varix, varicis swelling on veins — the change of veins which is characterized by uneven increase in their gleam with formation of protrusions in a zone of the thinned venous wall, the distorted course of vessels with development of their nodularlike crimpiness, functional insufficiency of valves and the perverted blood-groove. The genes located in easily compressed fabrics are exposed to a varicosity: Most often the varicosity of superficial veins of the lower extremities, a submucosal layer of a gullet meets at portal hypertensiaa rectum see.
Hemorrhoidsa seed cord see. The varicosity of superficial Dermatitis bei varicosity of the lower extremities can be divided on primary, developing out of communication with any disease, and secondary, appearing after the postponed deep vein thrombosis, at traumatic and inborn arteriovenous fistulas, at displaziya and an aplasia of deep veins, Dermatitis bei varicosity pregnancy, etc.
Approximately with an identical frequency damage of both the right, and left extremity is observed, Dermatitis bei varicosity the disease is more often happens bilateral. The reasons it is considered the weakness of muscular and Dermatitis bei varicosity fibers of walls of superficial veins and inborn inferiority of their valve device which is descended by toxi-infectious factors, the defeat of the nervous device of veins weakening effect of hormones on muscles of Dermatitis bei varicosity venous wall during pregnancy.
The listed factors in itself do not cause a phlebectasia, and only result in anatomic and functional inferiority of superficial venous system of the lower extremities. Expansion of a gleam of veins happens under the influence of increase in intravascular pressure. If the normal vein reacts to hypertensia strengthening of the tone, then at the inborn or acquired weakness of muscular and elastic formations of a venous wall in response to increase in intravascular pressure irreversible increase in a gleam of a vein Dermatitis bei varicosity. In superficial veins of the lower extremities lead to constant or periodic hypertensia: To a professional factor the profession connected with long stay in a standing position in a crust, time is Dermatitis bei varicosity attached crucial importance in V.
This click here, apparently, only promotes progressing of a disease at already existing inferiority of a wall of veins or the valve device.
The size of peripheral venous pressure in the absence of valves in a gleam of a vein or at a leaky smykaniye of their shutters is directly proportional to height of a blood column from the place of measurement Dermatitis bei varicosity the level Dermatitis bei varicosity the right auricle. In vertical position of the person of a wall of veins of the lower extremities are under big pressure from within.
Action of this factor is aggravated with a long static load on the lower extremities, increase in Dermatitis bei varicosity intra belly pressure connected with a raising of weights, cough, pregnancy. Lead also ekstravazalny narrowings Dermatitis bei varicosity the main veins to difficulty of outflow of blood e.
In the specified situations Dermatitis bei varicosity is hypertensia both in superficial, and in deep veins. However the last owing to the arrangement in muscular and fascial cases more rezistentna to increase in intravascular pressure. Stagnation of blood first of all affects a condition of superficial veins.
Their Dermatitis bei varicosity develops, as a result a cut of a shutter of valves depart one from another and lose switching function. Accession of valve insufficiency leads to significant increase Dermatitis bei varicosity the hydrostatic pressure operating on walls of veins of the lower extremities as a result of increase Dermatitis bei varicosity the column of wie die Krampfadern an den Beinen Bewertungen entfernen which is directly pressing on walls of veins.
In the changed veins there is a retrograde blood stream. Pathological dumping of blood from deep in superficial veins plays an important and most constant role in V. It can occur at the level of mouths of superficial highways high veno-venous dumpingthrough defective perforantny veins Arzt prüft Varizen veno-venous dumping both at the same time that and some other way.
During reduction of muscles of a shin pressure in deep veins increases. If at the same time valves of perforantny mb obere Thrombophlebitis Extremität 10 and ostialny valves of big and small saphenas are insolvent, then the portion of blood at reduction of muscles comes juckende Haut Beine mit Krampfadern Behandlung big pressure to superficial veins and creates in Dermatitis bei varicosity conditions for an ectasia.
Not quite clear is a question of the reason of Dermatitis bei varicosity of valves of perforantny veins. It is the most probable go here at disturbance of venous outflow from the Dermatitis bei varicosity extremities and build-up of pressure in deep veins the gleam of perforantny veins extends and there is an insufficiency of their valves. Thus, functional insufficiency of deep veins shall accompany insufficiency of valves of perforantny veins and emergence of Dermatitis bei varicosity reflux of blood from deep veins in superficial.
On the basis of numerous flebografichesky researches it is established read article expansion of deep veins often accompanies a varicosity superficial blow and quite often results in functional insufficiency Dermatitis bei varicosity valves of deep Dermatitis bei varicosity. According to some authors [R.
It is about functional, but not morphological insufficiency of valves of deep veins. Expansion of a vein with the subsequent functional insufficiency of valves leads to disturbance of venous outflow, emergence of a retrograde blood-groove, to increase in venous stagnation and development hron, venous insufficiency.
Existence of arteriolo-venulyarny shunts, but to opinion of most of researchers, is estimated not as the reason, and as click the following article result Dermatitis bei varicosity V. Macroscopically varicose expanded superficial veins the most part of an izvita with the sacculate protrusions sometimes considerably exceeding diameter of the main vessel. Walls of veins are condensed and thickened, in sites of expansion, on the contrary, thinning of walls is noted.
Microscopically Dermatitis bei varicosity various changes depending Dermatitis bei varicosity a phase Dermatitis bei varicosity pathological process and the joined complications.
The early stage stage of compensation is characterized by formation of blyashkovidny thickenings of an intima which cornerstone the hyperplasia of elastic fibers of an internal cover, and also a focal hypertrophy of longitudinal and circular muscle fibers is.
In the last the considerable maintenance of a Dermatitis bei varicosity and high activity of oxidation-reduction enzymes testimonial of considerable sokratitelny ability of a muscular coat is noted. High enzymatic activity of muscle fibers is combined with increase in quantity of circulatory capillaries in outside and the interlayer of a venous wall that demonstrates the increased blood supply. The described changes are regarded as the compensatory and adaptive processes arising in the conditions of excessive load of a wall of saphenas.
In the following stage a stage of the beginning decompensation treatment of Dermatitis bei varicosity thickenings by plasma proteins, coarsening of an argyrophil and elastic framework of an intima with development in it collagenic fibers is observed fibroelastosis. Further a stage of a decompensation the diffusion thickening of an internal cover of veins which is followed along with its fibrosis also considerable thickening and coarsening of elastic fibers develops.
The inner elastic membrane is represented on a big extent loosened and destroyed. In internal and average covers fields of the hyalinized fibrous fabric appear. Muscle fibers are exposed to a gradual atrophy and a sclerosis that considerably reduces functionality of a vessel. In various pieces of a vein it is possible to find all described changes that demonstrates continuous progressing of pathological process. Thus, a final stage B. Most classification meets the requirements of the clinical physician, the cut is the basis the pathogenetic principle:.
These complaints are characteristic of the persons staying Dermatitis bei varicosity long time standing. The appeared phlebectasia progresses, nodes, crimpiness of vessels appear. Distribution of process goes both up, and from top to bottom. Complaints of patients to weight and a raspiraniye in a leg become constants. There are night spasms in gastrocnemius muscles. Thrombophlebitisbleeding from nodes, trophic changes and diseases of skin, hl.
At bystry progressing Check this out. However there is no strict dependence between V. Therefore during a disease allocate a stage Dermatitis bei varicosity compensation of venous go here and a stage of a decompensation.
It is established that the decompensation develops at low veno-venous dumping quicker. The diagnosis comes easy. The changed veins clearly are found at survey and a palpation in the form of direct or twisting tyazhy, textures and protrusions tsvetn.
It is much more difficult to diagnose dysfunction of valves of all three systems Dermatitis bei varicosity, perforantny and deep veins and localization of a venous reflux. Significant assistance is given by so-called functional trials. In horizontal position of the patient raise a sore leg up for emptying varicose of Dermatitis bei varicosity veins. Press a big saphena at its mouth a finger or in an upper third of a hip Dermatitis bei varicosity a venous rubber plait.
The patient gets up. If immediately to eliminate a prelum of a vein, then at inferiority of its ostialny valve the rapid inflow of expanded superficial veins at the expense of a reversed current of blood from above is defined.
Sheynis gives an idea of function of valves not only superficial, but also perforantny veins. In position of the patient lying after release of superficial veins from blood Dermatitis bei varicosity 3 plaits: The rapid inflow of veins between plaits or on a shin speaks about inferiority of valves of perforantny veins in these zones.
After removal of plaits consistently from below up retrograde to a wave of blood notice localization of insufficiency of valves of superficial veins. Disturbance of a blood-groove on deep veins can be established by means of mid-flight test Delbe — Pertesa.
Test is carried out as follows: Emptying varicose of expanded veins of a shin speaks about normal function of valves of deep veins. However preservation of intense varicose nodes after walking does not allow to approve categorically the return since the similar effect can be observed also at considerable insufficiency Behandlung von Krampfadern Chelyabinsk Preis valves of perforantny veins.
In this regard five-cordlike test is offered, edges it is similar mid-flight, but with that difference that impose 5 plaits: Fall of varicose nodes after walking at least of one of mezhzhgugovy zones speaks about a solvency of valves of deep veins; preservation of the filled varicose nodes demonstrates localization in this zone of perforantny veins with the insolvent valve device.
On same specifies a rapid inflow of V. At Dermatitis bei varicosity indurative and inflammatory changes of skin, the expressed hypostases and obesity assessment of results of functional trials is complicated or even becomes impossible.
Invaluable help is given at the same time flebotonometriya see and flebografiya see. The distal ascending flebografiya is made in vertical position of the patient with preliminary observation of passing of a contrast agent on veins by means of a fleboskopiya. Before administration of drug in nadlodyzhechny area impose a plait. The patient several times strains and relaxes muscles of a shin. Roentgenoscopic advance of the contrasted blood is determined by deep veins and its dumping in superficial through perforantny veins with the click to see more valve device fig.
Consistently do pictures of a shin, area of a knee joint and a hip. Apply Dermatitis bei varicosity transdermal puncture of a femoral vein under an inguinal sheaf to identification of a condition of the main veins of a basin and administration of radiopaque substance on a breath. Only the proximal department of the general femoral vein is normal visible. Contrasting of a big hypodermic or femoral vein below a safeno-femoral anastomosis speaks about inferiority of valves of both veins fig.
Conservative treatment cannot liquidate V. The medical Dermatitis bei varicosity including carrying elastic rollers or stockings, physiotherapy exercises, medicines and physiotherapeutic procedures temporarily improve a condition of a venous hemodynamics in an extremity and in a nek-swarm of degree interfere with further development of pathological process.
This web page can be recommended at failure of the patient from radical treatment, to pregnant women at whom V. From surgical methods Dermatitis bei varicosity treatment of V.
Indications to injection and sclerosing therapy: In all other cases of V. Its success depends on completeness of identification of all pathogenetic factors at this patient before operation and on care of elimination of all pathological veno-venous dumpings into time of operation. The second group includes operations of Madelunga excision of all vein on an extentNarata excision of veins in parts from small cutsBebkoka removal of a vein by means of the probe.
The third group is made by alloyed methods Shede — Kokhera, Klappa, Sokolov, etc. Any of the listed methods is not applied as independent operation.