CHRONIC VENOUS DISEASE

CHRONIC VENOSAL DISEASE (CVD) or Chronic Venous Insufficiency results from a structural change in the venous system. The essential function of this system is to perform the return of venous blood from the legs to the heart and therefore against gravity.

This whole process is aided by extensions of the vein wall, existing inside the vein, called venous valves, and also by the muscular system of the lower limbs. The leg muscles, when contracting, promote an ejection of venous blood that only doesn't recede and accumulate inside the veins due to the presence of the aforementioned valves that, when closed, prevent the reflux of blood.

Venous function is thus dependent:

• of the vein wall performance;
• of competent venous valves;
• of propulsive muscles that ensure the normal flow of blood toward the heart.

The accumulation of blood inside the vessels due to lesions on the vein walls or on their valves leads to their dilation and deformation. Being an evolutive disease, these alterations are progressive, which aggravates the removal of the valves and leads to the appearance of varicose veins.

The risk of developing CVD increases with age and women are affected more frequently than men. This difference is related to the presence of estrogens in women and therefore the high frequency of CVD also during pregnancy. Family predisposition, obesity, constipation and some risk behaviors such as lack of physical exercise, smoking, activities that require long periods of standing or sitting, wearing tight clothing or wearing shoes that are too high or too flat, can favor the appearance of this pathology.

The symptomatology of venous disease is characterized by pain in the lower limbs, heavy and tired legs, edema (swollen legs), itching, numbness, and night cramps. These symptoms usually occur without there being any outward sign of the disease yet. The first indicator of CVD are enlarged veins in the ankle (varicose veins) and effusions (telangiectasis).  This is followed by swollen legs, a condition that worsens with heat and after long periods of standing or sitting, itching that can develop into dermatitis, and hyperpigmentation that results in darkening of the skin in localized areas. At a more advanced stage of the disease, if preventive measures or adequate treatment are not taken, venous ulcers may appear, many of which are difficult to treat.

The treatment that is indicated in CVD is pharmacological treatment associated with compressive treatment (elastic stockings). The drugs act to improve venous tone, increase capillary resistance and normalize capillary permeability. Elastic compression promotes the reabsorption of edema and prevents its formation, decreases venous caliber and increases blood flow velocity, reduces reflux in the standing position, and improves muscle contractility.

Prevention is the best way to avoid CVD or its progression. In this sense it is important:

• Avoid standing or sitting for long hours (particularly with crossed legs): try to make circular movements with your feet or walk in the evening.
• Regular exercise as it stimulates muscle contraction and venous return. It is important to choose the most appropriate sport. Prefer walking, gymnastics, cycling, or swimming to sudden-impact sports like tennis or basketball that cause variations in blood pressure in the veins.
• Wear comfortable clothes and shoes that do not hinder movement.
• Eat a diet rich in fiber, with good hydration and reduced saturated fat intake to avoid both overweight and constipation that increase venous blood pressure.
• Massage the legs from the bottom up to stimulate venous return.
• Facilitate blood circulation during sleep: do some pedaling movements before going to sleep and raise your feet 10 to 15 cm from the bed.
• Avoiding hot places like prolonged sun exposure: running cold water over your legs and staying in cool places, stimulates venous function and relieves pain and the feeling of heavy legs.

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