Xiaomei developed edema in her left leg in the late stages of pregnancy, thinking that it was a normal reaction to pregnancy and did not take it seriously, but died of pulmonary embolism a few weeks later. The family was overwhelmed by grief, and the doctor explained that because the pregnancy was in a hypercoagulable state, a venous thrombosis of the lower limbs was generated, and the blood clot broke off and blocked the lungs. Severe pulmonary embolism is fatal, and the success rate of rescue is extremely low.
The sequelae of venous thrombosis of the lower extremities is one of the causes of venous insufficiency of the lower extremities. In addition to vascular injury and hypercoagulability, immobilization is also a risk factor for venous thrombosis of the lower extremities. Professor Dai Xiangchen, vice president of Tianjin Medical University General Hospital and director of Tianjin Key Laboratory of Precise Vascular Reconstruction and Organ Function Repair, pointed out in an interview with a reporter from the "Physician Daily" that such as the economy class syndrome of inactivity for more than ten hours on a plane for a long time, and the mahjong legs that have been played for a long time and forget to move, are all people with a high incidence of venous thrombosis in the lower limbs, and deep vein thrombosis may be fatal if it falls off.
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Learn more about the diagnosis and treatment of venous insufficiency of the lower extremities
Blockages and regurgitation Blood has a long way to return to the heart
"The prevalence of venous insufficiency of lower extremities in China is 9%, and nearly 100 million Chinese people are deeply disturbed." Professor Dai Xiangchen introduced that lower limb venous insufficiency is a general term for lower limb venous reflux disorders, including lower limb venous obstruction disease and lower limb venous reflux disease, whether it is obstruction or reflux, its pathology is that the blood of the lower limbs cannot return normally to the heart, which causes various symptoms.
In order to allow the blood of the lower limbs to overcome the effect of gravity and return smoothly to the heart, the human body cleverly fits venous valves into the veins of the lower limbs. These venous valves act like one-way valves that allow blood to flow only to the proximal end, and if the blood wants to retrograde to the distal end, the valves will automatically close to ensure that the blood returns to the heart normally. If the valve function is impaired, some of the blood backs up to the distal end, causing venous hypertension. This is an important pathological type of venous insufficiency of the lower extremities.
In addition, thrombosis or iliac vein compression syndrome can directly block venous return, which can also cause venous hypertension, leading to venous insufficiency in the lower extremities.
Mild cases affect the quality of life, and severe cases can be fatal
The veins of the lower limbs are divided into three systems: deep veins, superficial veins and traffic veins, forming a transportation network with both highways and country roads, and bridges connecting the two in the middle.
Deep veins are buried in muscles, and deep vein thrombosis is the main cause of venous insufficiency in the lower limbs, which is extremely harmful to health. Professor Dai Xiangchen introduced that there are three causes of deep vein thrombosis: the lower limbs do not move for a long time; Hypercoagulability due to pregnancy, illness, medication, etc.; Blood vessels are damaged due to surgery, chemotherapy drugs, etc.
"If deep vein thrombosis falls off, it can easily lead to pulmonary embolism, which can be fatal once it occurs, which is also the biggest harm of deep vein thrombosis." Professor Dai Xiangchen said that even if the thrombus does not fall off, as the thrombus increases, it will cause deep vein blockage, forming thrombotic sequelae, that is, a very obvious calf vein dystrophy disease, commonly known as "old rotten legs". In the early stage of the patient, local skin pigmentation, dermatitis, sclerosis, desquamation, itching, etc., continue to develop local ulcers, and the ulcers pseudo-heal and recurrent ulcers develop to "old rotten legs".
"Although the ulcer will not be amputated if it is not fatal, it seriously affects the quality of life of patients due to local high pressure and increased secretions." Professor Dai Xiangchen emphasized.
Superficial veins are divided into large saphenous veins and small saphenous veins, and the "earthworm legs" often referred to by ordinary people are superficial varicose veins. Varicose veins slow blood flow and blood clots to form blood clots, causing severe local pain, redness, and inflammation, called superficial thrombophlebitis. "The chance of superficial vein thrombosis falling off is very low, and the main manifestations are local pain, congestion and redness. The primary manifestation of deep vein thrombosis is localized swelling, and pain in the gastrocnemius muscle of the calf is the hallmark symptom of the patient with dorsiflexion of the toes. Professor Dai Xiangchen emphasized that if the calf suddenly swells for unknown reasons, you must be careful of deep vein thrombosis.
The communicating vein is the connecting blood vessel between the deep vein and the superficial vein, and when there is a problem with the deep vein, the high-pressure blood flow will flow to the superficial vein, and the superficial varicose veins will appear, which is called the communicating vein reflux disease. As with deep vein thrombosis, thrombosis sequelae can occur, affecting the quality of life of patients.
Break through all barriers and let the blood flow back smoothly
Patients with venous insufficiency of the lower extremities should be treated conservatively with pharmacotherapy and compression.
Drug treatment mainly includes intravenous active drugs, anticoagulant drugs, and drugs to improve microcirculation. Intravenous active drugs, such as escin sodium tablets, can increase venous tone, strengthen valve function, and promote blood return. In addition, this class of drugs can also be anti-inflammatory, reduce the permeability of the venous wall to reduce exudation, and have a good therapeutic effect on venous insufficiency of the lower limbs.
Vein compression stockings and elevation of the affected limb are common options for compression therapy. Vein elastic stockings close the tortuous and dilated veins through pressure, so that the blood can flow back through other unobstructed blood vessels to ensure effective blood circulation, which can improve the symptoms of early soreness, fatigue and fatigue, and also have a certain relieving effect on severe pigmentation and itching. Elevating the affected limb changes the pressure difference, which is also beneficial for blood return and reduces symptoms.
"For conservative treatment, stress therapy and medication should go hand in hand and be used at the same time." Professor Dai Xiangchen emphasized.
Although conservative treatment is good, poor patient compliance will greatly reduce the treatment effect, so surgical treatment has become the second choice for patients. Saphenous vein peeling can remove the problem blood vessels and is one of the methods to treat varicose veins, but the treatment effect is affected by inaccurate judgment of the reflux point and saphenous nerve damage. In addition, thermal ablation, chemical ablation and other methods are also constantly explored and applied in clinical practice, relieving the pain of many patients.
For deep vein thrombosis, clinical observation found that the sequelae of venous thrombosis began to occur about 5 years after the patient got the thrombosis, and Professor Dai Xiangchen suggested that patients with surgical conditions should actively have their thrombectomy as early as possible.
For patients with iliac vein compression syndrome, the compressed position is propped up by placing a stent or balloon dilation, and the blood vessels are opened to maintain smooth blood return.
"Venous insufficiency of the lower extremities not only affects the quality of life of patients, but is also life-threatening, and it is essential to prevent its occurrence." Professor Dai Xiangchen emphasized that first of all, try to avoid staying still for a long time, such as high-risk groups such as truck and taxi drivers, need to stop regularly to rest and carry out activities, office workers should avoid sitting for a long time, teachers, salespeople, etc. should avoid standing for a long time, and it is very important to ensure the movement of the lower limbs; Secondly, for pregnant women, long-term corticosteroid users, cancer patients and patients with autoimmune diseases, it is necessary to carry out on-the-spot testing to prevent deep vein thrombosis, and early detection and early intervention are important methods for the treatment of venous insufficiency of the lower limbs.