Patogeneza kronične venske insuficience = The pathogenesis of chronic venous insufficiency
Šikovec, Andrej
The term chronic venous insufficiency means changes in the venous circulation in the leg which result from a permanent elevation of the venous pressure. It corresponds to an entire spectrum of ...clinical conditions, from the feeling of heavy legs and edema to the most severe form, crural ulcers. Even though this condition extremely rarely affects the patient as gravely as to endanger his/her life, it is a large medical and social problem because of its chronic course and high incidence. Except in cases when it results from deep venous thrombosis, the exact cause of this condition is still unclear. What we know is that a venous valves defect (primary or secondary) leads to the incompetence of venous valves. This enables venous reflux and a parmanent elevation of the venous pressure, even during muscular activity. The high venous pressure is transmitted to the venular side of the microcirculation, which in turn, via different paths which are not yet entirely understood, leads to edema, inflammatory response and increased capillary permeability. This causes metabolic changes in skin tissue and ultimately, in a crural ulcer. Present improved understanding of the mechanisms involved at the level of the macro- and microcirculation has enabled us to intervene more rationallyand efficiently by therapy. A model is described in greater detail which illustrates the disturbances of the venous microcirculation. Certain more recent theories of the consequences of this disturbances at the level of microcirculation are described as well.
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