Modern ideas about the mechanisms of development of valvular insufficiency in chronic venous insufficiency

Abstract

Annotation. Despite the improvement of methods of diagnosis and treatment of chronic venous insufficiency of the lower extremities, this problem remains relevant and not fully resolved. The confirmation is a large percentage of patients with trophic changes, as a result of deep disorganization of the venous wall and valves in the system of deep and superficial veins. The purpose of this article is to conduct a literature analysis of the various mechanisms of the development of valvular insufficiency in order to improve the treatment of patients with chronic venous insufficiency. A scientific search was carried out for the period from 2000 to 2022 according to the primary search strategy “valvular failure of the veins of the lower extremities”, and the AND/OR combination in the scientific databases MEDLINE (PubMed), Scopus, Web of Science. Among practicing doctors, there are two views on the initial levels of the formation of valvular insufficiency in varicose disease: the beginning of varicose transformation is associated with the expansion of individual venous branches, and the failure of the main trunks of the subcutaneous veins joins much later. Another factor in the pathogenesis of trophic changes in chronic venous diseases is changes in the viscoelastic properties of the walls of deep veins, which lead to valvular insufficiency and impaired venous outflow. The main cause of trophic ulcers in patients with chronic venous insufficiency is the formation of persistent pathological vertical reflux in the system of deep and superficial veins and the presence of horizontal reflux at the level of communicating and penetrating veins of the lower third of the thigh. Orthostatic venous stasis causes a progressive violation of venous hemodynamics and leads to deterioration of microcirculation and disruption of tissue nutrition.