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Modern aspects of studying of an aetiology and classification of varicose illness of the bottom extremities

Varicose illness of the bottom extremities (VBNK) is the most widespread vascular pathology. The epidemiological situation concerning chronic diseases of veins in Russia does not concede to universal indicators [54, 137, 145, 173, 193].

Varicose illness is a polyetiological disease. Till now it was not possible to frame the universal theory of its aetiology and a pathogenesis. However it is possible to speak about full enough studying of some the pathogenetic factors playing the leading part at development of given disease. For long years of studying of this illness the considerable quantity of assumptions of value of variety of factors in its occurrence [54, 137, 145, 173, 193] has been put forward.

1. A genetic predisposition (presence of the given pathology at both parents raises risk of inheritance of illness to 60 %) [94, 122, 202]. Illness, and the only genetically caused features of a structure of the venous wall bound to insufficiency of a connecting tissue in which basis delicacy of muscularly-elasticheskih formations of a venous wall lays, and the congenital valval insufficiency leading to inferiority of valves superficial, deep and perforantnyh of veins is by right of succession transferred not. The congenital combination of both factors is shown early and quickly progresses, leading VBNK [60, 68, 118, 121,201].

2. A sex. Women are ill in 1,5-2 times more often in connection with dishormonal conditions at application of hormonal contraception, a replaceable hormonetherapy at a climacterium, pregnancy [56, 94, 132, 154, 155, 182].

3. Adiposity at which there comes augmentation of the general peripheric resistance to a blood flow and reduction of minute volume of blood, depression sokratitelnoj abilities of a myocardium, with the subsequent deterioration of haemocirculation. In aggregate these disorders lead to fivefold augmentation of risk of development VBNK [94, 155, 201].

4. Long static loads and a small motor performance bound to character of work (a long static load at loaders, motionless or inactive position standing or sitting, work in vertical position at hairdressers, cooks, waiters, surgeons, etc.) [67,94,145,156].

5. Life conditions. In development VB the adverse influence of underwear squeezing venous highways at level of inguinal cords, and also the various corsets raising intraabdominal pressure matters.

High frequency VB in industrially developed countries in any measure is caused by features of a food. High degree of processing of foodstuff and depression in a ration of crude vegetables and fruit leads to constant deficiency of the vegetative fibers necessary for remodelirovanija of a venous wall, to the chronic constipations, being the reason of permanent rising of intraabdominal pressure [42, 67, 94, 114, 118].

Some classifications of varicose illness [67,89,94,118,148, 186, 212] are offered. However until recently there were no uniform, popular, satisfying all clinicians of classification of varicose illness. Now it is widely discussed

The international classification of chronic diseases of veins of the bottom extremities (SEAR).

SEAR (With - Clinical, E - Etiology, And - Anatomical, R - Pathophysiological), developed taking into account clinic (), aetiologies (), anatomy () and pathophysiological disorders (), It is accepted it in 1995 and includes following sections: '

I.

Clinical classification (With — Clinical sings - disease implications)

Stage 0. - Absence of symptoms of illness of veins at survey and a palpation.

Stage 1. - Teleangiectasias or reticular veins.

Stage 2. - the varicose-expanded veins.

Stage 3. - the Edema.

Stage 4. - the Dermal changes caused by disease of veins (pigmentation, a venous eczema, lipodermatoskleroz).

Stage 5. - the Dermal changes specified above, and the begun to live ulcer.

Stage 6. - the Dermal changes specified above, and an active ulcer.

II. Etiological classification (E — Etiology - an aetiology)

(EU) Congenital disease.

(ER) Primary disease with the unknown reason.

(ES) Secondary disease with the known reason: posttromboticheskoe, posttraumatic, etc.

III. Anatomic classification (And - Anatomical)

IV. The Pathophysiological classification based on ultrasonic data (R - Pathophysiological dysfunction)

(PR) the Reflux

(RO) Obstruction

(PR,) the Reflux + obstruction

V. The Clinical scale (score)

VI. The Scale of decrease of working capacity (points)

International classification SEAR covers plural aspects of an aetiology, clinic, patofiziologii, but yet has not received a full recognition flebologov as it is represented rather bulky and is difficultly applicable in practical activities.

In this connection, in 2000 in Moscow at Meeting of experts of leaders Russian flebologov new classification of the varicose illness based on the International classification (SEAR) has been developed and accepted. The classification offered by domestic authors is more simple for clinical use and considers the disease form, degree of chronic venous insufficiency and the complications caused by varicose illness.

Forms of varicose illness: 1 intradermal and hypodermic segmentary varices without pathological veno-venous dump; 2 segmentary varices with a reflux on superficial or perforantnym to veins; 3 widespread varices with a reflux on superficial and perforantnym to veins; 4 varicose expansion in the presence of a reflux on deep veins.

Degree of chronic venous insufficiency: 0 - is absent; 1 - a syndrome of "serious feet», a transient edema; 2 - a proof edema, hyper-or a hypopigmentation, lipodermatoskleroz; 3 - an eczema, a venous trophic ulcer (opened or begun to live)

Complications: a bleeding; a thrombophlebitis; a trophic ulcer (with the indicating of localisation and a wound process stage).

The given classification is approved by the majority of clinicians and now is widely used in daily practice and it is necessary to notice, that, since 1994 work on improvement and a concrete definition of separate sections of this classification [11, 12, 94, 148] did not stop.

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A source: KORCHAGINA VALENTINA JUREVNA. ENDOVAZALNAJA the ELECTROCOAGULATION With HYPODERMIC CROSSING of VEINS In TREATMENT of the COMPLICATED FORMS of VARICOSE ILLNESS of the BOTTOM EXTREMITIES. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2008. 2008

More on topic Modern aspects of studying of an aetiology and classification of varicose illness of the bottom extremities:

  1. the Chapter I Modern aspects of studying of an aetiology and classification of varicose illness of the bottom extremities (the literature Review)
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  4. the Chapter of III Feature of operation endovazalnoj electrocoagulations with hypodermic crossing of veins at treatment of the complicated forms of varicose illness of the bottom extremities (own observations)
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