Major vein insufficiency

A dysfunction of the deep veins of the leg, in which the valves in the deep veins no longer close and can therefore no longer fulfill their function as a valve, is referred to as guide vein insufficiency . The early form of guide vein insufficiency is called early incompetence of the guide veins . It is defined as the delayed valve closure of the deep leg veins.

causes

A distinction is made between primary and secondary venous insufficiency. While secondary valve insufficiency is limited to a certain section of the vein at the beginning (= immediately after thrombosis has resolved), primary venous venous insufficiency affects the entire deep venous system fairly evenly. Nonetheless, insufficiency occurs (of course) first on one and only then one after the other on all of the following venous valves. Naturally, primary vein insufficiency occurs on both sides, while secondary vein insufficiency affects one leg (at least initially only in the affected section).

Primary major vein insufficiency

One speaks of primary venous insufficiency when it occurs without a recognizable trigger, as a consequence of an innate disposition (predisposition) that manifests itself (occurs) at some point in life.

The fact that the valves in the deep leg veins no longer close could be a result of deep vein dilation. In this case, predisposition or at least without a recognizable trigger would lead to expansion of the deep leg veins and, as a result, valve insufficiency. It is also conceivable that the valves give up their function without a recognizable cause ( idiopathy ) and as a result the veins expand (dilate).

What is certain is that every enlargement (dilatation) must lead to insufficiency at some point, namely at the moment when the valve edges can no longer come together due to the divergence of the valve base. Even before this, it becomes more and more difficult for the flaps to close tightly under load, since the part of the flaps that rests against each other under load becomes smaller and smaller. In these cases, there is an early incompetence of the deep venous system with delayed valve closure and insufficiency some time later.

It is not clear whether only one of the two mechanisms exists, but there is much to suggest that both are possible.

Secondary venous insufficiency

The leading vein insufficiency as a result of another change is practically always the result of a deep vein thrombosis . The thrombus (clot) destroys the fine tissue of the valve. At the beginning of the thrombosis, the vein is blocked by the thrombus. As soon as the body has broken up the clot, the blood flow is free again, but the valves have suffered from the breakdown processes. In the worst case, they have been completely dismantled and are barely visible, but in any case have no function. In such a case, the guide vein insufficiency is initially a pure valve insufficiency of the deep veins, regardless of whether the deep vein has a normal diameter or is enlarged. Expansion of the deep vein can occur as a result. Whether this happens depends to a large extent on the quality of the therapy, primarily on the compression.

Diagnosis

Evidence of the expansion is possible by means of venography or sonography . The detection of valve insufficiency, the extent and duration of the blood reflux and, if necessary, the determination of the amount of blood flowing back are the domain of duplex sonography . Color duplex ultrasound is nowadays carried out as standard if a vein insufficiency is suspected in order to prove the valve insufficiency and to determine the extent of the reflux, especially the distance that is without valve function.

therapy

There are neither surgical nor medicinal options for therapy. Compression therapy alone is effective. It can prevent the long-term damage of the guide vein insufficiency and, depending on the quality of the compression, has a more or less strong effect on the flow behavior of the blood in the guide veins.