2 Traffic venous insufficiency
The role of calf traffic venous insufficiency in the pathogenesis of CVI limb skin changes (including venous leg ulcers) has long been noted, although there are still some controversy, but most scholars agree attitude. Due to the function of the valve, a functioning venous vein can ensure unidirectional drainage from the superficial venous system of the lower extremity to the deep venous system. When its insufficiency is achieved, the blood flow of the deep venous leg of the lower extremity will flow into the superficial vein through the incompetent venous veins Veins, causing calf superficial venous congestion, hypoxia, resulting in the corresponding skin changes. It has been reported that CEAP grading of CVI limbs correlates positively with the number and diameter of calf traffic veins, especially those with venous blood flow (insufficiency). Nicolaides et al. Also reported that the incidence of venous leg ulcers in the simple superficial venous return was 6%, superficial venous reflux with venous insufficiency was 30%, no traffic venous insufficiency but the presence of deep \ superficial venous reflux When 33%, while there are deep and superficial venous reflux and traffic venous insufficiency was 47%. All of these studies show that the increase of calf traffic veins, diameter and dysfunction plays an important role in the development of CVI and the formation of venous ulcers.
In patients with venous ulcers and superficial venous reflux, if the deep venous system is functioning well, correcting the superficial venous return will significantly reduce the number and diameter of dysfunctional veins. In contrast, if deep venous insufficiency is present, correcting for superficial venous reflux does not correct the outward flow of the traffic vein in most cases. This may be used to explain why there is a high rate of healing of ulcers after superficial vein resection in those cases where there are only venous and superficial venous insufficiency. This also shows that in patients with deep venous reflux, superficial venous pumping is not enough to reduce venous hypertension and promote ulcer healing.
3 Calf muscle dysfunction
Gastrocnemius muscle pump is mainly composed of the calf muscle and the intermuscular sinus, contraction is it can discharge more than 60% of the total volume of the calf venous blood, the venous pressure drop, this contraction can be vividly compared to the contraction of the heart. Function similar to the heart pump, gastrocnemius muscle pump function is also affected by calf muscle contractility, pre-load and post-load effects. When there is regurgitation, the performance of the pre-load increased; when there is proximal vein obstruction, the performance of the post-load increase. In theory, these factors will be to varying degrees, weakened gastrocnemius muscle pump function. In fact, the normal contraction of the calf muscles can be offset to a certain extent, before and after the impact of load. When gastrocnemius muscle pump dysfunction caused by various reasons, lower extremity venous pressure, it may lead to the formation of venous ulcers. Studies have shown that: Good gastrocnemius muscle pump function, can reduce the incidence of moderate reflux of limb ulcers from 63% to 30%, severe reflux limb ulcer incidence decreased from 70% to 41%; on the contrary, gastrocnemius muscle pump Poorly functioning limbs, even with mild regurgitation, had significantly higher rates of ulceration than normal (32%).
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