Venous insufficiency of the lower extremities

Venous insufficiency of the lower extremities is a syndrome caused by a disorder of blood circulation in the venous system of the legs. Pathology is mainly caused by varicose veins of the lower extremities, or post-thrombotic disease. The chronic form of the disease is also found in patients with congenital angiodysplasia, Klippel-Trennon syndrome.

Venous insufficiency is a long-known problem that was often encountered in ancient times. In particular, during excavations of Egyptian tombs, mummies with traces of attempts to treat venous trophic ulcers of the lower leg were found. Famous healers Avicenna and Hippocrates devoted many of their works to the study and description of this disease.[1]

Epidemiology

To date, venous insufficiency is one of the most common pathologies among the population of Europe and North America. According to statistical data, the disease affects at least 35-40% of adults of the Caucasian race, and the probability of the disease increases significantly with age.

Especially often venous insufficiency affects women: more than 40% of women after 45 years of age suffer from one or another form of this pathology.

Due to the fact that the disease progresses slowly and at the initial stages is practically asymptomatic (low-symptomatic), most patients do not seek medical help immediately. Thus, according to statistics, no more than 8-10% of patients receive timely therapy, while the rest turn to doctors only at advanced stages, or do not turn at all.[2]

Causes of the venous insufficiency of the lower extremities

Venous insufficiency of the lower extremities is not a separate nosological unit, but a painful condition characterized by congestion or pathological changes in the blood flow in the venous network of the legs. Specialists voice two basic causes of this phenomenon: varicose veins and post-thrombotic disease.

Varicose veins is a polyetiological pathology, in the development of which plays a role hereditary deterministic predisposition, hormonal status (periods of pregnancy, contraceptives, etc.), constitutional features (more often people with obesity), lifestyle and work activities (heavy loads on the lower extremities, prolonged standing on the legs).

The disease itself consists of a gradual increase in the internal cavity of venous vessels, which leads to relative valve insufficiency (they continue to work, but the closure of the flaps becomes incomplete). As a result, reflux of blood flow downward through the saphenous veins and from deep to superficial veins is formed.

Postthrombotic disease is a consequence of acute venous thrombosis: thrombi "stick" to the inner wall of the vein, retraction occurs with incomplete leukocyte and plasma lysis. Thrombi are sprouted by fibroblasts with further processes of recanalization and revascularization. The lumen of the main vessels is partially restored, in contrast to the restoration of integrity and functional ability of the valve system of deep and superficial veins, which does not occur.

Intravenous pressure gradually increases, vascular walls lose their elasticity, permeability increases. Edema and trophic disorders occur.[3]

Risk factors

Venous insufficiency of the lower extremities is a polyetiologic disease. A number of predisposing factors for the development of pathology can be listed:

• genetic predisposition;
• constitutional features;
• hormonal changes, including those caused by long-term use of hormonal contraceptives;
• peculiarities of labor activity (prolonged standing on legs, excessive physical strain, etc.);
• Pathologies of connective tissue structures affecting the venous wall and causing incompleteness of the valve mechanism.

Directly to the producing factors include various pathological and physiological conditions that cause an increase in intravascular and intra-abdominal pressure. For example, among them: static overload, pregnancy, chronic pulmonary pathologies, chronic constipation, arteriovenous fistulas.[4]

Pathogenesis

The venous system of the legs includes three networks: superficial, deep and perforating. All of these veins are equipped with valves that provide directional blood flow and prevent backflow in conditions of increased intravascular pressure.

Normal blood flow is from the tibial venous vessels to the saphenous, femoral and on to the iliac vein, and from the superficial network to the deep network.[5]

The superficial vein system is represented by the great and small saphenous veins: the great saphenous vein carries blood from the medial femoral surface and the tibia, then flows into the femoral vein. The small saphenous vein carries blood from the lateral and posterior part of the tibia and foot to the saphenous vein.

The deep vein network is represented by the paired anterior and posterior tibial vessels, as well as the peroneal, hamstring, femoral, and iliac veins.[6]

The perforating network connects the superficial and deep veins. The perforating vessels are equipped with valves that direct blood flow in one direction to the deep venous network.

The pathogenetic basis for the development of venous insufficiency of the lower extremities is intravenous pressure increase, which is due to functional or organic deficiency of the venous valve mechanism. Pathological vascular reflux occurs - blood retrogradely enters the superficial network. The problem can be caused by both congenital valve defects and other factors - for example, overweight, pregnancy, age-related changes, transferred pathologies of the venous system of the lower extremities.[7]

Symptoms of the venous insufficiency of the lower extremities

Usually venous insufficiency is first manifested by functional disorders (a feeling of heaviness in the lower extremities), visible dilated veins or vascular stars, which do not disappear for a long time, or even progress. Acute venous insufficiency of the lower extremities starts rapidly: blood circulation in the affected vein abruptly stops, swelling of the leg increases. Along the main vessel is felt a strong pain that does not disappear either when changing the position of the body, or at rest. Applying cold and taking an anesthetic (nonsteroidal anti-inflammatory drug) somewhat reduces the pain syndrome. The skin on the affected limb becomes bluish with a visible venous pattern.

The first signs of chronic venous insufficiency are characterized by a gradual increase. The patient begins to feel heaviness and discomfort in the legs in the afternoon. By evening, swelling of the lower legs and feet appears, and at night may be bothered by twitching muscles. The skin on the legs becomes drier and may change color.

Further progressive chronic venous insufficiency of the lower extremities is characterized by the following clinical symptom complex:

1. Varicose subcutaneous veins.
2. A feeling of "heaviness" in the legs.
3. Nocturnal muscle cramps.
4. Swelling of the ankle in the afternoon.
5. Soreness along the varicose vessel.
6. A sensation of "tumescence" in the affected leg.
7. Distal skin pigmentation disorder.
8. The phenomena of lipodermosclerosis.
9. Appearance of trophic ulcers closer to the medial ankle.

If treatment is not started in time, valve venous insufficiency of the lower extremities can be complicated by a trophic ulcer, and the accumulation of a large amount of blood in the non-functioning vein can lead to damage to the vessel and bleeding.

Patients should be vigilant and seek medical attention at the first suspicious symptoms, especially if there are risk factors for venous insufficiency. What to watch out for:

• Not in all cases of swollen legs, venous insufficiency of the lower extremities is confirmed. Swelling can occasionally be present in kidney pathologies, joints, hormonal fluctuations, obesity, as well as relatively harmless causes - such as wearing tight shoes or high-heeled shoes, excessive fluid intake and so on. In venous insufficiency, swelling is found both on one leg and on both legs. Most often the distal part of the lower leg swells, less often - the foot. If a sick person takes off a sock, you can see clear traces of squeezing on the skin: such traces do not go away for a long time. Among the frequent complaints: a feeling of heaviness and bloating in the legs, itching, dull pain. Swelling usually subsides after a night's sleep.
• Pain with venous insufficiency of the lower extremities is localized mainly in the calf muscles and along the affected vessel. In the acute form of pathology, the pain is sharp, due to the inflammatory process or thrombosis, and in the chronic form - dull, pulling, moderate, disappearing after a night's rest. It never irradiates to the thigh or feet.
• Ulcers in venous insufficiency of the lower extremities are the result of trophic disorders. Even before their appearance, the patient should be alarmed if the skin in the lower leg changes color, hyperpigmented areas appear, which are eventually supplemented by a whitish area of thickening with a kind of "varnished" surface. This stage is called "white atrophy": in this area, the skin becomes particularly vulnerable and any mechanical impact forms a wound that transforms into an ulcerous defect.

Forms

There is a clinically based classification of lower extremity venous insufficiency:

• Stage 0: no clinical signs of venous pathology during examination and palpation.
• Stage 1: reticular veins or vascular "asterisks" are found.
• Stage 2: varicose vessels are found.
• Stage 3: edema of the lower extremities is present.
• Stage 4: there are cutaneous changes associated with vascular problems (hyperpigmentation, lipodermatosclerosis, eczema, etc.).
• Stage 5: the above disorders are present, as well as a protracted ulcer.
• Stage 6: the above disorders are present, as well as ulcer in the active phase.

Etiologic type of classification:

• EC is a congenital pathology.
• EP is a primary pathology with an unspecified cause.
• ES - secondary pathology with an established cause (post-thrombotic, post-traumatic venous insufficiency, etc.).

Anatomical type of classification:

Superficial vein (AS) lesions:

• 1 - GSV - great saphenous vein;
• 2 - above the knee;
• 3 - below the knee;
• 4 - LSV - small saphenous vein;
• 5 - non-magistral vessels.

Deep vein injury (AD):

• 6 - inferior vena cava;
• 7 - common iliac;
• 8 - internal iliac;
• 9 - external iliac;
• 10 - pelvic veins;
• 11 is the common vein of the thigh;
• 12 is the deep vein of the thigh;
• 13 - superficial vein of the thigh;
• 14 - hamstring;
• 15 - venous vessels of the tibia;
• 16 - Muscle veins.

Perforant vein lesions:

• femoral;
• tibia.

Classification by pathophysiologic type:

• PR is due to reflux;
• PO - due to obstruction;
• PR,O - due to both reflux and obstruction.

Degrees of chronic venous insufficiency of the lower extremities:

• Grade 0: asymptomatic course.

• 1 degree of venous insufficiency of the lower extremities: symptomatology is present, but the ability to work is preserved, there is no need for the use of supportive measures.
• 2 degree of venous insufficiency of the lower extremities: the patient is able to work, but has to use supportive devices.
• Degree 3: the patient is incapacitated.

Based on the results of treatment, symptoms may change or disappear: in this case, the degree of the disease is reviewed.[8]

Complications and consequences

Possible complications of venous insufficiency of the lower extremities:

• Superficial ascending thrombophlebitis is an acute inflammatory process in superficial venous vessels. Symptomatically manifested by pain, redness and thickening along the large and small saphenous veins. If the pathology spreads further to the deep venous network, the risks of developing pulmonary embolism increase significantly.
• Bleeding, tearing or ulceration of the damaged tissue above the affected vessel. Bleeding usually occurs when the patient is in a standing position. There is no pain. Tight bandaging or stitching of the injured vein is used to achieve hemostasis.
• Trophic ulcers are skin defects that appear mainly in the lower third of the medial part of the lower leg. It is there that trophic disorders are most pronounced. The ulcer is formed due to increasing tissue necrosis and increased pressure in the venous-capillary network.[9]

Diagnostics of the venous insufficiency of the lower extremities

Physical examination of patients with suspected chronic venous insufficiency is performed in a standing position. The doctor evaluates the appearance of the lower extremities: color shade, presence and location of dilated veins and vascular stars, areas of increased pigmentation. The anterior abdominal wall and inguinal areas are also examined, where dilated saphenous veins typical of post-thrombotic disease and congenital deep vein disease may be found.

The presence of vertical and horizontal venous reflux is determined by these clinical tests:

• Gackenbruch's test: against the background of a sharp increase in intra-abdominal pressure (with coughing, pushing) palpatorially under the inguinal fold can be felt retrograde blood wave, which indicates failure of the valves of the proximal section.
• Horizontal reflux test: palpate aponeurosis defects in the areas of localization of failed perforating veins.

Laboratory tests are of secondary importance, since the fundamental are instrumental methods. However, the doctor may prescribe:

• blood glucose test (diabetes is one of the factors of trophic ulcers);
• evaluation of D-dimer (indicates the formation of blood clots in the blood vessels);
• index of activated partial thromboplastin time (assessment of blood clotting quality);
• indicator of soluble fibrin-monomer complexes (assessment of thrombotic processes).

Instrumental diagnostics

• Ultrasound Doppler ultrasonography helps to determine the degree of venous patency and clarify the condition of the valve system of the superficial network. The specialist receives a sound and graphic picture of blood circulation and can apply the information obtained both for differential diagnosis and to assess the state of the valve apparatus.
• Ultrasound duplex vascular scanning involves color-coding of blood flows and helps to clearly identify anatomical and morphological changes in the venous channel, which is very important for the correct treatment.
• Phlebotonometry and rheovasography provide comprehensive information on venous return status, but are useless for topical diagnosis.
• Phlebography - is a radiologic examination of the venous apparatus using contrast.

Differential diagnosis

Differential diagnosis is required for such diseases:

• venous thrombosis, post-thrombotic disease;
• lymphedema;
• congenital vascular defects;
• chronic heart failure, renal pathologies;
• joint diseases;
• arterial insufficiency;
• peripheral polyneuropathy.

Treatment of the venous insufficiency of the lower extremities

Currently, surgical treatment is considered the only radical way to get rid of venous insufficiency syndrome of the lower extremities. Conservative methods can act as a preparatory moment for surgical intervention. They include:

• regular bandaging with an elastic bandage, or wearing special knitwear with elastane;
• Giving your feet an elevated position while resting at night;
• use of non-steroidal anti-inflammatory drugs (Diclofenac, Ketoprofen, Indomethacin, etc.);
• use of antispasmodics (Drotaverine, Papaverine);
• The use of drugs that promote vascular tone and improve lymph flow (Troxevasin, Escuzan, Anavenol, Venoruton, Detralex, Endotelon, etc.);
• taking drugs that normalize microcirculation and hemorheology (Trental, Aspirin, Plavix or Clopidogrel, Ticlopidine, etc.);
• taking vitamins PP, B-group, ascorbic acid;
• physiotherapy (electrophoresis of novocaine, heparin, trypsin, as well as ultrasound treatment and laser therapy);
• local treatment of ulcerative processes (necrectomy, dressings with antiseptic solutions and proteolytic enzymes, etc.);
• LFC.

Drugs and medicines for venous insufficiency of the lower extremities

Medications for venous insufficiency are prescribed to control symptoms, prevent the development of complications, preoperative preparation or postoperative recovery, as well as to improve the quality of life.

To date, there are many systemic and local preparations. Anavenol, Troxevasin, Escuzan, Venoruton, Glivenol are prescribed to increase venous tone. As monopreparations, new generation drugs are used: Detralex, Flebodia, Antistax.

To improve drainage function, drugs from the series of benzopyrones are suitable: Troxevasin, Venoruton, Wobenzyme or Flogenzyme.

In order to eliminate microcirculatory disorders and stabilize blood circulation, low-molecular-weight dextrans, Trental (Pentoxifylline), Aspirin, Ticlid, Clopidogrel are used. The well-known Detralex and Flebodia have a similar effect.

When indicated, anti-inflammatory drugs such as Diclofenac, Ketoprofen, Indomethacin are used, as well as external agents (ointments with nonsteroidal anti-inflammatory components, corticosteroids, heparin, etc.).[10]

Given the variety of clinical symptoms and course in different patients, there is no clearly defined treatment regimen for venous insufficiency of the lower extremities. However, it is recommended to follow some basic principles:

• treatment is necessarily carried out by a course, short or long, one-time or regular, but not less than 8-10 weeks in duration;
• The approach should be comprehensive, combined with other therapies;
• treatment regimens are individually tailored;
• the patient must clearly follow all medical recommendations and understand all possible consequences of failure to do so.

Particularly difficult patients are considered patients with severe forms of chronic venous insufficiency, who develop secondary lymphostasis, skin diseases - in particular, rusty inflammation, trophic ulcers, eczema. In such cases, initially prescribe the introduction of disaggregants (Reopolyglukin), antibiotics, antioxidants, non-steroidal anti-inflammatory drugs. Then gradually connect angioprotectors, polyvalent angiotonics.[11]

Antistax	For the prevention and treatment of chronic venous insufficiency take 1-2 capsules after waking, with water.
Phlebodia	Patients over 18 years of age are recommended to take 1 tablet in the morning, therapeutic course up to 2 months. Side effects: mild digestive disorders, headache.
Diosmin	It is taken orally, based on a daily dosage of 600-1800 mg. The drug is contraindicated in children and women in the first trimester of pregnancy.
Troxerutin	Take 1 capsule three times a day. Contraindications: peptic ulcer and 12-acid ulcer, chronic and acute gastritis.
Venoruton	Take 2-3 capsules per day. Contraindications: pregnancy.
Troxevasin capsules	It is prescribed as a course of 2-3 months, one capsule in the morning and evening. Side effects include: nausea, malaise, allergies.
Glyvenol	Take one capsule twice a day. Contraindications: pregnancy and lactation period.
Venarus	Take 1 tablet per day, during breakfast. The duration of the treatment course may be several months.
Detralex	It is administered 1 tablet (1000 mg) in the morning, or 2 tablets (500 mg) in the morning and evening, with food. Treatment may be prolonged, depending on the indication.
Venolek	The daily dose ranges from 600 to 1800 mg. Possible side effects: mild digestive upset, allergy.

Detralex in venous insufficiency of the lower extremities

The composition of Detralex is represented by flavonoids, such as diosmin and hesperidin. The drug is characterized by a pronounced phlebotic ability - that is, it increases the tone of venous vessels, optimizes lymphatic drainage. Among other features of the drug:

• anti-inflammatory effect (stops the production of prostaglandins PGE2 and thromboxane B2 - the main mediators of inflammatory reaction);
• antioxidant effect (prevents the appearance of free radicals - factors of intravascular damage);
• lymphatic stimulation;
• elimination of microcirculatory disorders.

Detralex 500 is taken one tablet twice a day for 8 weeks. Detralex 1000 is taken one tablet at breakfast time. If the patient has active trophic ulcers of the lower extremities, the course of treatment should be longer - up to 4 months.

The only contraindication to taking Detralex is an allergy to the components of the drug. The possibility of using tablets during pregnancy is discussed individually with the attending physician.

Ointments and gels for venous insufficiency of the lower extremities

Ointments and other external preparations used for venous insufficiency are divided into several categories:

• Heparin-containing - includes agents that affect blood clotting and thus improve blood circulation.
• Anti-inflammatory - stops the development of inflammatory reaction, relieves pain.
• Phlebotonic - used to increase the elasticity of vascular walls and improve blood flow.

It is important to understand that external remedies are not able to cure venous insufficiency. However, they are able to alleviate the patient's condition, reduce the symptomatology. At the same time, such drugs are practically devoid of negative side effects, so they can be safely used as a supplement to the main treatment.

Name of drug	General information	Advantages	Disadvantages
Heparin ointment	Anti-inflammatory, analgesic and vasoconstrictive ointment containing heparin, benzocaine, benzylnicotinate. The drug thins blood, improves lymphatic outflow, eliminates pain.	The ointment is affordable, safe, effective, and does not require a doctor's prescription.	Prohibited in low blood clotting.
Troxevasin	Anti-inflammatory and vasodilating ointment based on troxerutin. Prevents the development of thrombosis.	Ointment is safe, can be used in pregnancy, well eliminates pain and swelling.	Sometimes causes an allergic reaction and is relatively expensive.
Venitan	Venitan cream and gel are presented with the active ingredient escin - a product from the seed of horse chestnut. It is characterized by vasoostrengthening, anti-inflammatory, tonic and analgesic action.	Well tolerated by patients, acts quickly and effectively.	It is not used to treat children.
Lyoton	Lyoton contains heparin, has a strengthening, anti-edematous and antithrombotic effect.	Effective blood thinner, practically safe.	It is relatively expensive, contraindicated in low blood coagulation.
Dolobene	The composition of the gel is represented by heparin, dexpanthenol, dimethyl sulfoxide.	Good analgesic, eliminates swelling and inflammation, can be used in children.	Undesirable in pregnancy and breastfeeding.

LFK, gymnastics and exercises

Special exercises and massage help to improve venous circulation. It is important to do such manipulations regularly, every day. So, every evening before going to bed, you should raise your legs above the level of the heart, holding them in this position for at least fifteen minutes (it is also recommended to sleep with your feet on a small pillow). This will relieve the feeling of fatigue and facilitate venous blood flow.

Ointments based on horse chestnut are used for gentle massage. Practice light stroking movements, gentle kneading, without aggressive influences.

Doctors advise performing physical therapy exercises that do not load the lower limbs, but help maintain vein tone. Heavy weight-bearing exercises and running are excluded, as well as exercises involving squatting, squatting, etc. Walking, exercises involving frequent changes of body position and leg lifts are encouraged.

Among the most useful exercises:

• up and down on your toes;
• in a standing position, alternately lift the right and left legs and perform "figure-eight" movements in the air;
• walking on the spot with active arm swings and as high a knee raise as possible;
• forward-backward leg movements (extending and bending) while sitting on the floor.

As a rule, no special equipment is needed for LFK exercises. The first training sessions should preferably be supervised by an instructor.

Treatment with folk remedies

The use of folk remedies is a fairly common practice in the treatment of venous insufficiency. However, the benefits of it are tangible only at the initial stages of pathology: herbs, herbal ointments help to significantly reduce the risk of thrombosis and alleviate the course of the disease, including reducing pain, activate blood flow through the veins and strengthen their walls.

Among the general recommendations is proper nutrition, which includes eating foods to thin the blood and reduce stress on the cardiovascular system.

Folk healers advise to enrich the diet with products containing flavonoids: all kinds of berries, citrus, cabbage, bell peppers, kiwi, green tea.

Particularly useful for venous insufficiency:

• Fish oil and omega-3 fatty acids that provide vascular elasticity;
• onion, garlic, lemon, which have anti-cholesterol effects;
• freshly squeezed juice (carrot, beet, spinach, parsley root, etc.) to strengthen blood vessels and the body as a whole;
• Citrus fruits and kiwis, which help collagen and elastin production to keep blood vessels in good condition;
• Vegetable oils, nuts, seeds, avocados that contain vitamin E, which helps fight harmful radicals.

Among external folk methods, baths and foot wraps occupy a special place. An excellent remedy for venous insufficiency - compresses from cabbage leaves. They are applied directly to the area of the affected vessels, which helps to prevent inflammation and improve blood flow.

Additionally applied:

• Honey wraps (wrapping the lower extremities with cotton cloth dabbed with honey).
• Clay compresses (clay dissolved in water, applied to the feet, kept until completely dry, then washed off).
• Baths from the infusion of swamp wheatgrass (steamed 100 g of raw materials for 1 liter of boiling water).
• Baths from the infusion of willow bark and oak (steamed 100 g of plant mixture in 1 liter of boiling water).
• Baths from the infusion of pine buds (steamed 2 tbsp. In 1 liter of boiling water, then add 1 tbsp. Vinegar).

It is important to realize that venous insufficiency is not only a problem of the lower extremities, so it is necessary to affect the pathology in a comprehensive way, including nutritional correction, therapeutic exercises and drug treatment.

Surgery

Selection of the type of surgical intervention is carried out, depending on the underlying pathology, which ultimately led to the development of venous insufficiency of the lower extremities.

• Microsclerotherapy only removes cosmetic imperfections, such as small vascular asterisks. Curved dilated veins cannot be removed by this procedure. The essence of microsclerotherapy is as follows: the doctor injects a sclerosing agent into the center of dilated vessels. As a result, the vascular walls are destroyed, fused, and the skin is cleaned.
• Endovasal laser photocoagulation is suitable for the removal of pathologically altered small and medium-sized vessels (but not large veins). The procedure is often used in patients with hemangiomas and trophic ulcers. The course of laser coagulation: the doctor blocks blood flow in the affected vein, after which he introduces a catheter with a laser into it and treats the vascular walls. As a result, they "stick together". The procedure is painless, no scars are left after it.
• Foam sclerosing is practiced if pathologically altered veins have a lumen exceeding 10 mm. The doctor injects a sclerosing substance into the vessel, which transforms into foam and quickly fills the intravascular space: the vein gradually "sticks" and is disconnected from the blood flow.
• Miniphlebectomy is indicated for patients with vein dilatation up to 10-18 mm, varicose veins and thrombophlebitis of the main saphenous vessels. The affected vein is removed in parts, the intervention lasts about an hour. Full recovery takes two weeks.

Prevention

Prophylactic measures to prevent the development of acute venous insufficiency of the lower extremities include:

• early motor activity of postoperative patients;
• use of compression underwear, stockings;
• Performing periodic tibial compression;

Taking medications to prevent thrombosis, which is especially important if you are at high risk.

Chronic venous insufficiency can be prevented by following these guidelines:

• adjust the diet, prevent the development of constipation;
• lead an active lifestyle, do sports, walk in the fresh air, do daily gymnastic exercises;
• avoid prolonged immobility (standing, sitting);
• Prothrombin index should be regularly monitored during prolonged use of hormonal drugs;
• avoid wearing tight underwear and clothing, tight pants and belts;
• control body weight, prevent overweight;
• avoid wearing high-heeled shoes on a regular basis.

Forecast

No single treatment can give an immediate effect: treatment is usually long and complex. The only radical method is surgery, the success of which also depends not only on the qualifications of the surgeon, but also on the patient's compliance with the doctor's instructions.

Basic tips to improve the prognosis of the disease:

• Do calisthenics exercises every morning, except heavy weight lifting, loaded squats and running.
• Wear compression hosiery that supports the vascular walls and evenly distributes pressure on them.
• Do not sit or stand still for long periods of time: this puts additional strain on the vascular system of the lower limbs.
• Avoid frequent exposure directly near an open flame or heat source.
• Consume less salt, which contributes to poor circulation and aggravates swelling.
• Relaxing baths are better to prefer a contrasting shower.
• If possible, try to keep your legs horizontal, or better yet, elevate them above the level of your heart.

It is important to see a doctor in time, who will conduct an examination and tell you about the next necessary steps. For some patients, medication will be sufficient, and sometimes it is a question of surgery. With timely diagnosis and treatment, venous insufficiency of the lower extremities generally has a favorable prognosis.