Differential diagnosis of chronic venous insufficiency:
1. Obstruction of venous return: The process of systemic venous tube transporting blood back to the right atrium. The blood volume of the systemic venous system is very large, accounting for more than half of the total blood. Veins are easy to dilate and can contract, so they act as a blood storage stock. The contraction and relaxation of veins can effectively regulate the amount of blood returned to the heart and the cardiac output, so that the amount of blood circulation can adapt to the needs of the body in various physiological states. The basic force of venous return is the difference in pressure between the small vein (also known as the peripheral vein) and the vena cava or right atrium (also known as the central vein). The increase of venule pressure or the decrease of vena cava pressure are conducive to venous return. Due to the thin wall of the vein and the pressure of the vein, the venous return is also affected by external forces such as the squeezing effect of muscle contraction, respiratory movement, gravity, and so on. When the above factors hinder venous return, the body will appear a variety of manifestations.
2, thrombophlebitis: acute non-suppurative phlebitis secondary to caval thrombosis is characterized by venous vascular disease, skin redness and swelling involved in the superficial vein area, spontaneous involvement of pain, can feel a tender strip or nodal, venous blood flow is slow.
3. Deep static thrombosis: Deep vein thrombosis (DVT) has received clinical attention due to its serious fatal complication - pulmonary embolism, and the remaining chronic venous insufficiency syndrome. In order to reduce the serious threat of pulmonary embolism, all high-risk patients with deep vein thrombosis should be prevented in advance. Femoral head fracture, large orthopedic or pelvic surgery, middle-aged and elderly people with risk factors such as increased blood viscosity, most of them take low-dose heparin prevention before receiving more than 1 hour of surgery. Heparin 5000U was injected subcutaneously 2 hours before surgery and every 8-12 hours thereafter until the patient was up and moving. Heparin therapy for acute myocardial infarction is also beneficial for preventing venous thrombosis. Warfarin and other similar drugs are also available. Dextran 40 May be used in patients with bleeding tendencies. Aspirin and other antiplatelet drugs have no preventive effect, and conservative preventive methods should be adopted for those with obvious anticoagulant contrainidations, including getting up early and exercising and wearing elastic stockings. Periodic inflatable compression of the sural is also better, but patients are more difficult to accept.
