Primary Chronic Deep Venous Insufficiency of the Lower Limb

　　The etiology of primary incomplete function of the deep venous valves in the lower extremities has not been clearly defined yet. Possible etiological factors include:

　　1. Weak valve structure.

　　2. Due to persistent overloading of blood return, causing the valves to be relatively short and incomplete in closure, hence also known as 'relative incomplete closure of the deep venous valves in the lower extremities'.

　　3. Abnormal development of deep venous valves.

　　4. The calf muscle pump is weak, with insufficient blood pumping, leading to venous hypertension and incomplete valve closure.

　　Since the venous valves are responsible for preventing blood reflux, if the venous valves have problems, it can lead to problems with blood flow. If not treated in a timely manner, it may lead to the following complications:

　　1、Thrombophlebitis

　　The blood flow in the varicose veins is slow, which is prone to thrombosis and is accompanied by infectious phlebitis and varicose vein periphlebitis. It can be treated with antibiotics and local hot compresses. After the inflammation subsides, local hard nodules and skin adhesions often remain. After the symptoms subside, surgical treatment for varicose veins should be performed.

　　2、Ulcer formation

　　The area above the ankle is far from the center and bears high pressure, with a constant communicating vein. Once the valve function is destroyed, the blood stasis worsens, and the skin will undergo degenerative changes, making it easy to develop cellulitis. There are often skin itching and eczema, and ulcers that cause long-term non-healing after breaking. Most of them are complicated with infection.

　　Primary lower limb deep venous valve insufficiency refers to the failure of the deep venous valves to close tightly, causing blood reflux and producing corresponding clinical manifestations. According to the severity of clinical manifestations, it can be divided into:

　　1、Mild

　　Mild discomfort in the lower limbs, varicose veins, mild ankle swelling, mostly early cases.

　　2、Moderate

　　Skin pigmentation in the foot area, subcutaneous tissue fibrosis, but no ulcers. After prolonged standing, there may be distension and pain, with moderate swelling of the affected limb.

　　3、Severe

　　After standing, pain and swelling are more obvious, with marked varicose veins, and the foot area is accompanied by widespread skin changes, edema, eczema, and ulcers.

　　The occurrence of primary lower limb deep venous valve insufficiency is closely related to daily living habits. To prevent the occurrence of this disease, it is recommended that everyone avoid long-term standing work, heavy physical labor, pregnancy, chronic cough, habitual constipation, and other triggers. For long-term standing occupations such as teachers, ticket collectors, and nurses, it is recommended to wear elastic stockings to reduce the venous pressure in the lower limbs and promote blood return. For patients with existing venous insufficiency, the above measures can delay the progression of the disease.

　　Since varicose veins are one of the main manifestations of deep venous valve insufficiency, all patients with varicose veins should undergo examination of deep venous valve function to clarify the diagnosis.

　　1、Venography

　　This is currently the most reliable examination method.

　　2、Venous pressure measurement

　　It can indirectly understand the valve function and is often used as a screening examination.

　　3、Non-invasive vascular examination

　　If an ultrasound Doppler flowmeter and a photoplethysmograph are used for examination, it can also be diagnosed whether there is reflux in the veins. The ultrasound Doppler imager can observe the valve closing activity and whether there is retrograde blood flow. Primary lower limb deep venous valve insufficiency should be differentiated from post-thrombotic syndrome, as the clinical manifestations are similar, but the treatment methods are not entirely the same.

　　A reasonable diet is the key to disease recovery, and this is no exception for primary chronic deep venous insufficiency of the lower limbs. Below, we will introduce how patients with this disease should eat.

　　1. Eat

　　In terms of diet, choose light, easy-to-digest, vitamin-rich, and low-fat foods.

　　2. Avoid eating

　　Avoid greasy, sweet, and spicy foods, strictly quit smoking. Choose easily digestible liquid foods such as vegetable soup, congee, egg soup, egg pudding, milk, etc. The diet should be light and low in fat, meeting the nutritional needs while also enhancing appetite. White rice porridge, millet porridge, red bean porridge, and small dishes such as sweet and sour vegetables, turnips, pickled vegetables, or bean curd paste can be provided, with a preference for light and refreshing flavors. Avoid sticky, greasy, and difficult-to-digest foods; avoid high-fat and fried, grilled, and roasted foods.

　　Venous valves are structures in veins that prevent blood from flowing back. When primary chronic deep venous insufficiency of the lower limbs occurs, the following measures can be taken for treatment:

　　1. Non-surgical Treatment

　　All patients diagnosed with this disease should engage in moderate exercise, avoid prolonged standing or sitting, wear medical elastic stockings, promote venous return, and reduce the pressure in the lower limbs. Non-surgical treatment can delay the progression of the disease and prevent the occurrence of complications, and is an effective supplement to surgical treatment.

　　2. Surgical Treatment

　　For patients with clear diagnoses and reflux grades above level II, combined with the severity of clinical manifestations, deep venous valve reconstruction surgery can be considered. The main methods include:

　　(1) Direct vision repair of the superficial femoral vein valve;

　　(2) Circular narrowing of the femoral vein valve;

　　(3) Vein segment transplantation with valve;

　　(4) Procedures such as the semitendinosus-biceps femoris tenodesis for the replacement of the popliteal venous valve, etc. For those with deep venous valve insufficiency of the lower limbs accompanied by superficial venous varicosities, it is necessary to perform both high ligation of the great saphenous vein and stripping of the varicose veins. For those with hyperpigmentation or ulcers in the calcaneal region, subfascial venous ligation should also be performed. The risk of surgical treatment and the incidence of complications are relatively high, and the indications for surgery should be strictly controlled. Currently, surgical treatment for this disease is less commonly used in clinical practice.