Impact of Microcirculatory Disorders on the Symptoms of Chronic Venous Disease and Their Pharmacological Correction

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The review is devoted to prevalence, pathogenesis and pharmacological correction of major specific venous symptoms. Incidence of subjective manifestations of chronic venous diseases (CVD) is 53—65% in general population and up to 80% in patients with confirmed disease. The most common symptoms are heaviness (36—81%), fatigue (33—72%), feeling of swelling (29—58%) and pain (15—70%). The most of symptoms are based on microcirculatory disorders (hypertension, inflammation, stasis, ischemia), which do not always correlate with hemodynamic disorders. However, these changes may be objectively confirmed by video microscopy, laser Doppler flowmetry, transcutaneous oximetry. Recent studies of microcirculation with orthogonal polarization spectral imaging demonstrate abnormalities in dermal capillaries (reduced functional density, enlargement) even in patients with CVD class C0s. More significant violations are observed along with progression of disease. Modern venoactive drugs can improve tissue perfusion and successfully relieve venospecific symptoms. Topical agents based on liposomal form of delivery are of particular interest because these agents increase bioavailability of drugs and their clinical effectiveness. Detragel is one of the drugs with liposomal delivery among the known ointments and gels for CVD management. Its effectiveness has been demonstrated in 12 clinical trials involving healthy volunteers, patients with chronic venous disease, diabetic angiopathy and superficial vein thrombosis. The use of this agent is associated with improved tissue perfusion, relief of venospecific symptoms, inflammation and reduced risk of adverse events after sclerotherapy. Thus, available data on the prevalence and pathogenesis of venospecific symptoms justify advisability of microcirculatory correction over macrohemodynamic measures in CVD patients.

Keywords:

chronic vein disease

microcirculation

pathogenesis

inflammation

local remedies

liposome

Authors:

Lobastov K.V.

Kafedra obshcheĭ khirurgii lechebnogo fakul'teta GOU VPO RGMU Roszdrava, Moskva

ORCID: 0000-0002-5358-7218

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