Author/Editor		Šikovec, Andrej
Title		Patogeneza kronične venske insuficience
Translated title		The pathogenesis of chronic venous insufficiency
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 2
Publication year		2000
Volume		str. 115-22
Language		slo
Abstract		The term chronic venous insufficiency means changes in the venous circulation in the leg which result from a permanent elevation of the venous pressure. It corresponds to an entire spectrum of clinical conditions, from the feeling of heavy legs and edema to the most severe form, crural ulcers. Even though this condition extremely rarely affects the patient as gravely as to endanger his/her life, it is a large medical and social problem because of its chronic course and high incidence. Except in cases when it results from deep venous thrombosis, the exact cause of this condition is still unclear. What we know is that a venous valves defect (primary or secondary) leads to the incompetence of venous valves. This enables venous reflux and a parmanent elevation of the venous pressure, even during muscular activity. The high venous pressure is transmitted to the venular side of the microcirculation, which in turn, via different paths which are not yet entirely understood, leads to edema, inflammatory response and increased capillary permeability. This causes metabolic changes in skin tissue and ultimately, in a crural ulcer. Present improved understanding of the mechanisms involved at the level of the macro- and microcirculation has enabled us to intervene more rationally and efficiently by therapy. A model is described in greater detail which illustrates the disturbances of the venous microcirculation. Certain more recent theories of the consequences of this disturbances at the level of microcirculation are described as well.
Summary		Kronična venska insuficienca (KVI) je izraz, ki opisuje spremembe na spodnjih okončinah, ki so posledica stalno zvišanega pritiska v venah spodnjih okončin. Izraža se v celem spektru kliničnih stanj od blagih motenj, kot so občutek težkih nog in otekanje, do najhujšega kliničnega stanja - golenske razjede. Čeprav KVI le zelo redko tako prizadene obolelega, da bi ogrozila življenje, pa zaradi svoje kronične narave in zelo velike pojavnosti predstavlja velik medicinski in socialni problem. Razen, ko je posledica predhodne globoke venske tromboze, temeljni vzrok za nastanek KVI ni popolnoma znan. Vemo, da je posledica primarne ali sekundarne okvare venskih zaklopk spodnje okončine, ki postanejo inkompetentne. To ima za posledico venski refluks in stalno zvišani venski pritisk tudi pri mišični aktivnosti. Ta motnja ima za posledico porast pritiska na venski strani mikrocirkulacije, ki preko še ne popolnoma razjasnjenih mehanizmov povzroči edem, vnetni odgovor in povečano prepustnost kapilar. To ima za posledico metabolne spremembe tkiva kože, ki v skrajnem primeru privede do golenske razjede. Današnje boljše razumevanje dogajanja na nivoju makrocirkulacije in mikrocirkulacije omogoča smotrnejšo in učinkovitejšo terapijo. V prispevku je podrobneje opisan model, ki ponazarja motnje venske mikrocirkulacije. Opisana so tudi novejša spoznanja o odrazu teh motenj na nivoju mikrocirkulacije.
Descriptors		VENOUS INSUFFICIENCY CHRONIC DISEASE VARICOSE ULCER MUSCLE CONTRACTION MICROCIRCULATION POSTPHLEBITIC SYNDROME ENDOTHELIUM, VASCULAR