Postthrombophlebitis syndrome
Post-thrombophlebitis syndrome is a disease of the veins that is difficult to treat. Therefore, it is important to identify it at an early stage and start treatment as soon as possible.
Postthrombophlebitic syndrome manifests itself against the background of thrombosis of the great veins of the legs. It is a complication of chronic venous insufficiency. In this case, the patient develops persistent edema, trophic changes in the skin of the lower extremities are possible. About 4% of the world's population suffers from the disease.
Content:
- What is post-thrombophlebitic syndrome characterized by?
- Symptoms of post-thrombophlebitic syndrome
- The clinical course of the syndrome
- Diagnostics
- Treatment of post-thrombophlebitic syndrome
- How to prevent relapse?
What is post-thrombophlebitic syndrome characterized by?
Postthrombophlebitis syndrome manifests itself, provided that there is a thrombus in the lumen of the vein. It blocks the vein most often partially, but complete occlusion of the vessel by a thrombus cannot be ruled out.
Already in the second week after a thrombus has formed in the vein, the process of its resorption begins. In this case, the existing gaps in the vein are replaced by connective tissue. If the thrombus dissolves quickly, then the lumen of the vein will be restored, and not much connective tissue will form. Provided that the replacement with connective tissues is massive, occlusion will occur in the vein, that is, its lumen will be blocked.
Restoration of the lumen of a vein is always accompanied by the destruction of its valve. Therefore, no matter how much connective tissue has formed in the vessel cavity, phlebothrombosis will still lead to persistent disruption of blood flow in the deep veins.
Violation of their patency entails an increase in pressure, which provokes persistent expansion of the veins and the development of their failure. Blood begins to flow into the superficial veins, which in the future will also lose their patency and will not be able to function normally. As a result, all vessels of the lower extremities will suffer.
These irreversible disorders negatively affect the state of the lymphatic system. The outflow of lymph worsens, the capillaries become more permeable. The patient develops severe edema, venous eczema, sclerotic skin changes, trophic ulcers may develop.
Symptoms of post-thrombophlebitic syndrome
If a person notices symptoms of post-thrombophlebitis syndrome, then he should immediately consult a doctor.
The main manifestations of the disease are:
- Severe edema of the lower extremities that does not go away for a long time.
- The appearance of spider veins.
- The appearance of subcutaneous tubercles on the veins.
- Leg cramps.
- The appearance of heaviness in the legs, a feeling of fatigue.
- Loss of sensitivity of the lower extremities.
- Feeling of wadded feet, especially after a person has been in an upright position for a long time. The legs get tired especially in the late afternoon.
The clinical course of the syndrome
The main characteristics of the clinical picture of post-thrombophlebitic syndrome:
- Chronic venous insufficiency.
- Expansion of the subcutaneous veins.
- The appearance of a vascular network on the legs, which can be purple, pink or blue.
When deep veins become insolvent, subcutaneous superficial vessels take over their function. That is why vascular networks appear on the legs. In this case, the disease may not give any visible manifestations for a long time.
Symptoms of post-thrombophlebitic syndrome develop during the first year in only 12% of patients. After 6 years from the onset of the disease, its symptoms will be found in 40-50% of people. Moreover, in 10% of them, by this time, a trophic ulcer is already beginning to form.
The most indicative symptom of post-thrombophlebitic syndrome is severe swelling in the lower leg. It appears against the background of acute thrombosis of the lower extremities and will persist during the restoration of venous flow with the formation of collateral vessels.
In the future, the puffiness may subside, but it does not completely go away. Most often, the edema spreads to the distal legs, reaching the thigh.
Edema characteristic:
- The muscles themselves swell. At the same time, the calf muscle becomes larger in size. A person can notice this by how difficult it becomes for him to zip a boot or put on his usual shoes.
- The fluid is retained in soft tissues, which leads to limb deformation. So, dimples on the sides of the ankle become less noticeable or disappear altogether.
There are 4 forms of post-thrombophlebitis syndrome, which differ depending on the symptoms of the disease:
- Edematous pain.
- Varicose.
- Ulcerative.
- Mixed.
The edema that forms in post-thrombophlebitic syndrome has some similarities with edema in varicose veins. It increases towards the evening, so the shoes that a person could freely put on in the morning becomes too small for him by the end of the day. The left leg suffers more often, it is on it that the edema will be most pronounced.
If the patient wore knee-highs or socks, then the mark from the rubber band will persist for a long time. In the morning, the swelling becomes less, but does not completely dissolve. A person experiences severe fatigue and heaviness in the legs, constraining pains. The pain intensifies with prolonged pastime in the same position.
The pain is dull, is present on an ongoing basis, but not too intense. She kind of spreads her leg from the inside. If you raise your legs higher than your torso, the pain will decrease.
Extremity cramps often accompany pain. They happen at night, or when a person is forced to be in an uncomfortable position for a long time.
Sometimes pain does not bother a person at all and appears only when the vein is touched.
If post-thrombophlebitic syndrome progresses, then in 70% of cases the deep veins are again exposed to varicose veins. Most often, a loose form of vasodilation of the lower leg and foot is found. Disturbances in the structure of the GSV and SSV trunks are diagnosed less frequently.
Venous trophic ulcers are a common complication of post-thrombophlebitic syndrome. They are most often located on the inside of the shins and ankles. The formation of an ulcer is preceded by changes in the skin:
- The skin becomes darker and its color changes.
- Hyperpigmented areas of the dermis appear on the legs.
- The skin becomes denser.
- Inflammation is noticeable on the skin, as well as in the deep layers of the dermis.
- The fabrics are covered with a whitish coating. Some of its parts may undergo atrophy.
- An ulcer is forming.
Diagnostics
The diagnosis is possible only in medical institutions.
To do this, the patient will need to undergo the following procedures:
- Phleboscintigraphy.
- X-ray using a contrast agent.
- Complex diagnostics to differentiate this disease from others.
An informative method of the study is ultrasound of veins using contrast. This makes it possible to qualitatively assess their condition, the rate of blood flow through the vessels, the presence of working and non-working valves.
Evaluation of the ultrasound results makes it possible to draw a conclusion on the following points:
- Does the patient have the main signs of post-thrombophlebitic syndrome?
- Does the patient have the process of vein recanalization?
- The nature, density and age of blood clots.
- The degree of vascular obliteration.
- The thickness of the venous walls, places of their compaction.
- The operability of the valves of the veins, etc.
UZAS objectives:
- Detect the frequency of the destruction occurring in the veins.
- Clarify the dynamics of these processes.
- To fix the process of restoration of the venous bed and vein patency.
- Assess the general condition of the veins.
It is also possible to conduct a preventive study in order to prevent a relapse of the disease.
Treatment of post-thrombophlebitic syndrome
Treatment of post-thrombophlebitic disease is most often medication.
To this end, the following activities are carried out:
- Wearing compression garments.
- Quitting bad habits and adjusting your lifestyle.
- Implementation of complexes of physiotherapy exercises.
- Drug treatment.
- Performing local treatment.
If treatment with conservative methods does not allow achieving the desired effect, then the patient is sent for surgery. In this case, the veins are either reconstructed or removed. It is also possible to restore the functionality of damaged valves.
Wearing compression garments or wrapping the legs with compression stockings can reduce the severity of venous hypertension. In parallel, a person must receive medications. This will increase venous tone, restore lymphatic drainage, eliminate microcirculatory disorders, and reduce the degree of inflammation.
How to prevent relapse?
To prevent the disease from recurring, the patient is prescribed anticoagulants (direct and indirect). These can be drugs such as: Heparin, Fondaparinux, Fraxiparin, Warfarin, etc.
The duration of the therapy is determined on an individual basis. If the disease was caused by trauma, surgery, acute illness, or involuntary immobilization, then the treatment lines are most often six months.
In idiopathic thrombosis, anticoagulant therapy lasts for 6-8 months, but not less. If thrombosis recurs, or there are other risks of complications of the disease, then treatment can be prescribed until the end of a person's life.
So, post-thrombophlebitic syndrome is a disease characterized by severe pain, increased fatigue of the legs, edema of the lower extremities, trophic disorders, compensatory varicose veins, etc. Most often, this pathology develops after acute thrombosis affecting the deep veins of the legs. About 90% of people diagnosed with post-thrombophlebitic syndrome suffer from thrombophlebitis or deep vein thrombosis.
The reasons for the development of the syndrome are reduced to gross violations in the structure of the veins, which are accompanied by a failure of blood flow, destruction of venous valves, and insufficient venous outflow. As a result, the patient develops first functional and then organic changes in the vessels, which affect the lymphatic system and soft tissues of the legs.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
