Posttromboflebitichesky syndrome

Description:

Posttromboflebitichesky syndrome - the symptom complex developing owing to the postponed deep vein thrombosis of the lower extremities. It represents a typical kind of chronic venous insufficiency, the shown secondary varicosity, persistent hypostases, trophic changes of skin and hypodermic cellulose of a shin. According to statistical data, in various countries this disease suffers from 1,5-5% of the population.

Symptoms of the Posttromboflebotichesky syndrome:

Depending on dominance of these or those symptoms distinguish four clinical forms of a poyettromboflebitichesky syndrome: edematous and painful, varicose, ulcer and mixed.

The main symptoms are the feeling of weight and the pain in the affected extremity amplifying at long stay standing. Bol pulling, stupid, only occasionally is intensive, calms down in position of the patient lying with the raised leg. Quite often sick spasms of gastrocnemius muscles disturb during long standing and at night. Sometimes independent extremity pains are absent, but develop at a palpation of gastrocnemius muscles, pressing on an inner edge on - doshva or squeezing of fabrics between tibial bones. Hypostases usually arise by the end of day; after night rest with sublime position of legs they decrease, but completely do not disappear. At the combined damage of ileal and femoral veins hypostasis takes all extremity, at defeat of a femoral and subnodal segment - only foot and a shin; when involving in pathological process of tibial veins - area of anklebones and the lower third of a shin.

At 65-70% of patients the secondary varicosity of saphenas develops. For most of patients the loose type of expansion of lateral branches of the main venous trunks on a shin and foot is typical. Expansion of the main venous trunks is rather seldom observed. The varicosity most often develops in case of a rekanalization of deep veins.

Ultrasonic duplex scanning is successfully applied to assessment of a condition of deep veins at a posttromboflebitichesky syndrome along with the tests described above on passability of deep veins (mid-flight test of Delbe-Pertes and test of Pratta-1). In case of a rekanalization of a deep vein in a gleam it is possible to see it the heterogeneous trombotichesky mass of various degree of organization.

Reasons of the Posttromboflebotichesky syndrome:

Formation of a poyettromboflebitichesky syndrome is connected with destiny of the blood clot formed in a gleam of the affected vein and which did not undergo a lysis during the near future. The most frequent outcome of a deep vein thrombosis is the partial or full rekanalization of blood clot, loss of the valve device, the obliteration of deep veins is more rare. Process of the organization of blood clot begins with the 2-3rd week from the beginning of a disease and comes to an end with partial or its full rekanalization in terms from several months to 3-5 years. As a result of inflammatory changes the vein turns into the rigid sclerosed tube with the destroyed valves. Around it the paravazalny squeezing fibrosis develops. Rough organic changes of valves and wall of a vein conduct to a blood reflux from top to down, to substantial increase of venous pressure in shin veins (venous hypertensia), to the heavy disturbances of a venous blood-groove in an extremity which are shown in the form of a blood reflux on kommunikantny veins from deep in superficial veins. And стаз blood in veins of a shin lead high pressure to disturbance of limfovenozny microcirculation, increase in permeability of capillaries, hypostasis of fabrics, a scleroderma and hypodermic cellulose (liposclerosis), to a necrosis of skin and formation of trophic ulcers of a venous etiology.

Treatment of the Posttromboflebotichesky syndrome:

For treatment of a poyettromboflebitichesky syndrome and chronic venous insufficiency, inseparably linked with it, use the conservative treatment including compression, medicamentous therapy, and various surgical interventions.

Conservative treatment is the basic, despite achievements of reconstructive surgery of vessels and existence of various methods of removal or an obliteration of vessels with the broken function of valves. A basis of conservative treatment is the compression therapy directed to reduction of venous hypertensia in veins of a shin and foot. The compression of veins can be reached by use of elastic stockings and bandage with various degree of distensibility and a compression of tissues of shin, imposing zinc - a gelatinous bandage of Unn or a multilayer bandage from the rigid, well modelled up to a shin fabric strips. On the action mechanism it is similar to Unn's bandage. In recent years with success various devices are used to an intermittent pneumatic compression of a shin and a hip.

Along with a compression method apply the drug treatment directed to increase in a tone of veins, improvement of lymphatic drainage function and microcirculator frustration, suppression of an inflammation.

Compression therapy is applied throughout the entire period of treatment of chronic venous insufficiency and a trophic ulcer of a shin. The principles of use of compression therapy are stated above. Efficiency of compression therapy is confirmed with long-term clinical observations. Long use of the elastic stockings or bandage which are well chosen for the patient allows to achieve improvement in 90% and healing of an ulcer of a shin in 90 - 93% of cases. In an initiation of treatment many patients feel discomfort from a constant compression. In similar cases it is necessary to recommend to carry at first bandage or stockings during the time accepted for them, gradually increasing it. It is necessary to regulate intensity of a compression, to begin with 20-30 mm of mercury. and gradually to increase it. It is reached by use of knitted bandage and stockings II and III of a compression class.

The zinc-gelatinous bandage and bandages from the modelled rigid tapes fixed by the Velcro (sticky tapes) are applied at treatment of trophic ulcers of a shin more often. They are used for treatment of patients who cannot or do not want to wear the squeezing elastic stockings or bandage. Zinc-gelatinous bandages change in 1-2 weeks, gradually increasing a compression. Unn's bandages render not only a compression, but also local medical impact on an ulcer. Well trained personnel have to apply bandages. Healing of an ulcer under Unn's bandage occurs in 70% of cases. Multilayer bandages from the rigid tapes which are well modelled on the surface of a shin render a compression like Unn's bandages, but they are simpler in technology of imposing, effectively reduce extremity hypostases. Preliminary estimate of efficiency of use allows to consider them that these bandages can eliminate better hypostases, than elastic stockings.

The pneumatic intermittent compression was not widely adopted. It can be useful at treatment of the venous ulcers which are not giving in to treatment by other compression methods.
Surgical treatment of a posttromboflebitichesky syndrome is usually applied after completion of process of a rekanalization of deep veins when recover a blood stream in deep, kommunikantny and superficial veins. Numerous surgical interventions are offered. The greatest distribution in treatment of a posttromboflebitichesky syndrome was gained by superficial and kommunikantny vein operations.