Postflebotichesky syndrome

Description:

Postflebitichesky syndrome — a combination of signs of the chronic functional insufficiency of veins, usually lower extremities (hypostases, pains, bystry fatigue, trophic frustration, a compensatory varicosity) developing after thrombophlebitis with damage of deep veins of an extremity. Frequency — 90–96% of patients with thrombosis and thrombophlebitis of deep veins.

Symptoms of the Postflebotichesky syndrome:

Benign disturbance of a venous blood-groove is expressed slightly and is shown only at the raised exercise stress, long stay in a standing position when the patient begins to complain of hypostasis, feeling of weight and extremity pain. In a prone position and at usual loading these symptoms or disappear or disturb the patient a little. Working capacity is almost not changed.
In an average form the specified symptoms gain more expressed character and do not pass in rest.

Disturbance of outflow on veins is observed not only during the work, but also at rest. Working capacity is limited. Quite often patients are forced to change a profession. They cannot long stand, sit and carry out an exercise stress, receive some simplification only from wearing special medical stockings and elastic bandage.
The severe form of a postflebitichesky syndrome is characterized by a perversion of a venous blood-groove, stagnation of a venous blood in small vessels and disturbance of lymphatic outflow. As a result elephantiasis of an extremity — increase in its volume not only at the expense of hypostasis, but also owing to destructive changes in venous, absorbent vessels and hypodermic cellulose develops. Constant hypostasis leads to thinning of skin, disturbance of its food and trophicity. Appear eczema, dermatitis, trophic ulcers, skin because of hypostasis becomes easily vulnerable and very susceptible to consecutive infection (especially to streptococcal) Therefore post-флебитический the syndrome quite often is complicated by an erysipelatous inflammation.
Stagnation of blood promotes a periodic exacerbation of thrombophlebitis which considerably burdens disease. The arising trophic ulcers have long character and will badly respond to treatment. Patients become a little efficient, quite often to ukholit nynuzhdena on disability. According to statistical data, 38% of such patients have disability of the III group and 10% — the II groups.

Reasons of the Postflebotichesky syndrome:

Rough morphological changes of deep veins in the form of an incomplete rekanalization, destruction of valves and disturbance of outflow of blood. At the same time there are secondary, at first functional, and then and organic changes preferential in lymphatic system and soft tissues of an extremity owing to microcirculation disturbance.

Treatment of the Postflebotichesky syndrome:

Conservative therapy.
The I stage — need for purpose of HP is not present. Rational work-rest schedule, constant carrying flexible casts (bandage, stockings), normalization of body weight, activity of intestines, restriction of exercise stresses.
II stage. Mode: use of flexible casts and organization of the rational mode of exercise stresses. A reference point for the choice of the motive mode, stay duration standing — change of degree of puffiness of an extremity. Medicinal therapy. Anticoagulants of indirect action (for example, Fenindionum). Antiagreganta (пентоксифиллин, реополиглюкин). Fibrinolitic means.
The III stadiya:lekarstvenny therapy — same, as at a stage of II. Elimination of venous hypertensia (main reason for formation of ulcers). The medical squeezing bandage imposed on 1–2 weeks before healing of an ulcer. Bandages with zinc oxide and gelatin. Coat with the warmed paste containing zinc oxide, gelatin and glycerin gauze bandage, impose them in 2–3 layers on the affected leg which is in sublime situation. If for 3 weeks of carrying a bandage the trophic ulcer does not heal, the bandage is applied repeatedly.

Operational treatment. Bandaging of perforantny veins for elimination of a pathological overflow from deep veins in superficial (Linton's operation). Recovery in rekanalizovanny deep veins of functions of valves (for example, ekstravazalny correction of valves frame spirals by Vvedensky's method). Change of the direction of outflow of blood through the large veins containing full-fledged valves (for example, hypodermic and femoral shunting by a method De Palma).