Post-thrombophlebitic syndrome is a symptom complex that corresponds to different stages of venous insufficiency, which can develop for various reasons. It is very important for the phlebologist to establish these reasons to try, through the prescribed treatment, to reduce the severity of the symptoms, so negatively affecting the life of patients.
Clinical picture of the disease, i.e. The symptoms found during physical examination, palpation and patient questioning help to make a preliminary diagnosis. However, in many cases, patients do not complain about anything and can not recall the episode of acute thrombosis of the vessels of the lower limbs. If it is a question of blockage of large vessels, then there is the appearance of severe pain, heaviness and feeling of raspiraniya in the leg, edema of tissues, fever, chills. But thrombosis of small veins can not show itself in any way, so a person may not even remember about such an event, which has such unpleasant consequences.
Assignments in this case (a general blood test and a coagulogram) can only record the presence of inflammation and increased blood coagulability, which is a predisposing factor to the formation of blood clots. On the basis of this, the doctor can presume one of the pathologies: thrombophlebitis, varicose veins, thrombosis of the vessels or their complication - buccal phlebitis.
If the patient has previously applied for vascular disease, the doctor can more easily assume the development of PTFs. But at the first reference to orient in the causes of the appearance of unpleasant symptoms, which in the described pathologies are similar, is not so simple. And here instrumental diagnostics helps to assess the patency of blood vessels, to detect foci of varicose veins, to draw conclusions about the presence of trophic tissue lesions hidden from the eyes.
Previously, the diagnosis of venous pathologies was carried out by means of samples. This could be Delbe-Perthes' "march test", in which the patient was dragged by a tourniquet in the thigh area and offered to march for 3-5 minutes. On the decline and swelling of the subcutaneous vessels, we were judged how deep the veins are. True, this test produced many erroneous results, so its relevance was questioned.
To evaluate the condition of deep vessels, Pratt's No. 1 sample is also used. To measure it, the patient is measured with the shin circumference at its center. Then the leg in the supine position is tightly bandaged with an elastic bandage to create a compression of the subcutaneous vessels. After the patient gets up and actively moves for 10 minutes, he is asked to tell about his feelings and visually assess the calf volumes. The pathology of the deep veins will indicate rapid fatigue and pain in the area of the gastrocnemius, and an increase in the shin circumference, which is measured with a meter.
To assess the performance and condition of the valves of the perforating veins, it was possible by carrying out a Pratt sample No. 2 using a rubber bandage and a tourniquet, a three-jaw sample of Sheinis, a modified version of this test developed by Talman. To assess the condition of superficial veins, Troyanov and Gakkenbruch tests are performed.
These studies give enough information to the doctor in the absence of the opportunity to conduct instrumental research. However, today most medical institutions are equipped with the necessary equipment, and this is not only the apparatus for ultrasound (ultrasound). It must be said that the informativeness and accuracy of the results of instrumental research methods are much higher than those of the listed diagnostic tests.
In our time, an accurate diagnosis of venous diseases is carried out by ultrasonic duplex scanning (UZDS). Using this technique, it is possible to diagnose both the presence of a thrombus in deep veins and the narrowing of the lumen of blood vessels due to the accumulation of thrombotic masses therein or the proliferation of connective tissue during lysis of the thrombus. Information reflected on the computer monitor allows the doctor to assess the degree of severity of the pathology, i.e. How much thrombotic masses block the flow of blood.
No less relevant in postthrombophlebitic syndrome and such a method of diagnosing diseases of the veins of lower vessels, like Dopplerography (UZGD). This study makes it possible to assess the uniformity of the blood flow, to identify the cause of its violation, to assess the consistency of venous valves and compensatory possibilities of the vascular bed. Normally, the doctor should see even walls of veins without foreign inclusions inside the vessels, and the valves should rhythmically fluctuate in time to the breath.
Particularly popular with PTFs was a color Doppler mapping, with the help of which areas with missing blood flow are identified, due to vein occlusion by thrombotic masses. Multiple bypasses of blood flow (collaterals) can be found at the site of thrombus localization. Such blood flow below the occlusion zone (blockage) does not respond to respiratory movements. Over the blocked vein apparatus does not receive a reflected signal.
Functional dynamic phlebography (one of the methods of assessing the state of vessels) with contrasting with PTFs is much less frequent. With its help, it is possible to detect irregularities in the contours of venous vessels, reverse flow of blood from the deep veins to the superficial through the expanded perforating veins, the presence of collaterals. When the patient performs some exercises, one can notice a slowing of the removal of contrast from the venous vessels, the absence of a contrast agent in the area of the vein occlusion.
To determine the occlusion of blood vessels, diagnostic methods such as computer and magnetic resonance venography are also possible. The truth about the dynamic state of the venous system, they do not give information.
An additional diagnostic method for venous pathologies is phlebomanometry, which makes it possible to measure intravenous pressure. And through radionuclide phlebography, the nature and direction of the blood flow is determined not only in the lower extremities, but also in the entire venous system.