Postphlebitic syndrome of the lower extremities

A syndrome is a complex of symptoms that occurs under certain conditions against the background of existing health pathologies. Thus, against the background of varicose veins and phlebothrombosis, a symptom complex called "post-thrombophlebitic syndrome" (PTFS) can develop. A feature of PTFS is that the severe symptoms characteristic of it develop some time after an episode of acute thrombosis, and it is even more difficult to fight them than the underlying disease.

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Causes post-thrombotic syndrome

When considering the causes of various pathologies, we usually encounter a situation where there are several factors at once that can cause a specific disease. In the case of post-thrombophlebitic syndrome, the cause of very unpleasant symptoms is one - a thrombus in the vessels of the lower extremities and the hemodynamic disturbances caused by it.

We already know that any obstacle to the blood flow reduces its intensity, as a result of which the organs whose blood supply was provided by the diseased vessel suffer. When it comes to the lower extremities, two diseases are considered to be one of the most common causes of circulatory disorders in them:

• phlebothrombosis, in which thrombus formation begins in the deep main veins running between muscle tissue,
• thrombophlebitis, which in most cases is a complication of varicose veins, when blood clots form in the superficial veins located near the subcutaneous fat.

Post-thrombophlebitic syndrome is a complex of symptoms characteristic of deep vein thrombosis (phlebothrombosis), which, according to statistics, is diagnosed in 10-20% of the world's population. And about 2-5% of people, several years after an acute attack of vascular thrombosis, note pronounced symptoms of PTFS, which appear against the background of developing chronic venous insufficiency.

Despite the fact that PTSF is diagnosed mainly in patients with phlebothrombosis, risk factors for the development of post-thrombophlebitic syndrome can be considered any venous diseases that pose a risk of thrombus formation and vein occlusion (varicose veins, thrombophlebitis). In this case, phlebothrombosis is a complication of the above-mentioned diseases. On the other hand, PTSF itself is characterized by secondary venous dilation and impaired soft tissue trophism that occurs as a result.

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Pathogenesis

So, the cause of the symptoms of PTSF is a blood clot (thrombus), which forms in the lumen of the vessel, can migrate along it, increase in size and eventually cause acute circulatory disorder in the lower extremities. The pathogenesis of post-thrombophlebitic syndrome is based on the behavior of the thrombus inside the vein.

The resulting blood clot has 2 paths of self-realization:

• lysis or dissolution of the thrombus (the sooner and faster this happens, the fewer negative consequences it will cause),
• a change in the structure of an undissolved thrombus with the formation of dense connective tissue, which, growing, blocks the lumen of the vessel, disrupting blood circulation in it (vascular occlusion).

The result will depend on which process predominates: lysis or replacement of the thrombus with connective tissue.

In most cases, thrombus lysis under the influence of enzymes and drugs occurs in a short time and the lumen of the deep veins is restored. This does not exclude repeated thrombus formation, but symptoms of PTFS are also not observed.

It happens that the thrombus is not completely absorbed, but only partially, which becomes an obstacle to the blood flow, but not so serious as to cause irreversible tissue trophic disorders. Although over time, it cannot be ruled out that they will still occur, because if you do not remove the inflammation in the vascular tissues, it is difficult to avoid the destruction of the structures responsible for the movement of blood through the veins.

If, for some reason, the thrombus does not dissolve for a long time, blocking the blood flow and causing hemodynamic disturbances, both the vessel itself and the organs it nourished suffer. Usually, thrombus lysis begins a couple of months after its formation. It occurs against the background of an inflammatory process in the venous walls, and the longer the inflammation lasts, the higher the risk of fibrous tissue formation.

In this case, there is an overgrowth of connective tissue, destruction of nearby valves of the main veins, which are distributed along the vessels and work on the principle of a pump, directing blood towards the heart, and a serious, irreversible disruption of blood circulation in them.

The fact is that the inflammatory process leaves its mark on the condition of the walls and valves of the veins of the lower extremities. The valves gradually, over several months or years, are destroyed in parallel with the changes in the thrombus. The destruction of the valves leads to an increase in blood pressure in the vessels, they overflow, and the sclerotic venous walls weakened by the inflammatory process cannot withstand such pressure and stretch. Blood stagnation occurs in the deep venous vessels.

Normally, the blood flow in the lower extremities is directed from the bottom up, and the blood enters the deep vessels from the superficial ones, and not vice versa. When the valve apparatus of the deep veins is damaged and these vessels overflow, the perforating veins, which can be considered transitions between the superficial and deep venous vessels, are also involved in the process. The perforating veins can no longer contain the blood pressure in the deep veins and allow it to flow in the opposite direction.

The failure of the main veins and the inability to effectively pump blood leads to blood spilling into small vessels that are not designed for such a strong pressure and also become overstretched. This phenomenon is called varicose veins, which in this case is secondary to PTFS.

All veins of the lower extremities are involved in the pathological process, which causes serious hemodynamic disorders, and along with them, the vital processes of the surrounding tissues. After all, they receive nutrients and oxygen with the blood flow, but if the blood stagnates, it is not enriched with useful substances and oxygen. Soft tissues, in which the metabolism is disrupted, begin to suffer first.

Severe venous insufficiency causes swelling of the legs and the formation of long-term non-healing trophic ulcers on the skin of the lower extremities. Swelling of the legs is caused by increased pressure in the blood vessels, as a result of which the liquid part of the blood partially flows out into the surrounding tissues. This leads to a decrease in the volume of blood remaining in the vessels, and the swelling itself prevents the release and penetration of nutrients from the blood into the deep layers of soft tissues. This leads to the formation of ulcers on the skin, and in severe cases, gangrenous changes in deeper structures.

The blood pressure in the vessels of the lower extremities reaches its maximum when a person is standing. It is not surprising that even with a short period of standing, patients with PTFS experience severe swelling of the legs and a feeling of painful heaviness in them.

Since the culprit of what is happening is considered to be a thrombus, it would be useful to mention the factors that can lead to its formation. Among the common causes of blood clots inside blood vessels, we can highlight:

• diseases that lead to increased blood viscosity, including severe pathologies of the heart and lungs,
• surgical operations during which damage to blood vessels occurs,
• long-term immobilization, causing blood stagnation and inflammatory processes in the vessels,
• damage to the inner walls of blood vessels by pathogens or chemicals, including drugs,
• various limb injuries.

Excess weight, diabetes, pelvic cancer, hormonal medications (corticosteroids, contraceptives), pregnancy and childbirth have a negative impact on the condition of the veins of the lower extremities. These factors themselves do not cause post-thrombophlebitic syndrome, but they can cause venous diseases and thrombosis, which sometimes become a complication of PTFS.

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Symptoms post-thrombotic syndrome

Some authors call PTFS a disease, because the symptoms characteristic of this syndrome are a manifestation of venous insufficiency, which leads to serious health problems. It is not for nothing that post-thrombophlebitic syndrome is called a difficult-to-treat pathology, because it is characterized by a chronic course with progression of symptoms.

The first signs of PTFS can be considered the following manifestations, which are worth paying attention to without waiting for the appearance of more characteristic symptoms:

• the appearance on the skin of the legs of a translucent network of capillaries, spider veins or small thickenings in the form of tubercles that form along the veins (according to various sources, secondary varicose veins of the superficial veins are observed in 25-60% of patients with post-thrombophlebitic syndrome),
• severe, long-term, persistent swelling of the tissues of the lower extremities, not associated with kidney disease (this symptom is typical for all patients, although its severity may vary),
• a feeling of tired legs and heaviness in them even with light loads (for example, a person had to stand in line for 10-15 minutes),
• episodes of leg cramps not associated with being in cold water (most often they occur at night, disrupting the patients' sleep),
• impaired sensitivity of the tissues of the lower extremities,
• the occurrence of a feeling of wobbly legs as a result of prolonged standing or walking.

A little later, pain and a feeling of distension in the legs appear, which can only be dealt with by raising the limb above the horizon, thus ensuring the outflow of blood. Patients try to lie down or at least sit down and give the sore limb a horizontal position, reducing the blood pressure in the vessels. In this case, they experience noticeable relief.

It should be noted that the appearance of the first symptoms of PTFS does not indicate the onset of the disease. Venous insufficiency is a progressive pathology that begins at the moment of thrombus lysis, but its first signs can be observed only after several months, and most often after 5-6 years. Thus, in the first year after an acute attack of vascular thrombosis, the appearance of symptoms of PTFS is noted by only 10-12% of patients. This figure steadily increases as it approaches the six-year limit.

The main symptom of post-thrombophlebitic syndrome is pronounced swelling of the shin. Why does the shin suffer? The blood flow in the veins goes from the bottom up, and no matter where the thrombus blocks the vessel, congestion will be observed in the area below the thrombus. This is the shin, the area of the gastrocnemius muscle and ankle.

As a result of increased blood pressure, fluid accumulates in the muscles, which simply has nowhere to go until the lumen of the affected vessel is restored. The situation is complicated by the resulting disruption of lymph flow, characteristic of venous insufficiency. Due to the need to remove large volumes of fluid, compensatory expansion of the lymph vessels occurs, which negatively affects their tone, worsens the functioning of the valves and causes failure of the lymphatic system.

Edema syndrome in PTFS is widespread and persistent. After several months, dense, inelastic fibrous tissue forms in place of the edematous soft tissues of the shin and ankle, compressing the nerve fibers and blood vessels, thereby complicating the situation, causing disturbances in leg sensitivity and pain.

The most common location of swelling is the lower leg: the shin and ankle, but in some cases, if the thrombus is high (the iliac or femoral veins are affected), swelling can also be observed in the lower thigh and knee. Over time, the severity of the swelling may decrease somewhat, but it does not go away completely.

Edema in post-thrombophlebitic syndrome has a noticeable similarity with the same symptom in varicose veins of the legs. The severity of the edema is stronger in the evening, which causes certain difficulties with putting on shoes and fastening the zippers on boots. The right leg usually suffers less than the left.

Due to swelling of soft tissues during the day, by the evening you can see stripes and dents on the skin from the compression of the elastic band of socks and tight shoes.

In the morning, the swelling of the affected leg is less, but even after a night's rest, the feeling of tired legs and heaviness in them does not go away. The patient may be tormented by a mild or intense nagging pain in the limb, which is somewhat reduced by movement. There is a desire to stretch the leg in the foot, but cramps may occur. Cramps may also appear when the affected limb is overtired, when the patient has to stand or walk for a long time.

The pain associated with PTFS is not acute, which, however, does not make it less excruciating. It is a dull pain, accompanied by a feeling of distension due to the overflow of blood vessels and swelling of soft tissues. Only by raising the leg above the horizon can you feel relief, but this is only a temporary solution to the pain problem.

But the presence of pain, unlike the edematous syndrome, is not mandatory for PTFS. Some patients feel pain only when pressing on the tissues of the sore leg in the area of the calf muscles or the inner edge of the sole.

With further progression of venous insufficiency, long-term non-healing wounds - trophic ulcers - begin to appear on the inner side of the ankles and shins. This symptom is observed in every hundredth patient with post-thrombophlebitic syndrome. But such wounds do not appear suddenly. There are some signs that precede the ulcer process:

• The appearance of hyperpigmentation areas in the lower part of the shin and ankle area, encircling the leg in a kind of ring. The skin may acquire a bright pink or reddish hue, which is explained by the penetration of red blood cells from the affected veins into the subcutaneous layer.
• Subsequently, the skin in this area changes color, becoming darker with a brown tint.
• The tactile characteristics of soft tissues also change. The skin and muscles become denser, areas of dermatitis and weeping eczematous lesions may appear on the body, and skin itching may occur.
• If you dig deeper, you can see the presence of inflammatory foci in both the superficial and deep tissues of the lower extremities.
• Due to chronic circulatory disorders, soft tissues atrophy and change color to whitish.
• At the last stage of PTFS, specific wounds are formed at the site of localization of degenerative changes in muscle tissue and subcutaneous tissue, from which exudate is constantly released.

It is worth noting that post-thrombophlebitic syndrome can progress differently in different people. In some patients, symptoms appear quickly and in full, while others may not even suspect the disease.

Forms

Postthrombophlebitic syndrome can occur in different forms. The most common are the edematous and edematous-varicose variants of the pathology. In the first case, the main symptom is severe swelling of the extremities, in the second, there are manifestations of varicose veins, characterized by tissue swelling that intensifies in the evening, the appearance of vascular networks on the body and seals along the deep veins.

According to the world-famous classification developed by scientists G. H. Pratt and M. I. Kuzin in the mid-sixties of the last century, there are 4 types of post-thrombophlebitic syndrome, a pathology that is a remote consequence of acute venous thrombosis:

• Edema-pain. Its main manifestations are swelling of the legs, a feeling of heaviness, distension and pain in the legs, especially if a person has to stand or walk for a long time, cramps in the lower extremities.
• Varicose. Edema syndrome in this case is less pronounced, but symptoms of secondary varicose veins are evident.
• Mixed. It is characterized by a combination of symptoms of previous forms of the disease.
• Ulcerative. The least common type of PTFS, which is characterized by the appearance of trophic ulcers on the legs.

As we have already said, PTSD is a progressive disease that goes through 3 main stages in its development:

• Stage 1 – heavy legs syndrome, when symptoms such as swelling of the affected limb at the end of the day, pain in it, a feeling of distension and fatigue with the slightest exertion prevail.
• Stage 2 – degenerative changes in tissues caused by trophic disorders: widespread constant edema syndrome, tissue compaction, skin discoloration, appearance of eczematous and inflammatory foci.
• Stage 3 – formation of trophic ulcers.

There is another classification from 1972, authored by the Soviet surgeon V.S. Savelyev. According to it, post-thrombophlebitic syndrome is divided into the following types and forms:

• By localization of the affected area:

• femoropopliteal or lower form (swelling is localized mainly in the area of the shin and ankle),
• iliofemoral or middle form (edema may involve the distal part of the thigh, knee area, shin)
• upper form (the inferior vena cava is affected, the entire limb may swell).

• By the size of the affected area:

• common form,
• localized form.

• By form (symptoms):

• edematous,
• edematous varicose.

V.S. Savelyev identifies the following stages of post-thrombophobic syndrome:

• compensation stage,
• stage of decompensation without the appearance of trophic disorders,
• stage of decompensation with disruption of tissue trophism and the appearance of ulcers.

According to the classification developed by Russian scientists L.I. Klioner and V.I. Rusin in 1980, post-thrombophlebitic syndrome is divided into:

• by localization of the affected vein:

• inferior vena cava (its trunk and segments),
• iliac vein,
• iliofemoral vessels,
• femoral segments of venous vessels.

• according to the state of vessel patency:

• obliteration or complete obstruction of the veins,
• recanalization (partial or complete restoration of venous vessel patency).

• by the degree of blood flow disturbance:

• compensated form
• subcompensated form
• decompensated form of PTFS.

Since PTFS is a clinical manifestation of chronic venous insufficiency, doctors often use the international classification of CVI according to the CEAP system, developed in 1994. According to it, the following degrees of venous insufficiency can be considered:

1. it is characterized by a complete absence of symptoms of the disease detected during physical examination or palpation,
2. the appearance of spider veins (telangiectasia) and translucent vessels up to 3 mm in diameter in the form of dark stripes or a mesh,
3. varicose veins (the appearance of dark, rather soft nodes and bulging veins),
4. edema (leakage of water and electrolytes from diseased vessels into surrounding tissues),
5. the appearance of skin symptoms corresponding to venous pathologies:

• a change in skin color to brown and black caused by the leakage and destruction of red blood cells, releasing hemoglobin, which causes the dark color of the skin,
• compaction of soft tissues caused by oxygen starvation and activation of leukocytes (lipodermatosclerosis),
• the appearance of inflammatory foci with eczematous rashes and an erosive process, provoked by a slowdown in blood flow and the activation of inflammatory mediators.

1. the appearance of a trophic ulcer against the background of existing skin symptoms, which subsequently heals,
2. severe disturbances in tissue trophism, which provoked the appearance of long-term non-healing trophic ulcers.

Within this system, there is also a scale according to which a patient can receive disability:

• 0 – no symptoms of the disease,
• 1 – the existing symptoms allow the patient to remain able to work without special supportive measures,
• 2 – the manifestations of the disease do not prevent a person from working full time with the availability of supportive measures,
• 3 – supportive measures and ongoing therapy do not allow the patient to work fully, he is recognized as incapacitated.

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Complications and consequences

Post-thrombophlebitic syndrome is a progressive chronic pathology, which in most cases is considered a complication of existing venous diseases of an inflammatory-degenerative nature. It should be said that PTFS is not as dangerous a complication as the detachment and migration of a thrombus in acute thrombosis of the veins of the lower extremities. The syndrome has a rather severe course and an unpleasant clinical picture, but in itself does not cause the patient's death, although it significantly complicates his life.

It is impossible to completely get rid of PTFS. Effective therapy and lifestyle correction will only restrain the progression of trophic disorders. Long-term edema causes lymph flow disorders and the formation of lymphedema, which is a severe swelling of the leg tissues caused by stagnation in the lymphatic system. In this case, the limb greatly increases in size, becomes dense, its mobility is impaired, which can ultimately lead to disability.

The formation of lymphedema is also associated with trophic disorders in soft tissues. Atrophy of soft tissues leads to a decrease in their tone, a violation of the sensitivity of the limb, and therefore to a limitation of motor activity, which causes partial or complete loss of working capacity.

Over time, ulcers may appear on the body that ooze and do not want to heal, because the ability to regenerate tissues is now noticeably reduced. And any open wound can be considered a risk factor for the development of an infectious process. The introduction of infection, dust, dirt into the wound is fraught with blood poisoning or the development of a purulent-necrotic process (gangrene). A person can simply lose a limb if his life depends on it.

In any case, the progression of PTSF, regardless of the form of the syndrome, eventually leads to disability. How soon this happens depends on the measures taken to slow down the development of the disease. It is very important to understand that venous insufficiency is not only a cosmetic defect in the form of swelling of the limb and swollen veins on it. This is a serious problem that affects the patient's quality of life and his professional capabilities, which is important for people of working age. And even though the process is irreversible, there is always the opportunity to stop it and delay the onset of disability.

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Diagnostics post-thrombotic syndrome

Post-thrombophlebitic syndrome is a symptom complex that corresponds to different stages of development of venous insufficiency, which can develop due to various reasons. It is very important for a phlebologist to establish these reasons and try to reduce the severity of symptoms that have such a negative impact on the lives of patients by means of prescribed treatment.

The clinical picture of the disease, i.e. the symptoms revealed during physical examination, palpation and questioning of the patient, help to make a preliminary diagnosis. However, in many cases patients do not complain of anything and cannot remember an episode of acute thrombosis of the vessels of the lower extremities. If we are talking about blockage of large vessels, then severe pain, heaviness and a feeling of distension in the leg, tissue edema, increased body temperature, chills may appear. But thrombosis of small veins may not manifest itself in any way, so a person may not even remember such an event that has such unpleasant consequences.

The tests prescribed in this case (general blood test and coagulogram) can only record the fact of inflammation and increased blood clotting, which is a predisposing factor to the formation of blood clots. Based on this, the doctor can assume one of the pathologies: thrombophlebitis, varicose veins, vascular thrombosis or their complication - postthrombophlebitic disease.

If the patient has previously sought help for vascular diseases, it is easier for the doctor to assume the development of PTFS. But at the first visit, it is not so easy to understand the causes of the unpleasant symptoms, which are similar in the pathologies described above. And here instrumental diagnostics come to the rescue, helping to assess the patency of the vessels, detect foci of varicose veins, and draw conclusions about the presence of trophic tissue damage hidden from view.

Previously, venous pathologies were diagnosed using tests. This could be the Delbe-Perthes "march test", in which the patient's leg was tied with a tourniquet in the thigh area and asked to march for 3-5 minutes. The collapse and swelling of the subcutaneous vessels was used to judge how passable the deep veins were. However, this test gave many erroneous results, so its relevance was questioned.

Pratt's test No. 1 is also used to assess the condition of deep vessels. To perform it, the patient's shin circumference is measured in its center. Then the leg is tightly bandaged with an elastic bandage in a lying position to create compression of the subcutaneous vessels. After the patient stands up and moves actively for 10 minutes, he is asked to talk about his feelings and visually assess the volume of the shin. Rapid fatigue and pain in the area of the calf muscles, as well as an increase in the circumference of the shin, which is measured with a meter, will indicate pathology of deep veins.

The performance and condition of the perforating vein valves could be assessed by performing Pratt's test No. 2 using a rubber bandage and tourniquet, the three-tourniquet Sheinis test, and a modified version of this test developed by Talman. The Troyanov and Gakkenbrukh tests are used to assess the condition of the superficial veins.

These studies provide enough information to the doctor in the absence of the possibility to conduct instrumental studies. True, today most medical institutions are equipped with the necessary equipment, and this is not only ultrasound equipment (US). It must be said that the information content and accuracy of the results of instrumental research methods are much higher than those of the listed diagnostic tests.

Nowadays, accurate diagnostics of venous diseases is performed by means of ultrasound duplex scanning (USDS). This method can diagnose both the presence of a thrombus in deep veins and the narrowing of the lumen of the vessels due to the accumulation of thrombotic masses there or the proliferation of connective tissue during thrombus lysis. The information displayed on the computer monitor allows the doctor to assess the severity of the pathology, i.e. how much the thrombotic masses block the blood flow.

No less relevant in post-thrombophlebitic syndrome is such a method of diagnosing diseases of the veins of the lower vessels as Dopplerography (UZGD). This study allows you to assess the uniformity of blood flow, identify the cause of its violation, assess the viability of the venous valves and the compensatory capabilities of the vascular bed. Normally, the doctor should see smooth walls of the veins without foreign inclusions inside the vessels, and the valves should rhythmically oscillate in time with breathing.

Color Doppler mapping has become especially popular in PTFS, with the help of which areas with absent blood flow are detected due to vein blockage by thrombotic masses. Multiple bypass blood flow pathways (collaterals) can be detected at the site of thrombus localization. Such blood flow below the occlusion zone does not respond to respiratory movements. Above the blocked vein, the device does not receive a reflected signal.

Functional dynamic phlebography (one of the methods for assessing the state of the vessels) with contrast in PTFS is performed much less frequently. With its help, it is possible to detect irregularities in the contours of the venous vessels, reverse blood flow from deep veins to superficial ones through dilated perforating veins, and the presence of collaterals. When the patient performs certain exercises, it is possible to notice a slowdown in the removal of contrast from the venous vessels, and the absence of contrast in the area of venous occlusion.

Such diagnostic methods as computer and magnetic resonance venography also allow to determine vascular occlusion. However, they do not provide information about the dynamic state of the venous system.

An additional diagnostic method for venous pathologies is phlebomanometry, which makes it possible to measure intravenous pressure. And by means of radionuclide phlebography, the nature and direction of blood flow is determined not only in the lower extremities, but also in the entire venous system.

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Differential diagnosis

Differential diagnostics in case of post-thrombophlebitic syndrome allows differentiating PTFS from diseases with similar symptom complex. It is very important to understand what the doctor is dealing with: varicose veins caused by heredity or the patient's lifestyle, or secondary varicose veins, typical of post-thrombotic disease. PTFS develops as a consequence of venous thrombosis, which may be indicated in the anamnesis. Or this will be evidenced by such moments as the "scattered" nature of varicose veins, typical for most patients, high severity of trophic disorders, discomfort in the legs when wearing elastic stockings, tights, high socks, applying an elastic bandage - in cases where there is compression of superficial veins.

Acute venous thrombosis, which is also similar in symptoms to PTFS, is characterized by intense squeezing pain in the legs, which puts the patient into a stupor. In addition, the acute period of the disease lasts no more than 2 weeks, after which the symptoms subside, without leading to the appearance of trophic changes. And after several months and years, a person may again experience unpleasant sensations in the legs, which may indicate the development of post-thrombophlebitic syndrome.

Increased volume of the lower extremities can also be observed with congenital antriofenous fistulas. But in this case, the legs can also increase in length, multiple manifestations of varicose veins, excessive hair growth and shapeless dark spots scattered in different orders are observed on them.

Patients with cardiac and renal failure may also complain of pronounced swelling of the legs. However, in this case we are talking only about swelling, and there are no painful sensations, as well as trophic changes. In addition, with PTFS, one leg, where the thrombus formed, most often suffers, while with cardiac or renal failure, swelling is noted on both limbs at once.

Another couple of vascular pathologies that have the same symptoms as PTFS are obliterating endarteritis and atherosclerosis of the vessels of the lower extremities. However, in this case we are talking about damage not to venous vessels, but to large and small peripheral arterial vessels, which can be noticed during instrumental diagnostics.

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Treatment post-thrombotic syndrome

Read more about treatment in these articles:

Traditional medicine and treatment of post-thrombophlebitic syndrome with the help of drugs and surgery.

Prevention

As we can see, treating PTFS is a thankless task. Probably, many patients of vascular surgeons will agree with the statement that it would be easier to prevent the disease than to now deal with its consequences. But prevention of post-thrombophlebitic syndrome consists in preventing episodes of acute venous thrombosis, which in fact is more like the requirements of a healthy lifestyle.

The main rules for preventing vascular thrombosis and its complications are the following:

• Abstaining from bad habits, be it drinking alcohol, smoking or eating disorders. Alcoholism and smoking have a toxic effect on the body, which cannot but affect the quality of the blood and the condition of the vessels. And overeating causes excess weight and increased stress on the lower limbs and all their structures (vessels, bones, cartilage, muscles, etc.).
• Preference for a balanced diet. A person's diet should contain a large number of products with a high content of vitamins, minerals, amino acids, bioflavonoids - all those substances that participate in the construction of living cells and their vital processes. But the number of dishes rich in fats and carbohydrates should be limited, especially if a person is already overweight or has diabetes.
• In the spring and winter, when our body does not receive enough nutrients from food, we need to help it maintain its functions by taking vitamin and mineral complexes from the pharmacy.
• It is important to pay attention to your drinking regime. Insufficient fluid intake often causes increased blood viscosity. Doctors recommend drinking at least 2 liters of water per day, including liquid contained in drinks, first courses, and juices.

In case of problems with the gastrointestinal tract, accompanied by diarrhea and vomiting, it is necessary to carry out dehydration therapy, which will prevent blood thickening and the formation of blood clots.

• Hypodynamia is the best friend of any stagnant phenomena, including venous insufficiency. A sedentary lifestyle and sedentary work lead to a slowdown in cellular metabolism. Hence, excess weight, metabolic disorders, weakening of blood vessels, etc.

In addition to a daily set of physical exercises, you should include walks in the fresh air, cycling, swimming, and yoga in your life.

When working at a computer or doing any other sedentary work, it is essential to take breaks, during which it is recommended to tap your heels on the floor, walk on your toes, roll from heel to toe, lift your knees, etc.

• If you have blood clotting disorders, it is important to take anticoagulants as prescribed by your doctor and treat incipient venous diseases without waiting for them to start to manifest themselves with all sorts of complications.

It makes no sense to consider post-thrombophlebitic syndrome as an independent disease, because it does not occur on its own, but is a consequence of acute vascular thrombosis. But thrombosis is nothing more than a consequence of a person’s unhealthy lifestyle. A pathology, the occurrence of which in most cases could have been avoided. But in our lives, we most often pay attention to our health only when symptoms of the disease appear and prevention becomes irrelevant, giving way to treatment procedures.

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Forecast

Despite the many existing methods of conservative and surgical treatment of post-thrombophlebitic syndrome, the use of various non-traditional methods of therapy for this pathology, the prognosis of the disease still remains unfavorable. Even effective surgical treatment methods give good results only if the patient is young and the disease is not advanced. With the destruction of the venous valve apparatus, there is little hope for a positive result, because valve prosthetics are still in the development stage.

PTFS is a progressive venous disease, and the only thing that can be achieved today is long-term remission, which is possible if the process of destruction of the venous vessels and their valves can be slowed down. In this case, stable remission is achievable only if the patient consistently and regularly follows all the doctor's instructions and recommendations.

Even if the unpleasant symptoms of post-thrombophlebitic syndrome have gone away and the patient has felt noticeable relief, it is still too early to stop treatment. After all, the risk of repeated vascular thrombosis still remains, and in order to prevent a relapse of the disease, patients will have to take anticoagulants for a certain period of time, which help thin the blood and prevent platelet aggregation.

The duration of anticoagulation therapy may vary depending on the stage of the disease and the causes that cause it. How long the patient will have to take the above drugs and how often the course of treatment will need to be repeated is determined by the attending physician, with whom the patient will be registered throughout his life. Usually, the course of treatment takes at least six months, and in the case of recurrent thrombosis, anticoagulants are prescribed on a permanent basis for life. If nothing is done, the disease will progress and soon the person will simply become disabled.

The worst prognosis is for patients with trophic ulcers, because long-term non-healing wounds attract bacterial infection, causing purulent processes and tissue necrosis. In some cases, gangrene develops, and the leg has to be amputated. And even if it does not come to this, the chronic inflammatory process in the body makes its own adjustments to the health and well-being of a person, causing disruptions in the immune system and the development of allergies.

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