Trenone Syndrome

Trenone's syndrome (also called the Klippel-Trenone syndrome, the Klippel-Weber-Trenone syndrome, or the varicose osteo-hypertrophic nevus) is an abnormal development of deep-lying trunk leg veins on the background of worsening of their permeability. The disease received its name on behalf of the French doctor P. Trenaunay, who conducted research on this pathology.

Epidemiology

The Trenone syndrome is most often detected by chance and recorded as sporadic cases.

The incidence of the syndrome in the population is unknown. It is believed that the disease affects mainly boys, although this statement has no real and valid evidence.

[1], [2], [3], [4], [5], [6]

Risk factors

Risk factors that lead to a violation of embryogenesis in the early stages of pregnancy:

• poisoning by chemicals;
• reception of illicit drugs;
• stressful loads;
• exposure to radioactive exposure;
• infectious diseases - viral and microbial infections.

[7], [8], [9], [10], [11], [12]

Pathogenesis

The pathogenesis of the Trenone syndrome is thought to be a violation of embryogenesis with dysplasia of deep venous vessels.

The possibility of mechanical damage to the embryo at the time of insertion of the vascular system is also not excluded.

Nevertheless, Trenone syndrome in some cases was found in patients of one related line, which is represented mainly by women.

There is no reliable and definitive information about the options and the possibility of genetic inheritance of the disease. However, scientists insist that the degree of danger inheritance of the syndrome Trenone is reduced to a minimum.

It is generally believed that, due to deterioration of patency in deep veins, increased venous pressure develops. Blood from the deep venous vessels passes into the subcutaneous veins. The hypoxic condition develops, the trophicity of the limb tissues worsens, fluid accumulation in the tissues and lymphostasis occur. Additionally, venous-arterial anastomoses are revealed, which leads to aggravation of circulatory disorders.

[13], [14], [15], [16]

Symptoms of the syndrome Trenone

The first signs of the syndrome Trenone can be found already in a newborn baby. Less often such signs proceed imperceptibly and appear after 2 years.

Typical symptoms of the disease are:

• Vascular hemangiomas are peculiar spots, large enough in area and located in most cases on one limb. The spots can be light or dark purple. The skin above them is very vulnerable: it is damaged and bleeds at the slightest physical impact.
• Varicose nodules and dilations of the subcutaneous venous vessels of the lower limb: the veins are thickened in places, wriggle, hurt when touched.
• The affected lower limb is usually larger in volume than the healthy leg. The size of the foot, the volume of the shank, and the length of the affected leg can be increased. Such changes occur due to the pathology of deeply located venous vessels.

The patient can have all three characteristics, or only two of them. Depending on this distinguish these types of syndrome Trenone:

• without vascular hemangiomas;
• without increasing the limb;
• without varicose veins.

It is also possible to develop cross-species of the syndrome, when vascular spots appear on one leg, and hypertrophic features on the other limb.

Sometimes the syndrome develops slowly, and sometimes - rapidly: in the second case, the pathology spreads from the affected leg to the lower one, and then to the upper part of the trunk.

Among additional, but optional symptoms may appear:

• cataracts;
• glaucoma;
• Kolobory;
• heterochromia of the iris;
• gastrointestinal bleeding;
• blood in the urine;
• viscromegaly;
• lipodystrophy;
• seizures;
• additional large vessels.

Stages

• Stage 0 - without visible symptoms of venous defeat.
• Stage 1 - the presence of vascular asterisks, a visible mesh of veins, areas of reddening of the skin.
• Stage 2 - the presence of varicose-dilated veins.
• Stage 3 - the presence of limb hypertrophy without skin changes.
• Stage 4 - the presence of visible skin changes in the form of pigmentation, venous eczema, dermatosclerosis.
• Stage 5 - the presence of visible skin changes with a healed ulcer.
• Stage 6 - the presence of visible skin changes with a ulcerative process in the active phase.

[17], [18], [19], [20], [21], [22]

Complications and consequences

The Trenone syndrome can lead to the development of other pathological conditions that affect not only the vasculature, but also the internal organs of the patient.

In most cases, changes in the vessels provoke the development of "elephantiasis" and lymphangiomas. External signs of the disease manifest gigantism, dislocation of the hip joint (as a result of disruption of the formation of the musculoskeletal system), non-healing of the palate or lip.

When the pathology spreads to the organs of the digestive system, internal bleeding may occur, rectal bleeding (with damage to the rectum veins).

If the timely assistance is not provided, it is possible to develop extremely negative consequences, one of which is a fatal outcome.

[23], [24], [25], [26], [27], [28]

Diagnostics of the syndrome Trenone

The diagnosis of the Trenone syndrome is established based on the collected information about the history and the results of a physical examination. Additional methods of examination can be:

• Analyzes - a general analysis of blood and urine, a biochemical blood test, a study of blood coagulability, a blood test for cholesterol, a blood glucose test;
• instrumental diagnostics - ultrasound with dopplerometry, magnetic resonance imaging, angiography (venography).

[29], [30], [31], [32], [33], [34]

Differential diagnosis

Differential diagnosis of the Trenone syndrome is carried out with such diseases and conditions as:

• varicose symptom complex (proceeds without hemangiomas and hypertrophic changes in the bone system);
• Servei syndrome (characterized by the appearance of enlarged varicose veins with the formation of calcifications in them, against the background of osteoporosis and shortening of limbs);
• Muffucci syndrome (characterized by the fact that, in addition to vascular spots, there is bone dyskondroplasia);
• Syndrome Bina (proceeds with the formation of cavernous hemangiomas, the development of gastrointestinal bleeding).

In some cases, Trenone's syndrome has to be differentiated with lymphedema and Sturge-Weber syndrome.

[35], [36], [37], [38], [39], [40], [41], [42]

Treatment of the syndrome Trenone

The treatment of the Trenone syndrome presents certain difficulties and largely depends on the results of the examination and the general condition of the patient.

The main types of treatment for the syndrome are usually:

• application of compression underwear and clothes;
• laser treatment;
• sclerotherapy;
• surgical treatment;
• drug therapy.

The treatment of the Trenone syndrome is carried out by several types of medicines that are prescribed in the complex, or, depending on the symptoms present.

Necessarily prescribe medications that improve the tone of the vascular wall: Detralex, Escuzan, Troxevasin, etc.

In the presence of an inflammatory process, anti-inflammatory drugs are prescribed, which are used, both in the form of tablets, and in the form of external preparations: Ketoprofen, Voltaren, Ibuprofen.

With a high probability of thrombosis, Heparin, Curantil, Fraxeparin is used.

	Dosing and Administration	Side effects	Special instructions
Detralex	Take 2 tablets per day, after meals.	Dyspepsia, pain in the head, skin rashes.	Detralex is well combined with other drugs.

	Dosing and Administration	Side effects	Special instructions
Troxevasin	Take after meals, 1 capsule three times a day. The duration of treatment can be 3-4 weeks or more.	Nausea, heartburn, headache, stomach ulcer.	The use of the drug for treating children under 15 years of age has not been investigated.

	Dosing and Administration	Side effects	Special instructions
Ibuprofen	Apply for pain of 200 mg three times a day.	Pain in the abdomen, indigestion, pain in the liver, shortness of breath, increased blood pressure, anemia.	Do not use to treat children under 12 years.

	Dosing and Administration	Side effects	Special instructions
Currantil	Take on an empty stomach, from 75 mg per day, depending on the doctor's appointment.	Tachycardia, abdominal pain, headache, sensation of weakness, stuffiness in the nose.	It is not used to treat children under 12 years old.

	Dosing and Administration	Side effects	Special instructions
Fraxyparin	It is used in the form of subcutaneous injections. Dosage is selected individually.	Allergy, thrombocytopenia, local hypersensitivity reactions.	Assign only to patients after 18 years of age.

To improve the recovery and repair of tissues use complex vitamins:

• Actovegin - a therapeutic drug, created on the basis of blood components - deproteinized hemoderivate;
• Ascorutin - a drug that replenishes the lack of vitamins C and P;
• Ascorbic acid is a known vitamin remedy taking part in collagen production and strengthening vascular walls;
• Aevit - prevents the development of atherosclerotic changes in blood vessels.

In addition, it is necessary to adhere to a diet with a high content of ascorbic acid and calcium. A natural source of vitamin D is a dosed stay in the sun. If such a stay is impossible for any reason, the doctor can prescribe 400 to 800 units of vitamin D.

Walking, easy jogging and aerobics are welcome.

Physiotherapeutic treatment

Complex treatment of the Trenone syndrome is often supplemented by periodic courses of physiotherapy. The most common are the following procedures:

• UHF, or the application of infrared radiation - is based on the effect of heat, which contributes to increased blood circulation;
• darsonvalization - the impact of impulse currents of high frequency;
• diadynamic currents are the use of a constant electric current with low voltage and low power;
• treatment with leeches - hirudotherapy;
• sunlight - light therapy using a special incandescent lamp.

Alternative treatment

With the syndrome of Trenone, you can actively use the recipes of alternative medicine, which assume both the use of infusions and decoctions inside, and the external application of various drugs to the affected limb.

Patients with the syndrome Trenone should pay special attention to the following recipes:

• At night it is useful to apply a few burdock sheets to the diseased limb, the inner side of the leaf to the leg. Leaves pribintovyvayut and removed only by morning, using such treatment every other day. In the absence of burdock leaves, it is quite possible to replace them with horseradish leaves.
• Prepare an infusion of 100 g of grated nutmeg and 500 ml of vodka (insist 2 weeks, in the dark, periodically mixing). Infusion strain and drink 20 drops in the morning before breakfast, before dinner and before dinner.
• Prepare a tincture of Kalanchoe: on 200 g of leaves of the plant should take 500 ml of vodka, insist for a week, filter. The tincture can be used to rub the diseased limb.
• Take 500 g of peeled garlic cloves, chop in a meat grinder, combine with 700 ml of honey, stir and insist for a week in the refrigerator. Then you should take a medicine for 1 tbsp. Spoon three times a day immediately before eating. Duration of treatment - at least 2 months.

Herbal Treatment

To facilitate the state of the Trenone syndrome, it is useful to use such medicinal plants as:

• drivel drug - positively affects the processes of intravascular coagulation of blood, improves blood circulation in the limbs;
• peony, raspberry - they include salicylic acids, which serve to prevent the formation of thrombi;
• cones of hops - improve venous tone;
• buckthorn, alder - eliminate the signs of the inflammatory process;
• horse chestnut - strengthens the vascular walls, reduces permeability.

It is useful to make foot baths every day for 15 minutes on the basis of mint infusion and camomile color.

Homeopathy

Homeopathic medicines will support and improve the effect of the traditional medication treatment for Trenone syndrome. Among the homeopathic remedies the following are most suitable:

• Carbo vegetalis - natural charcoal (from beech or birch) improves blood circulation and hematopoiesis, eliminates stagnant processes in the venous network (in particular, the work of the inferior vena cava system improves).
• Pulsatilla is a preparation that improves venous circulation, which is especially relevant for stagnant processes in the portal and hollow venous vessels.
• Silicea is a preparation based on silicic acid, which improves rheological abilities of blood, raises venous tone and facilitates interstitial microcirculation.

The dosage of these drugs is prescribed individually, depending on the characteristics of the disease and the age of the patient.

Side effects when taking homeopathic remedies are usually minimized: only occasionally is it possible to develop an allergic reaction to the components of the drug.

Among complex homeopathic remedies Esquilus compositum is especially popular. The drug is taken orally 10 drops, previously dissolved in 30 ml of pure water. The scheme of reception: three times a day for half an hour before a meal, or 1 hour after a meal. The duration of therapy is not less than 4-5 weeks. Escolus compositum is not prescribed in pregnancy, but also in childhood (under 18 years). Before using the drug should always consult with a doctor.

Operative treatment

Operative treatment is one of the main ones in the syndrome of Trenone. However, not all patients are resolved on the operation, since the probability of unfavorable postoperative consequences is very high.

With Trenone's syndrome, the doctor can recommend the following surgical options:

• If vasoconstriction is considered critical, then shunting is possible - creating an additional vessel that bypasses the narrowed section and resumes normal blood flow.
• With a significant lesion of the main vein, the replacement of the vessel portion with an artificial analog is carried out. This operation is called vascular transplantation.
• To "cut off" narrowed small venous vessels, sclerotherapy can be used - the introduction into the lumen of the vein of a specific sclerosing drug that causes the junction of the vascular walls and further resorption of an already unused vessel.
• Laser surgery, or laser vascular removal, can be used to eliminate small vascular asterisks or single surface venous nets.

Before appointing an operation, the doctor is obliged to inform the patient and his relatives about possible negative consequences of the operative intervention. The final decision on the operation is taken by the patient (or his relatives, if the patient is a child).

It is generally believed that the most optimal results after surgical treatment can be expected if the operation is performed at the age of 6-7 years. If there are indications, the intervention can be carried out even during the period of newborn and infancy.

Prevention

The prevention of further progression of the Trenone syndrome consists in the following recommendations:

1. Regularly it is necessary to undergo treatment with diluting and anti-inflammatory drugs, strengthen blood vessels and take medications that help improve blood circulation. Preventive treatment should be aimed at preventing thrombosis and narrowing of the vascular walls.
2. Prevention should include proper nutrition. The diet for the Trenone syndrome should limit the amount of salt, sugar, baking, smoked and fatty foods, sausages and semi-finished products. The emphasis in nutrition should be placed on vegetable and fruit dishes, herbs, berries, cereals and vegetable oils.
3. Every day, drink plenty of fluids. Water naturally dilutes blood, improving blood circulation and preventing the formation of blood clots.
4. It is not recommended to drink too often: dog rose, nettle, valerian, St. John's wort. Broths and infusions of these plants can lead to the opposite effect and worsen the condition of the patient with the syndrome Trenone.
5. It is necessary to "forget" about alcohol, smoking, taking diuretics and hormonal birth control pills.
6. It is necessary to exclude from your life hypodynamia. Recommended dosage physical activity. Especially welcome swimming, walking, yoga, dancing.

[43], [44], [45], [46], [47], [48]

Forecast

Trenone's syndrome may be accompanied by the development of adverse health conditions. Perhaps worsening due to cardiovascular failure. Hemangiomas can form in the brain, provoking the onset of neuromuscular disorders.

As a rule, children survive and become adults, but the syndrome forecast remains serious. With a successful operation, the Trenone syndrome for a long time passes into the stage of stable remission.

[49], [50], [51], [52], [53], [54]