Treatment of postthrombophlebitic syndrome

Despite the fact that such a pathology as PTFS, characterized by irreversible destruction of the valvular apparatus of the venous vessels of the lower extremities, can not be cured by medical treatment, doctors do not lower their hands. After all, with the help of effective medications, compression and physiotherapy, exercise therapy and lifestyle correction, you can slow the progression of the disease, keep working capacity and ease the lives of patients who due to illness can not actually stand.

Medication Therapy

For the treatment of postthrombophlebitic syndrome, doctors prescribe several types of drugs that can strengthen the venous walls and protect them from the negative effects of damaging factors, restore blood microcirculation, eliminate inflammation inside the vessels and reduce pain, prevent the formation of blood clots (thrombi). Through drug therapy it is possible to restore lymph drainage and prevent the penetration of activated lymphocytes from the blood into soft tissues.

Patients are given course treatment through parenteral (injectable or in the form of a dropper), oral (for oral administration) and local remedies. The usual duration of treatment is at least 2 months.

Since the cause of post-thrombophlebitic syndrome is considered to be the formed thrombus and the subsequent changes that occur with it, the drugs that help to prevent thrombogenesis: antiplatelet agents and anticoagulants come to the fore. The first reduce the possibility of gluing together platelets, and the second improves blood flow, by reducing the viscosity of the blood, which is also the prevention of thrombosis.

Antiaggregants include: "Acetylsalicylic acid", "Ticlopidine", "Clopidogrel", "Pentoxifylline", "Aspigrel", etc.

Among the anticoagulants used to prevent deep vein thrombosis, we can distinguish: Warfarin, Heparin, Fenindion, Dalteparin, Sulodexide, Nadroparin, and others.

But the prevention of thrombus formation alone will not help. It helps restore blood flow in the recanalization of blood vessels, but has no effect on the condition of the venous walls and valves.

There are a number of drugs that can improve the condition of the venous walls and valves, increase the tone of the vessels, thereby normalizing microcirculation and lymph drainage function. Such drugs are called phlebotonics. In the list of such effective drugs with PTFs, we find: Detralex, Rutozid, Vasoket, Endotelon, Antistaks, Troxevasin, and Flebodia.

With secondary varicose veins, the use of local phlebotonics in the form of ointments, creams and tinctures is also shown. This is the same "Troxevasin", "Venoruton", "Troxerutin", "Venoton". 

To facilitate the state of patients with PTFs, external means such as "Heparin Ointment", "Lyoton", "Venobene", "Venoruton", "Rutozid", and "Indovazin", which have a phleboprotective, anti-inflammatory and antithrombotic effect, can also help. These are local remedies with various effects, with some of the above medications being combined preparations that simultaneously have several useful actions.

So "Venobene" contains heparin and dexpanthenol, which provides the drug with antithrombotic, anti-inflammatory and regenerative action, i.e. It improves microcirculation of blood in the surface vessels and metabolic processes in soft tissues at the site of application. "Indovazin" contains an anti-inflammatory and anti-edema component indomethacin, which also helps to remove pain syndrome, as well as angioprotector and venotonik troxerutin, which among other things improves soft tissue trophism in the affected area.

With postthrombophlebitic syndrome in the vessels there is a chronic inflammatory process. To combat it, patients are prescribed oral NSAIDs that help reduce the severity of inflammation and the pain caused by it. These can be the following drugs: Diclofenac, Ibuprofen, Nimesulide, Ketoprofen, Ryopirin, etc.

To combat leg edema and venous congestion, popular diuretics "Furosemide", "Mannitol", "Lasix" are prescribed. Although many doctors believe that such treatment in this case is ineffective and even unsafe, because forced removal of fluid from the body makes the blood more viscous, which in pathologies of the vessels is very undesirable. In addition, the nature of edema in venous insufficiency is slightly different than in those diseases where diuretics are actively included in the therapy regimen (renal, cardiac, and liver failure).

Domestic phlebologists, in contrast to European phlebologists, who are usually limited to the appointment of phlebotonics and local remedies, adhere to a 3-stage treatment regimen using all the above-mentioned drug groups.

At stage 1, with a duration of 1-1.5 weeks, patients are prescribed injection therapy with antiaggregant and anti-inflammatory non-steroid agents. In addition, antioxidants are prescribed, of which vitamins are part (for example, B6, E, etc.). And in the presence of trophic ulcers, a tank is sown and antibiotic therapy is prescribed.

At stage 2, lasting 2-4 weeks, antiplatelet and antioxidant administration is continued (it is possible to switch to forms for oral administration), but phlebotonics and preparations that improve regenerative processes in tissues (reparants), for example, injections of "Solcoseril" or " Actovegin ".

Reception phlebotonics continues and at the 3 stage of treatment, which lasts at least 6 weeks. At the same time, external means that normalize blood flow and metabolic processes in surface tissues are actively used. If there are trophic disorders, manifested as dermatitis and eczematous rashes, patients may additionally be prescribed antihistamines.

Physiotherapeutic treatment of varicose veins and PTFE

Physiotherapy in postthrombophlebitic syndrome can be prescribed at different periods of treatment. At the same time, different methods of physical impact pursue their goals:

• interstitial medicinal electrophoresis with venotonics is aimed at improving the condition of the venous walls, increasing their tone, resistance to increased blood pressure,
• vacuum therapy, prescribed for secondary varicose and trophic ulcers, strengthens microcirculation and lymph drainage in areas affected by the disease, reduces edema, helps purify wounds from pus and exudate, prevents reproduction of the infection and enhances regenerative processes,
• electrophoresis with proteolytic enzymes is prescribed for trophic ulcers and promotes the healing of such skin lesions,
• lymph drainage massage stimulates the outflow of lymph, treats lymphostasis and varicose veins, reduces swelling of the legs, caused by accumulation of fluid in the intercellular space,
• low-frequency magnetotherapy improves lymphatic drainage, helps reduce swelling and pain, stimulates blood flow, while high-frequency improves the functioning of the vegetative system,
• electrophoresis with preparations preventing fibrosis (development of connective tissue at the site of resorption of the thrombus) of the venous wall (eg, with trypsin),
• Ultrasound therapy helps to reduce the dosage of antibiotics in the treatment of trophic ulcers and cause wound healing within a week,
• laser therapy for varicose veins and PTFs has anti-inflammatory, anti-edematous and analgesic effect,
• mud therapy is used to relieve edema, pain and heaviness in the legs,
• darsonvalization is used to stimulate lymph drainage, improve metabolic processes in tissues, accelerate regenerative processes,
• electrophoresis with anticoagulants helps to reduce blood viscosity and improve blood flow in the venous system,
• infrared saunas contribute to strengthening the walls of blood vessels, relieve pain and heaviness in the legs, stimulate blood flow in the vessels of the lower limbs,
• pulse magnetotherapy, amplipulse, diadynamic therapy contribute to an increase in the tone of the venous wall, strengthen the vessels, improve blood flow in them,
• oxygenotherapy, oxygen and ozone baths reduce the consequences of oxygen deficiency of tissues, which arises as a consequence of circulatory disorders.

With secondary varicose caused by postthrombophlebitic syndrome, doctors can prescribe multiple foot baths: turpentine, salt, radon, hydrogen sulphide, mud, etc. The choice of physiotherapy is determined by the doctor according to the severity and severity of the veins as an adjunct to drug therapy.

Compression therapy. This method of treating venous diseases with PTFs and trophic ulcers is given special attention, since many years of experience in its use shows remarkable results. More than 90% of patients who have been using this treatment for a long time have noted a marked decrease in unpleasant symptoms. Repeated diagnosis showed a significant improvement in the condition of the venous vessels of the legs. The overwhelming majority of patients with trophic ulcers noted a rapid and effective healing of them, which is difficult to achieve by other methods.

Compression therapy is included in the overall scheme and is used throughout the treatment period. The patient should always wear compression socks and tights, and in their absence, bandage the affected limb with an elastic bandage. By the way, elastic bandage is considered more effective at the beginning of treatment, because it allows you to adjust the density of bandaging and the level of compression. But with the normalization of the patient's condition, it is better to switch to a special compression knitwear.

Wearing compression knitwear has a positive effect on the veins of the legs, not allowing them to stretch under the pressure of the blood, giving them a kind of rest for the time of recovery, while drug therapy helps strengthen and tonify the vascular walls.

Alas, some patients note a certain discomfort, worsening their condition and quality of life. Such people can be advised to resort to special non-stretchable bandages of the German company Varolast, which regulate the compression depending on whether the person is at rest or actively moving. Correction of pressure on the vessels helps to avoid discomfort while wearing bandage. The inclusion of zinc paste in the bandages makes it possible to use them for the treatment of trophic ulcers, which heal faster with an antiseptic.

If the post-thrombophlebitic syndrome occurs severely with the formation of lymphedema, and trophic ulcers do not heal for a long time even under the influence of the therapy, doctors use the pneumatic intermittent compression technique, for which a special apparatus is used which has special air cuffs with a corrected air supply. This allows you to consistently change the pressure, depending on the needs of different parts of the limb. The procedure is aimed at improving venous outflow and is especially useful for patients who, for various reasons, can not take anticoagulants.

Lifestyle of patients. The effectiveness of therapy conducted with PTF depends largely on the patient's desire to return to a full life. And for this you will have to give up some bad habits, perhaps change your job or profession, and revise your diet.

What are the requirements of the doctors for patients with post-thrombophlebitic syndrome:

• Since after stabilization of the patient's condition, his treatment is carried out on an outpatient basis, the patient becomes on a dispensary account with a phlebologist or vascular surgeon and undertakes to regularly undergo medical examinations and prescribed diagnostic tests, the frequency of which is set individually.
• Sore legs require physical exertion, i.e. Heavy physical work, carrying heavy loads, prolonged stay on the legs for patients is strictly forbidden, because all this creates a big load on the venous vessels of the lower extremities.
• With the restriction of physical activity, there is a demand for a change in labor activity, if one has to stand for long periods of time to perform his professional duties, work in conditions of high or low temperatures, high vibration, and carry heavy objects.
• Such bad habits, like smoking and drinking, have a negative effect on the state of the vessels, because tobacco smoke and alcohol in large doses are considered poison for the body, cause intoxication and destruction of the circulatory system. Sometimes these habits, which are loved by many, become one of the reasons for the painful pains in the legs, which are evidence of the unhealthy vascular system. It is clear that a person who is engaged in restoring one's health will have to give up harmful addictions.
• Hypodinamia has never contributed to the restoration of health. It is only about limiting physical exertion, but the motor activity in this case should not only be preserved, but also be supplemented by exercises of physiotherapy exercises. When and to what extent the exercises of exercise therapy will be assigned, the attending physician is appointed. And the lessons themselves should be conducted under the guidance of an experienced coach.

• No one is surprised by the fact that the quality of our food depends on the condition of the blood vessels, because useful and harmful substances enter the bloodstream from its composition. The patient's diet should be adjusted in such a way that products that promote blood viscosity increase and are able to negatively affect the vascular walls (for example, with a high content of harmful cholesterol or with chemical additives that have a toxic effect on the body) have been removed from it.

Post-thrombophlebitic syndrome is a disease that can not be cured completely, but the patient's state of health depends on fulfilling the physician's requirements for medical procedures and lifestyle changes. And the longer it will be possible to slow down the progression of the disease, the longer a person will remain able to work and serve himself without outside help.

Effective drugs

Drug therapy is not able to give a person a recovery, but it is able to maintain the vessels for a long time in working condition, strengthening them and stopping the destructive processes that occur inside the veins and arteries. To maintain the functionality of the venous system, doctors prescribe drugs of different plan. Consider some of the most effective medicines.

We will begin consideration of preparations from phlebotonics, which increase the tone of blood vessels and improve lymphatic drainage. The acknowledged leader among the preparations of this group is the polyvalent phlebotonic drug Detralex, which is available in the form of tablets and is intended for oral administration. The drug has a pronounced venotonic and angioprotective action. It prevents venous congestion, increases the resistance of the veins to stretching, reduces the permeability of small vessels. The drug has repeatedly proved its effectiveness in the treatment of chronic venous pathologies of the lower extremities.

With venous insufficiency and lymphostasis caused by postthrombophlebitic syndrome, Detralex is prescribed at a dosage of 1000 mg per day, which should be divided into 2 divided doses. The first reception is at lunch time, the second - in the evening. Take the pill while eating.

The only contraindication to the use of the drug, noted in the official instruction, is hypersensitivity to its components. Prescription of the drug to pregnant women is possible only with the permission of an obstetrician-gynecologist. The experiments did not reveal a negative effect of the drug on the fetus, but no studies were carried out in humans.

Frequent side effects during taking the drug are considered reactions from the gastrointestinal tract: nausea, vomiting, bloating, diarrhea. Less often there are dizziness, headaches, worsening of the general condition, dermatological manifestations in the form of rashes on the body and itching.

"Rutozide" is an angioprotector of glycoside quartzetin, which is otherwise called routine, so the effect of the drug is similar to the effects of taking vitamin P. It reduces the permeability of small vessels, strengthens the venous and arterial walls, and slows the aggregation of red blood cells. With venous insufficiency and stagnant processes in the lymphatic system, characteristic for postthrombophlebitic syndrome, the drug significantly reduces pain and swelling of the soft tissues, helps combat trophic disorders and ulcerative process.

Produced in the form of tablets (forte) or capsules for internal administration and a gel for local treatment.

Tableted and capsular forms should be taken with food. Capsules usually take 2-3 pcs. Per day, and tablets - 2 pcs. (one per appointment) with a course of at least 2 weeks. But with chronic venous disturbances and lymphostasis, the dose can be increased 2-3 times, so you should not worry about overdosing with the drug. The best effect can be achieved if you take ascorbic acid in parallel.

The gel has a cooling effect and helps to fight the pain and swelling syndrome with external application. It should be applied to the skin and rubbed with massage movements twice a day. In this case, the disappearance of symptoms occurs within 2-3 weeks. However, doctors recommend continuing treatment for at least 2 weeks to fix the result.

The drug is contraindicated in the first three months of pregnancy (especially in the form of oral forms), as well as with individual sensitivity to its components, manifested as allergic reactions. Side effects of the drug are limited to reactions from the gastrointestinal tract (the appearance of gravity in the stomach, flatulence, stool disorders), headaches (sometimes complaints about sensations similar to hot flashes in menopause), allergic reactions. Local treatment may be accompanied by the appearance of irritation on the skin and eruptions at the site of application.

"Flebodia" is an angioprotector of French production on the basis of bioflavonoids with selective action. It has no effect on the tone of arterial vessels. Its action is aimed at increasing the tone of small venous vessels (venules), which contributes to the improvement of venous outflow and lymph drainage. Also, the drug has a moderate anti-inflammatory and antiaggregant effect.

The drug is given in the form of tablets for oral administration with a dosage of 600 mg. Penetrating from the gastrointestinal tract into the blood, it concentrates mainly in the walls of large and small veins. The content of the active substance in the surrounding tissues is much lower.

Assign the drug for symptoms corresponding to the clinical picture of post-thrombophlebitic syndrome, such as severity and pain in the lower extremities, edema of the legs, trophic disorders. Take the pill you need from morning to meal 1 tablet a day. The course of treatment with the drug on average lasts for 2 months.

The drug is not prescribed for hypersensitivity to the components of the drug. Most often, such reactions occur with respect to the red dye (additive E124) present in the drug. When pregnancy is taken, the medicine is not prohibited, but the need and safety of its administration should be agreed with the doctor. But when breastfeeding, taking the drug is not desirable at all.

Side effects of the drug are similar to other venotonics: digestive system disorders, headaches, mild allergic reactions in the form of rash and itching on the body.

"Indovazin" is a combined agent based on bioflavonoid with angioprotective action of troxerutin (the active substance of the popular drug "Troxevasin") and a non-steroidal anti-inflammatory component called "indomethacin". Troxerutin reduces the permeability of capillaries and increases the tone of the veins, has anti-inflammatory and anti-edematous action against nearby soft tissues, improves cellular nutrition. Indomethacin increases the action of troxevasin, since it has a pronounced anti-inflammatory effect, it relieves pain and swelling of the legs well.

The preparation is produced in the form of a gel or ointment and is intended for topical application in a lesion site. The medicine easily penetrates deep into the tissues and quickly removes the pain syndrome and increases the temperature at the site of inflammation.

The drug is designed to treat patients older than 14 years. Apply it to the skin of a sick leg 3-4 times a day and gently massage it. The effective dosage is determined by the length of the strip of cream squeezed out of the tube. On average, it should be 4-5 cm, but not more than 20 cm per day.

This combination drug has a little more contraindications. In addition to hypersensitivity to the components of the drug and agents from the category of NSAIDs, this includes bronchial asthma, the period of pregnancy and breastfeeding. The external agent should not be applied to open wounds, therefore, for trophic ulcers, its use is limited.

In most cases, "Indovazin" does not cause side effects. Rarely complaints are received about the irritant effect of the drug, which manifests itself as a burning sensation and warmth on the skin, redness of the tissues, the appearance of rashes and itching on them. With long-term use, in addition to local reactions, systemic dyspeptic phenomena and minor disruptions in liver function, manifested by an increase in specific enzymes, asthma attacks, anaphylactic reactions, may occur.

"Venoton" is a herbal preparation with venotonic, anti-inflammatory and anti-edematous effect. It is available in the form of balm (tincture), gel and capsules, the composition of which may be slightly different, but they can all be used to treat post-thrombophlebitic syndrome.

In the composition of balm there are extracts of horse chestnut and oats seeds, fruits of sophora and mountain ash, hazel leaves, celandine grass and sweet potato. Due to this composition, the natural drug reduces the permeability of capillaries, strengthens the venous walls and makes them more elastic, restores blood veins, reduces blood clotting, promotes the excretion of bad cholesterol from the body, effectively fights inflammation and swelling.

The gel has a similar composition, which is supplemented with essential oils (mint, lemon, juniper), which help to effectively combat the vascular network on the legs. As in the tincture, the main component in it is horse chestnut extract, which is used as a good venotonic and antithrombotic agent.

Capsules "Venoton" have a completely different composition:

• extract of garlic, which improves blood circulation, cleans vessels and has an antibacterial effect on the entire body,
• an extract of buckwheat, rich in such useful for the health of blood vessels as a routine that strengthens arterial and venous vessels, prevents their sclerosis, reduces the permeability of capillaries, reduces edema caused by lymphovenous insufficiency,
• vitamin C, reducing the viscosity of the blood and strengthening the vessels, which has a pronounced antioxidant effect.

Balm is designed for systemic treatment of varicose veins and PTFs, i.e. It should be taken orally, diluted 1 tsp. Preparation in 50-60 ml of water. Take the medicine half an hour before meals 3 or 4 times a day, but not more than 20 ml per day. The treatment course consists of 20 days, after which you can make a ten-day break and repeat treatment.

Capsules "Venoton" should be taken with food, 1 pc. 3 times a day. The course of treatment is 21-28 days, you can repeat it 2-3 times a year.

The gel is used for local treatment of the disease. It is applied to the skin with a small layer 2 or 3 times a day, and then rubbed with massage movements. After applying the product, a good effect results in the wearing of compression knitwear or the use of elastic bandages that tighten the superficial veins of the diseased limbs.

Contraindications to the use of the drug in any form of release are considered hypersensitive to the components of the drug, the presence of internal bleeding or predisposition to them, severe disruption of the kidneys (especially for peroral forms), angina pectoris, epilepsy. The drug is not used during pregnancy and lactation (even external forms).

Capsules "Venoton" are allowed to use from the age of 12, tincture and gel in the treatment of children are not used at all.

The application of the gel requires some caution. It can not be applied on the surface of wounds, but it can be applied to intact skin around the trophic ulcers that can appear with PTFs. It is also not recommended to intensively rub the product into the skin. Movements should be gentle, not traumatic.

A common side effect of various forms of the drug is the possibility of developing allergic reactions with increased sensitivity of the organism to various components of a complex herbal remedy. With topical application of the drug, everything is usually limited to reddening of the skin, rashes and itching, sometimes patients notice fever and burning at the site of application of the gel. With oral administration, a complication such as Quincke's edema is possible.

Reception tincture and capsules can also be accompanied by pain behind the sternum on the left, increased heart rate (tachycardia), lower blood pressure, unpleasant sensations in the gastrointestinal tract (nausea, dyspepsia, heartburn, diarrhea).

Excess doses of oral forms of the drug may trigger the appearance of overdose symptoms, which manifests itself in the form of headaches, disruption of the digestive tract (possibly even vomiting), dizziness and fainting, respiratory disorders. If such symptoms appear, you should immediately rinse the stomach and take a sufficient number of tablets of "Activated Carbon" (1 for every 10 kg of the weight of the victim) or any other sorbent.

All listed medicines used in the treatment of postthrombophlebitic syndrome can be purchased at the pharmacy without a doctor's prescription. But all of them provide correction of dosage depending on the existing pathology and the degree of its severity, which is impossible without the appointment of a doctor. Self-medication in this case may not bring the expected result, but only harm, aggravating an already unattractive situation.

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Surgery

Since the conservative treatment of post-thrombophlebitic syndrome does not allow to completely get rid of the disease, the development of various surgical methods for treating this serious pathology was conducted in parallel. True, surgical treatment of postthrombotic disease is possible only after restoration of blood flow in the affected deep vessel, i.e. Its recanalization. And in this task the medicamental and physiotherapy comes to the fore. After all, if the blood flow is not restored, an operation involving suppression of bypass (collateral) ways of blood flow may be bad for the patient's well-being.

After the blood flow in the venous system of the lower extremities is restored, the doctor can offer the patient one of the options for operations effective with PTFs. The most popular surgical interventions on perforating and superficial veins, for which often enough local anesthesia.

The most common operation with PTFS is a crossectomy. Its essence lies in bandaging large and small saphenous veins at the site of their connection with deep veins (in the area of perforating vessels). The incision is made in the inguinal or popliteal fossa, the damaged vessel is bandaged in two places, and then removed by means of a special probe.

Cross -ectomy as an independent operation is rare. Often, it is part of a complex operation that involves a crossectomy (bandaging of affected superficial veins), stripping (extraction through a probe), miniflebectomy (removal of the extracted vein), removal of a perforating vein that does not fulfill its function and allows for reflux of blood from the deep veins into the superficial veins.

As a matter of fact it is a question of removal of a part of superficial veins at presence of such complication, as a reflux. But there are other methods of restoring the damaged venous blood flow. For example, the technique of Psatakis provides for correction of blood flow with the help of a tendon in the popliteal region. From the selected area the tendons make a peculiar loop for the affected vein, which will squeeze it while walking, acting on the principle of a pump.

If the patency of the iliac veins is impaired, Palme's procedure for bypassing the vessels comes to the rescue. The shunt is inserted into the affected vein of the inguinal region at the point of its connection with the normally functioning. The design, which often has the form of a spiral, maintains a constant lumen of the vessel, not allowing its walls to stretch under the pressure of blood.

This ensures a more tight fit of the valves of the veins, which let the blood flow in only one direction and work on the principle of a pump. Lack adherence of valves or their destruction just cause stagnation of blood in the lower limbs, because in itself the blood will not flow upwards. Alas, such operations are not very popular because of the high risk of repeated thrombosis.

Occlusion in the femoral-popliteal region is treated by phlebectomy and autotransplantation of the vessel (the site of the vein with good valves, taken from the axilla, most often acts as an implant). If the reflux remains, a part of the subcutaneous vessels is removed. In neglected situations of post-thrombophlebitic syndrome, with the defeat of large veins after their recanalization, an operation called safhenectomy is appointed, which consists in removing such vessels.

Due to the fact that the majority of phlebologists see the cause of the development of venous insufficiency in the failure of the valvular system, active development of artificial valves of the vessels (intra- or extravascular) is being conducted today. So far, such operations are in the testing phase and are being improved, because less than fifty percent success is not a sufficiently convincing proof of the effectiveness of the implemented methods for correcting the work of venous valves.