Postphlebitic lower limb syndrome

Syndrome is usually called a complex of symptoms that occurs under certain conditions against the background of existing pathologies of health. So against a background of varicose veins and phlebotrombosis may develop a symptom complex, called "post-thrombophlebitic syndrome" (PTFS). The peculiarity of PTFs is that the severe symptoms characteristic of it develop long after the episode of acute thrombosis, and it is even more difficult to fight them than with the underlying disease.

[1], [2],

Causes of the postthrombophlebitic syndrome

Considering the causes of various pathologies, we usually come across the situation that there are several factors at once that can cause a particular disease. In the case of postthrombophlebitic 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 in the path of blood flow reduces its intensity, as a result of which organs suffering from the disease of the vessel are engaged in blood supply. When it comes to the lower extremities of one of the most common causes of circulatory disorders in them are considered 2 diseases:

• phlebothrombosis, in which thrombus formation begins in deep trunk veins running between muscle tissue,
• thrombophlebitis, in most cases a complication of varicose veins, when thrombi 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 the pronounced symptoms of PTFs appearing against the background of developing chronic venous insufficiency.

Despite the fact that PTSF is diagnosed mainly in patients with phlebothrombosis, all venous diseases can be considered risk factors for post-thrombophlebitic syndrome, in which there is a risk of formation of blood clots and plugging of veins (varicose veins, thrombophlebitis). In this case, phlebothrombosis acts as a complication of the aforementioned diseases. On the other hand, PTSF itself is characterized by a secondary expansion of the veins and a violation of soft tissue trophism, resulting from this.

[3], [4], [5], [6], [7], [8], [9]

Pathogenesis

So, the cause of the symptoms of PTSF is a blood clot (thrombus), which forms in the lumen of the vessel, can migrate through it, grow in size and eventually become an acute circulatory disorder in the lower extremities. The pathogenesis of postthrombophlebitic syndrome is based on the behavior of the thrombus within the vein.

The formed clot of blood has 2 ways of self-realization:

• lysis or dissolution of a thrombus (the earlier and sooner it happens, the less will cause negative consequences),
• a change in the structure of the non-dissolved thrombus with the formation of a dense connective tissue, which, expanding, overlaps the lumen of the vessel, disrupting the circulation in it (vessel occlusion).

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

In most cases, the lysis of the blood clot 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 the re-formation of thrombosis, but the symptoms of PTFs are also not observed.

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

If, for some reason, the blood clot does not resolve for a long time, blocking the flow of blood and causing hemodynamic disturbances, the vessel itself suffers, as well as the organs, the nutrition of which it was engaged. Usually lysis of the thrombus begins a couple of months after its formation. It occurs against the background of the inflammatory process in the venous walls, and the longer the inflammation lasts, the higher the risk of the formation of fibrous tissue.

In this case, there is a proliferation of connective tissue, the destruction of nearby valves of the main veins, which are distributed along the vessels and operate on the principle of a pump, directing the blood towards the heart, a serious, irreversible circulatory disturbance in them.

The fact is that the inflammatory process leaves its imprint on the condition of the walls and valves of the veins of the lower limbs. Valves gradually, within a few months or years, are destroyed in parallel with changes in the thrombus. The destruction of the valves leads to an increase in the blood pressure in the vessels, they overflow, and the sclerosed venous walls weakened by the inflammatory process can not contain this pressure and stretch. There is a stagnation of blood in deep venous vessels.

Normally, the blood flow in the lower limbs is directed upward, while the deep blood vessels get the blood from the surface, and not vice versa. When the valvular apparatus of the deep veins is damaged and these vessels overflow, the perforating veins, which can be considered as adapters between the superficial and deep venous vessels, are involved in the process. Perforating veins now can not contain blood pressure in deep veins and allow it to flow in the opposite direction.

The inconsistency of the main veins and the inability to effectively pump blood leads to the pouring of blood into small vessels that are not designed for such a strong head and also overstretch. This phenomenon is called varicose veins, which in this case is secondary to PTFs.

All the veins of the lower extremities are involved in the pathological process, which causes serious hemodynamic disorders, and with them the process of vital activity of surrounding tissues. After all, they receive nutrients and oxygen with the blood flow, but if the blood stagnates, enrichment with its beneficial substances and oxygen does not occur. First of all, soft tissues begin to suffer, in which the metabolism is disturbed.

Severe venous insufficiency causes swelling of the legs and the formation of long-lasting non-healing trophic ulcers on the skin of the lower limbs. 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 into the surrounding tissues. This leads to a decrease in the volume of blood remaining in the vessels, and the edema itself prevents the exit and penetration of nutrients from the blood into the deeper layers of soft tissues. Hence the formation of ulcers on the skin, and in severe cases, gangrenous changes in deeper structures.

The maximum blood pressure in the vessels of the lower limbs becomes when the person is standing. Not surprisingly, even with a short standing in patients with PTF strongly swollen legs and there is a painful heaviness in them.

Since a blood clot is considered to be the culprit, the factors that could lead to its formation may be superfluous. Among the frequent causes of the formation of blood clots inside the blood vessels can be identified:

• diseases that lead to increased blood viscosity, including severe heart and lung diseases,
• surgical operations, during which there is damage to blood vessels,
• prolonged immobilization, causing stagnation of blood and inflammatory processes in the vessels,
• damage to the internal walls of blood vessels by pathogens or chemicals, including medicines,
• various injuries of the limbs.

Excess weight, diabetes, cancer in the pelvic area, hormonal (corticosteroids, contraceptives), pregnancy and childbirth exert negative influence on the condition of the veins of the lower extremities. By themselves, these factors do not cause postthrombophlebitic syndrome, but they can cause venous diseases and thrombosis, a complication of which sometimes becomes PTFs.

[10], [11]

Symptoms of the postthrombophlebitic syndrome

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

The first signs of PTFs can be considered the following manifestations, which are worth paying attention to, not waiting for the appearance of more characteristic symptoms:

• the appearance on the skin of the legs of a translucent mesh from capillaries, vascular asterisks or small seals in the form of tubercles forming along the veins (according to various information, secondary varices of superficial veins are observed in 25-60% of patients with postthrombophlebitic syndrome)
• strong, long-term non-recurrent swelling of the tissues of the lower limbs, not associated with kidney disease (this symptom is typical for all patients, although its severity may be different),
• a feeling of fatigue in the legs and heaviness in them even under small loads (for example, a person had to stand in line for 10-15 minutes),
• episodes of seizures in the legs, not related to being in cold water (most often they occur at night, disturbing patients' sleep),
• a violation of the sensitivity of the tissues of the lower extremities,
• the appearance as a result of prolonged standing or walking sensation of the vitality of the legs.

Somewhat later, there are pains and a feeling of raspiraniya in the legs, which can be handled only by lifting the limb above the level of the horizon, thus ensuring the outflow of blood. Patients try to lie down or at least sit down and give the sick limb a horizontal position, lowering blood pressure in the vessels. In this case, they experience considerable relief.

It must be said that the appearance of the first symptoms of PTFs does not at all indicate the onset of the disease. Venous insufficiency is a progressive pathology that starts at the time of the beginning of the thrombus leasing, but its first signs can be observed only after a few months, and more often in 5-6 years. So 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 is steadily increasing as we approach the six-year boundary.

The main symptom of postthrombophlebitic syndrome is pronounced edema of the lower leg. Why does the shin suffer? The blood flow in the veins goes from the bottom up, and in whatever place the blood clot overlaps the vessel, stagnation will be observed in the area lying below the thrombus. This is the leg, the area of the calf muscle and ankle.

As a result of increased blood pressure in the muscles, a fluid accumulates, which simply has nowhere to go, until the lumen of the affected vessel is restored. Complicating the situation is an emerging lymph flow disorder, characteristic of venous insufficiency. Due to the need to remove large volumes of fluid, compensatory expansion of the lymphocytes takes place, which negatively affects their tone, worsens the operation of the valves and causes the lymphatic system to fail.

Otter syndrome with PTFs differs in prevalence and persistence. A few months later on the place of edematous soft tissues of the lower leg and ankle, dense inelastic fibrous tissue forms, compressing the nerve fibers and blood vessels, thereby complicating the situation, causing disturbances in the sensitivity of the legs and pain.

The most frequent localization of the edema is the lower part of the leg: the shin and ankle, but in some cases, if the thrombus is high (the iliac or femoral veins are affected), edema can also be observed in the lower part of the thigh and knee. With the passage of time, the severity of the edema may somewhat decrease, but completely it does not come off.

Edema in postthrombophlebitic syndrome has a marked similarity with the same symptom in leg varicose. Expression of edema is stronger in the evening, which causes certain difficulties with the training and fastening of locks on boots. The right leg usually suffers less than the left leg.

Their-for the swelling of the soft tissues during the day to the evening on the skin you can see streaks and dents from the squeezing of the socks and tight shoes.

In the morning, the swelling of the aching leg is less, but even after a night's rest, the feeling of fatigue and heaviness in them does not go away. The patient may be tormented by an unexpressed or intense pulling pain in the limb, which is somewhat reduced from motion. There is a desire to pull the leg in the foot, but there may be convulsions. Cramps can also appear when the patient's limb is overworked, when the patient has to stand or walk for a long time.

Pain in PTFs is not acute, which, nevertheless, does not make it less painful. This dull pain, accompanied by a feeling of bursting because of the overflow of blood vessels and swelling of soft tissues. Only lifting your leg above the level of the horizon can feel relief, but this is only a temporary solution to the problem of pain.

But the presence of pain, unlike edematous syndrome, is not mandatory for PTFs. Some patients experience pain only when they apply pressure to the tissues of the diseased leg in the calf muscles or the inner edge of the sole.

With further progression of venous insufficiency, on the inner side of the ankle and shin, long-lasting non-healing wounds begin to appear-trophic ulcers. This symptom is noted in every hundredth patient with postthrombophlebitic syndrome. But such wounds do not appear suddenly. There are some signs preceding the ulcer process:

• Appearance of the areas of hyperpigmentation in the lower part of the shin and the ankle area, covering the leg with a peculiar ring. The skin can 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.
• In the future, the skin in this area changes color, becomes darker with a brown tinge.
• Tactile characteristics of soft tissues also change. Skin and muscles become more dense, on the body can appear areas of dermatitis and wetting eczematous foci, skin pruritus appears.
• If you dig deeper, you can note the presence of inflammatory foci in both superficial and deep tissues of the lower extremities.
• Because of chronic circulatory disturbance, soft tissues atrophy, change color to whitish.
• At the last stage of PTFS in the place of localization of degenerative changes in the tissues of muscles and subcutaneous tissue, specific wounds are formed, of which exudate is constantly released.

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

Forms

Post-thrombophlebitic syndrome can occur in various forms. The most common are edematous and edematous-varicose variant of pa. In the first case, the main symptom is a severe swelling of the extremities, in the second - there are manifestations of varicose veins, characterized by edema of the tissues, increasing by evening, the appearance on the body of the vascular networks and seals along the deep veins.

According to the world-famous classification developed by scientists GH Pratt and M.I. Cousin in the mid-sixties of the last century, there are 4 types of postthrombophlebitic syndrome, pathology, which is a remote consequence of acute venous thrombosis:

• Osteo-painful. Its main manifestations are swelling of the legs, a feeling of heaviness, raspiraniya and pain in the legs, especially if a person has to stand or walk for a long time, convulsions in the lower limbs. 
• Varicose. The edema syndrome is less expressed in this case, but the symptoms of secondary varicose veins are evident.
• Mixed. He is characterized by a combination of symptoms of previous forms of the disease.
• Ulcerative. The least widespread type of PTFs, which is characterized by the appearance on the feet of trophic ulcers.

As we have already said, PTFs are a progressive disease that develops in its development in three main stages:

• Stage 1 - a syndrome of heavy legs, when such symptoms predominate as the edema of the affected limb at the end of the day, pain in it, a feeling of bursting and fatigue at the slightest load.
• Stage 2 - degenerative changes in tissues caused by trophic disorders: widespread permanent edema syndrome, tissue tightening, skin discoloration, appearance of eczematous and inflammatory foci.
• Stage 3 - the formation of trophic ulcers.

There is another classification of 1972, sponsored by the Soviet surgeon V.S. Saveliev. According to her postthrombophlebitic syndrome is divided into the following types and forms:

• By localization of the affected area:

• femoropopliteal or inferior form (edema is localized mainly in the region of the lower leg and ankle),
• ileum-femoral or middle form (edema can cover the distal part of the thigh, knee area, shin)
• the upper form (the lower hollow vein is affected, the entire limb can swell).

• By the size of the affected area :

• common form,
• localized form.

• According to the form (symptoms ):

• edematous,
• edematous-varicose.

V.S. Saveliev identifies the following stages of postthrombbbebic syndrome:

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

According to the classification developed by Russian scientists LI. The Clioneer and V.I. Rusin in 1980, the post-thrombophlebitic syndrome is divided:

• localization of the affected vein :

• lower hollow vein (its trunk and segments),
• iliac vein,
• ilio-femoral vessels,
• femoral segments of venous vessels.

• for the state of the vessel's patency :

• obliteration or complete violation of the patency of veins,
• recanalization (partial or complete restoration of the permeability of venous vessels).

• by the degree of disturbance of blood flow :

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

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

1. for it is characterized by a complete absence of symptoms of the disease, found during physical examination or palpation,
2. the appearance of vascular asterisks (telangiectasia) and translucent vessels with a diameter of up to 3 mm in the form of dark bands or mesh,
3. Varicose veins (the appearance of dark rather soft knots and swelling of the veins),
4. edema (seepage of water and electoliths 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 seepage and destruction of red blood cells with the release of hemoglobin, which causes a dark skin color,
• soft tissue tightening, provoked by oxygen starvation and activation of leukocytes (lipodermatosclerosis),
• the appearance of inflammatory foci with eczematous eruptions and an erosive process provoked by the slowing of blood flow and activation of inflammatory mediators.

1. appearance on the background of existing skin symptoms of a trophic ulcer, which is subsequently delayed,
2. severe violations of trophic tissue, which provoked the appearance of long-term healing trophic ulcers.

Within the framework of this system there is also a scale on which the patient can receive a disability:

• 0 - the symptoms of the disease are absent,
• 1 - the existing symptoms allow the patient to remain able to work without special supporting means,
• 2 - manifestations of the disease do not prevent a person from working for a full working day if there are supporting means,
• 3 - supportive agents and ongoing therapy do not allow the patient to fully work, he is recognized as incapacitated.

[12], [13]

Complications and consequences

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

It is impossible to completely get rid of PTFFS. Effective therapy and lifestyle correction will only contain the progression of trophic disorders. For a long time, the presence of edema causes lymph flow and lymphedema, which is a severe swelling of the leg tissue caused by congestion in the lymphatic system. In this case, the limb greatly increases in size, becomes dense, its mobility is disturbed, which in the end can lead to disability.

With the formation of lymphedema, trophic disorders are also associated in soft tissues. Atrophy of soft tissues leads to a decrease in their tone, a violation of the sensitivity of the limb, and hence to the restriction of motor activity, which causes partial or complete loss of ability to work.

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

In any case, the progression of PTSD, regardless of the form of the syndrome, leads to disability over time. As soon as this happens, it already depends on the measures that are being taken to slow the development of the disease. It is very important to understand that venous insufficiency is not only a cosmetic defect in the form of an edema of the limb and swollen veins on it. This is a serious problem affecting the patient's quality of life and professional capabilities, which is important for people of working age. And even though the process is irreversible, there is always an opportunity to suspend it and delay the onset of disability.

[14], [15], [16], [17],

Diagnostics of the postthrombophlebitic syndrome

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.

[18], [19], [20], [21], [22], [23], [24]

Differential diagnosis

Differential diagnosis in the case of postthrombophlebitic syndrome allows to differentiate PTFs from diseases with a similar symptom complex. It is very important to understand what the doctor is dealing with: varicose veins, caused by the heredity or way of life of the patient, or secondary varicose typical of post-thrombotic disease. PTSF develops as a consequence of vein thrombosis, which can be indicated in the anamnesis. Or this will be evidenced by such moments as the "loose" nature of varicose, characteristic of most patients, high severity of trophic disorders, unpleasant sensations in the legs when wearing elastic stockings, tights, high socks, applying elastic bandage - in those cases when there is a squeezing superficial veins.

For acute venous thrombosis, which is also similar in symptomatology with PTFs, there are intense compressive pains in the legs that lead the patient into a stupor. In addition, the acute period of the disease lasts no more than 2 weeks, after which the symptoms subside, not leading to the appearance of trophic changes. And after a few months and years, a person can again encounter unpleasant sensations in the legs, which can speak of the development of post-thrombophlebitic syndrome.

An increase in the volume of the lower limbs can also occur with congenital antifovirus fistulas. But the legs can also increase along the length, they are marked by multiple manifestations of varicose veins, excessive hair and scattered in different orders of formless dark spots.

Patients with cardiac and renal insufficiency may also complain of pronounced edema of the legs. True, in this case we are talking only about edema, and there are no painful sensations, however, like trophic changes. In addition, when PTFS suffers more than one leg, where a thrombus is formed, while with insufficient functions of the heart or kidneys, edema is noted immediately on both extremities.

Another couple of vessel pathologies that have the same symptoms as PTFs are the  obliterating endarteritis  and atherosclerosis of the vessels of the lower extremities. However, in this case we are talking about the defeat of non-venous, and large and small peripheral arterial vessels, which can be seen in the conduct of instrumental diagnosis.

[25], [26], [27], [28], [29], [30]

Treatment of the postthrombophlebitic syndrome

For more information about treatment, see these articles:

Alternative treatment  and Treatment of postthrombophlebitic syndrome with the help of lekartsv and surgery.

Prevention

As we see, treatment of 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 now to deal with its consequences. But the prevention of post-thrombophlebitic syndrome is to prevent episodes of acute vein thrombosis, which actually resembles the requirements of a healthy lifestyle.

The following points are considered to be the main rules for prevention of vascular thrombosis and its complications:

• Abstinence from bad habits, whether it be drinking alcohol, smoking or eating errors. Alcoholism and smoking have a toxic effect on the body, which can not but affect the quality of blood and the state of blood 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. In the human diet should be a large number of foods with a high content of vitamins, minerals, amino acids, bioflavonoids - all those substances that participate in the construction of living cells and processes of their life. But the number of dishes rich in fats and carbohydrates should be limited, especially if a person already has excess weight or diabetes.
• In the spring-winter period, when the insufficient amount of nutrients comes into our body with food products, it is necessary to help it maintain its functions by taking pharmacy vitamin-mineral complexes.
• It is important to pay attention to the drinking regime. Insufficient intake of liquid in the body often leads to increased viscosity of the blood. In a day, doctors recommend drinking at least 2 liters of water, including the liquid contained in drinks, first courses, juices.

In case of malfunctions in the LCD, accompanied by diarrhea and vomiting, it is necessary to conduct dehydration therapy, which will prevent blood clotting and blood clots.

• Hypodinamy 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 the daily complex of physical exercises, it is worthwhile to include walks in the open air, cycling, swimming, yoga.

During lessons at the computer or any other sedentary work, it is necessary to take breaks, during which it is recommended to knock the heels on the floor, to look like socks, to do rolling from the heel to the toe, to raise the knees, etc.

• With the presence of blood clotting disorders, it is important for the doctor to take anticoagulants and treat the beginning venous diseases without waiting for them to talk about themselves with all sorts of complications.

Post-thrombophlebitic syndrome does not make sense to be considered as an independent disease, because it does not arise by itself, but is a consequence of acute acute vascular thrombosis. But already thrombosis is nothing but a consequence of the wrong way of life of a person. Pathology, the occurrence of which in most cases could be avoided. But we in our life most often pay attention to our health only when symptoms of the disease appear and prevention becomes irrelevant, giving way to therapeutic procedures.

[31], [32], [33]

Forecast

Despite the many existing methods of conservative and surgical treatment of postthrombophlebitic syndrome, the use of various non-traditional methods of therapy of this pathology, the prognosis of the disease still remains unfavorable. Even effective methods of surgical treatment give good results only if the patient is young and the disease is not started. With the destruction of the valvular apparatus of the veins, the hope for a positive result is small, since valve replacement is still under development.

PTFs are a progressive disease of the veins, and the only thing that can be achieved today is prolonged remission, which is possible if the process of destruction of venous vessels and their valves can be stopped. Strong remission in this case is achievable only if the patient will consistently and regularly perform all the prescriptions and recommendations of the doctor.

Even if the unpleasant symptoms of post-thrombophlebitic syndrome have gone away, and the patient has sensed a noticeable relief from discontinuing treatment, it is too early. After all, the risk of re-vascular thrombosis still remains, and in order to prevent a relapse of the disease, patients will have to take anticoagulants for a certain time, which help the blood thinning and prevent the platelets from clumping.

The duration of anticoagulation therapy can be different 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 it will be necessary to repeat the course of treatment, determines the attending physician, on the account of which the patient will be a lifelong person. Usually treatment takes at least six months, and in the case of recurrent thrombosis, anticoagulants are prescribed permanently for life. If you do nothing, the disease will progress and soon a person will simply become disabled.

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

[34], [35], [36]