Post-thrombophlebitic disease is characterized by chronic difficulty in the outflow of venous blood from the lower extremities, which develops after deep vein thrombosis. Clinically, this pathological condition can manifest itself only a few years after acute thrombosis. At the same time, patients experience bursting sensations in the affected limb, painful nocturnal cramps, swelling and annular pigmentation develop, acquiring fibrous density over time.
Diagnostic conclusions for the diagnosis of "post-thrombophlebitic disease" (ICD code 10 I87.0) are based on the results of ultrasound examination of the veins of the extremities and anamnestic data. Increasing circulatory decompensation is an indication for surgical treatment of this pathology.
Causes of occurrence
During deep vein thrombosis, a thrombus forms in the lumen of the vessel. After the acute process subsides, thromboticmasses undergo partial lysis and begin to be replaced by connective tissues. If lysis predominates in this case, recanalization occurs, in which the lumen of the vessel is restored. When thrombi are replaced by connective tissue elements, occlusion develops (complete closure of the vessel lumen).
Restoration of the vascular lumen is usually accompanied by the destruction of valve structures in the area of thrombus localization. Therefore, regardless of the predominance of certain processes, the outcome of phlebothrombosis in most cases is persistent blood flow disorders in the deep veins.
The increase in pressure in these vessels contributes to the development of expansion (ectasia) and failure of perforating vessels. Blood from the deep veins begins to be discharged into the lumens of the superficial veins. Subcutaneous vessels begin to expand and also become insolvent. Subsequently, all venous vessels of the lower extremities are involved in the pathological process.
A further inevitable complication of this condition is microcirculatory disorders. Impaired nutrition of the skin leads to the appearance of trophic ulcers. The movement of blood through the veins is largely provided by muscle contractions. Due to ischemia, muscle contractility gradually weakens, which leads to the subsequent progression of signs of venous insufficiency.
Classification
In medicine, there are two options for the course of such a pathology as post-thrombophlebitic disease(edematous-varicose and edematous forms), as well as three stages of development:
- Transient swelling, "heavy leg syndrome".
- Persistent edema accompanied by trophic disorders (disturbance of skin pigmentation, lipodermatosclerosis, eczema).
- Trophic ulcers.
Symptomatics
The initial signs of the disease post-thrombophlebitic disease in most cases appear several months or years after the development of acute thrombosis. At the initial stages of the disease, people complain of soreness, a feeling of fullness of the limb, heaviness when walking or standing. Lying down, after giving the limb an elevated position, the symptoms quickly decrease. A characteristic symptom of the pathology of post-thrombophlebitic disease is the painful cramps of the muscles of the diseased limb, which occur mainly at night.
Varicose changes
Modern studies in the field of clinical phlebology have shown that in about 25% of cases this pathology is accompanied by varicose changes in the walls of the veins of the lower limb. Edema of varying degrees is observed in almost all patients. A few months after the initial onset of edema, indurating disorders in the soft tissues appear. In the subcutaneous tissue and skin, the process of formation of fibrous tissue begins. Soft tissues acquire density, the skin begins to solder with subcutaneous tissue, and its mobility is lost.
Annular pigmentation
Specifica symptom of such an ailment as post-thrombophlebitic disease is ring-shaped pigmentation. Similar changes begin above the ankles and gradually cover the lower part of the lower leg. In the future, dermatitis, weeping or dry eczema may develop in this area, and in the late period of the disease, long-term non-healing trophic ulcers are formed.
Post-thrombophlebitic disease of the lower extremities in different patients can proceed in different ways. In some patients, the pathological process for a long time period manifests itself extremely weakly or with moderate symptoms, in the rest it progresses rapidly and can lead to the development of trophic disorders and permanent disability.
Diagnostic measures
If a pathology of post-thrombophlebitic disease is suspected, the doctor needs to find out if the patient suffered from a disease such as thrombophlebitis. Some patients with this disease do not turn to phlebologists in time, therefore, when clarifying the anamnesis, it is necessary to pay attention to episodes of prolonged swelling of the leg and a feeling of fullness with it.
To confirm the diagnosis, some instrumental diagnostic methods are carried out, for example, ultrasound of the vessels of the lower extremities. In order to determine the shape, localization of the lesion and the degree of hemodynamic disturbances are used:
- radionucleoid phlebography of extremities;
- rheovasography;
- ultrasound angioscanning.
Therapy
During adaptationperiod (the first 12 months after thrombophlebitis), patients are prescribed conservative treatment. The main indication for surgical intervention is considered to be early decompensation of the circulation of the problem limb of a progressive nature.
After the end of the adaptation period, therapeutic tactics depend mainly on the stage and form of such an ailment as post-thrombophlebitic vein disease. At the stage of compensation and subcompensation of circulatory disorders, the constant use of compression elastic means (underwear, stockings), as well as physiotherapeutic measures, is recommended. Even in the absence of symptoms of circulatory disorders, patients with post-thrombophlebitic disease are contraindicated in hard physical work, work in the cold, in hot shops, as well as work associated with prolonged stay on their feet.
If there are signs of circulatory decompensation, the patient is prescribed medications from the category of antiplatelet agents (pentoxifylline, dipyridamole, acetylsalicylic acid), fibrinolytics, drugs that reduce inflammation of the venous wall (hydroxyethyl rutoside, horse chestnut extract, tribenoside, troxerutin). In the presence of trophic disorders, multivitamins, pyridoxine, desensitizing drugs are indicated. With the diagnosis of "post-thrombophlebitic disease", clinical recommendations should be strictly followed.
Surgical treatments
Surgery makes it impossiblecompletely eliminate the pathology. The operation only helps to delay the occurrence of pathological disorders in the venous system. In this regard, surgical treatment is carried out only in the absence of a positive effect from conservative therapy.
Types of surgical interventions
The following types of surgical interventions for the diagnosis of post-thrombophlebitic disease (ICD 10 I87.0) should be noted:
- Corrective operations (miniphlebectomy and phlebectomy), through which the saphenous veins affected by varicose veins are removed, and the communicating veins are also ligated.
- Reconstructive surgery (plasty and resection of veins, the so-called bypass grafting).
To date, no therapeutic technique, including surgical treatment, can stop the progressive development of post-thrombophlebitis disease in its unfavorable course. Approximately 10 years after diagnosis, 38% of patients become disabled.
What medicines are used in the treatment?
Postthrombophlebitic disease is a pathological process that requires the constant use of a variety of medications that can slow down the course of the disease and reduce the intensity and severity of symptoms. Patients are prescribed drugs that protect and restore vascular walls, normalize microcirculationblood and rheological parameters. The drugs are taken in two-month courses, with interruptions. Post-thrombophlebitic disease of the lower extremities is very unpleasant.
Treatment also consists in the fact that the patient is given antioxidants, antiplatelet agents and anti-inflammatory drugs. If infected trophic ulcers appear, antibiotics are prescribed. Reparants and phlebotonics are then added to these medicines. In addition to systemic medicines, it is necessary to use ointments, gels, creams that have antithrombotic and anti-inflammatory properties. Among the most prescribed medicines are:
- heparin ointment;
- "Troxevasin";
- "Flebodia";
- Detralex.
Depending on the stage of therapy, the stage of the disease and complications, radon baths, electrophoresis, magnetotherapy, darsonvalization, ozone baths and other procedures may be prescribed.
