Postthrombophlebitis disease is characterized by chronic difficulty in the processes of 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 have a bursting sensation in the affected limb, painful night cramps, swelling and annular pigmentation develop, which acquires fibrous density over time.
Diagnostic findings for the diagnosis of "post-thrombophlebitic disease" (ICD code 10 I87.0) are based on the results of ultrasound of the limb veins and anamnestic data. Increasing decompensation of blood circulation is an indication for surgical treatment of this pathology.
Causes of occurrence
With deep vein thrombosis, a thrombus forms in the lumen of the vessel. After the acute process subsides, thrombotic masses undergo partial lysis and begin to be replaced by connective tissues. If lysis predominates, recanalization occurs in which restoration of the lumen of the vessel occurs. When blood clots replace connective tissue elements, occlusion develops (complete closure of the lumen of the vessel).
The restoration of the vascular lumen is accompanied, as a rule, by the destruction of valve structures in the thrombus localization site. Therefore, regardless of the predominance of certain processes, the outcome of phlebothrombosis in most cases becomes persistent blood flow disorders in deep veins.
An increase in pressure in these vessels contributes to the development of expansion (ectasia) and insolvency of perforating vessels. Blood from deep veins begins to be discharged into the gaps of the superficial veins. The 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. Disrupted 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, the contractile ability of the muscles gradually weaken, which leads to the subsequent progression of signs of venous insufficiency.
Classification
In medicine, there are two variants of 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 (violation of skin pigmentation, lipodermatosclerosis, eczema).
- Trophic ulcers.
Symptomatology
The initial signs of an illness of post-thrombophlebitic disease in most cases appear a few months or years after the development of acute thrombosis. In the initial stages of the disease, people complain of pain, a feeling of fullness of the limb, heaviness when walking or standing. Lying down, after giving the limb an elevated position, the symptomatology quickly decreases. A characteristic symptom of the pathology of post-thrombophlebitic disease is painful muscle cramps 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 extremity. Edema of varying degrees is observed in almost all patients. A few months after the initial occurrence of puffiness, inductive disorders in the soft tissues appear. In the subcutaneous tissue and skin, the formation of fibrous tissue begins. Soft tissues gain density, the skin begins to fuse with subcutaneous tissue, its mobility is lost.
Ring pigmentation
A specific 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 can develop in this area, and in the late period of the disease long-term non-healing trophic ulcers form.
Postthrombophlebitic disease of the lower extremities in different patients can occur in different ways. In some patients, the pathological process for a long time period is manifested extremely weakly or with moderate symptoms, in others it progresses rapidly and can lead to the development of trophic disorders and permanent disability.
Diagnostic measures
If a post-thrombophlebitic disease is suspected of developing a pathology, the doctor needs to find out whether the patient suffered from a disease such as thrombophlebitis. Some patients with this disease do not go to phlebologists on time, therefore, when clarifying the anamnesis, it is necessary to pay attention to episodes of prolonged swelling of the leg and feelings of bursting with it.
To confirm the diagnosis, some instrumental diagnostic methods are performed, for example, ultrasonography of the vessels of the lower extremities. In order to determine the shape, location of the lesion and the degree of hemodynamic disturbances are used:
- limon nucleonoid phlebography;
- rheovasography;
- ultrasound angioscanning.
Therapy
During the adaptation period (the first 12 months after the thrombophlebitis), patients are prescribed conservative treatment. The main indication for surgery is considered to be an early decompensation of blood circulation of a 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 physiotherapy measures, is recommended. Even in the absence of symptoms of circulatory disorders, patients with post-thrombophlebitis 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 venous wall inflammation (hydroxyethylrutoside, horse chestnut extract, tribenoside, troxerutin). In the presence of trophic disorders, multivitamins, pyridoxine, desensitizing drugs are indicated. When diagnosed with post-thrombophlebitic disease, clinical guidelines should be strictly followed.
Surgical treatments
Surgery does not allow to completely 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
It should be noted the following varieties of surgical interventions with a diagnosis of post-thrombophlebitis disease (ICD 10 I87.0):
- Corrective operations (miniflebectomy and phlebectomy), through which the saphenous veins affected by varicose veins are removed, as well as communicating vein ligation.
- Reconstructive surgery (plastic and vein resection, the so-called bypass surgery).
To date, not a single therapeutic technique, including surgical treatment, can stop the progressive development of post-thrombophlebitis disease in its unfavorable course. About 10 years after diagnosis, 38% of patients have a disability.
What medicines are used in treatment?
Post-thrombophlebitic disease is a pathological process in which the constant use of a variety of medications is necessary, with which you can slow down the course of the disease and reduce the intensity and severity of symptoms. Patients are prescribed drugs that protect and restore the vascular walls, normalize blood microcirculation and rheological parameters. Drugs are taken in two-month courses, intermittently. Postthrombophlebitic disease of the lower extremities is very unpleasant.
Treatment also consists in the fact that antioxidants, antiplatelet agents and anti-inflammatory drugs are administered to the patient. If infected trophic ulcers appear, antibiotics are prescribed. To these medicines, then add reparants and phlebotonics. In addition to systemic medicines, it is necessary to use ointments, gels, creams, which have antithrombotic and anti-inflammatory properties. Among the most prescribed medications include:
- heparin ointment;
- Troxevasin;
- Phlebodia
- 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.