Post-thrombotic disease, features of its course and the likelihood of recovery

Post-thrombotic disease( PTB) is a serious disease that is common in both men and women. This concept combines different hemodynamic disorders.

The disease delivers many unpleasant moments to people who suffer them. Measures to prevent PTB, timely treatment of the disease in the early stages will help avoid complications.

General information

Postthrombotic disease is a typical type of chronic venous insufficiency that develops after a previous thrombosis. PTB is characterized by secondary varicose veins, edema of the lower extremities, changes in the skin and subcutaneous tissue of the lower leg, which are trophic in nature.

In different countries of this disease, from 1.5 to 5% of the population is affected. Mostly it affects men over 60 years and women over 50 years. In rare cases, the disease occurs in younger people.

Causes and Risk Factors of

The main cause of the onset of post-thrombotic disease is , a previously suffered thrombosis of the main veins of .After this, numerous morphological changes occur in the walls of the vessels, which lead to a violation of microcirculation and macrocirculation of the blood. Valves of the main veins lose their normal function, after which the blood stagnates in the lower leg and foot.

Other causes of post-thrombotic disease include pregnancy, childbirth, lower extremity trauma, or pelvic surgery for the ( for example, in the treatment of an aneurysm of the abdominal aorta).

The appearance of the disease is possible in a healthy person, a quarter of patients do not notice deep vein thrombosis ( about it - here).

Classification of the disease

Post-thrombotic changes in the deep veins of lower extremities and other vessels are classified as follows:

1. By forms:
   
   • edematous-painful - manifestation in the form of swelling of the legs. The edema is located on the basis of the location of the disease( it can spread all over the leg), the degree of load on the legs changes every day, therefore the swelling also changes its character,
   • venous form - localization depends on the degree of defeat of deep veins. This form is always found in PTB.The expansion of the veins affects the veins of the lower leg, knees, anterior abdominal wall, in some cases varicose can affect the thoracic and abdominal walls,
   • trophic form - disorders that can be expressed in different ways: eczema, ulcers, dermatitis or skin pigmentation. Trophic disorders can cover the whole leg of the patient, the pigmentation of the skin of the affected area changes, the skin becomes dry, loses the scalp,
   • the mixed form - combining several forms of the disease at the same time.
2. By stages:
   • complete recanalization,
   • partial recanalization.
3. According to the degree of chronic venous insufficiency:
   • venous insufficiency is absent,
   • regular nocturnal cramps, "cotton feet",
   • swelling, which appears in the evening and disappears in the morning,
   • constant swelling of the lower extremities,
   • venous trophic ulcers.

Danger and complications

During post-thrombotic disease , the valves of the deep veins cease to perform the main function, therefore, the expressed stagnation of blood occurs. This disease has a rapidly progressive and pathological character. May lead to a decrease in the quality of life and even disability.

Causes of complication of post-thrombotic disease:

• obesity,
• stroke,
• consequence of severe injuries,
• operations in the thigh or knee area,
• pregnancy,
• genetic predisposition,
• cancers,
• smoking, alcohol abuse.

Symptoms of

Symptoms of the disease are the same, typical for each form of the disease:

• severe swelling of the legs, up to elephantiasis, puffiness occurs in 80% of patients,
• varicose veins - observed in 75% of cases of PTB, expansion appears to compensate for outflow of blood,
• constantpain in the legs, which increases after physical exertion - occurs in 70% of patients,
• skin disorders that turn into ulcers at later stages of the disease - is observed in 50-60% of people suffering from postthromboticillness,
• excessive fatigue of the legs, a constant feeling of "bursting" in the affected area.

When to see a doctor and to what?

At the first signs of post-thrombotic disease, should be addressed to a phlebologist( or vascular surgeon) - a specialist who treats veins.

To phlebologist it is necessary to address with the following symptoms:

• previously transferred thrombosis,
• frequent soreness along the surface of the legs,
• swelling of the lower extremities,
• marked prominence of the veins or their obvious protrusion,
• convulsions and frequent feeling of heaviness in the legs.

Diagnostics

The vascular surgeon can put the exact diagnosis. The doctor examines the patient, then collects an anamnesis. Diagnosis is carried out using instrumental methods:

• X-ray contrasting phlebography - study of the patient's vascular system with fluoroscopy,
• dopplerography of the veins of the pelvis, trunk and hollow veins is a study of blood flow in the vessels, which allows to assess the real state of the valves of the veins of the legs.

The doctor may suggest that be performed in the lower extremity ultrasound or MRI with the introduction of a special drug.

For correct differential diagnosis of , it is necessary to carefully examine the patient, perform functional tests and phlebologic examination of , collect anamnesis.

Conservative treatment

Conservative method is indicated to all patients with postthrombotic syndrome of lower extremities or other veins. It is used by both as a stand-alone method of treatment, and as preparation for surgery or post-operative recovery of .With its help, edema decreases, ulcers heal, inflammation subsides, new ways of venous outflow and lymph drainage develop, microcirculation of tissues normalizes.

Conservative therapy includes the following methods:

• elastic compression - wearing special elastic bandages, stockings, compression and pulling clothes. Such a procedure eliminates or reduces venous congestion, promotes improvement of blood flow through the deep veins,
• exercise therapy is a set of specially designed physical exercises aimed at accelerated recovery. The complex should be performed daily,
• use of anticoagulants - drugs that promote blood thinning, which helps recovery,
• use of venotonic drugs - drugs that stimulate venous blood outflow,
• elevated position of the legs during rest - this situation improves the outflow of blood from the distaldepartments, is practiced daily, within 30 -40 minutes after physical exertion.

Indications for conservative treatment:

• The initial stage of development of post-thrombotic disease, usually develops in the first - second year after the transferred thrombosis of the lower extremities.
• Severe condition of the patient, neglected stage of the disease, which excludes surgical intervention.
• Explicit inflammation of the affected limb.
• Refusal of patients from surgical intervention.
• Slowly developing form of the disease, when conservative methods are excellent in curing venous and lymphatic outflow.

Surgical intervention

This type of treatment is used in case of advanced disease, when conservative treatment does not help the patient .Surgical intervention is carried out in two ways:

• valvuloplasty - an operation during which the unsuccessful valves in the veins are restored;
• endoscopic removal of perforon veins - operations to remove veins.

Prognosis and prevention measures

Systematic examinations in the phlebologist will help to avoid the appearance of this pathology, especially if there is a predisposition to it.

To prevent post-thrombotic disease, is prescribed anticoagulant drugs that prevent the formation of thrombi .It is recommended to perform physical exercises: pull your toes towards the head, walk more.

Treatment of the disease at an early stage and compliance with preventive measures will help avoid complications of the disease and surgical intervention.

Post-thrombotic disease of the veins of the lower extremities is fraught with complications. It brings great inconveniences, as patients constantly suffer from edema of the legs, are very tired after physical exertion of .Legs can become covered with trophic ulcers, puff up almost to elephantiasis. But PTB lends itself to conservative treatment, if you turn to a specialist with the first symptoms.