Def .: The disease is characterized by anatomical changes (dermatolipofasciosclerosis, trophic skin discoloration, scars from healed ulcers or active skin ulceration), haemodynamic changes (presence of reflux, narrowing of the vein or segmental obstruction of the flow) and unpleasant symptoms (venous claudication, troublesome muscle cramps, severe shin swelling, persistent night pains).
Epid .: The annual cumulative incidence of post-thrombotic syndrome is 76 patients per 100. people. Of patients who have had a thromboembolic event, 25% will develop a post-thrombotic syndrome within 20 years. After a history of proximal venous thrombosis in 40% of patients. Information on a history of thrombosis in 22% of cases comes from hospital information cards, and in 4% from imaging tests. In 45% of cases, post-thrombotic changes are found on ultrasound, although the history of thrombosis is negative. It occurs mainly in the industrialized countries of Europe and America.
Etiol .: Past inflammation of deep veins with subsequent damage to the valvular apparatus (the popliteal valve is very important from the haemodynamic point of view).
Loc: Lower limbs below knee, rarely upper limbs.
Clinical: The disease picture depends on the extent of damage to the venous system and the valve apparatus. In mild form, it is manifested by swelling in the ankle area and brown discoloration of the skin, painful muscle cramps, especially at night. However, these are not symptoms specific to this disease entity. In a more advanced form, there are post-inflammatory changes in the form of hardening of the skin, subcutaneous tissue and muscle fascia (dermatolipofasciosclerosis). You may experience increasing pain when you walk (venous claudication). Often there is allergic skin eczema resulting from blood stagnation and the escape of proteins and blood cells beyond the vascular bed. Sometimes there are repeated bacterial infections with oozing and peeling of the epidermis.
DL: Ascending and descending venography, ultrasound-kolordoppler, angio-MRI.
But: Conservative – unless there is concomitant arteriosclerosis (ankle / brachial ratio above 0,8), graded compression is recommended using flexible fabric products or low stretch bandages worn daily. Periodic elevation of the limbs. Segmental, alternating pneumatic massage, manual lymphatic drainage. Pharmacotherapy – due to the accompanying blood coagulation, chronic anticoagulation, phlebotropic drugs and sometimes immunosuppressants should be used. Surgical treatment – reconstruction of damaged venous valves, elimination of reflux in insufficient trunks of superficial veins. Liquidation of ineffective piercing veins. Spans bypassing obstructions or stenting narrowed sections of the veins.
Profile: Early detection and treatment of thrombosis in both deep and superficial veins (approximately 30% of blood clots penetrate through the penetrating vein system into the deep system), monitoring of patients for disturbances in blood haemostasis. Wearing prophylactic graded compression products on a daily basis.
DIG. Z-49. Post-thrombotic syndrome.
Lit .: [1] Rybak Z .: Clinical phlebology. Blackhorse Scien. Publish, Warsaw 2008. [2] Ramelet AA: Phlebology. Elsevier, London 2008. [3] Ciostek P., Grochowicz Ł., Michalak J .: Post-thrombotic syndrome – clinical concept or pathophysiology? Przegl Fleb 2003, 11 (4); 91-3. [4] Bergan JJ: Th e vein book. Elsevier, New York 2007.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House