Post-thrombotic syndrome of the lower extremities
Post-thrombotic syndrome (PTS) is a problem that can develop in about half of all patients who have had deep vein thrombosis (DVT), often in the lower extremities. The symptoms of this disease include chronic leg pain, swelling, redness and sores.
How is PTS?
Veins in the deep tissues of the legs have tiny valves that control the direction of blood flow. The formed blood clots in leg veins can cause inflammation and block blood flow, leading to destruction of these valves. This damage valves in the outflow of blood from the legs is broken, resulting in delays in the lower extremities. Feet become painful, swollen, sometimes red. As it progression of post-thrombotic syndrome of the lower extremities leads to the formation of trophic ulcers, which are very difficult to treat.
How can a man know what he PTS?
Some patients PTS develops more frequently than others. The following factors increase the risk of developing this disease:
- The presence of blood clots above the knee (proximal DVT).
- The presence of more than 1 blood clot in the same leg.
- The presence of symptoms of DVT 1 month after diagnosis.
- Excess weight and obesity.
- Difficulty maintaining the level of blood thinning during the first three months of anticoagulants.
The most common symptoms of PTS:
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- Pain, aching sensations, edema of the lower extremities that worsen after walking or prolonged standing and relieved with rest or elevated position of your feet.
- Heaviness in the legs.
- Itching in the legs.
- Tingling sensation in the lower extremities.
- Cramps in the legs.
- Trophic ulcers.
If the patient has any of these symptoms, he should consult a doctor who will be able to establish the presence of PTS.
How can we prevent the development of PTS?
The best way to prevent the development of PTS is to prevent the formation of blood clots in the veins of the lower extremities. Some patients have an increased risk of developing blood clots, especially patients in hospitals after undergoing surgery or confined to bed. Such patients (as long as they are in the hospital or even after discharge) frequently prescribe wearing compression stockings or prescribe drugs that prevent the formation of blood clots.
Patients with blood clots in the legs elastic compression stockings help prevent the accumulation of fluid in the lower extremities, which leads to edema. These stockings are made of special elastic elastic substance. They are very tight-fitting ankle compression helps the muscles to push blood in the right direction, improving its outflow and decreasing pain in the lower extremities.
The patient needs to start wearing these stockings as soon as possible after diagnosis of deep vein thrombosis and continue to do so for at least 2 years. Compression stockings have different density (compression level). To find suitable stockings, you need to follow the doctor’s recommendations. They should be worn on the leg with deep venous thrombosis throughout the day, and at night you can withdraw.
How to treat PTS?
Unfortunately, surgical treatment of PTS no. This is because surgery on the deep veins of the lower extremities, as a rule, unsuccessful. The results of attempts at surgical reconstruction of the valves of the deep veins are almost always unsatisfactory. Trophic ulcers after being treated PTS is very difficult. For their healing needs patience and care, application of compression bandages. Sometimes you need skin grafts. Some ulcers do not heal, they are constantly inflamed and hurt.
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Wearing compression stockings – the basic treatment of PTS. Unfortunately, patients often don’t wear them because they are uncomfortable and ugly. People should know that there are stockings in different colors and shapes, sizes and materials. To relieve symptoms they need to be worn for years. If the swelling is gone in a few weeks or months of wearing compression stockings after acute DVT, the patient can stop wearing them. If you are still having swelling again you need to start wearing stockings.
Also, you need the high position of the limb above the heart level during rest or sleep. In addition, to reduce the symptoms, normalization of weight and physical exercises aimed at strengthening muscles of the lower extremities. PTS treatment also includes pain relief. Because many patients with this disease are taking Warfarin, they should not use medications that increase the risk of bleeding, including aspirin or nonsteroidal anti-inflammatory drugs.
PTS of the upper extremity
PTS of the upper extremities is studied less, but it occurs in 15 – 25% of patients after DVT of the arms. This disease affects the quality of life of the patient, especially if the affected dominant arm. Symptoms include swelling, heaviness and fatigue in the hand, the expansion of surface veins and discoloration. For treatment use compression gloves and elastic bandages, and venoactive drugs.