Post-thrombotic syndrome

As a post-thrombotic syndrome ( PTS) is defined as the effects of permanent damage to the deep venous system of the arm or leg after a previous DVT. During the dissolution of the clot takes place at the vein wall an inflammatory process instead - but without bacteria or viruses. This reaction is a self-healing attempt by the body and makes the veins again consistently. However, the venous valves are often attacked in the affected area or even destroyed. This is missing the most important part of the reflux mechanism, the veins are no longer fully functional. It develops the " post-thrombotic syndrome." About 50 percent of all thrombosis patients are affected. Because of the rarity of Armvenenthrombosen and the low static load on the arms, the arms are rarely affected by a PTS.

Disease

In venous thrombosis occurs only very rarely in a complete resolution of the clot and thus to a restoration of normal venous flow. Most arise as a result of thrombosis in the vascular strands scars, some with permanent occlusion of a vein. Since the scarred changes involve the venous valves, the valves can no longer fulfill its function, so that it can come to a chronic blood stasis in the affected leg. Symptoms are: Severe or tightness in the leg, swelling and pain. In the further course - often only after months and years - can make edema and secondary varicose veins at first. The leg can be perceived as difficult and it can, including causing tension pain. With a sufficiently long course of the disease, it may due to deposition of iron pigment ( = Hemosiderine deposition ) for browning the skin on the lower leg and later as a result of chronic under-supply of the upper skin layers with arterial blood to structural damage to the skin come (eg, atrophy blanche ). Upon further skin damage then often develops a chronic leg ulcer ( venous ulcers ). The ulcers may occur here at almost every point of the lower leg, preferably, the region is affected by the inner and the outer ankle.

The severity of post-thrombotic syndrome depends on the extent of the initial thrombosis and additional factors ( prolonged standing at work, female gender, obesity) from.

The post-thrombotic syndrome can be divided into four stages:

• Stage I: tendency to edema without induration of tissue ( Gewebssklerose )
• Stage II: hardening of the skin and subcutaneous adipose tissue ( dermatoliposclerosis )
• Stage III: sclerotic tissue changes of the skin and subcutaneous tissue and circumscribed areas of the fascia ( Dermatoliposklerosis regionalis )
• Stage IV: as stage III, in addition to extensive, sometimes circular ulcers (ulcus cruris postthromboticum )

Diagnosis

If a previously expired thrombosis known and are typical symptoms ( see above) are present, the diagnosis is easy. Not infrequently, thrombosis but unrecognized and are to be made sometimes years later by the presence of post-thrombotic complaints likely.

Ultrasound

Drug of choice is the study of color-coded duplex sonography using, in the well can be detected by an experienced examiner structural damage of the deep venous system and especially venous valve damage.

Venography

An X-ray examination with contrast medium ( venography ) shows a chronic venous occlusion by thrombosis very well with reference to the large number of small vessels to bypass. The venous valves can be well assessed. As venography but compared to the ultrasound is expensive and unpleasant to the patient, it is always carried out less frequently.

Therapy

Basic principle of the treatment is the application of external compression either by applying a compression bandage with short-stretch bandages or by coating a medical compression stocking. At the same time, the activation of the muscle pump is important, which is achieved by regular active movement of the affected limb ( cycling, walking ). An overload of the leg by extreme endurance sports, however, should be avoided. An elevation of the leg relieves the venous system in addition. Diuretic drugs are useful only in individual cases and then only for a short time. An anticoagulation with coumarins is useful when re- thrombosis risk.

A Canadian multicenter, randomized, placebo-controlled study of over 800 patients came in 2013, however, to the conclusion that compression therapy with compression stockings the development of post-thrombotic syndrome can not be avoided. The subjects received either a compression stocking with a pressure of 30-40 mmHg or a stocking with only 5 mmHg. In both groups, there was little difference in the development of post-thrombotic syndrome.

In general: LLLSSS: Dear running and chairs instead of standing and sitting.