Post-thrombotic syndrome


Post-Thrombotic Syndrome (PTS) is that most common late complication after a leg vein thrombosis (A blood clot has blocked a vein). Chronic reflux congestion occurs, preventing blood from flowing properly back to the heart. The blood therefore bypasses the partially closed veins by using continuous veins (so-called. Bypass circuit), and a so-called chronic venous insufficiency result. On the other hand, the result of the thrombosis is often a weakness and Venous valve malfunction back or it often intensifies. This means that the valves are unable to prevent blood from flowing back into the legs, causing more blood to sink into the legs. House changes and vacancies can arise.

Causes of Post-Thrombotic Syndrome

Post-thrombotic syndrome affects patients with deep vein thromboses or multi-tier thromboses. The post-thrombotic syndrome is a consequence of 50% and more Multi-stage thrombosis. This means that there are multiple blood clots in different places in the leg. For example, these can be in the calf, knee or thigh and partially extend into the pelvis.

The risk factors for developing a thrombosis and thus suffering from a post-thrombotic syndrome include all previous diseases in the venous system, such as Phlebitis or varicose veins (varices), as well as congenital tendencies to thrombosis. The risk factors also include:

  • Obesity
  • Smoke
  • Medicines containing estrogen, such as the pill
  • pregnancy
  • Cancers
  • Operations and Trauma

The trigger for a thrombosis is often a longer one Immobilization, for example on long flights, in hospitals or after fractures. In the hospital, compression stockings and drug prophylaxis are used to try to minimize the risk of thrombosis.

Read more on this topic: Thrombosis prophylaxis

Staging of post-thrombotic syndrome

To the To assess the severity of a post-thrombotic syndrome, the disease was divided into four stages. Tissue hardening or changes and their depth as well as swelling are taken into account.

  • The first stage is accompanied by swelling, but there is no hardening or change in the tissue.
  • In stage II there is swelling, hardening of the skin and the subcutaneous fat tissue.
  • Stage III is characterized by a tissue change that goes beyond the subcutaneous fatty tissue.
  • The fourth stage is accompanied by a hardening that is extensive (for example, affecting the entire lower leg) and deep. Usually, in the fourth stage, open ulcers also appear.

Symptoms of Post-Thrombotic Syndrome

The post-thrombotic syndrome can appear in different forms. Symptoms range from rather minor Swelling with just a little Feeling of tension up to oozing skin (Eczema) and open ulcers (Ulcers) especially on the lower leg.

The symptoms of post-thrombotic syndrome result from the long-lasting Drainage disorder the blood out of the extremities. At the onset of post-thrombotic syndrome, one occurs Heaviness in the extremities, feeling of tension or pain, water retention (edema) and also a reduction in mobility. The water retention can occur after long standing in the evening, after heavy exercise or permanently.

Skin changes can be detected optically. The skin is usually tight and shiny. If the syndrome is more advanced, the skin becomes thinner and more vulnerable due to an insufficient supply. Due to the lack of nutrients, you can Wound healing disorders and chronic ulcers consequences.

Pain in post-thrombotic syndrome

The pain associated with post-thrombotic syndrome can be mild Tension pains up to severe, persistent pain with dilated ulcers, often on the lower leg. The pain can be in a specific area of ​​the leg, such as just the calf, or it can extend over the entire leg. Usually these pains are considered by the patient dull pulling described.

The tension pains are usually accompanied by a feeling of heaviness in the legs. The term "Claudication venosa " describes pain that occurs in a post-thrombotic syndrome when moving and only slowly subsides when the patient is in a resting position (in contrast to an arterial occlusion). At rest, the blood can be adequately pumped to the heart through bypass circuits via the veins. However, when the patient moves, more blood is pumped through the arteries, which then also enters the venous system. This increased volume is then difficult to pump via the bypass routes and causes pain.

Chronic venous insufficiency

The chronic venous insufficiency can result from deep vein thrombosis and thus be part of the post-thrombotic syndrome or as primary varicosis (predisposed varicose veins) can occur.

There is one here Malfunction of the venous valveswhich normally ensure that the blood does not sink into the legs but can flow back to the heart. So it comes to one swelling in the legs, especially in the feet and lower legs. Symptoms such as edema, skin changes with itching and flaking up to ulcers and wound healing disorders resemble those of the post-thrombotic syndrome.

Care for post-thrombotic syndrome

In the advanced stages of post-thrombotic syndrome, it is very important to ensure that as few injuries as possible occur, including small ones Injuries are properly cared forto prevent the formation of ulcers, as even the smallest scratches can lead to ulcers. Therefore, even such small injuries require careful care. For example, iodine antiseptic ointment may be necessary to prevent infection.

Since there is a high risk of venous ulcers recurring, it should be sufficient in addition MoveProper skin care should also be taken to encourage the outflow of the blocked blood. It is also the right one if compression bandages or compression stockings are worn Skin care very important. At first glance, care products should be used that moisturizing and which maintain or restore the fatty film on the skin. Besides, they should be ph-neutralto preserve the skin's natural protective acid mantle. Creams that donate and bind moisture contain, for example, urea, glycerine or hyaluronic acid. To support the fatty film on the skin, creams with almond oil, jojoba oil or beeswax should be used. Since the skin reacts more sensitively to care products in post-thrombotic syndrome, low-allergen, gentle products should be used. An acute ulcer should be treated by qualified personnel.

Surgery for post-thrombotic syndrome

Whether and which operation is performed depends on the cause of the thrombosis and the current stage. In order to improve the blood circulation in the extremities, with simultaneous varicose veins in the larger veins (Trunk varicosis), one Variceal surgery be performed. The veins are removed by a laser and the blood circulation is improved.

in the Stage I. can do the so-called Perforating veins, which represent a connection between superficial and deep leg veins, are shut down. Of course, only insufficient perforating veins are switched off.

If tissue changes and hardening or wound healing disorders have already occurred, so-called nonselective subfascial perforation dissection or endoscopic perforation dissection the blood circulation and thus the skin care are improved. Both are procedures in which the severed damaged veins become.

There is still the possibility Vascular grafts or to transplant vein segments with functioning valves. These surgical procedures are only used in special cases. A relatively new and modern procedure is the implantation of a stent in the large deep veins. As this procedure is still new, long-term results are not yet known.

Complications of Post-Thrombotic Syndrome

The most serious complication of post-thrombotic syndrome is that Lower leg ulcer (Leg Ulcer), which is also known as the "open leg". The ulcer develops because the blood can no longer drain from the legs towards the heart. The congestion causes tissue swelling. Often it is The ulcer is caused by a small injury that is difficult to heal due to the insufficient supply of the skin. These open wounds can become infected quickly if left untreated. Infection can be local, but it can also spread to the whole body, which is a life-threatening situation.

In addition, the undersupply - especially if there is an arterial circulatory disorder at the same time - can lead to death of the extremity and the need for amputation.

In order to prevent serious complications, from stage II onwards, it is advisable to wear compression stockings at all times to support the blood flow from the legs towards the heart.

Exercise in post-thrombotic syndrome

It has been discussed for a long time whether exercise is useful in post-thrombotic syndrome. Exercise sports are now often part of the therapy, because an improvement in the syndrome could be seen. Sports that are beneficial for the course of the disease include Swimming, cycling, gymnastics and so-called "vein jogging".

Vein jogging is a specific type of walking. The tip of the foot is pulled up when walking. With the knee slightly bent, the heel is first placed on the floor and the rest of the foot rolled towards the toes. This activates the muscle pump in the legs, which means that the blood in the veins can flow more easily towards the heart.

Post-thrombotic syndrome in the arm

Post-thrombotic syndrome can also occur after a deep one Arm vein thrombosis occur. In the Arm vein thrombosis it is an occlusion of the veins in the arm caused by arm pain, swelling, cyanosis (Blue color) of the arm and restricted arm mobility. This is also known as deep vein thrombosis of the upper extremity.

Causes of the thrombosis can occur after strenuous work, after a central venous catheter or a closure of vessels in the transition between the chest and arm area. Thrombosis in the arm occurs in comparison to deep vein thrombosis kinda rare on. Thus, the post-thrombotic syndrome in the arm is relatively rare and also runs in one milder form than in the legs.