Post-thrombotic Syndrome - Chronic Venous Insufficiency

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Post-thrombotic syndrome

Acute deep leg or pelvic vein thrombosis (DVT) results in partial or complete obstruction in the main vein system. If a deep vein thrombosis is not detected in good time, chronic congestion symptoms develop in the deep vein system, which are summarized under the term "post-thrombotic syndrome (PTS)". This leads to blood congestion and swellings in the affected leg, changes in the skin and subcutaneous fat as well as ulcers on the lower leg (ulcus cruris venosum), possibly also secondary varicose veins. The entire clinical picture of the post-thrombotic syndrome is also summarized under the term "chronic venous insufficiency (CVI)".

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Chronic venous insufficiency occurs in connection with venous thrombosis due to a backflow of blood and an increase in pressure in the leg veins with gradually increasing damage to the vessel walls and venous valves.

What are the symptoms?

If chronic venous insufficiency is mild, dull leg pain often occurs, which becomes worse after prolonged standing and disappears again when the legs are raised. Often enlarged, dark small veins form on the edge of the foot and on the inside of the ankle, as well as discoloration and hardening of the skin. In severe cases, there is inflammation with weeping and itchy eczema and finally leg ulcers, especially in the ankle area.

The venous leg ulcer (ulcus cruris, "open leg") causes severe wound pain, which can restrict mobility. This slows down or prevents the healing of the wounds. If the wound is infected by germs, an unpleasant wound odor can develop.

How is the diagnosis made?

The examination often reveals increased leg circumference, swellings and spider veins, reticulated veins and varicose veins, redness, skin changes (dark-colored regions, eczema, rough skin areas, etc.), and in the most severe cases also leg ulcers, especially in the ankle region.

How is post-thrombotic syndrome treated?

In any case, the underlying disease should be treated. Depending on the severity of the chronic venous insufficiency, in addition to wearing medical compression stockings, various vein medications, pain relievers, skin care products and measures for wound treatment are prescribed.

Note Patients should avoid standing and sitting for long periods of time and often raise their legs.

By consistently using the available treatment options, every leg ulcer should be curable, even if it has existed for years or even decades. In 90 percent of the cases, this can be achieved by means of compression therapy, wound treatment (special dressings), drugs (systemically acting antibiotics, local antiseptics) and physical therapy (decongestive gymnastics, etc.). Only the remaining ten percent require surgery. In many cases, superficial varicose veins have to be removed. If the ulcer appears like a gaiter, it is removed in layers under anesthesia ("shave therapy"). A skin graft is then removed from the thigh and applied to the wound.

Tips for patients with an "open leg"

In addition to the general advice for people with venous disease, special measures are recommended for patients with leg ulcers to support healing:

• Get plenty of exercise to help the healing process and prevent new ulcers from forming.
• The best way to prevent complications is to strengthen your leg muscles.
• Always wear medically prescribed compression stockings, except at night and during prolonged bed rest. Wear your compression stockings for a maximum of six months.
• Do not use local antibiotics. It has been proven that these do not improve ulcer healing.

For more information, see What can I do myself if I have venous disease?

Whom can I ask?

If you have symptoms that indicate chronic venous insufficiency, you should go to one of the following offices:

• General Practitioner,
• Specialist in dermatology and venereology,
• Specialist in internal medicine.

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

There is a deductible for compression stockings prescribed by the doctor, which the patient has to wear himself. Depending on the health insurance provider, a pair of compression stockings is approved every six months. Treatments required for cosmetic reasons must be paid for by yourself.