Why does the disease develop?
The deep veins of the legs have valves that allow blood to flow only upward to the heart. The thrombus damages them and the vein wall itself. Even after successful dissolution of the thrombus, the valves often remain incompetent, and the lumen of the vein remains partially narrowed by scars. When walking, the blood rises worse, some of it returns down, the pressure in the veins of the lower leg increases. Fluid and blood cells leak into the tissues, chronic inflammation develops, and the skin becomes thinner and darker. The higher the level of thrombosis and the longer it was not treated, the more severe the consequences.
- Damage to venous valves by thrombus
- Scar narrowing of the vein lumen
- Reverse blood flow and venous stasis
- Increased pressure in the veins of the leg
- Chronic inflammation and skin changes
Symptoms
The first complaints appear gradually: by the end of the day, the leg feels heavy, the shoes become tight, and marks remain from the elastic of the sock. The swelling first goes away overnight, then becomes permanent. Bursting pain, night cramps in the calves, and itching occur. The skin of the lower third of the leg acquires a brownish tint, becomes dense, and the hair on it falls out. Against this background, even a small scratch can turn into a long-lasting ulcer, usually above the inner ankle.
- Swelling of the lower leg, worsening in the evening
- Heaviness and swelling in the leg
- Night cramps, itchy skin
- Brown pigmentation in the lower third of the leg
- Thickening of the skin and subcutaneous tissue
- Dilated saphenous veins
- Trophic ulcer above the ankle
Diagnostics
The main method is ultrasound examination of veins with Dopplerography. It shows whether there are residual thrombotic masses, how much the lumen of the vein has been restored, whether the valves are working and whether there is reverse blood flow. The doctor examines the skin, measures the circumference of both legs and assesses the degree of changes according to the international classification. In case of repeated thrombosis, thrombosis at a young age or unusual location, the coagulation system is additionally examined. In case of an ulcer, a culture of the discharge is taken and the arterial blood flow is assessed, since compression is not acceptable in all conditions.
- Ultrasound of the veins of the lower extremities with Dopplerography
- Dynamic calf circumference measurement
- Skin and ulcer assessment
- Coagulogram, examination for thrombophilia according to indications
- Assessment of arterial blood flow before compression
- Sowing of discharge from an ulcer during suppuration
Treatment
The basis of treatment is constant compression: knitwear or bandage that is correctly selected in size and grade, which is put on in the morning, without getting out of bed, and worn all day. This is not an auxiliary measure, but the main method to reduce swelling and prevent ulcers. The second support is movement: walking, ankle exercises, raising legs in a lying position. Phlebotropic drugs reduce heaviness and swelling, but do not replace compression; Anticoagulants are continued strictly as prescribed by the doctor. Ulcers require regular care and dressings under the supervision of a specialist. In some cases, endovascular interventions on narrowed veins are discussed.
- Everyday compression hosiery of the right grade
- Regular walking and calf exercises
- Elevated leg position while resting
- Skin care: hydration, protection from injury
- Phlebotropic drugs prescribed by a doctor
- Continuation of anticoagulants according to the doctor’s regimen
- Dressings and treatment of ulcers by a specialist
- Losing weight, avoiding standing for long periods of time
Prevention of complications
The main task is to prevent recurrent thrombosis and trophic ulcers. Repeated thrombosis sharply worsens the condition of the veins, so it is important to follow recommendations on anticoagulants, prevention during long flights and after operations, and weight control. The skin of the lower leg should be protected: avoid hot baths and saunas, do not comb, do not use aggressive products, treat small wounds in a timely manner. At the first signs of skin inflammation or a non-healing wound, you should see a doctor and not be treated with homemade compresses.
- Do not stop anticoagulants yourself
- Compression on long trips and flights
- Warm up your legs during sedentary work every hour
- Avoidance of saunas and hot baths
- Daily moisturizing of the skin of the legs
- Comfortable shoes without putting pressure on the foot
- Immediate visit to the doctor if a wound does not heal