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Postphlebitic Syndrome

What is Postphlebitic Syndrome?

In legs, deep veins are present with tiny valves, which regulate flow direction of blood. Damage of these valves can be occurred due to blood clotting in the leg valves and resultant of this leads to inflammation and pain. Because leakage in the damaged valves allows to the accumulation of fluid around the ankle.

Even delayed healing or partial healing of blood clotting also obstructs blood circulation and red swollen painful leg develops. This condition is termed as a postphlebitic syndrome. In worsening of the postphlebitic syndrome can cause leg ulcers and that is difficult to treat^1,4.

Symptoms

The following are the symptoms included in postphlebitic syndrome:

Leg ache or leg pain
Inflammation of affected leg
Prolonged walking or standing can worsen the pain and swelling and resting posture provides a gradual reduction of the aggravated condition.
Heaviness in the affected leg
Itching at the affected leg
Tingling sensation in the leg
Leg cramping
Development of the leg ulcer
Pigmented skin on the affected leg
Skin hardness
Affected skin become dried
Varicose vein development^1,4

Pathophysiology

Persistent venous hypertension is a primary pathophysiologic condition associated with the Post-thrombotic syndrome. Blood clotting causes lack of valvular effectiveness and clot-induced blood flow obstruction leads to venous hypertension – both combined refluxes contribute to the development of the post-thrombotic syndrome.

The increased venous pressures are passed to the capillary beds, leakage of fluid and large molecules and resulting of these lead to tissue edema, in complex condition oxygen deficiency occur in tissue level and ulcer formation occur.

Severe deep vein thrombosis obstructs partial or complete venous blood flow. In association with this, interleukin-6 and intercellular adhesion molecule-1 are different inflammatory cytokines are increased and inflammatory condition develops with post-thrombotic syndrome.

Development of reflux in the more proximal lower extremity veins in association with popliteal valve incompetence is also important contributory factors in the development of post-thrombotic syndrome².

Prevalence

Patients with Deep vein thrombosis has a greater risk of development of Postphlebitic Syndrome. It has been found that about 30% of patients with Deep vein thrombosis have Postphlebitic Syndrome due to development permanent valvular incompetence.

However, the conversion from Deep vein thrombosis to Postphlebitic Syndrome takes time. Almost 10 to 20% of patients with Deep vein thrombosis develops Postphlebitic Syndrome after one to two years, whereas 20 to 30 percent patients develop Postphlebitic Syndrome after 5 years of the incidence of Deep vein thrombosis³.

Affects On Patient’s Psychology

Most of the patients with Postphlebitic Syndrome has psychologically frustrated or depressed because of their restricted movement, especially those were very active prior to the onset of post-thrombotic syndrome. The recovery of the Postphlebitic Syndrome is very slow and patient often unable to understand their improvement of functionality of lower extremities.

Therefore, the clinician should regularly communicate with the patient and discuss the treatment plan and its advantage, so that patient should maintain the follow-up therapy and treatment compliance. Some patients also require, psychological consultation to motivate patients and avoiding negative influences⁴.

Treatment

Following are the different treatments available for postphlebitic syndrome treatment.

Patients with postphlebitic syndrome need to wear a higher strength (30 to 40 mm Hg) stockings. In some patients, more higher strength stockings require solving the severe swelling.
“Anti-Embolism Stockings” is a type of stocking which assists in preventing blood cloting and usually recomended to patients who are undergone surgical intervention. However, most of the patients feel uncomfortable to wear these types of stockings.
The Certain medical device also available in the pharmacy store, which assist in improving blood flow.
Pentoxifylline is a medication available to treat wound and ulcer, which develops due to the postphlebitic syndrome.
Slightly elevated leg posture from the heart level during sleeping can assist to improve blood circulation, which reduces the inflammation of the lower extremity.
Physical exercise is important for weight management. Because obese individuals have a greater risk to develop Postphlebitic Syndrome.
Non-steroidal anti- inflammatory drugs, such as ibuprofen, Naprosyn, non-narcotic drugs like acetaminophen is usually prescribed to control the pain symptom. These drugs can also combine with narcotic drugs to control severe pain symptom. Recently, sustained pain management can be possible by using dermatological patches made with a different medication. If pain symptom of Postphlebitic Syndrome is associated with diabetic neuropathy, then Gabapentin prescribed to control neuropathic pain.
Stenting and balloon widening procedure need on the narrow or obstructed blood vessels to perform for maintaining the blood circulation. Because narrowing of blood vessels or obstructed blood vessels is primary pathophysiology of the Postphlebitic Syndrome.
Elastic bandages, which contain calamine lotion, glycerin, zinc oxide, and gelatin, or foam dressings often use to treat Venous skin ulcers and assist in wound healing. However, the effect of this bandages is slow. In addition, meticulous wound care is required.

References

Sara R. Vazquez, Susan R. Kahn; Postthrombotic Syndrome; http://circ.ahajournals.org/content/121/8/e217
Patrick C Alguire, Barbara M Mathes, Postthrombotic Syndrome http://www.uptodate.com/contents/post-thrombotic-postphlebitic-syndrome
What is the post-phlebitic or post-thrombotic syndrome? https://www.stoptheclot.org/diagnosis_symptoms/what_is_post_phlebitic.htm
Postthrombotic Syndrome; National Blood Clot Alliance; https://www.stoptheclot.org/postthrombotic-syndrome.htm