Long-term results of pathogenetically-grounded methods of treatment of patients with postthrombotic syndrome of the lower extremities according to three-year follow-up

Abstract

The aim of this study was to evaluate the effectiveness of surgical treatment using a modified method of correction of venous hemodynamic disorders of the lower extremities by the state of function of the leg muscle pump during long-term follow-up in the postoperative period of patients with postthrombotic syndrome of the lower extremities. 148 patients with lower limb postthrombotic syndrome (С5, 6, S, Es, As, d, p, Pr, LI by CEAP classification) were divided in two groups. The first group included 71 patients, which were treated by traditional methods of surgical intervention (crossectomy and venecseresis). The second group consisted of 77 patients who underwent closed separation of the perforating veins and paratibial fasciotomy in the complex of surgical treatment. The function of the leg muscle pump was studied using three methods: a 6-minute marching test measuring the circumference of the limbs, the amplitude indices of movements in the ankle joint with a protractor, and electromyography using a multichannel electromyography with skin electrode application. The quality of life was studied using the CIVIQ questionnaire, the severity of venous pathology by the VCSS scale and disability rates by the VDS disability scale. The examination was performed before the surgery, after 1 year and after 3 years of observation. In both groups of patients, there was a decrease in the basal levels of a 6-minute marching test, the movement amplitude in the ankle joint, the electromyography indicators, the presence of a strong correlation between these parameters, indicating venous dysfunction in the lower extremities. In the postsurgical period (in 1 and 3 years), there was a reduced circumference of the legs during the marching test, an increased amplitude of movements in the ankle joint and electromyography indicators – the mean and maximum amplitude of oscillations. In patients of group II, the results were better than in patients of group I. In the pre-surgical period, a significant deterioration of the life quality was observed in terms of the CIVIQ questionnaire, the severity of venous pathology – by the VCSS scale and a decrease in working capacity – by the VDS disability scale in both groups. In the long-term postsurgical period, there was an improvement of these indicators, more pronounced in patients of group II. Clinical study of long-term results of the closed separation of perforating veins and paratibial fasciotomy operation confirmed the high efficiency of this method and allowed us to consider it as a pathogenetically-grounded method of surgical treatment of patients with postthrombotic syndrome of the lower extremities.