In Bulgaria, his professional path passes through hospitals such as "Sofiyamed", "Ajibadem City Clinic", "Heart and Brain", "Burgasmed" and MC "Staykov" in Burgas.
He held responsible positions in a number of medical facilities. He has participated in numerous national and international scientific forums in the field of angiology.
The national information campaign "Take your feet in your hands actively", which is organized by the Bulgarian National Society of Vascular and Endovascular Surgery and Angiology (BNDSEHA) has started for the fourth year in a row.
Leading doctors in the field of venous pathology in our country issued a general call for the need to increase the awareness of he alth professionals and patients regarding early diagnosis and timely treatment of the disease by conducting regular educational initiatives.
We talk to Dr. Nasratullah Mobarakshah about post-thrombotic syndrome.
Dr. Mobarakshah, what causes the onset and development of postthrombotic syndrome?
- Postthrombotic syndrome (PTS) is a complication that occurs as a result of deep vein thrombosis (DVT). The veins in our arms and legs have tiny valves inside that ensure blood flows properly back to the heart. Deep vein thrombosis is a blockage or clot that obstructs a vein and can cause the valves to settle.
How often do people with deep vein thrombosis develop this syndrome?
- Over a third of people who have deep vein thrombosis develop postphlebitic syndrome, with its characteristic symptoms. The syndrome can affect mobility, so it is best to take certain preventive measures. Most often, deep vein thrombosis occurs in the legs.
What are the main reasons for the development of postthrombotic syndrome?
- The main reason for the development of the syndrome is the damage to the valves and walls of the veins, as a result of deep venous thrombosis. Prompt diagnosis and treatment is necessary to prevent this damage from occurring, because once the valves and walls of the vein are damaged, they cannot be repaired.
The valves of the veins are extremely fragile and can be easily damaged - the blood can start to flow in the wrong way. This is called reflux, which causes blood to pool in the veins in the lower legs, causing swelling and discomfort.
The walls of the vein can also be damaged and leave consequences after DVT. When we do certain physical activities, such as walking, the blood flow through our veins increases. Injured veins don't expand like normal ones, so when blood flow increases and they can't expand, it causes throbbing pain and swelling in the lower legs.
Eventually, it can also cause damage to the skin of the foot
It becomes dry around the ankles, discolored and itchy. It later changes color to brown, is hard and rough to the touch. Then a small abrasion can turn into a larger wound that does not heal. This is called a venous ulcer.
In more severe cases, the vein can be so severely damaged that it becomes completely blocked – no blood can flow through it at all. This is the most serious type of postphlebitic syndrome.
What treatment options for postthrombotic syndrome does modern angiology have?
- Treatment options vary, depending on how severe the condition is. Treatment usually includes elevation of the affected limb, exercise, and compression therapy or stockings. Blood thinners to prevent possible blood clots in the veins and pain medications may also be prescribed.
You mentioned compression stockings. What requirements must they meet to be an effective part of therapy?
- First, it is important to choose them well to ensure the right level of compression. Therefore, it is necessary to prescribe them from a specialist. The socks are made of a special elastic material and apply pressure to the ankle, which improves blood flow and reduces pain and swelling.
Compression stockings can be worn prophylactically in high-risk DVT situations. For example, during a hospital stay or on long-haul flights.
Socks are usually put on in the morning after getting up and taken off at night. Throughout the day, the compression they provide prevents blood pooling in the veins of the legs, thus helping general circulation and reducing any swelling in the legs.
Compression is graduated, with the strongest starting at the ankles and gradually decreasing towards the upper part of the leg. This gradual compression works in combination with the pumping action of the calf muscles, which also aid circulation.
What more serious complications can the neglect of postthrombotic syndrome lead to?
- Complications of postphlebitic syndrome often develop when the condition is not treated promptly and effectively.
When leg ulcers develop, they are extremely difficult to heal and can become infected. This compromises mobility and in rare cases can lead to sepsis.
Postphlebitic syndrome is a condition that is difficult to treat. It usually causes discomfort and can lead to greater complications. Given the fact that there is no cure for the condition, it is best to take measures to prevent its occurrence. The key to this is prompt diagnosis and treatment of deep vein thrombosis. The faster the clot breaks down, the less damage it will do to the valves and walls of the veins.
What tests are recommended to be done in patients with postthrombotic syndrome?
- Ultrasound vascular diagnosis can be done. Echo-Doppler examination is a painless, quick and non-invasive test. The scan precisely maps anatomy (what veins and arteries look like) and physiology (such as direction of blood flow).
The color duplex test may detect other important features such as additional reflux segments and variants of normal anatomy that may alter the optimal treatment plan.
Even with the most innocent spider veins, it is important to check for valve damage and reflux, as treating any type of venous problem without addressing the underlying cause will fail. There may be success in the short term, but the problem will recur and get worse.
In some patients, it is necessary to perform additional investigations for vascular diagnosis, such as conventional angiography, CT angiography and MRI angiography.
In conventional angiography, blood vessels that are not visible on an ordinary X-ray examination are visualized by contrast liquid.
CT angiography, on the other hand, combines a computed tomography scan with contrast injection to produce cross-sectional pictures of the blood vessels and tissues in the problem area. It is used to detect aneurysms, vessel narrowing, injuries, malformations, suspected atherosclerosis, aortic dissection, etc.
And through magnetic resonance angiography, information unavailable to other imaging methods (ultrasound, x-ray, computed tomography) can be obtained.
Don't ignore the symptoms of postphlebitic syndrome
The most common symptoms of postphlebitic syndrome are:
• Pain, swelling and soreness in the leg, which is usually worse after standing or walking for a long time, and is relieved by resting or elevating the leg;
• Heaviness in legs;
• Itchy feet;
• Numbness in legs;
• Leg cramps;
• Leg ulcers or sores;
If you develop any of these symptoms, especially if you know you have recently had deep vein thrombosis, you should see an angiologist as soon as possible. He can diagnose postthrombotic syndrome based on these symptoms
