Additional possibilities in conservative treatment of patients with post-thrombotic disease of lower limbs

Kuznetsov M.R.^1,4, Bogachev V.Yu.², Sapelkin S.V.³, Papysheva O.V.⁴, Neskhodimov L.A.², Khotinsky A.A.¹, Mazitova M.I.⁵

1) Chair of Faculty Surgery №1 of Therapeutic Department,
2) Chair of Faculty Surgery №2 of Therapeutic Department, Pirogov Russian National Research Medical University (RNRMU),
3) Department of Vascular Surgery, National Medical Research Centre of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health,
4) Department of General Surgery, Municipal Clinical Hospital №29 named after N.E. Bauman, Moscow,
5) Department of Obstetrics and Gynaecology, Kazan State Medical Academy – Branch of the Russian Medical Academy of Continuing Professional Education, Kazan, Russia

Objective. This study was undertaken to evaluate efficacy of Actovegin in the composition of comprehensive therapy in patients presenting with post-thrombotic disease of lower extremities free from trophic disorders.

Patients and methods. The study included a total of 60 patients (28 men and 32 women) diagnosed as having post-thrombotic disease of lower limbs without trophic disorders (C1-C3 according to the CEAP classification), induced by previously endured iliofemoral phlebothrombosis. The duration of the disease varied from 1 year to 10 years. All patients for 10 days received Actovegin intravenously in drips at a dose of 1200 mg (30 ml of the drug reconstituted in 400 ml of normal saline) followed by continuing taking the drug orally in a daily dose of 1200 mg for 30 days. During the whole follow up period the patients wore class 2 compression stockings (RAL standard). The results of the carried out treatment in relation to the subjective complaints (pain, feeling of heaviness, convulsions, pruritus and paresthesias) were assessed by the visual analogue scale and based on the CIVIQ-20 questionnaire, with additionally measuring the malleolar circumference.

Results. On the background of the carried out therapy the patients demonstrated a significant decrease in the oedematous syndrome in the area of the ankles. This parameter decreased form 26.88±0.39 cm to 25.02±0.35 cm (p<0.05). The patients’ complaints of tingling decreased form 5.73±0.79 to 2.32±0.68 points (p<0.05), the incidence and intensity of convulsions fell from 6.51±1.39 to 3.2±0.98 points (p<0.05). The intensity of the oedematous syndrome (swelling) decreased significantly from 8.11±1.75 to 4.33±1.20 points (p<0.05), the pain syndrome fell from 7.92±1.88 to 3.12±1.45 points (p<0.05), the feeling of heaviness in the lower limbs decreased from 8.52±1.73 to 3.91±1.48 points (p<0.05). Also, improvement of the general quality of life of patients was observed (the integral parameter decreased from 63.27±1.8 to 44.33±1.19 points, p<0.05).

KEY WORDS: post-thrombotic disease, veno-specific complaints, venous oedema, chronic venous insufficiency, Actovegin, conservative therapy.

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