OBJECTIVE

To present the lymphological approaches to diagnosis and treatment of acute and chronic venous diseases.

MATERIAL AND METHODS

There were 692 patients with venous diseases of the lower extremities (thrombophlebitis of superficial veins — 153, deep vein thrombosis — 154, chronic venous disease — 385). To clarify the state of lymphatic system, we used contrast-enhanced lymphography in 22 patients, radioisotope lymphoscintigraphy in 75 patients and ultrasound in 325 patients. These results were compared with data in 34 people without vascular abnormalities. Correction of lymphatic outflow disorders implied regional stimulation of lymphatic drainage. Lymphotropic therapy included subcutaneous administration of agents enhancing lymphatic resorption and lymphatic drainage. We also performed lymphatic drainage procedures simultaneously with surgical interventions on venous system. Patients with edema following post-thrombotic disease underwent fenestration of the fascia of the leg, tunnelization of subcutaneous fat base, external drainage of lymphocele, liposuction and, if indicated, imposing lymphovenous anastomoses. We compared healing of ulcers associated with post-thrombotic disease in the main group with lymphological approaches (35 patients) and the control group with standard techniques (27 patients).

RESULTS

Lymphoscintigraphy data revealed that initial stages of venous thrombosis were accompanied by 1.2—1.4-fold lymph flow acceleration in thrombosis of deep and superficial veins and radiopharmaceutical excretion increase from 29 to 42% compared to healthy individuals. In 14 days after venous thrombosis, lymph flow and resorption of radiopharmaceuticals decreased by approximately 2 times. Venous insufficiency was followed by slowdown in lymphatic drainage. Surgical and conservative lymphological approaches in patients with lymphatic and venous insufficiency increased lymphatic drainage and improved microcirculation. When comparing with the control group, we found more intense debridement, granulation and epithelization of trophic ulcers (p<0.001).

CONCLUSION

Venous diseases lead to significant disturbances in lymphatic drainage. Lymphological approaches are perspective in the treatment of patients with severe trophic disorders.