oa South African Medical Journal - The post-phlebitic syndrome of the lower limb



*A paper read at the South African Medical Congress, Johannesburg, September 1952. The incidence, etiology, pathology, and signs and symptoms of the post-phlebitic syndrome are descriptionbed. The special investigations now in vogue provide some pertinent information concerning the pathology and treatment. Of these retrograde phlebography in our hands is no sure means of estima.ting a true deep vein incompetence. A newer type of phlebography-via the lesser saphenous vein in the popliteal space-has proved most valuable, especially as regards valvular function and venous return. Superficial venous pressures are very useful in providing information regarding the degree of venous hypertension in the erect posture and especially after muscular activity of the lower limb. This is an efficient test carried out very simply. Popliteal vein pressures in our hands have proved valueless. Proper prophylactic measures have reduced the incidence of post-operative and post-decubitus acute venous thrombosis, but the incidence of the acute thrombosis itself is on the increase. Various factors are presented to account for this. Intensive anticoagulant therapy is our most potent weapon in preventing the crippling effects of the post-phlebitic syndrome. Conservative treatment aimed at reducing oedema by various efficient methods is still a mainstay in the treatment of these post-phlebitic legs. More recently the surgical approach of ligation of the popliteal or superficial femoral veins has been used rather extensively. The results of this operation vary in different hands and the indications for it are diminishing. It can in some cases do harm and should not be performed indiscriminately.


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