{"id":1065455,"date":"2025-12-15T22:49:20","date_gmt":"2025-12-15T19:49:20","guid":{"rendered":"https:\/\/analyse.optim.biz\/?p=1065455"},"modified":"2025-12-15T22:49:20","modified_gmt":"2025-12-15T19:49:20","slug":"sindromul-post-trombotic-si-prevenirea-membrului-post-trombotic","status":"publish","type":"post","link":"https:\/\/analyse.optim.biz\/?p=1065455","title":{"rendered":"Sindromul post-trombotic \u0219i prevenirea membrului post-trombotic"},"content":{"rendered":"
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Dr. Anda Grosu<\/span><\/a>, medic specialist <\/span>Chirurgie<\/span>vascular\u0103<\/span>, <\/span>Arcadia<\/span><\/a><\/p>\n<\/div>\n

I<\/span>nsuficien\u021ba<\/span>venoas\u0103<\/span>cronic\u0103<\/span> care se <\/span>dezvolt\u0103<\/span> ca <\/span>urmare<\/span> a <\/span>unei<\/span>tromboze<\/span>venoase<\/span>profunde<\/span>anterioare<\/span>este<\/span>denumit\u0103<\/span>\u00een<\/span> mod <\/span>obi\u0219nuit<\/span>sindrom<\/span> post-<\/span>trombotic<\/span><\/strong>sau<\/span>sindrom<\/span> post-<\/span>flebitic<\/span><\/strong>.<\/span><\/p>\n

Tratamentul<\/span>trombozei<\/span>venoase<\/span>profunde<\/span><\/a> a <\/span>fost<\/span>, din <\/span>punct<\/span> de <\/span>vedere<\/span>istoric<\/span>, <\/span>orientat<\/span>spre<\/span>prevenirea<\/span>extinderii<\/span>trombului<\/span>\u0219i<\/span> a <\/span>emboliei<\/span>pulmonare<\/span>\u00een<\/span>faza<\/span>acut\u0103<\/span>. S-a <\/span>acordat<\/span>pu\u021bin\u0103<\/span>aten\u021bie<\/span>tratamentului<\/span> pe termen lung <\/span>pentru<\/span> a <\/span>preveni<\/span>dezvoltarea<\/span>sindromului<\/span> post-<\/span>trombotic<\/span>. Cu <\/span>toate<\/span>acestea<\/span>, <\/span>30% <\/span>sau<\/span>mai<\/span>mul\u021bi<\/span>dintre<\/span>pacien\u021bi<\/span>i<\/span> cu <\/span>tromboz\u0103<\/span>venoas\u0103<\/span>profund\u0103<\/span>vor<\/span>dezvolta<\/span>caracteristici<\/span>u\u0219oare<\/span>sau<\/span> moderate de <\/span>sindrom<\/span> post-<\/span>trombotic<\/span>. <\/span><\/strong>Acest<\/span>risc<\/span>cre\u0219te<\/span>odat\u0103<\/span> cu o <\/span>tromboz\u0103<\/span>venoas\u0103<\/span>profund\u0103<\/span>mai<\/span>proximal\u0103<\/span>\u0219i<\/span> cu <\/span>episoade<\/span>recurente<\/span> de <\/span>tromboz\u0103<\/span>. <\/span>Chiar<\/span>\u0219i<\/span>\u00een<\/span>cazul<\/span>trombozei<\/span>izolate<\/span> a <\/span>venelor<\/span>gambiere<\/span>exist\u0103<\/span>riscul<\/span> de <\/span>dezvoltare<\/span> a <\/span>sindromului<\/span> post-<\/span>trombotic<\/span>.<\/span><\/p>\n

Riscul<\/span> de a <\/span>dezvolta<\/span>insuficien\u021b\u0103<\/span>venoas\u0103<\/span>cronic\u0103<\/span>sever\u0103<\/span> cu <\/span>ulcera\u021bie<\/span>\u00een<\/span>urma<\/span>unei<\/span><\/strong>tromboze<\/span>venoase<\/span>profunde<\/span><\/a>este<\/span> de 2-10% la 10 ani<\/span>.<\/span><\/strong><\/p>\n

Cauzele<\/span>sindromului<\/span> post-<\/span>trombotic<\/span><\/strong>legat<\/span> de o <\/span>tromboz\u0103<\/span>venoas\u0103<\/span>profund\u0103<\/span>anterioar\u0103<\/span> sunt fie <\/span>incompeten\u021ba<\/span>valvular\u0103<\/span>, fie <\/span>obstruc\u021bia<\/span>rezidual\u0103<\/span> a <\/span>fluxului<\/span> de <\/span>ie\u0219ire<\/span> cu <\/span>eventuala<\/span>insuficien\u021b\u0103<\/span> a <\/span>pompei<\/span>musculare<\/span> a <\/span>gambei<\/span>. <\/span>Tratamentul<\/span>trombozei<\/span>venoase<\/span>profunde<\/span>primare<\/span>trebuie<\/span>s\u0103<\/span>vizeze<\/span> nu <\/span>numai<\/span>prevenirea<\/span>propag\u0103rii<\/span>trombului<\/span>\u0219i<\/span> a <\/span>emboliei<\/span>pulmonare<\/span>, ci <\/span>\u0219i<\/span>prevenirea<\/span>leziunilor<\/span>venoase<\/span>\u0219i<\/span>conservarea<\/span>sau<\/span>restabilirea<\/span>func\u021biei<\/span>venoase<\/span>.<\/span><\/strong>Acesta<\/span>po<\/span>ate<\/span> include <\/span>anticoagularea<\/span>, <\/span>elevarea<\/span>membrelor<\/span>\u0219i<\/span>terapia<\/span> de <\/span>compresie<\/span>elastic\u0103<\/span><\/strong>. Din <\/span>ce<\/span>\u00een<\/span>ce<\/span>mai<\/span>mult<\/span>, <\/span>tromboliza<\/span>\u0219i<\/span>trombectomia<\/span>prin<\/span>cateter<\/span><\/strong> sunt <\/span>utilizate<\/span>\u00een<\/span>managementul<\/span>trombozei<\/span>venoase<\/span>profunde<\/span> acute ilio-<\/span>femurale<\/span>\u0219i<\/span>ar<\/span>trebui<\/span>s\u0103<\/span> fie considerate <\/span>terapie<\/span> de <\/span>prim\u0103<\/span>linie<\/span> la <\/span>pacien\u021bii<\/span>tineri<\/span>f\u0103r\u0103<\/span>contraindica\u021bii<\/span>. <\/span><\/p>\n

Pacien\u021bii<\/span> care au <\/span>suferit<\/span> o <\/span>tromboz\u0103<\/span>venoas\u0103<\/span>profund\u0103<\/span>trebuie<\/span>\u00eencuraja\u021bi<\/span>s\u0103<\/span>poarte<\/span>ciorapi<\/span> cu <\/span>compresie<\/span>elastic\u0103<\/span><\/strong> pe <\/span>toat\u0103<\/span>durata<\/span>vie\u021bii<\/span>, <\/span>\u00een<\/span> special <\/span>acei<\/span>pacien\u021bi<\/span> cu reflux <\/span>rezidual<\/span>\u0219i<\/span> care sunt <\/span>\u00een<\/span>ortostatism<\/span>toat\u0103<\/span>ziua<\/span>sau<\/span>fac<\/span>c\u0103l\u0103torii<\/span> lungi. <\/span>Ace\u0219tia<\/span>trebuie<\/span>\u00eencuraja\u021bi<\/span>s\u0103<\/span>fac\u0103<\/span>exerci\u021bii<\/span>fizice<\/span> regulate <\/span>pentru<\/span> a <\/span>stimula<\/span>pompa<\/span>muscular\u0103<\/span> a <\/span>gambei<\/span>\u0219i<\/span>pentru<\/span> a <\/span>men\u021bine<\/span>mobilitatea<\/span>gleznei<\/span><\/strong>. <\/span>Aceste<\/span>m\u0103suri<\/span> simple sunt <\/span>adesea<\/span>recomandate<\/span> pe <\/span>toat\u0103<\/span>durata<\/span>vie\u021bii<\/span>, <\/span>dar<\/span>exist\u0103<\/span> controverse <\/span>\u00een<\/span>ceea<\/span>ce<\/span>prive\u0219te<\/span>succesul<\/span> lor <\/span>\u00een<\/span>prevenirea<\/span>sindromului<\/span> post-<\/span>trombotic<\/span>.<\/span><\/p>\n

Pacien\u021bii<\/span> care <\/span>stau<\/span>\u00een<\/span>\u0219ezut<\/span>pentru<\/span>perioade<\/span> lungi de <\/span>timp<\/span> sunt <\/span>expu\u0219i<\/span> la o <\/span>presiune<\/span>venoas\u0103<\/span>ridicat\u0103<\/span> la <\/span>nivelul<\/span>gleznei<\/span><\/strong>pentru<\/span>perioade<\/span>mai<\/span> lungi de <\/span>timp.<\/span>Activitatea<\/span>zilnic\u0103<\/span>normal\u0103<\/span> include <\/span>activarea<\/span>pompei<\/span>musculare<\/span> a <\/span>gambei<\/span>prin<\/span>mers<\/span>, <\/span>sc\u0103z\u00e2nd<\/span>astfel<\/span>presiunea<\/span>venoas\u0103<\/span>, <\/span>iar<\/span>f\u0103r\u0103<\/span>aceast\u0103<\/span>reducere<\/span>a <\/span>presiunii<\/span>, <\/span>efectele<\/span>asupra<\/span>membrului<\/span> inferior sunt <\/span>similare<\/span> cu <\/span>cele<\/span>observate<\/span>\u00een<\/span>cazul <\/span>refluxului<\/span>venos<\/span>datorat<\/span>unei<\/span>\u201e<\/span>hipertensiuni<\/span>\u201d<\/span>venoase<\/span>prelungite<\/span>. Ca <\/span>urmare<\/span>, <\/span>pacien\u021bii<\/span>inactivi<\/span>, de <\/span>exemplu<\/span>cei<\/span>\u00een<\/span>scaun<\/span> cu <\/span>rotile<\/span>, pot <\/span>dezvolta<\/span> un <\/span>edem<\/span> de tip <\/span>venos<\/span> la <\/span>nivelul<\/span>membrelor<\/span>\u00een<\/span>absen\u021ba<\/span>unei<\/span>adev\u0103rate<\/span>patologii<\/span>venoase<\/span>. Pot fi <\/span>afecta\u021bi<\/span>\u0219i<\/span>cei<\/span> cu o <\/span>glezn\u0103<\/span>rigid\u0103<\/span>sau<\/span>fuzionat\u0103<\/span>. Prin <\/span>urmare<\/span>, ar <\/span>trebui<\/span>s\u0103<\/span> se <\/span>ia<\/span>\u00een<\/span>considerare<\/span>utilizarea<\/span>unei<\/span>terapii<\/span>profilactice<\/span> de <\/span>compresie<\/span><\/strong> la <\/span>ace\u0219ti<\/span>pacien\u021bi<\/span>. <\/span>Obezitatea<\/span>morbid\u0103<\/span> se <\/span>adaug\u0103<\/span> la <\/span>aceast\u0103<\/span>problem\u0103<\/span>\u0219i<\/span>devine<\/span> un factor etiologic major <\/span>\u00een<\/span>ulcera\u021biile<\/span>membrelor<\/span>inferioare<\/span>. <\/span>Managementul<\/span>obezit\u0103\u021bii<\/span>este<\/span> o <\/span>component\u0103<\/span>important\u0103<\/span> a <\/span>tratamentului<\/span> la <\/span>ace\u0219ti<\/span>pacien\u021bi<\/span>, <\/span>p<\/span>ut\u00e2nd<\/span> fi <\/span>realizat<\/span> cu <\/span>asisten\u021ba<\/span>medical\u0103<\/span>primar\u0103<\/span>\u00een<\/span>majoritatea<\/span>cazurilor<\/span>.<\/span><\/p>\n<\/div>\n<\/div>\n

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Cum <\/span>putem<\/span>preveni<\/span>tromboza<\/span>venoas\u0103<\/span>profund\u0103<\/span>?<\/span><\/h4>\n

Pacien\u021bilor<\/span> cu <\/span>risc<\/span> de <\/span>tromboz\u0103<\/span>venoas\u0103<\/span>profund\u0103<\/span><\/strong>li <\/span>se <\/span>recomand\u0103<\/span>:<\/span><\/p>\n