Cardiovascular changes in patients with post-thrombotic syndrome of the lower extremities during recanalization

Background: after deep vein thrombosis, 20-50% of patients demonstrate post-thrombotic syndrome of the lower extremities (PTSLE) that lead to severe hemodynamic disorders affecting not only venous system, but also heart, arteries and microcirculation. Despite vein recanalization, their function remains significantly impaired due to persistent obstruction and reflux through damaged valves. Aim: to evaluate a relationship between venous and arterial hemodynamics, as well as cardiac function in patients with PTSLE during recanalization, and to determine main pathogenetic mechanisms of its progression. Materials and Methods: 75 patients with PTSLE at a recanalization stage were enrolled in the study; a control group consisted of 20 healthy individuals. All patients underwent Color Doppler Imaging (CDI) of the extremity vessels, additional exfusion flow (AEF) measurement, echocardiography, electrocardiography, biophotometry and capillaroscopy. Results: PTSLE recanalization was verified by CDI data. The superficial femoral (SFV) and deep femoral veins (DFV) lost their transport function (blood flow velocity decreased by 61%, SFV volumetric outflow decreased by 3.8 times). Primary outflow (58.4%) was carried out through the bypasses and the dilated great saphenous vein (GSV). High AEF values (31-32 ml/min) confirmed abnormal counterpulsation. The patients demonstrated signs of underloading of the heart such as decreased filling pressure of the right heart chambers, longer phase of isometric contraction of the left ventricle, as well as decreased cardiac output and increased peripheral resistance in an upright position. Increased fluid filtration (up to 14.57 ml/min), protein loss (up to 4.6%), and tissue hypoxia (a decrease in рO2 level to 12.18 mmHg) evidenced progressive transcapillary exchange disorders. Compensatory arteriovenous bypass surgery aggravated hypoxia. Conclusion: vein recanalization does not lead to restoration of their function because main burden falls on the bypasses and GSV. Chronic venous return deficiency results in underloading of the heart and a decrease in its productivity. Progression of microcirculation disorders correlates with severity of PTSLE KEYWORDS: post-thrombotic syndrome, venous hemodynamics, arterial blood flow, cardiac dysfunction, vein recanalization, additional exfusion flow. FOR CITATION: Yarovenko G.V., Katorkin S.E. Cardiovascular changes in patients with post-thrombotic syndrome of the lower extremities during recanalization. Russian Medical Inquiry. 2026;10(4):177–183 (in Russ.). DOI: 10.32364/2587-6821-2026-10-4-1