THE POSTPHLEBITIC SYNDROME

The persistence of symptoms and the disability caused by the postphlebitic syndrome are frequently more serious than the originating thrombosis. The underlying cause of this circulatory disturbance of the lower extremity is venous hypertension due to incompetent valves of the deep, the communicating and the superficial veins of the leg. The symptoms are persistent edema, induration, bursting pain, varicosities, pigmentation, ulceration and recurrent streptococcic infections.

With the aid of venography Bauer¹ demonstrated valvular incompetence of the femoral and the popliteal veins in 55 of 100 consecutive cases of varicosities and leg ulcers. The remaining 45 patients presented prominent varicosities and a positive Trendelenburg reaction but no edema or leg ulcers. The phlebograms in these patients indicated normal femoral veins. The past history of 55 patients in Bauer's material revealed a previous deep thrombosis in 25 and absence of such a history in 30. Bauer concluded that a congenital weakness