POST-PHLEBITIC SYNDROME
About l-l .5% of patients suffering from deep venous
thrombosis in the legs develop post-phlebitic syndrome,
a complication that occurs as a consequence of
venous valve destruction. This complication is manifested
by swelling, induration and pigmentation
around the ankle and the lower third of the leg, as well
as by ulceration that usually occurs in the region of
the medial malleolus.
With the aim of decongesting the With the aim of decongesting the affected limb,
restoring skin microcirculation and introducing the
antihemostatic, vasodilatatory and anti-inflammatory
salivary agents, we started to use leeches on
patients with post-phlebitic syndrome.lo6 This ancient
treatment was used on 40 patients. Between 7 and 12
leeches were applied to the affected limb every 3-4
weeks in the course of l-25 sessions and the results
were impressive. Twenty-one patients reported
diminished leg pain and described the legs as feeling
‘less heavy’. Improved mobility, with a greater ability
to walk for long distances, was reported by 28
patients. The effect of leech therapy was almost
immediate and persisted for about three weeks.
Twelve patients came regularly once a month and
received between 6 and 25 treatments. The patients
had received other treatments prior to leech therapy,
including various vasodilators and pentoxifyllin. All
of them described leech therapy as being superior to
the other modalities. The above subjective effects
were accompanied by objective beneficial effects in
16 patients. Leech therapy improved skin circulation,
and skin color turned from dark purple to light red.
Healing of chronic skin ulcers was observed in seven
patients, and diminished circumference of the
swollen leg (by l-2 cm) was observed in five patients.
All of the patients received prophylactic tetracycline
(2 g/day) therapy for two days. None developed
fever or infection at the skin bites. No systemic
bleeding or drop in hemoglobin was noted even in
patients who received more than 20 treatments.
It usually takes about 20 min until the leech is
engorged, whereupon it drops from the bitten site
and side-effects include itching and scarring of the
bite wound. The bites are then cleaned with an antiseptic
and covered with dry gauze and an elastic bandage
to avoid excessive bleeding. We are currently
continuing this study, which has been approved by
the Human Experimentation Committee of Tel-Aviv
Sourasky Medical Center and the Ministry of