Postmastectomy phlebothrombosis and methods of physical therapy

Abstract

The leading complication of radical breast cancer treatment is upper limb edema. In its pathogenesis, intravasal disorders, i.e. phlebothrombosis, are also possible. 98 breast cancer patients (53.8 years old) were observed. The patients were diagnosed with phlebolymphedema stage II caused by subacute occlusive thrombosis (non-embolic) of the axillary vein on the side of the operation. After diagnosis, the hemorheological properties in patients were studied, and basic pharmacotherapy with enoxaparin was prescribed. The patients were randomized into 3 groups: group 1 (n=40) additionally received local magnetic therapy with an alternating magnetic field, group 2 (n=37) — continuous infrared laser radiation for 10–12 days, and group 3 (n=21) received only basic pharmacotherapy. The initial rheological parameters: structural and dynamic viscosity of blood exceeded the reference values by 2.8 and 1.6 times, respectively, aggregation of erythrocytes — by 1.5 times, and aggregation of platelets — by 1.4 times. On day 7 from the start of the procedures, pharmacotherapy did not cause statistically significant changes in rheological parameters, while in groups 1 and 2, there was a decrease in structural and dynamic viscosity of blood by an average of 15.5 % and 16.5 %, respectively, in aggregation of erythrocytes — by 14.5 %, and in aggregation of platelets — by 14.5 % (P<0.05). A comparative analysis of the degree of change in these parameters in patients of groups 1 and 2 did not reveal statistically significant differences, which indicates the unidirectional effect of the magnetic field and laser radiation on blood rheology. After the course of treatment, edema decrease accounted for 16.5±1.2 % in group 1, 13.8±1.8 % in group 2, and 7.5±1.4 % in group 3. Recanalization of the axillary vein lumen in group 1 was up to 80 %, in group 2 — up to 70 %, and in group 3–30 %. The rheological status of patients can be a potential marker of the effectiveness of their rehabilitation.