Thrombophlebitis of the veins of the lower extremities - Causes, symptoms and treatment. MF.
Thrombophlebitis of the veins of the lower extremities is the inflammation of the vein wall in combination with the formation of a thrombus. Currently, it is believed that closing the vein lumen with a blood clot and inflammation of the vein wall are two processes that exist in close connection, supporting each other.
This article will detail thrombophlebitis of the superficial veins of the lower extremities, and thrombophlebitis of the deep veins is detailed in the article phlebothrombosis( deep vein thrombosis of the lower extremities).
Causes of thrombophlebitis
Thrombus formation requires three groups of factors, one of which is usually stronger:
1. Damage to the venous wall. Surface veins, due to their location, are highly susceptible to mechanical attack, and the presence of a thin wall in them further increases the risk of injury. We should not forget about the undesirable iatrogenic( during the actions of the medical worker) effect on the vessels during surgical operations, the introduction of concentrated solutions, for example, hypertonic glucose solution, and also the placement of intravenous catheters.
2. Slowing the movement of blood. The long-term bed rest, compression of the surrounding tissues, for example, with gypsum fixation in case of a fracture, with trauma of the lower limbs as a result of crushing, is of great importance for the realization of this risk factor. It is also necessary to note the conditions associated with a general slowing of the blood flow in the body. A typical example is severe heart failure, when the heart can not pump the required volume of blood, stagnation forms with lowering of the blood flow velocity in the region of the lower limbs.
3. Increased blood clotting. May be congenital if there is a defect in the normal functioning of the blood system, and acquired, for example, in infectious diseases, hormonal imbalance, taking certain medications, as well as with cancer.
As a rule, inflammation in the vein is aseptic( without microbial), as a reaction to wall damage or thrombus formation. But in a number of cases, in the presence of microbes in the bloodstream or outside of the vein, a purulent process joins thrombosis. Then they say about purulent thrombophlebitis.
So, if the above conditions are met, a vein thrombus is formed in combination with an inflammatory reaction of its wall. In the future, the process can go in two ways.
Spontaneously or in the process of treatment, the growth of the thrombus stops, the inflammation of the wall subsides. The thrombus somewhat diminishes in size and, depending on its magnitude, can completely or partially cover the lumen of the vessel. In the case of complete closure of the lumen and the cessation of blood flow in this area, the vein starts to empty and falls. The risk of a thrombus rupture becomes minimal in this case.
In another scenario, thrombus formation and inflammatory events continue. As a result of constant growth, the thrombus becomes "floating", that is, one end is attached to the wall, and the other is freely located in the lumen of the vein. Inflammatory phenomena make the thrombus "loose", unstable. As a result, even a minimal mechanical impact can lead to the detachment of a part of the thrombus. Develops thromboembolism of the pulmonary artery - a formidable complication of thrombophlebitis. In this case, the thrombus enters the vessels of the lungs, partially or completely disrupting the work of the respiratory system. With a large thrombus, this complication becomes fatal.
In case of thrombus stability, it grows upwards, and through the communication veins, destroying their valves, it penetrates into the deep veins. Develops phlebothrombosis( deep vein thrombosis of the lower extremities).A growing thrombus destroys the valves in the superficial, communicative and deep veins, develops a chronic venous insufficiency.
The most common( in 95% of cases) is the large subcutaneous vein, in the small saphenous vein thrombophlebitis is formed much less often.
Symptoms of thrombophlebitis of superficial veins
Depending on the nature of the process, acute and chronic thrombophlebitis is isolated.
Often, acute thrombophlebitis develops suddenly, without any apparent cause. Sometimes there is an indication of a trauma to the lower limb. It is often possible to detect the presence of a virus infection in the patient, the use of oral contraceptives and other conditions that are accompanied by an increase in blood coagulability. Very often, thrombophlebitis develops as a complication of varicose veins.
Local manifestations of thrombophlebitis, as a rule, prevail, while overall health remains satisfactory. There are intense pain along the thrombosed vein, limiting limb movement. In the area of the affected vein, redness is noted, which, with the progression of the disease, becomes more extensive.
External manifestations of thrombophlebitis.
There is an increase in skin temperature in the area of redness. In this zone, a dense, cord-like, severely painful, severely affected vein emerges. If the enlarged veins are involved in the process, the varicose nodules become dense, painful, can significantly increase in size.
Sometimes a small swelling of the lower limb is noted, but only in the area of the affected vein, which distinguishes this disease from deep vein thrombosis.
General manifestations of the disease are considered to be fever, usually not more than 38 degrees, malaise, chills.
It is possible to distinguish the enlarged varicose veins from thrombosed veins by the absence of redness, rising temperature and pain in the area of their location. In addition, in a horizontal position, varicose veins collapse, as the blood goes into deep veins. The thrombosed vein can only increase in size with the progression of the disease.
Chronic thrombophlebitis proceeds for a long time, with periodic exacerbations. When the disease worsens, the above manifestations occur, outside the exacerbation, external symptoms may be absent.
Repeated thrombophlebitis occurring in different intact veins is designated as migrating phlebitis. Migrating phlebitis is an occasion for detailed examination, as it can accompany tumors.
Diagnosis of thrombophlebitis
Instrumental methods of the study are aimed at confirming the fact of thrombophlebitis and determining the location and extent of the thrombus, as well as assessing the risk of detachment of its part. As a rule, ultrasound of the veins of the lower extremities is quite informative.
Treatment of thrombophlebitis of superficial veins
During treatment, it is necessary to prevent the spread of the process to the deep veins( risk of pulmonary embolism), to reduce inflammation and prevent the recurrence of the disease.
If there is thrombophlebitis of varicose veins without spreading to deep veins, treatment at home is possible. If there is a threat of pulmonary embolism and severe inflammation, treatment in the hospital is indicated. Regardless of the treatment regimen, elastic compression, pharmacotherapy and topical treatment are necessary.
Elastic compression consists in tight bandaging of 7-10 days around the clock, then application of compression knitwear in the daytime.
Pharmacotherapy includes the use of drugs that strengthen the vein wall( Detralex, Cyclo 3 Fort, Ginkor Fort, Troxevasin), preventing further thrombosis( aspirin), anti-inflammatory drugs( ketoprofen, diclofenac).
Local - ointments that dissolve thrombi( heparin ointment, lyoton-gel), as well as ointments or gels that reduce inflammation( ketonal gel).
As an analgesic effect locally in the course of 2-3 days from the onset of inflammation, it is possible to apply cold to the area of the affected vein.
If there is a risk of thrombotic complications, anticoagulants are prescribed. Usually they start with the introduction of intravenous anticoagulants( low molecular weight heparins), and then they switch to taking anticoagulants inside. Oral anticoagulants are prescribed for several months to prevent recurrence. When using anticoagulants, it is necessary to regularly take tests and monitor the manifestations of bleeding( redness of the urine, discoloration of the stool, bleeding gums, bleeding from the nose). Hirudinotherapy( leeches) should be used only in acute thrombophlebitis if the patient has contraindications to anticoagulants( drugs that reduce coagulabilityblood).Hirudin, getting from the glands of leeches into the blood, lowers its viscosity and coagulability. Along with this, spasm of arterial vessels disappears. Leeches can be put simultaneously at 5-10 pieces per limb along the course of the affected vessel, after 5-6 days repeat the procedure. The skin on the limb should be shaved and washed with warm water without soap. To quickly suck on leeches, the skin is lubricated with glucose solution or sweet water. Force leech should not be removed, since it, pumping in 10-20 ml of blood, disappears itself. It is not recommended to use leeches for anemia, low blood clotting, during the first months of pregnancy and during treatment with mercury preparations.
As a means of directly affecting thrombi, fibrinolytics are used, which in the early stages of the process lead to the lysis of blood clots. Fibrinolytic drugs include fibrinolysin, streptokinase, urokinase, trypsin, chymotrypsin.
If thrombophlebitis is combined with deep vein thrombosis, thrombolytic drugs are administered orally.
Physiotherapy methods( ultraviolet irradiation, solux, infrared rays, etc.) are used in the chronic stage of superficial thrombophlebitis, during the period of thrombus organization. Spa treatment( Pyatigorsk, Sochi-Matsesta) can be resolved strictly individually only with long-term chronic superficial thrombophlebitis without exacerbations and trophic disorders.
Antibiotics are used at high temperature or suspected purulent thrombophlebitis.
In the absence of the effect of conservative treatment, operative removal of the vein or its site is shown depending on the severity of the process.
Prophylaxis for the detachment and transfer of the thrombus
The main task is to prevent the removal of thrombus and its migration into the lungs. At present, for these purposes, the introduction into the lumen of the inferior vena cava of a special trap - the cava filter - is widely used. This wire structure in the form of an umbrella, which through the puncture is inserted into the vein, where it opens. Cava filter passes blood, but delays large blood clots. The method is characterized by safety, high reliability, but has a number of significant drawbacks. When the filter catches a thrombus, it is often thrombosed itself, and this leads to the spread of edema and blood clots to the other leg with the development of severe venous insufficiency of both lower extremities. Thromboembolism does not occur, but post-thrombotic disease develops with the possible development of trophic ulcers. In rare cases, thrombosis can spread even above the cava filter.
There is no less effective method of preventing thromboembolism, but requiring high surgical skills. This is a thrombectomy( removal of thrombi from the veins).This surgery allows not only to eliminate the source of thromboembolism, but also to improve the long-term results of treatment of deep venous thrombosis. Post-thrombotic disease after qualitative removal of thrombi does not develop.
Surface vein thrombophlebitis complications and
prognosis Complications of superficial thrombophlebitis occur extremely rarely. It is dangerous when the thrombus breaks and leads to thromboembolism. However, unlike deep vein thrombosis, which is rarely accompanied by inflammation, superficial thrombophlebitis is usually accompanied by an acute inflammatory reaction, resulting in a thrombus sticking to the wall of the vessel. The likelihood of its detachment and entry into the bloodstream is very small. In addition, the superficial veins, unlike the deep veins, are not surrounded by muscles, the contractions of which contribute to compression and displacement of the thrombus, which can lead to its separation. For these reasons, surface thrombophlebitis is rarely complicated by thromboembolism. Nevertheless, possible complications of superficial thrombophlebitis are as follows.
Be sure to tell the doctor that despite the treatment of superficial thrombophlebitis, the symptoms do not decrease or increase. Also report on the appearance of new symptoms, such as fever, chills, pallor and swelling of the extremity.
Changes in skin color in the place of manifestation of thrombophlebitis can remain noticeably long after treatment, this is not a pathological symptom.
Thrombophlebitis prophylaxis
The main measure of thrombophlebitis prophylaxis is careful dynamic control in the presence of varicose disease of the lower limbs, and, if necessary, conservative or surgical treatment.
One of the main pre-factors of thrombophlebitis is the restriction of movements. In this regard, it is necessary to maintain a sufficient amount of movements in the limbs.
Doctor therapist Sirotkina EV