Thrombophlebitis of the lower extremities - Causes, Symptoms and Treatment .MF .
thrombophlebitis of the lower extremities - an inflammation of the vein wall in conjunction with the formation of a blood clot.It is now believed that the closure of the lumen of the vein blood clots and inflammation of the vein wall - two processes that exist in close connection, supporting each other.
This article will be considered in detail thrombophlebitis of superficial veins of the lower extremities, thrombophlebitis of deep veins detailed in Article flebotromboz (thrombosis of the deep veins of the lower extremities).
for thrombus formation is necessary the presence of three groups of factors, one of which is usually more pronounced:
1. Damage to the vein wall. Superficial veins, because of their location significantly exposed to mechanical stress, and the presence of the thin wall further increases the risk of injury.We should not forget about the Bad iatrogenic (when operating health professional) influence on blood vessels during surgical procedures, the introd
2. Slower blood flow. great importance for the realization of this risk factor is prolonged bed rest, compression of tissue surrounding the vein, such as gypsum in the case of fracture fixation at lower extremities injuries by crushing.Also it should be noted conditions associated with the general slowing of blood flow in the body.A typical example is the expressed heart failure, when the heart can not pump the necessary amount of blood in the lower extremities are formed of stagnation with a reduction of blood flow velocity.
3. Increased blood clotting. may be congenital, when there is a defect in the normal functioning of the blood system, and acquired, such as infectious diseases, hormonal imbalance, taking certain medications, as well as in cancer.
Usually, the inflammation is in the vein of aseptic (non-microbial), as a reaction to damage the wall or thrombus formation.But in some cases, the presence of bacteria in the bloodstream or outside the vein thrombosis joins purulent process.Then talk about suppurative thrombophlebitis.
So, in compliance with the above conditions vein thrombus formed in conjunction with the inflammatory response of its walls.In the future, the process can go two ways.
spontaneously or during treatment of thrombus growth stops, wall inflammation subsides.Thrombus somewhat reduced in size and, depending on its size, can completely or partially close the lumen.In the case of complete closure of the lumen and cessation of blood flow in this area Vienna zapustevaet and contracts.Risk of blood clot separation in this case becomes the minimum.
In another case scenario, thrombus formation and inflammation continues.As a consequence of continued growth thrombus becomes "floating", that is, one end is attached to the wall, and the other is free in the lumen of the vein.Inflammation makes the blood clot "loose" unstable.As a result, even minimal mechanical action can lead to detachment of the thrombus.Develops pulmonary embolism - a dangerous complication of thrombophlebitis.Thus thrombus enters the pulmonary vessels, partially or completely disrupting the respiratory system.For large amounts of thrombus this complication is fatal.
In the case of a blood clot stability, it grows in the upward direction, while through the perforating veins, ruining their valves, it penetrates into the deep veins.Develops flebotromboz (thrombosis of the deep veins of the lower extremities).The growing thrombus destroys the valves in the superficial and deep veins of communicating, develop chronic venous insufficiency.
most frequently (95%) affected the great saphenous Vienna, in the small saphenous vein thrombophlebitis formed much less.
Symptoms of thrombophlebitis of superficial veins
Depending on the nature of the process distinguish acute and chronic thrombophlebitis.
Often acute thrombophlebitis develops suddenly, without any apparent reason.Sometimes, there are indications of lower limb injury.Often it can detect viral infection in a patient, oral contraceptives and other conditions that are accompanied by increase in blood clotting.Very often, thrombophlebitis develops as a complication of varicose veins.
Local manifestations of thrombophlebitis usually prevail, and the general state of health is satisfactory.There are intense pain along the thrombosed veins, limb movement restrictions.In the area of the affected vein is marked redness, which becomes more extended with the progression of the disease.
external manifestations of thrombophlebitis.
noted an increase in skin temperature in the area of redness.In this area reveals a dense, braid, cord sharply painful - struck Vienna.If the process involved veins, the varices become dense, painful, can significantly increase in size.
Sometimes there is a small swelling of the lower limbs, but only in the area of the affected vein that distinguishes this disease from deep vein thrombosis.
Common manifestations of the disease are considered to be fever, usually no higher than 38 degrees, malaise, chills.
distinguish advanced varicose vein from the thrombosed veins can be the absence of redness, fever and pain in the region of their location.Furthermore, in a horizontal position fallen down varicose veins, as blood in the deep veins of leaves.Thrombosed Vienna can only grow in size with the progression of the disease.
Chronic thrombophlebitis is prolonged, with periodic exacerbations.At an exacerbation of the disease causes the above symptoms, is worsening external signs may be absent.
Repeated thrombophlebitis, occurring in different veins intact are referred to as migrating phlebitis.A migratory phlebitis - an occasion for a detailed examination, because it may be accompanied by tumors.
Instrumental methods of research aimed at confirming the fact of thrombophlebitis and determining the location and extent of thrombus, and assess the risk of separation of its parts.Typically, ultrasound of the lower extremities is quite informative.
Treatment of thrombophlebitis of superficial veins
In the course of treatment is necessary to prevent the spread of the deep veins (the risk of pulmonary embolism), reduce the symptoms of inflammation and to prevent recurrence of the disease.
the presence of thrombophlebitis varices without spreading to the deep veins can be cured at home.With the threat of pulmonary embolism and the severity of inflammation indicated treatment in a hospital.Regardless of the treatment regimen is needed elastic compression, pharmacotherapy and local treatment.
elastic compression bandaging is a tight 7-10 days around the clock, then the use of compression stockings during the day.
Pharmacotherapy involves the use of drugs that strengthen the vein wall (Detraleks, Cyclo 3 Fort Ginkor-fort Troxevasin), preventing further blood clots (aspirin), anti-inflammatory drugs (ketoprofen, diclofenac).Locally
- ointment dissolving thrombi (heparin ointment, gel lioton) and ointments or gels that reduce inflammation (ketonal gel).
As an analgesic effect locally within 2-3 days from the onset of inflammation can be applied cold on the affected area of the veins.
If there is a risk of thrombotic complications prescribe anticoagulants.Usually begins with intravenous administration of anticoagulants (LMWH), and then move on to receive anticoagulants inside.Oral anticoagulants prescribed for several months to prevent recurrence.If you are using anticoagulants need to be tested regularly and monitor the incidence of bleeding (redness of the urine, change in stool color, bleeding gums, bleeding from the nose) Girudinoterapiyu (leeches) should only be used in acute thrombophlebitis, if the patient has a contraindication to anticoagulants (drugs lowering coagulationblood).Hirudin, falling from leeches iron in the blood, lowers its viscosity and clotting.Along with this arterial spasm disappears.Leeches can be placed at the same time of 5-10 pieces on a limb along the affected vessel, in 5-6 days to repeat the procedure.The skin of the limb should be shaved and washed with warm water without soap.To quickly sucking leeches skin smeared with a solution of glucose or sugar water.Do not remove the power of the leech, as she sucked 10-20 ml of blood is no longer itself.Not recommended for use leeches for anemia, reduced blood clotting, in the first months of pregnancy and during treatment with mercury preparations.
As a means of direct exposure to blood clots using fibrinolytics, which in the early stages of the process leading to the lysis of blood clots.For drugs fibrinolytic action are fibrinolizin, streptokinase, urokinase, trypsin, chymotrypsin.
If thrombosis combined with deep vein thrombosis, prescribe thrombolytic drugs inside.
Physiotherapy techniques (ultraviolet irradiation, solljuks, infrared rays, etc..) Is used in the chronic stage of superficial thrombophlebitis, in the organization of a blood clot.Spa treatment (Pyatigorsk, Sochi-Matsesta) can be solved only when strictly individual long-existing chronic superficial thrombophlebitis without exacerbations and trophic disorders.
At high temperatures or suspected suppurative thrombophlebitis used antibiotics.
In the absence of effect of conservative treatment shows the surgical removal of veins or her area, depending on the severity of the process.
Prevention detachment and migration of thrombus
main task is to prevent thrombus detachment and migration of his lungs.Currently, for these purposes, it is widely used in the administration of the inferior vena cava lumen special traps - cava filter.This wire structure in the form of an umbrella, which is through a puncture into a vein, where disclosed.Cava filter passes the blood, but retains large clots.The method is security, high reliability, but it has some significant drawbacks.When thrombus filter catches, it is often thrombosing itself, and this leads to the spread of edema and blood clots on the other foot with the development of severe venous insufficiency of both lower extremities.Thromboembolism did not occur, however, the disease develops postthrombotic with the possible development of venous ulcers.In rare cases, thrombosis may spread above cava filter.
There are no less effective method of preventing thromboembolic events, but requires high surgical skills.This thrombectomy (removal of blood clots from the veins).This surgery can not only eliminate the source of thromboembolism, but also improve the long-term results of treatment of deep venous thrombosis.Postthrombotic disease after qualitative removal of blood clots do not develop.
complications thrombophlebitis of superficial veins and forecast
Complications of superficial thrombophlebitis are rare.It is dangerous when the clot breaks off and leads to thromboembolism.However, in contrast to deep vein thrombosis, rarely accompanied by inflammation, superficial thrombophlebitis is usually accompanied by an acute inflammatory response, resulting in thrombus adheres to the vessel wall.The probability of getting separation and very low in the bloodstream.Moreover, superficial veins, as opposed to deep, not surrounded by muscle, which contribute to reduce the compression and displacement of the clot, which can lead to its tearing.For these reasons, superficial thrombophlebitis rarely complicated by thromboembolism.However, possible complications are superficial thrombophlebitis.
Be sure to tell the doctor that in spite of the treatment of superficial thrombophlebitis symptoms do not decrease or increase.Provide also the appearance of new symptoms, such as fever, chills, pallor and limb edema.Changing of
color at sites of thrombosis may be significantly long time after the treatment, this is not a pathological symptom.Prevention of thrombophlebitis
The main preventive measure is the careful thrombophlebitis dynamic control in the presence of varicose veins of the lower extremities, and, if necessary, carrying conservative or surgical treatment.
One of the main factors predpraspologayuschih thrombophlebitis - restriction of movements.In this regard, it is necessary to maintain adequate range of motion in the limb.
therapists Sirotkin EV