Go Deep venous thrombophlebitis of the lower extremities: symptoms, treatment, photo
medicine online

Deep vein thrombophlebitis of the lower extremities: symptoms, treatment

Content:

Deep vein thrombophlebitis of the lower extremities Deep vein thrombophlebitis (DVT) of the lower extremities is characterized by the formation of blood clots (blood clots) in their cavities, accompanied by inflammation of the vascular walls. This potential threat to life is the result of septic processes developing around the affected vein.



Causes of disease

The exact causes of the development of deep vein thrombophlebitis of the lower extremities for each specific case cannot be always established. Doctors identify several major risk factors for its development.

  • Age. The risk of blood clot formation and the development of complications doubles after a person reaches the age of 40 years. This is due to the slowing down of blood flow and sclerosis (compaction, hardening) of the walls of blood vessels.
  • Lower limb varices are one of the most common causes of thrombophlebitis. In this case, the vessels already have all the prerequisites for its development: slowing blood flow, expansion and deformation of the walls.
  • Antiphospholipid syndrome. The condition is characterized by severe hypercoagulation (increased blood clotting), leading to the formation of blood clots in the bloodstream.
  • Hypercoagulable syndromes. Even in the absence of blood clots, there is an increased readiness of blood for clotting.
  • Fractures of the leg bones. Accompanied by the development of thrombosis in 60-70% of cases.
  • Surgical intervention. As a result of stress, long-term muscle relaxation under the influence of anesthesia, tissue injury, impaired microcirculation, the release of thromboplastin into the bloodstream is activated, the fibrinolytic activity (clotting index) of the blood decreases. The risk of thrombotic complications is directly proportional to the duration of the surgery.
  • Excess weight. Almost all cases of obesity are accompanied by thromboembolic complications. The risk of their development increases 5 times with III – IV degree of obesity.
  • Pregnancy and childbirth. In the presence of pathologies of deep veins, prolonged static loads on the legs are especially dangerous.
  • Circulatory insufficiency, accompanied by swelling of the legs and lack of motor activity (hypokinesia).
  • Damage to blood vessels in various injuries in the home, at work, in the event of a traffic accident, gunshot wounds.
  • Dehydration, hypothermia.
  • Disorders of the autoimmune system, as well as vasculitis , endarteritis, cardiac ischemia and other associated diseases.
  • Bacterial and viral infections that cause toxic damage to a single layer of cells lining the inner surfaces of blood vessels (endothelium)
  • Oncological diseases. The diagnosis of thrombophlebitis is the reason for further examinations for the presence of malignant tumors - the gastrointestinal tract, lungs, ovaries. It may be due to leukemia, a brain tumor.
  • Abuse of certain medications, such as contraceptives.
  • The inconvenient position of the legs during long trips in the bus, car, flight in an airplane, forced immobility with bed rest.
  • Smoking, drinking alcohol.

To provoke the development of thrombophlebitis of the deep veins of the lower extremities can any damage to the vessels as a result of industrial, household, firearms, road traffic injuries. Precursors of the disease may be exacerbation of allergies, tonsillitis.

The risk group includes:

  • persons older than 40 years;
  • overweight people;
  • pregnant women;
  • employees of "sedentary" professions - drivers, office workers;
  • active smokers;
  • alcohol abusers.

The risk group includes people who have to spend on their feet for a long time due to the nature of their professional activities. In Western Europe, there is such a thing as “television thrombophlebitis” - a disease that develops in the lovers of many hours sitting in front of a “blue” screen.

The course of deep vein thrombophlebitis on the legs can be without acute clinical manifestations. Often the symptoms of the disease appear only after 10 years, provided the external well-being of the general state of health. A detailed study of lifestyle reveals violations of the daily and nutritional regimes, as well as other factors contributing to the development of pathology.

The mechanism of development of deep vein thrombophlebitis of the lower extremities

The primary localization of thrombosis of the main pelvic veins, and the veins of the thigh are often veins located in the ileal-femoral region and deep veins of the leg. Initially, from platelets deposited in areas with impaired integrity of the endothelial layer and on the surface of the valves of the deep veins of the leg. Separation of the “white” thrombus is possible in the period of its weak fixation to the vessel walls - in the first 3-4 days after formation. The result may be thromboembolism of the branches of the pulmonary artery. After adhesion of the “white” thrombus to the venous wall and the release of tissue thromboplastin, a “red” thrombus is formed. The attachment of intimal inflammation (the inner lining of blood vessel walls) after 5–6 days ensures its fixation.

The main links in the mechanism of deep vein thrombophlebitis is hypercoagulation and slower blood flow. The blood flow is disturbed and the entire microcirculation system is upset. The blood flow changes its direction, which is accompanied by an overload of the superficial venous system, which is not adapted to receive blood from the deep veins. At the same time, the valves in the perforating veins, connecting the superficial vessels with the deep ones, change. Thrombotic vascular lesion covers the main veins.

Thrombosis can develop independently in two areas of the vein or isolated in one of the segments of the vein, as well as spread along the continuation, or Venous blood clots can shift, migrate, partially collapse or even resolve completely. Deep vein thrombosis of the leg can spread to the popliteal, and then the femoral vein.

Thrombophlebitis forms

The classification of deep vein thrombophlebitis of the lower extremities is determined by the course of the disease.

  • Acute deep vein thrombophlebitis is manifested sharply, often for no apparent reason. It is characterized by intolerable muscle pain, rapid swelling of the legs. The cure of the acute form of deep vein thrombophlebitis is completely possible. In most cases, the disease becomes the cause of chronic venous insufficiency - for life.
  • Chronic deep vein thrombophlebitis - can affect only deep veins or develop on the background of superficial thrombophlebitis.

Thrombophlebitis of the deep veins of the lower extremities may be accompanied by the development of abscesses, ulcers.

Symptoms of deep vein thrombophlebitis of the lower extremities

Clinical manifestations of deep vein thrombophlebitis of the lower extremities occur only in 50% of cases:

  • swelling of the legs and feet;
  • inflammation, "bursting" acute pain in the calf muscles;
  • cutaneous cyanosis (blue);
  • Lowenberg's symptom is tenderness of the calf muscles when a sphygmomanometer cuff is squeezed (80–100 mmHg);
  • Moses symptom - pain in the lower leg when squeezed;
  • a sign of Louvel - coughing, sneezing accompanied by painful sensations in the leg;
  • Homans symptom - when the foot flexes inward, the pain increases.

Thrombosis of the popliteal vein is accompanied by an increase in the volume of the tibia by 3 cm or more. Thrombophlebitis of the femoral vein edema extends to the thigh, which is simultaneously accompanied by the appearance of painful sensations along the course of the vascular bundle.

At the same time, deep vein thrombophlebitis may be accompanied by general signs of aseptic inflammation:

  • leukocytosis - an increase in the level of leukocytes in the blood;
  • adynamia - decrease or termination of motor activity;
  • pain in the lumbar and sacral spine;
  • lower abdominal pain;
  • general weakness;
  • moderate fever.

The nature and severity of symptoms is determined by the rate of development of the disease, its length, the degree of prevalence in the proximal (to the center of the body) and distal (from the center of the body) directions. The most dangerous is the first variant of the direction of development of thrombophlebitis - the risk of pulmonary thromboembolism. One motion is enough to increase the blood flow and trigger a tearing of the “floating” thrombus, with the proximal part sagging loosely into the lumen of the vessel.

Symptoms of deep vein thrombophlebitis often require a differential diagnosis with arthritis, arthritis, muscle sprains, Achilles tendon injuries, and other diseases characterized by similar symptoms.

Diagnostics

An experienced phlebologist is more likely to make a preliminary diagnosis based on history and physical examination. The doctor uses functional tests to detect latent deep vein thrombophlebitis.

  • Sample Moses. Phlebologist slightly squeezes the patient's lower back and front palms.
  • Homans symptom. The patient lies on his back on a couch with his legs bent at the knees and trying to rotate his foot.
  • Opitz-Ramines test - a sphingmanometer cuff is applied above the knee and it is pumped up to 150 mmHg. Art.
  • Test Lovenberg - cuff superimposed on the middle part of the leg.

At the same time, laboratory analyzes of blood composition and instrumental diagnostics are performed - ultrasound studies:

  • Doppler sonography - reveals the localization of thrombosis;
  • duplex angioscanning - used to determine the nature of thrombosis, thrombus boundaries, to assess the permeability of perforating veins and the degree of inflammation of the surrounding tissues.

In thrombotic processes in the inferior vena cava and ileal veins, retrograde ileokawagrafiya is performed.

Impedance plethysmography makes it possible to diagnose GWT above the knee with 90% accuracy.

To identify the causes of the disease and determine the treatment regimen, the phlebologist may prescribe an MRI or CT scan, as well as consult other specialists: an allergist, a gynecologist, a gastroenterologist.

Treatment of deep vein thrombophlebitis of the legs

Due to the high risk of thrombus separation, inpatient treatment of deep vein thrombophlebitis of the lower extremities is recommended. In severe forms of the disease, bed rest is prescribed for 7–10 days. During this time, the thrombus is fixed on the venous wall. To relieve pain, reduce swelling and improve blood flow, the lower end of the bed rises slightly. Then the patient is recommended motor mode. Static vertical staying is limited.

At the same time, physical exercises are prescribed - bending of the feet and fingers, walking in the ward. A good gymnastic complex performed in the supine position has a good rehabilitative effect.

Exercise stimulates venous outflow from the limbs and compensates for the activity of the cardiovascular system as a whole. At the same time, thanks to muscle contraction, growth of tissue plasminogen is ensured. All leg exercises are performed only under conditions of their elastic compression with bandages, special hosiery products from the feet to the inguinal folds.

Compression treatment helps to reduce the venous "capacity" of the legs, accelerate the venous outflow, and also improves the functional ability of the valve apparatus. The edema decreases, the fibrinolytic activity of the blood increases.

To improve the efficiency of elastic compression, the skin in areas of thrombotic processes is actively lubricated with non-steroidal anti-inflammatory drugs (NSAIDs), active phlebotropic ointments.

Subsequently, patients are encouraged to go swimming, jogging, skiing, cycling. The use of appropriate exercise equipment is also recommended.

Ointments, gels can reduce inflammation, relieve pain, reduce the level of blood clotting. But in case of thrombophlebitis of the deep veins of the lower extremities, they are ineffective; therefore, medication in tablets and injections are additionally prescribed.

Great importance for the treatment of thrombophlebitis is proper nutrition. Traditional medicine should be used only after prior medical consultation.

Deep vein physiotherapy for thrombophlebitis

There are several methods of physiotherapy treatment used in DVT of the legs.

  • Electrophoresis - drugs are injected through the skin using an electric current.
  • UHF - under the influence of high-frequency electric fields in the affected areas stimulated lymph flow, blood circulation, regeneration processes in general.
  • Paraffin applications are useful in case of the threat of formation of trophic ulcers. The technique is not used in acute thrombophlebitis.
  • Magnetotherapy - under the influence of a magnetic field, the characteristics of the blood are improved.

In acute thrombophlebitis of the deep veins of the lower extremities, hirudotherapy (leech therapy) can be used. Inflammation is removed, blood flow improves, and the risk of new clots is reduced. Aesthetically not attractive procedure is a good tool for people who do not tolerate drugs, thinning shelter.

Operative intervention

With the threat of pulmonary thromboembolism, ascending thrombophlebitis, as well as in the case of movement of a severed blood clot to the sapheno-femoral sustom, surgical intervention is indicated. The possibility of monitoring the progress of the operation with the help of special equipment allows minimizing its invasiveness - the cut length is about 1 cm.

  • Installing a kava filter. A metal filter is installed inside the inferior vein, which delays large clots of blood clots.
  • Thrombectomy - the cavity of the vein is cleared of blood clots with the help of a special flexible narrow tube (catheter).
  • Flashing veins. The vessel is stitched or clamped with a special clip. For the passage of blood, the surgeon leaves narrow channels.

The scheme and technique of surgical intervention is selected according to the condition of the veins, the results of ultrasound, the characteristics of the patient. It is possible to conduct combined operations or complete removal of the affected area of ​​the blood vessel.

Deep vein thrombophlebitis in pregnant women

Time from the beginning of conception, childbirth and the postpartum period are accompanied by multiple physiological and biochemical processes that have a serious impact on the venous system.

The most common causes of lower limb TB in women during pregnancy and after childbirth are:

  • the presence of pathology of the subcutaneous or deep veins;
  • hypertension;
  • heart diseases;
  • overweight;
  • the presence of varicose veins, thrombophlebitis in relatives;
  • autoimmune factors affecting blood coagulation.

Increased venous pressure, physiological dilatation of the veins, a natural decrease in the tone of their walls is compression of the fetal pelvic venous vessels by the head of the fetus. During birth, they are almost completely clamped, dramatically slowing the outflow of blood.

In pregnant women and in the postpartum period, the disease begins acutely:

  • sharp pain in the leg;
  • rapid formation of edema;
  • rapid pulse - about 120 beats per minute.

The complexity of the treatment is due to the inability to use some methods that can harm the health of the child, cause complications of labor, provoke uterine bleeding.

When the pain in the leg, its swelling, redness, you must call a doctor. To prevent the separation of a blood clot formed in a vein or its particles, a recumbent position should be adopted. In this case, the affected leg is placed on a slight elevation.

The “golden” preventive measure for deep vein thrombophlebitis in pregnant women and after childbirth is wearing compression knitwear - they are selected only by a doctor. In the veins compressed by stockings, the formation of blood clots is significantly complicated. At the same time, compression is a good prevention of fatigue, edema, and muscle cramps in the legs, which ensures a “high quality of life” during pregnancy and the postpartum period. Also recommended are long walks, a special set of exercises.

Active and practically harmless blood thinners are found in fruits and vegetables. Doctors strongly recommend to abandon self-medication and supplements, regardless of advertising, guaranteeing their safety for the health of the woman and the fetus.

Complications of deep vein thrombophlebitis of the lower extremities

The result of deep vein thrombophlebitis can be chronic venous insufficiency. Pathology is accompanied by swelling of the legs and a disturbance of the trophism (a set of cell feeding processes). Lipodermatosclerosis (fibrous degeneration of skin tissue) develops, trophic ulcers appear.

Тромбоэмболия легочной артерии — самое опасное осложнение ТГВ. Небольшие кусочки кровяных сгустков или оторвавшиеся от стенок сосудов тромбы, передвигаясь по сети кровеносных сосудов, попадают в полость легочной артерии и закупоривают ее (эмболия). Исходом эмболии становится острая дыхательная и сердечная недостаточность, способные стать причиной летального исхода. При закупорке мелких ветвей легочной артерии развивается инфаркт (омертвение, некроз) легкого.

Профилактика тромбофлебита глубоких вен

Особенно важно соблюдение профилактических мер для людей, входящих в группу риска. Самое простое средство — соблюдение здорового образа жизни.

  • Закаливание — контрастный душ, плаванье, ходьба босиком.
  • Комплекс физических упражнений — «ножницы», «березка», «велосипед» и другие.
  • Ношение компрессионного трикотажа — гольф, колготок, чулок, трико.
  • Соблюдение диеты — профилактика обезвоживания (не менее 2,5 л жидкости в сутки), отказ от продуктов, богатых углеводами, жирами.
  • Контроль над весом.
  • Своевременное лечение очагов инфекции.
  • Избегание переохлаждения ног.
  • Отказ от курения, употребления алкогольных напитков (в том числе пива).

При первых признаках заболевания необходимо обращаться к врачу. Самостоятельные прием медикаментов, пищевых добавок в целях профилактики может усугубить ситуацию развитием дополнительных осложнений.


| 10 May 2015 | | 4,137 | Surgery
Go
  • | Oksana | 27 August 2015

    I did not see any sense in ointments. When the superficial veins were inflamed - then yes, there was an effect, the pain did not stop for long. And when deep inflamed - ointments did not help. Phlebodia was prescribed, they said the same effect as from ointments, but stronger and from the inside. Yes, indeed, it became easier. Therefore, I think phlebotropic ointments are needed when the vein is on the surface and when deep - venotonics are needed.

  • | Lena | September 28, 2015

    Yes, ointments, by definition, cannot help, it will not reach the veins, they will settle on the skin. In addition, ointment you smear on one shred of the leg, and the veins, as a rule, suffer even inside. Phlebotonics are needed anyway.

  • | Daria | 25th October 2015

    Phlebotonics also need to be able to choose. The range is huge, everyone advises that it is more profitable. Personally, for the price and quality, I liked the phlebodia 600 most of all. Besides, I need to drink it only once a day.

Leave your feedback


sharad pant: In case of thrombosis doctor cut down the leg of father in law. Doctor told that if we will not cut the leg the infection will go to kidney and then by kidney failure he will die, so we permitted.

Steven Kell: I have DVTs & PE mine start as chest pain it Friday at 9:43pm November 15th I was hit with a factor 5 blood disorder from having trouble breathing this suck badly I had DVTs PE sent 2010 I'm on blood thinner but I honestly don't know if the blood thinner working

Yvette Q.: What about a little bump that pops out on the back of the leg. It only pops out when I flex. But it doesnt hurt no red patch just a bump that pops out.

Lillian Shute: Thank you. I have been told by gp i have phlebitus and also cellulitis. And been given antibiotics and prednisolene. I have had S.L.E. (Lupus) diagnosed since 1989, but gps believe and have been on hydroxychloroquine for 37 years, which has now been stopped by Moorfields Eye Hospital as they found I have hydroxychloroquine toxicity in my eyes. I also have Fybromyalgia Antiphosolophid syndrome Atthritis Angina Raynaulds Sjogrens disease Varicos veins Paroxy... Atrial Fibrillation My body is inflamed . I cannot describe the pain I am in and I had been trying to see my gp for over a week without success, after telling them I believe I have phlebitis as I have had it before and feel I need to see a dr urgently please and i feel I need antibiotics, when i had to let them see my legs to see how bad they were, swollen, red, inflamed, huge rash spreading very fast, round my ankles, whole of tops.of my feet and up both my legs up my chins, calves and thighs, and excrutiaing painful only to.be told they could see they were unbelievably painful but receptionist said she would see if dr.would see me but said she was sorry the dr had just gone to a meeting (on line) 2 mins and to go back at 5 and they will try and fit me in. I can't say an hour and 25 mins went quick because it didn't. I also have strange little swollen bumps on my feet, like bumps of fluid, my skin seems very thin and a I am very worried as I don't want an ulcer, as I had friends who Had ulcers, which were very nasty. I have a 20 morphine patch that I only use in extreme cases but even this doesn't seem to be helping. Please God help me. I dont want to go to hospital. Grateful for any advice x

Lilac Milkshake: Thank you! After seeing 5 doctors over the last 3 years, who all subscribed antibiotics (one course so strong, it warned it could cause permanent and serious liver damage), I am finally getting some answers by seeing their most hated and mocked "Dr. Google." Now knowing it could be dangerous ... And to think the latest doctor tried to pressure me into letting her take a puncture sample of the rash/scar tissue, with no word of an ultrasound. Just more blood tests. So over this horrible rash. Thank you again!

Go
Go