Thrombophlebitis: Symptoms and Treatment
- Symptoms of thrombophlebitis
- Thrombophlebitis of superficial veins of extremities
- Thighboneous deep veins thrombophlebitis
- Thrombophlebitis of femoral vein and deep pelvic veins
- Thrombophlebitis of mesenteric veins
- Thrombophlebitis portal vein
- Thrombosis of hemorrhoidal veins
- Diagnosis of thrombophlebitis
- Treatment of thrombophlebitis
Thrombophlebitis is a disease characterized by an inflammatory process in the vein wall in the presence of a blood clot (thrombus) in its lumen. In inflammation, to one degree or another, the surrounding tissue can be involved.
The middle layer of the vein is less dense, in contrast to the wall of the artery. The wall thickness of the vein is also smaller. These structural features and a much lower rate of blood flow in the direction of the heart, initially create the prerequisites, under appropriate conditions, for thrombophlebitis.
1. Decreased general immunity with frequent general and local hypothermia.
2. Low motor activity.
3. Traumatic damage to the vein wall.
4. Presence of a chronic infection in the body.
5. Various kinds of allergic reactions.
6. Paralysis of limbs with a violation of sensitivity, both residual manifestations after strokes, and in other serious diseases of the central and peripheral nervous system. .
7. Significant slowing of the blood flow rate (general - with cardiac circulatory failure and local - in the presence of compressive bandage and plaster bandages).
8. Change in the qualitative composition of the blood.
9. Increased blood clotting, due to hereditary or acquired causes (dehydration, etc.).
10. Complex surgical interventions, abortions, childbirth.
11. Varicose veins .
13. Hemorrhoids .
14. Injuries, injuries, accompanied by significant blood loss.
15. Catheterization of veins.
16. Intravenous administration of concentrated solutions of drugs, antibiotics.
17. Malignant neoplasms.
18. Taking oral contraceptives.
20. Myocardial infarction.
21. Use of vaccines and serums.
22. Blood transfusion.
The disease can begin with the closure of the lumen of the vessel with a thrombus and subsequent inflammation of the vein wall (phlebitis). This is especially often observed in severe septic conditions, when the thrombus initially carries an infectious agent. In the absence of treatment in such cases, the infection continues its development, and the blood clot that grows along the course of the blood stream becomes a new source of bacterial flora spread by the body (septicopyemia).
A variant with primary inflammatory changes in the vessel wall is also possible. This leads to damage to the smooth inner layer (intima). At the site of injury, the formation of a thrombus begins, followed by the overlap (obturation) of the lumen of the vessel.
Depending on the location of veins, distinguish thrombophlebitis of superficial veins and deep veins.
The greatest susceptibility to this disease is the veins of the lower extremities and the cavity of the small pelvis. More often with these localizations, thrombophlebitis occurs against the background of varicose veins.
But there are also rare localizations that have received their personal names for the authors:
1. Thrombosis with thrombophlebitis of the axillary and subclavian veins - Paget-Shreter disease.
2. Thrombophlebitis of the subcutaneous veins of the anterior thoracic surface - Mondor's disease.
3. Migratory, with various localizations, Burger's thrombophlebitis.
4. Thrombosis with thrombophlebitis of portal and other hepatic veins - Badd-Chiari disease.
In the course of the disease, there are:
1. Acute (lasts up to a month).
At the same time, modern methods of treatment can achieve a complete resumption of blood flow, if they are used in the first days of the disease. However, this effect can be achieved even after the beginning of treatment in the period up to two weeks from the manifestation of the first symptomatology, but already in a smaller percentage of patients.
2. Subacute (about six months)
3. Chronic thrombophlebitis (lasts for years, if there is a constant cause in the body for its appearance).
4. The emergence of thrombophlebitis in a short period of time in different veins, not subject to varicose changes - is called migratory. Often this type of thrombophlebitis accompanies a tumor. Therefore, in these cases, additional studies are prescribed to exclude the presence of a malignant neoplasm in the patient.
After the inflammation subsides, the blood circulation in the thrombosed vessel can resume if the recanalization has occurred. This process means a partial resolution of the thrombus with the piercing through it of new small capillaries, the lumen of which expands over time. This happens somewhere in the third month after the acute symptoms subsided. Sometimes there is no recanalization in the vessel. Promotion of blood is carried out by collaterals. About the transferred thrombophlebitis can indicate only the residual increased pigmentation of the skin area in the projection of the passage of the sickly vein.
Symptoms of thrombophlebitis
The symptomatology of thrombophlebitis is extremely variable and depends on the localization of the affected vein. The veins of the lower extremities are most often affected. Separate thrombophlebitis of superficial veins and deep ones.
The common symptoms for the manifestation of the disease in acute form is the appearance of a high, up to 38 ° C, body temperature, general malaise, soreness in the area of the affected vessel, an increase in regional lymph nodes.
Thrombophlebitis of superficial veins of extremities
In superficial veins, inflammation with the formation of a thrombus occurs most often against the background of the previously existing varicose enlargement of their lumen. Localization is characteristic - the shin and the lower third of the thigh.
Attention is drawn to:
1. The presence of a clear contour of the dilated vessel in the form of a dense warm strand or elongated row of rounded ball nodes. When giving the limb a horizontal or elevated position, the palpable cords do not disappear, which additionally indicates the formation of a thrombus within the lumen of the vessel. With an ongoing disease, the size of the palpable formations increases in length.
2. Acute pain and reddening of the skin along the course of the altered vessel, puffiness of surrounding tissues.
3. Increased pain during palpation.
4. Movement in the limbs are not broken, but can be painful.
5. Involvement of inflammation of the surrounding tissue - periflebit.
The temperature gradually decreases to the level of normal. Acute phenomena with a minor lesion and with the treatment that has begun, subsided by the end of the third week, when the thrombus ceases to form in the lumen of the vessel. However, the general trend is that, having once emerged in a person with an existing varicose veins of the lower extremities, thrombophlebitis has a great chance of appearing again. And it will already be recurrent thrombophlebitis.
If the lumen of the vein is not initially enlarged, then inflammation of it, followed by thrombosis, often occurs if an infectious focus (erysipelas, fungal lesions, phlegmon of soft tissues, osteomyelitis ) is located next to it or after an intravenous injection.
In this case, to the symptoms of the underlying disease, gradually join:
1. The appearance of pain of varying degrees of severity along the course of the vessel.
2. Redness of the skin and swelling in the areas of soreness.
3. Visual manifestation of the contour of the vessel. Palpation of it sometimes gives the feeling of a linear strand.
4. There may be a network of dilated superficial veins distal, not observed before.
Thrombophlebitis of superficial veins with unchanged lumen needs to be differentiated from skin diseases with subcutaneous tissue and cutaneous manifestations of other diseases. The main difference is that the reddening of the skin with thrombophlebitis is limited by the contour of the vessels, it does not tend to expand and is short-lived. In addition, the revealed seals in the skin have a linear shape.
In cases of transition of acute thrombophlebitis into purulent, multiple abscesses develop along the course of blood vessels, a significant deterioration of the general condition of the patient occurs due to severe intoxication.
If the disease of the superficial veins of the limbs takes a protracted character, then, to the above described pigmentation in the skin, changes are added and surrounding tissues. Subcutaneous tissue thickens, and thinning of the skin above it contributes to the development of long-healing trophic ulcers.
Complications of thrombophlebitis of superficial veins are most often local in nature:
- Wet gangrene of the limb.
- Deep vein thrombosis.
However, there are complications that go beyond the limb:
- The spread of infection to internal organs by the migration of purulent emboli along the bloodstream (sepsis).
- Pulmonary embolism.
The last complication is extremely rare because of the tight fixation of blood clots to the wall of the vessel and the absence of skeletal muscles around it, which could, with the reduction, contribute to their detachment and subsequent migration.
Thighboneous deep veins thrombophlebitis
The disease arises sharply. The clinic and intensity of manifestation depends on the size of the thrombus, its location, the total number of veins involved in the inflammatory process.
- Sudden occurrence of pain in the muscles of the lower leg "bursting" in nature. The pain subsides somewhat at the horizontal and elevated position of the limb. Possible and painless options, but with the presence of all of the following symptoms.
- Distal from the painful area, the skin of the lower leg takes a cyanotic (cyanotic) color.
- Appearance of edema of the lower leg. To determine it, just press the skin on the side surfaces of the ankle joint. In these places remains a dimple, which gradually disappears. Attention is paid to the intensity of the skin and its shine.
- Sharp soreness with the reduction of gastrocnemius muscles (try to stand on "tiptoe" or simulate dressing the boot on the leg). Palpation of these muscles significantly increases painful sensations.
- Symptom Moses - pain in the calf muscles, with pressure on them in the anteroposterior direction. With pressure from the sides of the shin, there is no pain or it is minimal.
- Symptom Opitsa-Ramines - increased pain in the lower leg when injecting air into the cuff of the tonometer, which is imposed above the knee. The pain becomes unbearable when the pressure is increased above 45 mm. gt; Art.
- The Lovenberg symptom is a variation of the previous one, with the difference that the cuff is superimposed on the middle third of the shin with pressure build-up up to 60-150 mm Hg. Art. in the cuff. Such a breakdown depends on the degree of skeletal musculature development and the degree of manifestation of venous insufficiency. With the decrease in pressure in the pressure gauge, the pain subsides.
Thrombophlebitis of femoral vein and deep pelvic veins
The development of thrombophlebitis in the femoral vein before the deep vein (the upper third of the thigh) penetrates into it, can pass without bright clinical manifestations, which is explained by the developed network of collaterals. There is fuzzy tenderness in the muscles of the inner surface of the thigh (leading group), expansion of the network of intradermal veins. A swelling of this zone is possible. With a deep palpation of this zone, soreness appears.
The thrombophlebitis of the vessel in the upper regions, after the entry of the deep vein and the superficial, when it already bears the name of the general femoral, proceeds with a more vivid clinical symptomatology: pain in all parts of the extremity becomes more intense, cyanosis increases, edema increases, and the overall body temperature rises significantly. When palpation in the inguinal area and below it, a seal can be found.
Thrombophlebitis of the transection of the femoral vein into the iliac, proceeds most severely. If the thrombus does not completely cover the lumen of the vessel, the pain may be fuzzy, fleeting in nature and determined in the area of the sacrum and waist, then in the lower lateral abdomen (iliac region). But their localization concerns only one side of the body. The patient complains of deterioration in general condition, high temperature. Asymmetry of the limbs in size and color, the soreness of it, still allows you to suspect a violation of the blood supply in the main vein. Sometimes the only clinical manifestation of the disease is thromboembolism of the pulmonary artery, and its branches, due to the separation of the thrombus from this department, which is the cause of the sudden death of the patient.
In the case when the thrombus completely blocks the lumen of the ileum vein, a more vivid clinical picture is observed than with an incomplete closure:
1. Pronounced edema of the entire limb from the side of the lesion with spread to the trunk, into the flesh to the lumbar and near-pustular region. The external genitalia are also pronounced edematous. The density of edema increases with time, the skin becomes smooth, shiny.
2. In the same areas, the skin color becomes pale-earthy (white phlegmase) or blue-purple (blue phlegmase).
White phlegmation is caused by a simultaneous reflex compression of the lumen of the arteries. Therefore, pronounced edema with it is not observed and the course of thrombophlebitis is more favorable.
Blue phlegmase has a negative prognosis due to a more pronounced edema, with a greater risk of attaching wet gangrene. There are intradermal hemorrhages, which merge form fields. The epidermis over hemorrhages is exfoliated by edematous hemorrhagic fluid with the formation of blisters. Painful sensations are intense.
3. Subcutaneous veins are strained and their lumen enlarged.
4. The temperature rises to 40 ° C. Symptoms of massive intoxication gradually increase. This manifests itself in a certain stagnation of pain and the appearance of general weakness, adynamy, lethargy, indifference.
Differentiating thrombosis of the deep veins of the extremities follows:
- With arterial thrombosis.
- With the violation of the lymph drainage, leading to the so-called "elephantiasis".
- With a deep intermuscular hematoma.
- Phlegmon is a deep soft tissue limb.
- With myositis of different origin.
- With benign and malignant tumors, the soft tissues are limbs.
- With manifestations of congestive heart failure.
- With neurological diseases, such as: lumbosacral radiculitis, neuritis of the femoral nerve.
- With various systemic diseases of the musculoskeletal system.
Thrombophlebitis of mesenteric veins
Thrombophlebitis of these parts of the venous bed is rare and symptomatic of it is close to the clinic of thrombosis of the same veins.
Unlike thrombosis of arteries in this localization, the disease proceeds without a clear clinical picture: in the form of blunt abdominal pains without clear localization for several days in a row. The abdomen becomes swollen, due to violation of the intestinal passage. A sharp exacerbation in the form of an emerging pattern of "acute abdomen" and massive intoxication, indicates already the onset of complications, such as gangrene of the intestine followed by diffuse peritonitis. Often, assistance in such cases is no longer possible.
Thrombophlebitis portal vein
Occurs in septic conditions, with malignant lesions of the liver and head of the pancreas, with cirrhosis of the liver, chronic pancreatitis .
- An increase in the size of the abdomen in a short time, caused by ascites (free fluid in the abdominal cavity).
- Severe pain in the right hypochondrium.
- A sharp rise in temperature to 40 ° C.
- The outline of the contour of the subcutaneous veins of the anterior surface of the abdomen, in the perepodal region.
- Massive intoxication, vomiting with blood.
Thrombosis of hemorrhoidal veins
He needs a history of hemorrhoids.
Characteristic of the following:
- The appearance of acute pain in the anus.
- There is a strong itch there.
- External nodes increase, become dense to the touch, hot.
- If internal nodes are damaged, the latter may fall out.
- Defecation brings a significant increase in pain.
- In feces appears liquid blood.
- The overall body temperature rises.
In the outcome of all thrombophlebitis, postthrombophlebitis syndrome is singled out separately.
It is caused by the development of reverse blood flow from the deep veins into the superficial ones due to the functional insufficiency of the vessels altered by the disease. This leads to a secondary varicose dilatation of the subcutaneous veins, increased edema, ischemia and sclerosis (densification) of tissues with the further formation of trophic ulcers.
Diagnosis of thrombophlebitis
To clarify the diagnosis, in addition to clinical manifestations, it is necessary to use additional methods of laboratory and instrumental research. The goal is to confirm the presence of a thrombus in the vein of the vein, determine its length, assess the risk of separation from the wall with further advancement along the bloodstream.
To do this, use:
1. Blood test for clotting factors (fibrinogen, plasma tolerance to heparin, plasma antiplasmin activity, timing of thrombogenesis, aggregation ability of platelets, etc.).
2. Investigation of vessels using ultrasound methods: Doplerography and duplex angioscanning of veins.
3. X-ray methods using contrast and without it: computed tomography, CT angiography.
4. Radionuclide diagnostics with the radioactive isotope iodine (I 131) and labeled fibrinogen (Tc 99).
Treatment of thrombophlebitis
Treatment at home and outpatiently allowed in cases of damage to the surface vessels of the foot and lower leg, hand and forearm.
In these cases, the active mode of the patient is saved. Recommended local effects of cold with application to the affected area of ointment heparin, troxevasin. To reduce the soreness and size of the edema, the limbs attach an elevated position. In addition to this, the intake of anti-inflammatory drugs, vasotonics (escus, anaverol, venoruton) is prescribed. When involved in inflammation of the surrounding tissue (pereflebitis), prescribe antibiotic therapy. After the acute phase subsides, physiotherapy methods are widely used to prevent complications and minimize residual effects (magnetotherapy, pulse currents). To achieve peace of the affected area, recommend not too tight elastic bandaging.
Treatment of deep vein thrombophlebitis and with massive damage to the superficial, should be done only in a hospital.
For emergency surgery, there are indications in the form of progressive thrombosis (both superficial and deep veins) with the threat of development of thromboembolic complications. In these cases, embobectomy is made from different approaches.
Sometimes due to the severity of the patient's condition and the presence of serious co-morbidities, auxiliary operations are performed:
1. Partial occlusion of the main vein by means of its plication.
2. Implantation of the intracaval umbilical filter.
These interventions reduce the risk of developing thromboembolic complications.
In the case when thrombophlebitis is complicated by local inflammatory processes, they are sanitized, by opening, excising, drainage. If the purulent process is most pronounced in the vein wall, it is removed.
With the development of gangrene with the threat of sepsis, amputation of the limb is made.
Conservative treatment in the hospital, to the already described medicines (anti-inflammatory drugs, antibiotics), is supplemented by the use of Novocain blockades to activate collateral circulation, the use of non-steroidal anti-inflammatory drugs.
Widely used the appointment of disaggregant agents (rheopoliglyukin, trental).
Under the control of blood clotting indicators, anticoagulants are prescribed. Possible hirudotherapy in the presence of contraindications to taking anticoagulants.
It depends directly on the localization, the vastness of the process, the timeliness of the treatment started, the age of the patient and the presence of concomitant diseases.