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Thrombophlebitis: Symptoms and Treatment

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Thrombophlebitis photo Thrombophlebitis is a disease characterized by an inflammatory process in the vein wall in the presence of a blood clot (thrombus) in its lumen. The tissue surrounding the vessel may be involved in inflammation, to one degree or another.

The middle layer of the vein is less dense, unlike the artery wall. Vein wall thickness is also smaller. These structural features and a much lower rate of blood moving towards the heart initially create the preconditions, under appropriate conditions, for the occurrence of thrombophlebitis.

Initiating factors.

1. Reduction of general immunity with frequent general and local hypothermia.

2. Low motor activity.

3. Traumatic damage to the vein wall.

4. The presence of chronic infection in the body.

5. Various allergic reactions.

6. Paralysis of the limbs with a violation of sensitivity, as residual manifestations after strokes, and in other serious diseases of the central and peripheral nervous system. .

7. Significant deceleration of the blood flow velocity (common - in case of cardiac insufficiency of the blood circulation and local - in the presence of squeezing bandage and plaster dressings).

8. Changes in the qualitative composition of blood.

9. Increased blood clotting due to hereditary or acquired causes (dehydration, etc.).

10. Complicated surgery, abortion, childbirth.

11. Varicose veins .

12. Obesity.

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. Oral contraceptive use.

19. Pregnancy.

20. Myocardial infarction.

21. The use of vaccines and serums.

22. Blood transfusions.

The disease may begin with the overlap of the vessel lumen with a thrombus and the subsequent inflammation of the vein wall (phlebitis). This is especially common in severe septic conditions, when a blood clot initially carries an infectious agent. In the absence of treatment in such cases, the infection continues to develop, and the thrombus growing along the bloodstream becomes a new source of bacterial flora (septicopyemia) spreading through the body.


It is also possible variant with primary developed inflammatory changes in the vessel wall. This results in damage to the smooth inner layer (intima). The formation of a blood clot begins at the site of injury, followed by overlapping (obturation) of the vessel lumen.

Depending on the location of the veins, distinguish thrombophlebitis of the superficial veins and deep veins.

The veins of the lower extremities and the pelvic cavity are most susceptible to this disease. More often with these localizations, thrombophlebitis occurs against the background of varicose vein lumen.

But they also meet rare localizations that have received their personal names by the authors:

1. Thrombosis with thrombophlebitis of the axillary and subclavian veins - Paget's disease - Schretter.

2. Thrombophlebitis of the subcutaneous veins of the anterior surface of the chest - Mondor's disease.

3. Migrant, with different localizations, Burger's thrombophlebitis.

4. Thrombosis with portal thrombophlebitis and other hepatic veins - Budd disease - Chiari.

The course of the disease secrete:

1. Acute (lasts up to a month).

At the same time, modern methods of treatment can achieve a full re-establishment of blood flow, if applied in the first days of the disease. However, this effect can be achieved even with the started treatment in the period up to two weeks from the onset of the first symptoms, but already in a smaller percentage of patients.

2. Subacute (about six months)

3. Chronic thrombophlebitis (lasts for years, if there is a permanent cause in the body for its occurrence).

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, appoint additional studies to exclude the presence of a patient with a malignant neoplasm.

After subsiding of the inflammatory processes, the blood circulation in the thrombated vessel can resume if recanalization has occurred. This process means the partial resorption of a blood clot with the construction of new small capillaries through it, the lumen of which expands with time. This happens somewhere in the third month after the acute symptoms subside. Sometimes recanalization in the vessel does not occur. Blood progression is performed along collaterals. About residual thrombophlebitis can only indicate residual increased pigmentation of the skin area in the projection of the passage of the ill vein.



Symptoms of thrombophlebitis

Symptoms of thrombophlebitis is extremely variable and depends on the location of the affected vein. Veins of the lower extremities are most often affected. Thrombophlebitis of superficial veins and deep veins are isolated separately.

Common symptoms for the manifestation of the disease in acute form are the appearance of 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 the superficial veins of the extremities

Thrombophlebitis treatment In the superficial veins, inflammation with the formation of a thrombus occurs most frequently against the background of the lumenal varicose expansion that is already present. Characterized by localization - the lower leg and the lower third of the thigh.

Noteworthy:

1. The presence of a clear outline of the expanded vessel in the form of a dense warm cord or an elongated row of rounded ball nodes. When giving the limb a horizontal or elevated position, the palpable strands do not disappear, which additionally indicates the formation of a thrombus inside the vessel lumen. With continued illness, the size of the palpable mass increases in length.

2. Acute pain and redness of the skin along the altered vessel, swelling of surrounding tissues.

3. Increased pain during palpation.

4. Movement in the limbs is not disturbed, but can be painful.

5. Involving surrounding tissue in inflammation - periphrititis.

The temperature gradually decreases to normal. Acute phenomena with minor lesions and with the treatment started, subside by the end of the third week, when the clot in the vessel lumen ceases to form. However, the general tendency is that, once having arisen in a person with an existing varicose expansion of the superficial veins of the lower extremities, thrombophlebitis has great chances for it to appear again. And it will be a recurrent thrombophlebitis.

If the lumen of the vein is not initially enlarged, then its inflammation, followed by thrombosis, more often occurs if there is an infectious focus nearby (erysipelas, fungal lesions, phlegmon of soft tissues, osteomyelitis ) or after intravenous injection.

In this case, the symptoms of the underlying disease gradually join:

1. The occurrence of pain of varying severity in the course of the vessel.

2. Redness of the skin and swelling in areas of pain.

3. The visual manifestation of the contour of the vessel. Palpation of his sometimes gives a sense of linear tension.

4. There may be a network of dilated superficial veins distal, not previously observed.

Thrombophlebitis of the superficial veins with an unchanged lumen must be differentiated from skin diseases with subcutaneous tissue and skin manifestations of other diseases. The main difference is that reddening of the skin during thrombophlebitis is limited to the contour of the vessels, it does not tend to expand and is short-lived. In addition, the identified seals in the skin are linear.

In cases of the transition of acute thrombophlebitis to purulent, there is the development of multiple abscesses along the vessels, there is a significant deterioration in the general condition of the patient due to severe intoxication.

If the disease of the superficial veins of the extremities takes a protracted nature, then changes in the surrounding tissues also join the pigmentation described above in the skin. Subcutaneous tissue is compacted, and thinning of the skin above it contributes to the development of long-healing trophic ulcers.

Complications of thrombophlebitis of the superficial veins are most often local in nature:

  1. Cellulite
  2. Wet gangrene of the limbs.
  3. Deep vein thrombosis.

However, there are also complications beyond the limbs:

  1. The spread of infection to internal organs by the migration of purulent emboli along the bloodstream (sepsis).
  2. Pulmonary embolism.

The latter complication is extremely rare due to the tight fixation of a blood clot to the vessel wall and the absence of skeletal muscles around it, which could, while contracting, contribute to their separation with subsequent migration.

Deep vein thrombophlebitis  

The disease is acute. The clinic and the intensity of the manifestation depends on the size of the thrombus, its localization, the total number of veins involved in the inflammatory process.

Symptoms:

  1. The sudden appearance of pain in the muscles of the leg "arching" character. The pain subsides somewhat with the horizontal and elevated position of the limb. There may be painless options, but with the presence of all the following symptoms.
  2. Distal from the painful area, the skin of the lower leg takes on a cyanotic (cyanotic) color.
  3. The appearance of swelling of the leg. To determine it, just press on the skin on the side surfaces of the ankle joint. In these places remains a depressed dimple, which gradually disappears. Draws attention to the tension of the skin and its brilliance.
  4. Sharp pain when reducing the calf muscles (an attempt to stand on tiptoe or imitate the boot on the leg). Palpation of these muscles significantly increases the pain.
  5. Moses symptom - pain in the calf muscles, with pressure on them in the anteroposterior direction. When pressed from the sides of the leg, there is no pain or it is minimal.
  6. Symptom Opitsa-Ramines - increased pain in the lower legs when air is forced into the cuff of the tonometer, which is applied above the knee. The pain becomes unbearable when the pressure is higher than 45 mm. Hg Art.
  7. Lowenberg's symptom is a variation of the previous one, with the difference that the cuff is superimposed on the middle third of the tibia with the pressure being increased to 60–150 mm Hg. Art. in the cuff. This variation depends on the degree of development of skeletal muscles and the severity of venous insufficiency. With a decrease in pressure in the manometer, the pain subsides.

Thrombophlebitis of the femoral vein and deep veins of the pelvis  

The development of thrombophlebitis in the femoral vein to the confluence of the deep vein (the upper third of the thigh) into it, can take place without clear clinical manifestations, which is explained by the developed network of collaterals. There is a fuzzy soreness in the muscles of the inner surface of the thigh (adductor group), an expansion of the network of intracutaneous veins. Edema of this zone is possible. With deep palpation of this area, there is pain.

Thrombophlebitis of the vessel in the upper areas, after a deep vein and a superficial vein, when it is already called the common femoral, flows with more vivid clinical symptoms: pain in all parts of the limb becomes more intense, cyanosis increases, edema increases, and the overall body temperature rises significantly. Palpation in the groin and below it can be a seal.

Thrombophlebitis of the site of transition of the femoral vein into the iliac, is most difficult. If a blood clot does not completely block the lumen of the vessel, then the pain may be fuzzy, fleeting, and then be determined in the region of the sacrum and lower back, then in the lower lateral sections of the abdomen (iliac region). But their localization concerns only one side of the body. The patient complains of deterioration of the general condition, high temperature. The asymmetry of the limbs in size and color, its soreness, nevertheless, makes it possible 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 a thrombus from this section, which causes the sudden death of the patient.

In the case when a blood clot completely covers the lumen of the iliac vein, there is a brighter clinical picture than with an incomplete closure:

1. Severe edema of the entire limb on the part of the lesion with spread to the body, in the flesh to the lumbar and umbilical region. External genitals are also pronouncedly swollen. The density of edema increases over time, the skin becomes smooth and shiny.

2. In the same areas, the skin color becomes pale earthy (white phlegmasy) or blue-purple (blue phlegmasy).

White phlegms caused by simultaneous reflex contraction of the lumen of the arteries. Therefore, there is no marked edema with it and the course of thrombophlebitis is more favorable.

Blue phlegmasy has a negative prognosis due to a more pronounced edema, with a greater risk of attaching moist gangrene. Intradermal hemorrhages are observed, which merge to form fields. The epidermis of hemorrhages exfoliates edematous hemorrhagic fluid with the formation of blisters. Pain is intense.

3. The saphenous veins are strained and their lumen is enlarged.

4. The temperature rises to 40 ° C. Symptoms of massive intoxication gradually increase. This is manifested in some subsiding pain and the appearance of general weakness, adynamia, lethargy, indifference.

Differentiate deep vein thrombosis of the extremities should:

  1. With arterial thrombosis.
  2. In violation of lymphatic drainage, leading to the so-called "elephantiness".
  3. With deep intermuscular hematoma.
  4. Phlegmon deep soft tissue limb.
  5. With myositis of various origins.
  6. With benign and malignant tumors, the soft tissue of the limb.
  7. With manifestations of congestive heart failure.
  8. With neurological diseases, such as: sciatica, femoral neuritis.
  9. With various systemic diseases of the musculoskeletal system.

Thrombophlebitis mesenteric veins  

Thrombophlebitis of these sites of the venous bed is rare and its symptoms are 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 dull abdominal pain without clear localization for several days in a row. The abdomen becomes swollen due to a violation of the passage of the intestine. A sharp exacerbation in the form of an emerging pattern of "acute abdomen" and massive intoxication, indicates already the onset of complications, such as intestinal gangrene with subsequent diffuse peritonitis. Often, assistance in such cases is no longer possible.

Portal vein thrombophlebitis  

It occurs in septic conditions, with malignant lesions of the liver and pancreatic head, with cirrhosis of the liver, chronic pancreatitis .

Symptoms:

  1. An increase in abdomen size in a short time due to ascites (free fluid in the abdominal cavity).
  2. Severe pain in the right hypochondrium.
  3. A sharp rise in temperature to 40 ° С.
  4. Performance of the contour of the subcutaneous veins of the anterior surface of the abdomen, in the umbilical region.
  5. Massive intoxication, vomiting with blood.

Hemorrhoidal Vein Thrombosis  

It requires a history of hemorrhoids.

The following is characteristic:

  1. The appearance of acute pain in the anus.
  2. Possible severe itching there.
  3. External knots increase, become dense to the touch, hot.
  4. With the defeat of the internal nodes - the latter may fall out.
  5. Defecation brings a significant increase in pain.
  6. Liquid blood appears in the feces.
  7. The overall body temperature rises.

In the outcome of all thrombophlebitis, post- thrombophlebitic syndrome is isolated separately.

It is caused by the development of reverse flow of blood from deep veins to the superficial due to the functional failure of the altered blood vessels. This leads to secondary varicose saphenous veins, increased edema, ischemia and sclerosis (compaction) 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 blood clot in the lumen 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 testing for coagulation factors (fibrinogen; plasma tolerance to heparin; plasma anti-plasmin activity; determination of thrombus formation time, platelet aggregation ability, etc.).

2. Vascular examination using ultrasound methods: Doppler sonography and duplex angioscanning of the veins.

3. X-ray methods using contrast and without it: computed tomography, CT angiography.

4. Radionuclide diagnostics using a radioactive isotope of iodine (I 131) and labeled fibrinogen (Tc 99).

5. Thermography.

Treatment of thrombophlebitis  

Treatment at home and on an outpatient basis is allowed in cases of defeat of the superficial vessels of the foot and lower leg, hand and forearm.

In these cases, the active mode of the patient is saved. Recommended local exposure to cold with applying to the affected area ointment heparin, troksevazina. To reduce pain and swelling, limbs give an elevated position. In addition to this, oral administration of anti-inflammatory drugs, vasotonic agents (escuzan, anaverol, venoruton) is prescribed. With the involvement of the surrounding tissue in inflammation (periflebity), antibiotic therapy is prescribed. After the acute phase subsides, physiotherapy is widely used to prevent complications and minimize residual effects (magnetic therapy, impulse currents). To achieve rest in the affected area, it is recommended that elastic bandaging be not too tight.

Treatment of deep vein thrombophlebitis and with a massive superficial lesion, should be carried out only in the hospital.

For emergency surgery there are indications in the form of progressive thrombosis (both superficial and deep veins) with the threat of thromboembolic complications. In these cases, produce embolectomy from various approaches.

Sometimes, due to the severity of the patient’s condition and the presence of serious comorbidities, auxiliary operations are performed:

1. Partial occlusion of the main vein with the help of its plication.

2. Implantation of intracaval umbrella filter.

These interventions reduce the risk of thromboembolic complications.

In the case when thrombophlebitis is complicated by local processes, they are reorganized, by dissection, excision, drainage. If the purulent process is most pronounced in the wall of the vein, it is removed.

With the development of gangrene with the threat of sepsis, amputation is performed.

Conservative treatment in the hospital, to the already described drugs (anti-inflammatory drugs, antibiotics), is complemented by the use of novocaine blockades to activate collateral circulation, taking non-steroidal anti-inflammatory drugs.

The use of disaggregant drugs (reopolyglukine, trental) is widely used.

Under the control of blood coagulation parameters, anticoagulants are prescribed. Possible hirudotherapy in the presence of contraindications to the use of anticoagulants.

Conduct massive detoxification therapy up to the "artificial kidney".

Forecast  

Directly depends on the location, the vastness of the process, the timeliness of the treatment started, the age of the patient and the presence of concomitant diseases.


| March 15, 2014 | | 29 354 | Diseases in men
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  • | Natalia | September 16, 2015

    I use about 2 months. Neither cold nor hot. Veins were as they were. You can't back them up. You can buy other ointments that will be cheaper and may be even more effective. So just pulling money.

  • | Natalia | September 16, 2015

    I'm talking about varicostero. Just pull the money.

  • | Marie | November 17, 2015

    Natalia, you'd better go to the doctor than do self-medication. if you have problems with your veins, then you most likely need a gel or ointment with heparin as the active substance, since it is an anticoagulant, and, as you know, it dilutes the blood, it starts to flow better, blood clots dissolve, and what's important, it prevents the formation of new blood clots.

Leave your feedback


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!

gerardoenmibarrio: Nice video. I just got diagnosed was at first given antibiotics. I then went back 4 days later and was prescribed asprin and am now waiting for the hospital to get back to me about a scan!!!

B Silver: Awesome video. It provided a brief explanation of each topic about which I had hoped to learn, and the narrator was thorough yet succinct and he spoke at a perfect, clear pace. Thank you kindly! 😊

The Whiteley Clinic: Phlebitis needs a duplex scan to make a diagnosis and get the right treatment. Antibiotics are NOT a treatment for phlebitis.

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