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Thrombophlebitis: the first signs, symptoms, diagnosis and treatment

What is thrombophlebitis? Inflammatory reactions in the venous walls, accompanied by the formation of blood clots in their lumens, received in medicine the name thrombophlebitis (thrombosis). In 90% of cases, the vessels of the legs are subject to the disease - superficial and deep venous networks and connecting perforating veins.

As a closely related disease can be noted - phlebothrombosis, characterized by the same signs (blood clots in the venous cavities), but without the influence of inflammatory reactions. Such a disease does not differ in a long course, because any vascular pathology always ends with the processes of inflammation and the development of thrombophlebitis.

Most often, the pathology is manifested by thrombosis of the superficial saphenous veins, accompanied by varicose veins or CVI syndrome (venous outflow disturbance). In this case, the disease often recurs, progresses, and is fraught with various complications.

Content

Etiology: causes and conditions for the development of thrombophlebitis

Thrombophlebitis

Until the middle of the last century, the formation of blood clots inside the vessels was an absolute mystery. Why, the same blood, in some cases, runs through the vessels freely, in others - clogs their lumen with clots?

The famous German doctor, Rudolf Vikhrov, while working at the Charite Hospital in Berlin, studied various mechanisms that affect the change in the structure of plasma elements and the identification of the prerequisites for the development of thrombosis.

He singled out the main components of the development of the disease, which remained in the practice of modern medicine under the definition of the Vikhrov Triunity. Its component is due to:

1. Changes in the vascular structure, directly the inner lining of the vessels

An important factor is any destructive changes in the internal choroid, including traumatic effects. It has been observed that the accumulation of blood clots always occurs in areas of obvious structural changes in the vascular walls. The initially smooth, healthy surface of the endothelium becomes rough in painful and damaged areas.

Small blood clots, floating by, are fixed on a rough surface and settle on the vessel wall. Clots accumulate, intertwine, forming a thrombus, completely blocking the vascular lumen. Pathological changes in the endothelium can cause various reasons:

  • inflammation of the venous walls (phlebitis);
  • inflammatory reactions affecting arteries (arteritis);
  • inflammatory processes in the heart structure (endocarditis).

Contribute to destructive changes in the epithelial intravascular layer, microorganisms of various infections. Due to the huge toxic mass in the blood plasma, the possibility of thrombus formation rises dramatically, which may well cause thrombophlebitis

development of thrombophlebitis, photo

development of thrombophlebitis, photo

2. Change in blood flow velocity

Dr. Vikhrov established: the most frequent places in the vascular beds, where clots are formed - zones of uneven flow of blood plasma and changes in its velocity. For example, the flow in the central part of the lumen is fast, and the course slows down at the edges of the vessel, forming turbulence.

This feature of the blood flow is characteristic in the places of the constricted or dilated areas of the vascular bed. What could be the result of aneurysm or varicose veins. Most prone to the formation of thrombosis - the place of vascular branches, where the turbulence of blood flow is a frequent phenomenon.

Violation of the speed of blood flow contribute to:

  • injuries of the lower extremities, as a result of which compressive soft or plaster bandages are applied;
  • prolonged immobility of the limbs;
  • blood stasis in cardiac pathologies caused by the failure of pumping the full volume of blood;
  • systemic and vascular diseases affecting the process of blood flow.

3. Hyperviscose syndrome (thick blood)

Another cause of thrombophlebitis of the lower extremities Vortices called "thick blood." Today there is no such term in medicine, it is said about the level of its viscosity. Reference standards do not exist, each of us, the viscosity level is different. But, there are circumstances when in one patient the viscosity of blood plasma is different in different vascular areas.

The main cause of thrombophlebitis is abnormal fluid loss due to insufficient intake or excessive discharge: excessive sweating, heavy loads that cause thirst, or illness accompanied by fever. In addition, indicators of plasma factors of anticoagulation and coagulation systems affect the development of thrombophlebitis.

Under completely identical circumstances, hypercoagulation (coagulability) can show different indicators - very high, elevated or lowered, each case is caused by - special properties of blood formation (hemopoiesis), metabolic processes, lack of specific protein that delays plasma coagulation (sometimes it is inborn defect).

A common cause of thrombophlebitis, blood with impaired hemostasis (dissolution of blood clots). Violation of hemostasis contribute to:

  • infectious diseases;
  • hormonal dysfunctions;
  • oncological diseases.

Types of thrombophlebitis

Types of thrombophlebitis By their nature, thrombophlebitis are infectious and non-infectious (aseptic). Which in turn are manifested by different species.

Infectious form of the disease manifests itself:

  1. Postpartum or postoperative thrombosis;
  2. As a result of purulent-inflammatory pathologies (cellulitis, boils, erysipelas);
  3. In infectious diseases (typhus, influenza, tuberculosis).

Non-infectious (aseptic) form:

  1. Thrombophlebitis varicose veins;
  2. Migrating thrombosis;
  3. Posttraumatic;
  4. Thrombosis, due to vascular and heart diseases.

By the nature of the clinical picture - acute thrombophlebitis and a form of chronic course.

In the area of ​​manifestation (localization) - the defeat of the superficial and deep network of veins on the limbs, the shape of the ilio-femoral lesion

The first signs of thrombophlebitis, photo

First signs of thrombophlebitis

manifestations of thrombophlebitis, photo

The onset of the disease may manifest unexpectedly - with excellent well-being, the first signs of thrombophlebitis quickly form.

  1. Pain syndrome while driving;
  2. Subfebrile fever and malaise;
  3. Edema in the area of ​​clot formation - the closer a blood clot is to the groin, the swelling expression;
  4. On palpation, there is a density and tenderness of the veins;
  5. The skin over the affected area is red with a bluish tinge, swollen and warm;
  6. Increased swelling indicates the defeat of the deep veins .

If at this stage the treatment is not started in time, the inflammatory reactions quickly spread through the vascular bed, significantly worsening the patient's condition.

It should be noted that there are thrombosis related to "dumb" forms, not showing any symptoms at all. The deterioration of the patient's condition occurs after the fact - when a thrombus completely covers the vascular lumen.

Symptoms of thrombophlebitis, the clinical picture

Symptoms of thrombophlebitis photo

The picture of the clinical manifestation of the disease mainly depends on the location of the thrombus, the prevalence of the inflammatory reaction, the level of damage to surrounding tissues.

Symptoms of the saphenous veins

Already existing large nodular varicose lesions exacerbate the situation, manifested by structural changes in the vascular walls. Nodes are susceptible to soldering with the skin, injuries and scratching, which causes trophic changes in the skin, facilitating easy penetration of the infection. As a result, inflammatory processes are formed and thrombophlebitis of the superficial veins develops. Symptoms are characterized by:

  • limiting the prevalence of the inflammatory process with localized thrombosis;
  • rare deterioration of the general condition;
  • changes in the structure of the saphenous veins - pain and tightness in the form of cords;
  • immobility caused by adhesions between them;
  • inflammatory processes of the subcutaneous tissue and skin;
  • compressed hyperemic skin with a glossy sheen.

The venous network of the femur and tibia is most affected. The prevalence of swelling in the ankle and an increase in the inguinal lymph nodes is noted. Usually, the general condition is not disturbed, the soreness at movement is moderate, it does not interfere with keeping the patient working.

In advanced cases, the spread of inflammatory reactions exacerbates the symptoms of thrombophlebitis. There is a sharp increase in pain and a rise in temperature to high levels. Persisting acute symptoms may last up to one and a half months.

Special attention deserves subcutaneous migrating thrombosis. The nature of the disease is due to the formation of a large number of thrombotic clots in the subcutaneous vessels. Symptomatology is characterized by moderate manifestation without disruption of general well-being.

The positive aspect is due to the absence of any trophic changes or traces. After a certain time, the inflammatory reaction migrates to another zone of the extremities, which fully justifies the name of the disease.

Signs of a lesion in the deep vein network

Signs of a lesion in the deep vein network

The development of this pathology is characteristic of the affected areas of bone fractures of the hip or thigh region, the treatment of which was carried out by surgical techniques. Or during abdominal operations and surgical treatment of chest pathologies. The formation of thrombosis contributes to the increase in coagulation factor necessary to prevent bleeding during surgery.

Symptoms of thrombophlebitis with localization in the deep venous system appear:

  • heaviness and fatigue of the legs, feeling of bursting;
  • severe swelling and tenderness of the legs ;
  • bluish color of the skin;
  • acute impaired pulmonary circulation (sometimes the first symptom);
  • febrile fever and glossy skin;
  • painful intra-articular syndrome;
  • change in local temperature (cold extremity);
  • sometimes signs of peritonitis and functional obstruction of the intestine.

With the background of the disease ( varicose ), there are frequent relapses each time aggravating trophic changes in the tissues and circulatory disorders. If there are clear symptoms of thrombophlebitis, treatment is not advisable to postpone.

The main threat is purulent complications in the form of phlegmon , abscess or sepsis . As well as the development of thromboembolism. The outcome can be expressed in two variants - obstruction of small blood vessels or blockage of vital arteries, which leads to mortality.

Diagnosis and treatment of thrombophlebitis

treatment of thrombophlebitis

The effectiveness of treatment depends on an accurate diagnosis, which includes:

  • diagnostic examination by a surgeon;
  • examination of Doppler ultrasound vessels;
  • radiopaque phlebography - the study of the advancement of a contrast agent injected into a vein;
  • the use of special functional tests to identify venous lesions at the earliest stages.

Treatment is due to an integrated approach combining drug and surgical techniques.

The method of conservative treatment of thrombophlebitis includes:

  1. The use of physiotherapy techniques - introduction of anticoagulants by electrophoresis, hydrotherapy with variable baths, UHF procedure.
  2. Drugs - anti-inflammatory, anticoagulants for plasma liquefaction, antispasmodics and antibiotics.
  3. The use of compression underwear preventing vascular expansion damage to their walls - bandages for special purposes, tights and socks for compression of the affected venous walls.

In case of failure of conservative therapy, radical and minimally invasive surgery is used.

  1. Radical surgical method involves the removal of the affected vein, to prevent further spread of the pathological process. Today it is used in exceptional cases, with an extensive process that threatens the life of the patient.
  2. Endovasal laser coagulation technique. As a result of laser treatment of the venous walls and thrombosis clot, the vessel is glued, completely removing it from the blood circulation process, directing the blood along a healthy channel.
  3. Removal of thrombus by endoscopic method. Using endoscopic instruments inserted into the vessel, a thrombus is removed and a special trap filter is installed or the vessel is ligated.
  4. Gluing the affected channel by sclerotherapy is the introduction of a special composition into the vessel.
  5. The method of venous thrombectomy is used for the extraction of thrombosis clots with a special catheter.

All these methods are quite effective. Allow patients to return to a normal, painless life.

Compression underwear with thrombophlebitis

The gold standard for the treatment of thrombosis in pregnancy - compression underwear. Its wearing is due to the effect of squeezing the superficial venous system, causing an increase in pressure in it, which improves venous outflow.

A varicose area suppressed by pantyhose or stockings will not allow a blood clot to settle in it, which will drastically reduce the risk of inflammatory reactions and the formation of thrombosis.

When using compression underwear, puffiness and convulsive manifestations are eliminated, the legs almost never get tired and the pregnancy is not complicated by anything. Pregnant women are recommended:

  • specially selected exercises that improve venous outflow;
  • long walks;
  • with chronic pathology - evening walks for at least half an hour;
  • a diet rich in fruits and vegetables, as they are stimulators of hemodilution (dilution of thickening).

In order to avoid puffiness, it is not recommended to use large amounts of fluids and drugs that affect the vascular system (phlebotonics). Selection of compression underwear with thrombophlebitis should be carried out on the recommendation of a physician, taking into account the type and degree of compression of products.

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