Symptoms and treatment of lower venous thrombophlebitislimbs

Update: October 2018

Thrombophlebitis is an inflammatory disease of the venous vessels.
system arising from the formation of a blood clot (blood clot)
in the lumen of the vein. In the initial stage, when inflammatory
changes are expressed slightly, the disease is called
phlebothrombosis (vein thrombosis without inflammation).

Thrombophlebitis can develop in both deep and
superficial veins. Чаще – в поверхностных венах limbs.
This form of the disease is called superficial thrombophlebitis.

Any injury can cause the development of this disease.
vessel. Since the veins do not have their own muscle structures,
blood clots forming in them do not come off and continue to develop in
superficial vessels causing prolonged disturbance
blood circulation in a separate part of the limb.

With deep vein thrombosis occurring in the thickness of the muscle tissue,
with pressure drops, blood clots can break off from the vessel wall and
plug small vessels in other parts of the body (brain, lungs,
a heart). In this case, the thrombosis causes severe
complications – emboli, which can cause death
the patient.

Interesting cases
  • Former US President Richard Nixon and Former Vice President Dan
    Quayle had thrombophlebitis;
  • During the filming of “The Mind and Feelings” (1995), actress Kate
    Winslet, who played the role of Marianne Dashwood, suffered
    thrombophlebitis;
  • Mario Lanza was sick with thrombophlebitis, and the cause of his death was
    pulmonary embolism (blockage of pulmonary vessels by a blood clot that has come off
    from the vessel wall on the leg));
Impact on national culture
  • In one of the Simpsons, when Bart gets a deuce,
    the school nurse suspects that he has phlebitis;
  • Peter Boyle’s character in the sitcom “Everybody Loves Raymond” suffers
    thrombophlebitis. Or pretends to suffer to avoid
    performing certain family responsibilities;
  • In the animated series King of the Hill, when Mr. Strickland
    attended Bible study courses in the pool with Luanna, Hank said,
    that “it is useful for his thrombophlebitis”;
  • In the episode “The Young and the Restless” on the series “Hospital M.A.S.H.”
    Colonel Potter suffers from acute thrombophlebitis caused by
    his own failure to recognize the presence of the disease;
  • In the animated series “Futurama” the head of Richard Nixon indulges
    memories of his “Glorious Republican body pierced
    phlebitis “.

Causes of Thrombophlebitis

The cause of thrombophlebitis of the superficial veins is damage
стенки vessel. This is due to incorrect setting.
catheter or needle for intravenous infusion. Thrombophlebitis lower
limbs обычно развивается из-за варикозного расширения
veins.

Among the causes of deep vein thrombophlebitis are:

  • Inactive lifestyle. With a long absence of adequate
    physical activity thrombus grows to a very large size and
    causes severe circulatory disorders in the affected
    vessel;
  • Damage to the vein wall due to catheter irritation or
    needle, injuries, infections, irritants
    chemical substances.
  • Congenital or acquired anomalies of the coagulation system
    blood.

The risk factors for developing the disease include:

  • Long forced position with limited mobility
    limbs (затяжная поездка, авиаперелеты на большие расстояния,
    staying in bed due to illness or after
    surgical intervention);
  • Obesity;
  • Smoking, especially at the same time
    hormone therapy or hormone therapy
    противозачаточных препаратов (применение оральных
    contraceptive new generation significantly reduces the risk
    тромбообразования);
  • Pregnancy. The enlarged uterus can squeeze the large veins in
    the pelvis, increasing the risk of thrombosis;
  • Oncological diseases, hematological diseases;
  • Alcoholism;
  • Травмы limbs.

According to a 2004 study, women receiving
combined hormonal treatment (estrogen and progestin) in
постменопаузальном периоде имеют вдвое больший риск развития
venous thrombosis compared with a control group of women not
taking hormonal drugs.

Symptoms of thrombophlebitis

Superficial thrombophlebitis develops gradually and begins with
slight redness and compaction of the skin area in the affected
veins. As the inflammation progresses, the area of ​​redness
распространяется дальше по ходу veins. It is usually defined as
тонкий плотный и болезненный тяж, повторяющий контуры vessel.
Inflammation can develop in the form of cobwebs, involving in
pathological process smaller veins extending from the affected
vessel.

Thrombophlebitis symptoms, even in severe cases
may appear non-expressed and have a local character. In the plot
inflammation of the skin becomes dense, hot and painful.

Чаще развивается тромбофлебит нижних limbs, симптомы
which include the appearance of severe hyperemia and discharge
venous pattern in the area of ​​inflammation. Sometimes a blood clot may
lead to impaired blood circulation in the limb, leading to its
in the blue.

The skin over the vein swells, sore feels constant itchy skin,
pain becomes throbbing, burning. With quick change
leg positions symptoms may worsen. For example, in the morning at
lowering the legs of the bed. Patients may also complain of pain when
walking

Gradually increasing fever. Normally body temperature is not
exceeds 37.5 – 38 degrees Celsius. For postpartum patients
fever development departments within 4 – 10 days after
Delivery may indicate the presence of thrombophlebitis.

When joining the infection fever increases, appear
severe pain, may form under the skin
abscess that breaks through with the release of purulent discharge.

Deep vein thrombophlebitis

Symptoms of thrombophlebitis глубоких вен включают:

  • Redness (sometimes blue or blanching);
  • Local temperature increase;
  • Edema;
  • Pain in the affected limb.

Symptoms of thrombophlebitis ног при тромбозе глубоких вен
characterized by more pronounced swelling of the affected limb than
with superficial lesion. When viewed the difference between healthy and
the affected side is visible very clearly. In addition, patients
feel the rigidity (tension) of the muscles in the affected
limbs.

Thrombophlebitis treatment

If a disease like thrombophlebitis occurs, the symptoms
and treatment is closely related, since the principles of treatment of thrombophlebitis
superficial and deep veins vary significantly.

As a rule, patients with a diagnosis of lower thrombophlebitis
limbs лечение назначается в минимальном объеме. Sometimes he
runs alone without any treatment. This is a sick state.
can control independently at home.

Если у больного развился острый тромбофлебит нижних limbs,
лечение сводится к приему противовоспалительных препаратов и
keeping the affected limb in a raised position.
It is allowed to use ointments to improve blood flow, relieve edema.
and increase vascular tone.

  • A warm compress is recommended.
  • А также прием нестероидных противовоспалительных
    drugs (aspirin, ibuprofen) to achieve pain medication and
    антикоагуляционного (противосвертывающего) эффекта.
  • The use of local dosage forms (ointments,
    гелей), имеющих в составе нестероидные противовоспалительные
    agents: fastum gel, vltaren emulgel, diclofenac ointment or
    ortofena and others (see NSAIDs in the form of pain ointments).
  • The effectiveness of wearing special elastic stockings and
    dressings (see compression underwear for varicose veins).

Elastic bandaging and wearing stockings is indicated for patients with
диагнозом тромбофлебит вен нижних limbs, лечение которого
may be ineffective or have side effects when
lack of sufficient venous tone. Stockings have
strong enough pressure on the veins to discourage them
expansion and separation of a blood clot.

Depending on the height of the lesion, different stockings are used.
size (to the knee, to the upper third of the thigh). Their application
limits swelling and reduces the risk of deep vein thrombosis, and
also the probability of thromboembolism. A blood clot resolves over
several days or weeks, after which the symptoms of the disease
disappear.

  • The use of antibiotics is shown only when joining
    infections. Иначе назначение антибактериальной терапии окажется
    unjustified and will not lead to improvement.
  • Thrombophlebitis treatment включает специальные мази и препараты для
    topical administration with heparin (hepatrombin, lioton).

Heparin in their composition can replace the daily injectable
dosage that avoids parenteral administration
drugs, replacing them with local means. Although the concentration
Heparin in the preparation Hepatrombin is less than in Lioton, its
efficiency is slightly higher due to additional ingredients,
providing complex antithrombotic and
anti-inflammatory effect.

  • Thrombophlebitis treatment глубоких вен – более сложный процесс,
    требующий проведения терапии антикоагулянтами, а также
    maintain the limb in a raised position.

The main task of treatment in this case is warning
pulmonary embolism. At the time of treatment the patient
госпитализируется в специализированное отделение.

Studies have shown that the use of heparin, and then –
низкодозированного варфарина (непрямой антикоагулянт)
позволяет предотвратить тромбоэмболические осложнения у
больных thrombophlebitis. Further reduce the incidence of development
deep vein thrombosis and thromboembolism allowed the appointment of a new
anticoagulant – Ximelagatran. The effect of these drugs
develops within a few days.

In some cases, along with anticoagulants, treatment of deep
thrombophlebitis includes the appointment of thrombolytic drugs,
causing thrombus resorption. Their application позволяет существенно
reduce treatment time, but increases the risk of blood clot and development
embolism. To this end, enoxaparin (Lovenox) is prescribed to patients.
– быстродействующий препарат для рассасывания тромба, вводимый
parenteral (subcutaneously, intravenously). Тромбофлебит: симптомы, лечение

Given the delayed therapeutic effect of anticoagulants,
thrombolytics play the role of “bridge” from the beginning treatment and development
therapeutic effect of the main drugs.

To determine the effectiveness of treatment with warfarin, as well as with
the purpose of the correction of the input dose of the drug is used indicator
МНО, определяемый в ходе коагуологического исследования blood.
It reflects the state of the patient’s blood coagulation system. Analysis
repeated daily during the entire period of treatment.

  • Additional drugs that are effective in thrombophlebitis,
    are angioprotectors (venoruton, troxevasin) and venotonics
    (phlebodia, detralex).

They prevent further progression of wall lesions.
vessels, providing directly the treatment of veins with thrombophlebitis,
и обладают противовоспалительными свойствами. Recommended
intake of tablets as ointments have irritating
action.

Surgery

In the absence of the effect of therapy and progression
Surgical treatment is prescribed to patients for inflammation.
thrombophlebitis, since ongoing elevated
тромбообразование в пораженной вене значительно повышает риск
развития эмболии и, как следствие, смерти the patient.

A retrospective analysis revealed that about ¼ of cases of thrombophlebitis
deep veins with inadequate therapy ended
thromboembolism.

With the development of superficial phlebothrombosis in the groin, in place
merging of superficial and deep veins, the likelihood of
embolism rises. In this case, emerging in the surface
veins, blood clots can penetrate larger, larger veins, where
subsequently their separation occurs. The treatment is to remove
or ligation of the affected veins to prevent
тромбоэмболических осложнений. After the operation of the vein ligation,
which is performed under local anesthesia, the patient may be
discharged immediately and on the same day back to the full
life without limitation of physical activity.

In addition, modern technical equipment allows precise
determine the location of the development of a blood clot and conduct a sparing operation on its
удалению без удаления всего vessel. After improvement
possible additional surgery for
remove varicose veins that can cause re-development
diseases.

Thrombophlebitis treatment народными средствами

Thrombophlebitis treatment народными средствами предполагает
the use of decoctions and infusions of plants with
противовоспалительными свойствами. These include:

  • Infusion of nettle 1/3 cup inside three times a day;
  • The leaves of the golden whisker are local;
  • Hazel leaf tea;
  • Honey in the form of a compress on the area of ​​the affected veins;
  • Cabbage leaf locally, after crushing or crushing for
    highlight juice. Grease with vegetable before applying
    oil;
  • Birch buds tincture topically;
  • A mixture of gruel of wormwood with yogurt locally in the form
    compress

Remember that a disease like thrombophlebitis, a folk
treatment does not provide complete relief from the disease, but only
leads to temporary improvement by relieving symptoms. For
prevent re-development of thrombophlebitis
help to a specialist.

Prevention

The main method for the prevention of thrombophlebitis – the active way
of life. Recommended ежедневная физическая активность (прогулки,
swimming, jogging, dance courses and other sports).
For предотвращения заболевания рекомендуется:

  • Avoid prolonged lying in the same position or
    sitting;
  • Avoid long horizontal position. If not
    the ability to get out of bed (injury, illness) is necessary
    wear elastic stockings;
  • During long journeys and flights, be sure to get up,
    Walk around the cabin of the bus or plane. If you drive on
    car, make a stop every 100 – 150 km and
    do warm up;
  • Avoid dehydration. Drink more fluids;
  • In medical institutions, the measure of prevention of thrombophlebitis
    is a periodic change of intravenous catheters.

Forecast

Superficial vein thrombosis rarely progresses to severe forms and
usually does not lead to dangerous complications, although there are cases
thromboembolism of small vessels that do not lead to the death of the patient.

Deep vein thrombosis has an increased risk of developing
pulmonary thromboembolism and other vital arteries
important organs. This is a serious complication, which is very often
ends in death.

Deep vein thrombosis can result in
посттромбофлебитический синдром – повреждение стенки сосуда с
development of chronic edema of the limb, followed by
pronounced painful sensations.

Автор: Коробов Никита Александрович врач-анестезиолог

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