Phlebothrombosis
Phlebothrombosis is the formation in the vein of a thrombus vein fixed to the vein wall, completely or partially ("flotation thrombus") of the obturating vessel. In appearance, it matters: a change in the inner wall of the vessel, an increase in blood coagulability, and a slowing of the blood flow. These factors especially occur in the postoperative period in the deep veins of the lower extremities, the pelvic veins. During the first 4-5 days the thrombus is weakly fixed to the vessel wall, a thrombus can be separated with the development of pulmonary embolism. From the 5th day you can already talk about thrombophlebitis. With thrombosis of superficial veins, inflammatory changes are attached very quickly, which is associated with the proximity of the skin, frequent microtrauma of the skin. Primary thrombophlebitis occurs as a result of intravenous administration of irritants, with trauma or when there is an infectious process near the vessel wall.
Thrombophlebitis of the superficial veins of the limb is manifested by pain, flushing of the skin and painful during palpation by compaction along the vein (more often varicose veins). With septic tropicoflebitis, fluctuations in the compaction zone, high temperature, septic state can be determined.
Treatment of thrombophlebitis of superficial veins depends on the localization of the process. When localized on the shin, conservative therapy is appropriate: bandages with heparin ointment, elastic bandage of the limb, walking with elastic bandages. General anti-inflammatory therapy (butadione, rheopyrin, etc.), disaggregants. With the progression of thrombophlebitis, the transition to the thigh shows surgical treatment - the Troyanov-Trendelenburg operation, the excision of thrombosed vessels on the thigh and lower leg. When the thrombotic process reaches the upper third of the thigh, there is a very large possibility of forming a floating thrombus, the head of which can hang into the femoral vein. A typical operation in this case will lead to a clot ligation with the development of pulmonary embolism. In this case, as well as in the transition of thrombosis to the deep venous system (edema of the foot and lower leg), hospitalization in a specialized vascular compartment is shown for a detailed study of thrombus localization; Angiophage, radionuclide study using labeled fibrinogen. In a flotation thrombus hanging in the lumen of the femoral or iliac vein, in some cases implantation of the cavafilter for the prevention of thromboembolic complications with subsequent surgical removal of thrombosed superficial veins and extraction of thrombus from the deep system is shown.
Phlebotrombosis of the deep veins often affects the lower limbs, veins of the pelvis. In the initial stage, the clinical picture is minimal, the diagnosis is difficult. At this stage, there is often no complete occlusion of the vessel, the beds are preserved, only pain along the course of the vascular bundle, soreness in the rear folding of the foot (a symptom of Ho-man), pulling pains on the inner surface of the thigh and foot (a symptom of Payra) Cuffs on the shin and increase in her pressure above 150 mm Hg. Art. (A symptom of Lovenberg). With the growth of thrombosis, blood circulation in the limb is impaired: there is edema, the skin becomes glossy, the figure of the subcutaneous veins (Pratt's symptom), marbling and cyanosis of the skin (the Sperling symptom) clearly appears. In thrombosis of pelvic veins, there may be mild peritoneal phenomena and dynamic intestinal obstruction. The general condition of patients suffers: weakness, fatigue, fever, tachycardia.
There are the following clinical options for phlebotrombosis of deep veins. White painful phlegmasia: the disease is accompanied by a sharp spasm of arterial vessels. Pronounced salt syndrome, limb pale, cold to the touch, pulsation of peripheral vessels absent or sharply weakened. It is difficult to differentiate from acute violations of the arterial blood circulation.
Blue. Phlegmia - the most severe form of phlebotrombosis. Almost all venous vessels of the extremity with acute violation of venous blood flow and rapid development of gangrene of the extremity are affected.
In phlebotrombosis of deep veins, hospitalization is shown in a specialized department for a thorough diagnosis of the localization and extent of thrombosis and the development of an optimal treatment option.
Complications. Thromboembolism of the pulmonary artery, myoglobinuria, hypovolemic shock, hyperkalemia, coagulopathy of consumption. In the long-term development of post-thrombophybic syndrome.
Prevention. Elastic bandage of the limb during and after surgery, labor, should be avoided using lower limb veins for infusion. Early rising, therapeutic gymnastics after surgery.
Post-thrombophlebitic syndrome. After the last venous phlebotyrosis, recanalization of thrombotic masses occurs and the lumen of the vessel is partially restored, but even with sufficient restoration of the vessel's lumen, the disappearance of the valvular apparatus of the deep veins causes significant hemodynamic disturbances in the limb. Changes in blood flow in deep veins lead to the inclusion of pathological veno-venous shunts: discharge of blood through insolvent communicative veins and the mouth of large and small subcutaneous veins lead to a significant increase in pressure in the superficial venous system and the development of secondary varicose veins. The "muscular-venous pump" can not cope with the evacuation of blood from the limb. During the period of shank muscle contraction, the pressure in the deep veins increases significantly, part of the blood rushes through the insolvent communicative veins into the surface system, which leads to a significant increase in pressure, the discharge of the liquid portion of blood and red blood cells to paravasal fiber (skin induration and pigmentation), the opening of arteriovenous shunts with Increased tissue hypoxia and the development of ulcerative defects localized usually on the lower leg above the inner ankle.
Varicose tongues have a necrotic bottom, a purulent discharge with an unpleasant odor, dented edges, a tendency to healing is insignificant.
Patients with post-thrombophlebitic syndrome require a thorough examination: anamnesis, objective research data, special diagnostic tests (see Varicose Veins), which should be supplemented by a contrast radiography study, the correctness of which can be provided by using a combination of various phlebological methods to obtain data About the entire venous limb system.
Treatment. At present, there is no radical method of treating patients with postthrombophlebitic syndrome of the lower limbs. The nature of the treatment, its effectiveness depends on the type (failure of the valves, complete occlusion of the vein), localization and extent of the vascular lesion. The basis of surgical tactics is the maximum correction of the function of the "muscular pump" of the shin.
The prognosis is serious, the work capacity is reduced.
- Surgical diseases
- Abscess
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- X-ray diagnostics
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