thrombophlebitis

Thrombophlebitis - acute inflammation of the vein walls to form a blood clot in its lumen.

The development of the disease is set to a number of factors: the slowing of blood flow, the change in its composition, in violation of the blood coagulation system, damage or disease of the vascular wall, neurotrophic and endocrine disorders, infection, and allergic reactions. Thrombophlebitis often develops in patients with varicose veins, purulent infectious diseases, hemorrhoids, tumors, blood diseases and heart, as well as after surgery (especially pelvic), childbirth, during prolonged catheterization of veins, wounds and injuries, intravenous administration of antibiotics , concentrated solutions of drugs.

The clinical picture depends on the localization of thrombosis. There are superficial thrombophlebitis (predominantly varicose) veins and thrombophlebitis of deep veins of the lower extremities.

Acute superficial thrombophlebitis of the lower extremities has a characteristic clinical picture and develops, usually in the varicose-vein altered. Most affected large subcutaneous Vienna. In the course of thrombosed veins appear sharp nagging pain may increase in body temperature to 37.5 - 38 ° C. In the course of the affected veins are determined by local redness, skin redness and tenderness tight cord. In some cases, thrombophlebitis develops ascending the great saphenous vein with the threat of pulmonary embolism.

The clinical picture of acute deep vein thrombophlebitis shin depends on the extent and location of the thrombus, the number involved in the veins of the process. The disease usually begins acutely, with pain in the calf muscles, the emergence of a sense of fullness in the lower leg, especially when lowering it down, increase in body temperature. In the distal parts of the lower leg edema occurs, the skin becomes slightly cyanotic shade, and after 2 - 3 days there is a network of dilated superficial veins in the legs, thighs and abdomen. When dorsiflexion of the foot appear sharp pain in the calf muscles. There may be tenderness on deep palpation of the gastrocnemius muscle. Early diagnostic signs of deep thrombophlebitis are: Moses symptom -. pain when squeezing the tibia in the anteroposterior direction in the absence of pain after compression of the sides; symptom Opitz - Raminesa - a sharp pain along the tibia veins after pressure rises to 40 - 45 mm Hg. Art. the cuff sphygmomanometer, superimposed above the knee; after reducing the pressure the pain disappears; Lovenberga symptom - a sharp pain in the calf muscles at a pressure of 60-150 mm Hg. Art. cuff superimposed on the middle third of the tibia.

The development of thrombosis in the femoral vein to the confluence with the deep veins is characterized not so pronounced signs of violation of the venous outflow in connection with well developed collateral circulation. Pains in the field of leading hip muscles. On examination revealed slight swelling and expansion of the saphenous veins. Thrombophlebitis common femoral vein is accompanied by a sharp pain in the limbs, severe edema and cyanosis of her. Fever accompanied by chills. In the upper third of the thigh, groin and pubic areas appear dilated superficial veins.

The most difficult runs thrombophlebitis of iliac-femoral segment the main vein. With an initial total occlusion or external iliac veins with localized parietal thrombus, or blood clot, do not completely cover the lumen of the vein, there are slight pain in the lumbar and sacral areas in the lower abdomen on the affected side. Patients report a malaise, a slight increase in body temperature. When floating thrombus dimensional and the only sign of disease may be thromboembolism of pulmonary arteries. With complete occlusion iliac vein there are sharp pain in the groin area, developing common swelling limbs throughout the transition to the buttock and groin area, genitals, anterior abdominal wall on the affected side. Edema initially soft, then it becomes dense. The skin takes on a milky white or purple color. Venous pattern strengthened. Temperatura body rises to 38 -39 ° C, there are chills, lethargy, weakness, symptoms of intoxication.

The most severe complication of thrombosis of the deep veins of the lower extremities is a thromboembolism of pulmonary arteries.

L e h n e. The only radical method of treatment of thrombophlebitis varicose veins is surgery, since only operation reliably prevents the further spread of thrombosis, complications and recurrences. Thrombophlebitis arising in previously modified veins often treated conservatively. Emergency surgery is indicated in progressive ascending thrombophlebitis of large and small saphenous vein with the aim of preventing the spread of the deep vein thrombosis and thromboembolism prophylaxis.

Conservative treatment on an outpatient basis with a limited permissible superficial thrombophlebitis of the foot and lower leg. Patients thus maintain active mode. The affected limb is recommended to periodically give an elevated position. Locally applied cold bandage with heparin ointment, jelly troksevazin; prescribe anti-inflammatory and reduce congestion in the veins and equipment (indomethacin, Aescusan, venoruton, Anavenol, troksevazin). When the inflammatory process in the tissue surrounding the vein prescribe antibiotics and sulfa drugs. In the acute period of use UHF-therapy. An important role is played by elastic bandaging limbs.

Treatment of patients with deep vein thrombophlebitis should be carried out in a hospital. In the early days is shown with a raised bed rest at 15 - 20 ° limb bandaged with an elastic bandage. After confirming the diagnosis the therapy directed on clot lysis (introduction streptazy, streptokinase, urokinase) and the suspension of thrombosis - intravenous infusion of heparin (30-40 thousand units per day.) Under the control of blood clotting, reopoliglyukina (0.7 - 1.0 g / kg per day), pentoxifylline (3 - 5 mg / kg per day).

Activation of patients with deep vein thrombosis begins with 5 - 10 th day. Motor exercises (slow flexion and extension of the foot), patients begin to do lying down, then sitting up in bed with lowered feet; gradually moving to a dosage walking. Required elastic bandaging limbs.

After suffering acute thrombophlebitis after 3 - 4 months is shown spa treatment with radon or hydrogen sulfide baths in spas cardiovascular profile.

The prognosis of acute superficial thrombophlebitis is usually favorable. After 1-2 months, patients resumed previous career. After acute deep vein thrombophlebitis in 75 - 90% of patients develop chronic venous insufficiency, for which is often complicated by the development of edema, pain post-thrombotic syndrome form, trophic ulcers, erysipelas, which is the cause of permanent disability and disability.

Prevention. Patients with varicose veins should be promptly directed to surgical treatment. Elastic compression stocking or bandage the limb shown to pregnant women in the 2nd half of pregnancy. Postoperative physical therapy sessions are recommended, early activation of patients, elastic compression of the lower extremities, massage. When intravenous infusions must be strict adherence to the rules of aseptic and antiseptic. Avoid the use of lower extremity veins for infusions. When venous cannulation for intravenous infusion catheter is inserted a small dose of heparin. With the threat of troflebita (varicose veins, thrombophlebitis history, age over 60 years, and others.) Postoperatively shows the assignment of heparin, intravenous dextran, improve blood rheology (reopoligljukin).