Thrombophlebitis of the lower extremities
The content of the article:
- Causes and risk factors
- Forms of the disease
- Signs of thrombophlebitis of the lower extremities
- Diagnostics
- Treatment of thrombophlebitis of the lower extremities
- Diet for thrombophlebitis of the lower extremities
- Potential consequences and complications
- Forecast
- Prevention
Thrombophlebitis of the lower extremities is a disease of the veins of the lower extremities of an inflammatory nature, accompanied by the formation of blood clots in their lumen. In the general structure of the incidence of thrombophlebitis, this localization of pathology accounts for approximately 80-90%, i.e., the vast majority of cases.
Thrombophlebitis of the lower extremities is an inflammation of the venous walls of the legs with the formation of blood clots in the lumen of the inflamed vein
Causes and risk factors
The pathogenesis of thrombophlebitis of the lower extremities is rather complicated. Several factors are simultaneously involved in it:
- increased viscosity and blood clotting;
- slowing down of venous blood flow;
- damage to the valve apparatus or vein wall;
- accession of infection.
The most dangerous is deep vein thrombophlebitis of the lower extremities. This is due to the peculiarities of the blood clot forming here. A sharp slowdown in blood flow in the affected vein system in combination with increased blood coagulability causes the formation of a red blood clot, consisting of erythrocytes, a small number of platelets and fibrin filaments. The thrombus is attached on one side to the venous wall, while its other end floats freely in the lumen of the vessel. With the progression of the pathological process, the thrombus can reach a considerable length (20-25 cm). Its head is in most cases fixed near the venous valve, and its tail fills almost the entire branch of the vein. Such a blood clot is called floating, that is, floating.
In the first few days after the onset of thrombus formation, its head is poorly fixed to the vein wall, therefore there is a high risk of its separation, which, in turn, can lead to the development of thromboembolism of the pulmonary artery or its large branches.
After 5-6 days from the onset of thrombus formation, an inflammatory process begins in the affected vein, which contributes to better adhesion of the blood clot to the venous wall and reduces the risk of thromboembolic complications (caused by the separation of a thrombus).
The predisposing factors for the development of thrombophlebitis of the lower extremities are:
- Varicose veins;
- venous stasis caused by prolonged bed rest, pelvic tumors, pregnancy, overweight;
- local or systemic bacterial infection;
- postpartum period;
- taking oral contraceptives (in this case, the risk is especially increased in women who smoke);
- malignant neoplasms (cancer of the pancreas, stomach, lungs);
- disseminated intravascular coagulation syndrome (disseminated intravascular coagulation syndrome);
- post-thrombophlebitic disease;
- trauma;
- chronic diseases of the cardiovascular system;
- condition after an abortion or other surgical intervention;
- prolonged vein catheterization;
- systemic diseases.
Forms of the disease
Thrombophlebitis of the lower extremities, depending on the activity of the inflammatory process, is divided into acute, subacute and chronic. The chronic form of the disease occurs with periodically alternating stages of remission and exacerbation, therefore it is usually called chronic recurrent thrombophlebitis of the lower extremities.
Depending on the localization of the pathological process, thrombophlebitis of the superficial and deep veins of the lower extremities is isolated.
Thrombophlebitis of the veins of the lower extremities is superficial and deep
Signs of thrombophlebitis of the lower extremities
The clinical picture of thrombophlebitis of the lower extremities is largely determined by the form of the disease.
Acute thrombophlebitis of the superficial veins of the lower extremities occurs suddenly. The patient's body temperature rises sharply to 38-39 ° C, which is accompanied by severe chills (shaking chills). On palpation, the affected vein is felt as a painful cord. The skin over it is often hyperemic. The subcutaneous tissue can be compacted, which is explained by the formation of an infiltrate. The inguinal lymph nodes on the affected side are enlarged.
Symptoms of thrombophlebitis of the lower extremities in the subacute form are less pronounced. The disease usually occurs at normal body temperature (in some patients, in the first days, there may be a slight fever up to 38 ° C). The general condition suffers little. When walking, moderately pronounced painful sensations occur, but there are no local signs of an active inflammatory process.
Acute thrombophlebitis of the lower extremities is accompanied by fever and swelling of the skin
The recurrent chronic form of thrombophlebitis of the superficial veins of the lower extremities is characterized by an exacerbation of a previously arisen inflammatory process or the retraction of new sections of the venous bed into it, that is, it has symptoms similar to an acute or subacute course. During the period of remission, there are no symptoms.
Deep vein thrombophlebitis of the lower extremities in half of the patients is asymptomatic. The disease is diagnosed, as a rule, retrospectively after the development of thromboembolic complications, most often pulmonary embolism.
In the remaining 50% of patients, signs of the disease are:
- feeling of heaviness in the legs;
- persistent swelling of the lower leg or the entire affected lower limb;
- bursting pain in the calf muscle;
- an increase in body temperature up to 39-40 ° C (with an acute form of thrombophlebitis of the lower extremities);
- Pratt's symptom (glossy skin over the lesion, on which the pattern of the subcutaneous venous network is clearly visible);
- Payr's symptom (pain spreads along the inner surface of the thigh, lower leg and foot);
- Homans symptom (dorsiflexion of the foot is accompanied by pain in the calf muscle);
- Lyuvenberg's symptom (compression of the lower leg by the cuff from the tonometer when creating a pressure of 80-100 mm Hg leads to pain, although normally they should appear at a pressure of more than 150-180 mm Hg);
- the affected limb feels colder than the healthy one.
Diagnostics
Diagnosis of thrombophlebitis of the superficial veins of the lower extremities is not difficult and is carried out on the basis of the data of the characteristic clinical picture of the disease, an objective examination of the patient and the results of laboratory tests (an increase in the prothrombin index is noted in the blood, leukocytosis with a shift of the leukocyte formula to the left, an increase in ESR).
Thrombophlebitis of the superficial veins of the lower extremities is differentiated from lymphangitis and erysipelas.
The most accurate diagnostic method for deep vein thrombophlebitis of the lower extremities is distal ascending phlebography. The X-ray contrast agent is injected into one of the saphenous veins of the foot below the level of the tourniquet that squeezes the ankle, which allows it to be redirected to the deep vein system, after which X-rays are taken.
Distal ascending phlebography is the most accurate method for diagnosing thrombophlebitis
Also, in the diagnosis of this form of the disease, the following methods of instrumental diagnostics are used:
- Doppler ultrasound;
- impedance plethysmography;
- scan using fibrinogen labeled with isotope 125.
Deep vein thrombophlebitis of the lower extremities must be differentiated with a number of other diseases and, above all, with cellulite (inflammation of the subcutaneous tissue), rupture of a synovial cyst (Baker's cyst), lymphatic edema (lymphedema), compression of a vein from the outside by enlarged lymph nodes or a tumor, rupture or stretching the muscles.
Treatment of thrombophlebitis of the lower extremities
Treatment of thrombophlebitis of the lower extremities can be surgical or conservative.
Conservative therapy begins with providing the patient with bed rest for 7-10 days. The affected limb is bandaged with elastic bandages, which reduces the risk of thrombus separation and the development of thromboembolic complications and gives it an elevated position. Prolonged bed rest is unjustified. As soon as the inflammation begins to subside, the patient's motor regime should be gradually expanded. Physical activity and muscle contractions improve blood flow through deep veins and reduce the risk of new blood clots.
Compresses with Vishnevsky ointment, semi-alcoholic or oil compresses, as well as ointments and gels with heparin are used locally.
As a local therapy for thrombophlebitis, compresses with Vishnevsky ointment are used
For anti-inflammatory purposes, nonsteroidal anti-inflammatory drugs are prescribed. At a high body temperature or the development of purulent thrombophlebitis of the lower extremities, broad-spectrum antibiotics are used.
Fibrinolytic drugs can be used only in the very early stages of the disease, which usually go undiagnosed. In the future, attempts at thrombolysis can lead to fragmentation of the thrombus and the development of pulmonary embolism. Therefore, thrombolytic therapy in patients without installed cava filters is contraindicated.
In the scheme of conservative treatment of thrombophlebitis of the lower extremities, a significant role is played by anticoagulant drugs, which reduce the time of blood clotting and thereby reduce the risk of blood clots. If the patient has contraindications to the appointment of anticoagulants (open form of tuberculosis, gastric ulcer and duodenal ulcer, fresh wounds, hemorrhagic diathesis), then hirudotherapy (leech therapy) is possible in this case.
To improve the condition of the venous wall in patients with thrombophlebitis of the lower extremities, venotonic agents are used.
With the formation of a floating thrombus, accompanied by a high risk of thromboembolic complications, surgical intervention is indicated, the purpose of which is to install a cava filter in the inferior vena cava at a level below the renal veins.
With purulent thrombophlebitis of the superficial veins of the lower extremities, the Troyanov-Trendelenburg operation is performed.
Purulent thrombophlebitis of the veins of the lower extremities - an indication for surgery
After the acute inflammation subsides, patients with thrombophlebitis of the lower extremities are sent for sanatorium-resort treatment (hardware physiotherapy, radon or hydrogen sulfide baths are indicated).
Diet for thrombophlebitis of the lower extremities
Properly organized nutrition creates the necessary prerequisites for improving the condition of patients, shortens the rehabilitation period, and reduces the risk of relapse. The diet for thrombophlebitis of the lower extremities should provide:
- strengthening the venous wall;
- improving the rheological properties of blood;
- normalization of the patient's body weight.
Patients need to carefully observe the water regime. During the day, you should drink at least two liters of liquid. It is especially important to control the amount of fluid consumed in hot weather, as profuse sweating can cause blood to thicken.
With thrombophlebitis, it is important to drink at least 2 liters of water per day to avoid blood thickening
In the diet of patients with thrombophlebitis of the lower extremities, fresh vegetables and fruits should be included in sufficient quantities, which provide the body with vitamins and trace elements, which is necessary to improve the tone of the venous wall.
The diet for thrombophlebitis of the lower extremities includes the following foods:
- cold-pressed vegetable oils (it is advisable to use linseed oil daily for dressing salads);
- melons (watermelon, melon, pumpkin);
- ginger, cinnamon;
- onions, garlic, leafy vegetables;
- cocoa, chocolate;
- all types of fruits, berries;
- fatty varieties of sea fish.
Cherries and raspberries are especially useful for thrombophlebitis of the lower extremities. They contain a natural anti-inflammatory substance - salicylic acid, which not only reduces the activity of the inflammatory process, but also has some anticoagulant effect.
Potential consequences and complications
Complications of thrombophlebitis of the lower extremities can be:
- pulmonary embolism;
- streptococcal lymphangitis;
- white painful phlegmas (associated with a spasm of an artery running next to a thrombosed vein);
- blue pain phlegmas (develops in the affected limb with an almost complete blockage of the venous outflow of blood);
- purulent fusion of a thrombus, which can lead to the formation of an abscess, phlegmon, and in severe cases cause sepsis.
Forecast
The prognosis for thrombophlebitis of the lower extremities is serious. In the absence of adequate treatment in 20% of cases, the disease ends with the development of pulmonary embolism, which causes death in 15-20% of patients. At the same time, the timely appointment of anticoagulant therapy can reduce mortality by more than 10 times.
Prevention
Prevention of the development of thrombophlebitis of the lower extremities should include the following measures:
- timely detection and active treatment of diseases of the veins of the lower extremities;
- remediation of foci of chronic infection in the patient's body;
- early activation of patients in the postoperative period;
- active lifestyle;
- proper nutrition;
- compliance with the water regime;
- compulsory wearing of compression hosiery for varicose veins of the lower extremities.
In chronic recurrent thrombophlebitis of the lower extremities, it is necessary to carry out preventive treatment of the disease on a quarterly basis, aimed at preventing the occurrence of exacerbations. It should include the appointment of phleboprotectors and physiotherapy procedures (laser, magnetic therapy).
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
