Acute thrombophlebitis of superficial veins. Superficial thrombophlebitis of the lower extremities

Many people suffer from thrombophlebitis, but not everyone knows about the origin of the disease. Thrombophlebitis of the superficial veins is associated with thickening of the vein wall that occurs after an infectious etiology. A thrombus forms in the lumen of the vein.

The disease requires attention. Superficial thrombophlebitis is associated with actions occurring in the veins that are located at the bottom of the limbs, the subcutaneous tissue in them is not deep. The disease occurs in mild form, can soon go into an acute stage, then the treatment takes place in a hospital under the supervision of a doctor.

Three stages of development of thrombophlebitis are considered. Treatment depends on the stage of the disease:

The thrombus is located in the lumen of the vessel, blocking the path to the flow of blood, the vein gradually expands, delivering a lot of discomfort to the patient.
The thrombus has separated from the wall of the vessel, with blood it can get into any organ.
The most easy stage. Creation of a blood clot that can dissolve.

Treatment of thrombophlebitis of superficial veins is carried out under the supervision of a physician.

Causes of thrombophlebitis

There are many reasons for the occurrence of thrombophlebitis. It is worth considering everything in order to make the correct prognosis of the onset of the disease during treatment:

Infection passing from inflamed tissues to the vessel wall. If the disease does not appear immediately, gradually - a chronic course. The causes of infection carried through the veins can be tonsillitis, pneumonia, influenza.
Blood stasis contributes to blood coagulation, a change in composition, which is why it happens.
Trauma, mechanical damage.
The disease is inherited.
Thrombophlebitis of superficial veins lower extremities occurs due to allergic diseases.
Obesity, pregnancy. The disease proceeds in a mild form, it is worth starting to treat the disease on time.

These are the main causes that provoke thrombophlebitis.

Symptoms of thrombophlebitis

Recognizing the disease is not difficult. The disease is divided into two forms: chronic. Acute thrombophlebitis develops suddenly, sometimes the patient is unaware of the complexity of the disease. Symptoms accompanying this form:

Poor blood clotting.
Expansion of the veins, venous nodes become enlarged, which become inflamed, thickened.
Severe pain, swelling of the leg.
The body temperature rises, reaching 38 degrees.
Enlarged lymph nodes in the thigh area.

Thrombophlebitis is superficial - the veins located on the surface of the lower extremities are affected, and deep - the damage to the veins occurs deeper.

When the symptoms are different. The disease proceeds in a simplified form, a person does not pay attention for a long time. The pain doesn't happen all the time. If you use anesthetic ointments, the pain subsides, the temperature does not rise, and swelling does not occur. It is sometimes believed that the acute form is more dangerous than the chronic form. This is an erroneous opinion - acute thrombophlebitis immediately shows the form of the disease, the patient understands that treatment is required, in the chronic course of the disease, the patient postpones going to the doctor until the condition becomes critical.

Diagnostics of thrombophlebitis

The doctor, examining the patient, pays attention to the symptoms described by the patient, an examination is carried out from the groin to the foot. More often, the formation of blood clots occurs in the thigh, lower leg. The diagnosis takes into account the degree of redness of the affected areas, the presence of hyperthermia, pain.

Diagnostic measures:

Doppler ultrasound. With the help of a special sensor, a special signal is sent, which allows you to see the movement of blood through the veins. The computer shows a change in frequencies, which indicates confirmation of the symptoms of thrombophlebitis.
Computed or magnetic resonance imaging. An examination is ordered when the doctor cannot confirm the presence of thrombophlebitis by ultrasound.
Venography is used to make an accurate diagnosis. A special substance is injected into the vein, which allows you to view the vessels from the inside. The method resembles an x-ray, is rarely used.

After determining the presence of the disease, it is worth building a prognosis for treatment.

How is thrombophlebitis treated?

When the first symptoms of thrombophlebitis appear, you need to see a doctor. The disease is cured by early stages. When thrombophlebitis manifests itself in the lower leg, treatment can be done at home. If the disease is in the thigh area, treatment is carried out in a hospital under the supervision of a doctor.

In cases where the disease occurs with complications, hospitalization is also required. When sick, the patient is required to comply with bed rest. To avoid complications, the impact of weights on the lower leg and thigh area is prohibited.

When treating, it is necessary to take into account the symptoms, contraindications:

During treatment, move less, do not be active in sports.
Follow the bed rest prescribed by your doctor, especially for hip thrombosis.
Use elastic bandages, special stockings that tighten the shin area.
The use of medications aimed at reducing the symptoms of the disease, relieve inflammation, swelling.
They dissolve the stagnation of blood in the veins of an ointment based on heparin.

If it is not possible to cope with thrombophlebitis with medications, the help of a surgeon is required. The patient undergoes a venectomy - removal of a vein. The affected area of the vein is removed, the patient will be able to move normally.

The disease can be foreseen if the rules of prevention are followed. Sometimes used to fight folk remedies. You can simply follow the regime, which includes:

Proper nutrition that normalizes weight.
With severe leg fatigue, take cool baths that promote blood flow.
With swelling of the legs, raise them to a hill - the outflow of blood improves.
Do simple leg exercises daily.

If treatment is not started on time, there is a risk serious complications that lead to disability. Thrombophlebitis leads to varicose veins throughout the body, treatment is almost impossible.

achieve effective treatment it is possible when the first deviations in the human body are detected, in which case complications can be avoided. Thrombophlebitis is not considered harmless, it brings health troubles, including it can be fatal. The health and beauty of the legs depends on you, such problems should be treated with all the attention.

For citation: Kiyashko V.A. Thrombophlebitis of superficial veins: diagnosis and treatment // RMJ. 2003. No. 24. S. 1344

D this type of pathology is a very common disease venous system faced by a doctor of any specialty.

Currently in medical practice also often use such terms as phlebothrombosis and varicothrombophlebitis. All of them are legal to use, but the following points should be considered. Phlebothrombosis is considered as an acute obstruction of a vein as a result of hypercoagulation, which is the leading mechanism. But at the same time, after 5-10 days, the thrombus that has arisen causes reactive inflammation of the tissues surrounding the vein with the development of phlebitis, that is, phlebothrombosis is transformed into thrombophlebitis .

The term "varicothrombophlebitis" clearly indicates the actual cause of thrombosis that occurs against the background of the already existing patient varicose veins veins.

The pathology of the venous system listed above in the vast majority of clinical cases occurs in the large system and much less often in the system of the small saphenous vein.

Thrombophlebitis of the veins on the upper extremities are extremely rare, and the main provoking factors for their occurrence are multiple punctures for the introduction medicines or prolonged placement of the catheter in a superficial vein.

Particular attention should be paid to patients with spontaneously occurring blood clots in the upper and lower extremities, not associated with iatrogenic exposure. In such cases, the phenomena of thrombophlebitis can be suspected as a manifestation of a paraneoplastic reaction due to the presence of an oncological pathology in the patient, requiring an in-depth multifaceted examination.

Thrombus formation in the system of superficial veins is provoked by the same factors that cause thrombosis of the deep venous system of the lower extremities. These include: age over 40 years, the presence of varicose veins, cancer, severe disorders of cardio-vascular system(cardiac decompensation, occlusion of the main arteries), hypodynamia after major operations, hemiparesis, hemiplegia, obesity, dehydration, banal infections and sepsis, pregnancy and childbirth, oral contraceptives, trauma of extremities and surgical interventions in the area of passage of venous trunks.

Thrombophlebitis can develop in any part of the superficial venous system , with the most frequent localization on the lower leg in the upper or middle third, as well as the lower third of the thigh. The overwhelming number of cases of thrombophlebitis (up to 95-97%) was noted in the basin of the great saphenous vein (Kabirov A.V. et al., Kletskin A.E. et al., 2003).

Further development of thrombophlebitis can actually go in two ways:

1. Relatively favorable course diseases , against the background of the treatment, the process stabilizes, thrombus formation stops, inflammation subsides, and the process of thrombus organization begins, followed by recanalization of the corresponding section of the venous system. But this cannot be considered a cure, because. there is always damage to the initially altered valvular apparatus, which further aggravates the clinical picture of chronic venous insufficiency.

Also possible clinical cases when a fibrous-modified thrombus tightly obliterates a vein and its recanalization becomes impossible.

2. The most unfavorable and dangerous option in terms of the development of complications of a local nature - ascending thrombosis along the great saphenous vein to the oval fossa or the transition of the thrombotic process through the communicating veins to the deep venous system of the lower leg and thigh.

The main danger of the course of the disease according to the second variant is the threat of developing such a complication as pulmonary embolism (PE), the source of which can be a floating thrombus from the system of a small or large saphenous vein, as well as secondary deep vein thrombosis of the lower extremities.

It is quite difficult to judge the frequency of thrombophlebitis among the population, but if we take as a basis the position that among those hospitalized in surgical departments more than 50% of patients with this pathology had varicose veins, then taking into account the millions of patients with this pathology in the country, this figure looks very impressive and the problem is of great medical and social importance.

The age of patients ranges from 17 to 86 years and even older, and average age is 40-46 years old, that is, the able-bodied contingent of the population.

Considering the fact that with thrombophlebitis of superficial veins general state the patient and his health, as a rule, do not suffer and remain quite satisfactory, this creates the illusion of relative well-being and the possibility of various methods of self-treatment in the patient and his relatives.

As a result, this behavior of the patient leads to late accessibility for the provision of qualified medical care, and often the surgeon is already faced with complicated forms of this “simple” pathology, when there is a high ascending thrombophlebitis or deep vein thrombosis of the limb.

Clinical picture

The clinical picture of the disease is quite typical in the form of local pain in the projection of the saphenous veins at the level of the lower leg and thigh with the involvement of the tissues surrounding the vein in the process, up to the development of a sharp hyperemia of this zone, the presence of seals not only in the vein, but also in the subcutaneous tissue. The longer the zone of thrombosis, the more pronounced the pain in the limb, which forces the patient to limit its movement. Hyperthermic reactions in the form of chills and an increase in temperature up to 38-39 ° C are possible.

Quite often, even a banal acute respiratory disease becomes a provocative moment for the occurrence of thrombophlebitis, especially in patients with varicose veins of the lower extremities.

Inspection is always carried out from two sides - from the foot to inguinal zone. Attention is drawn to the presence or absence of pathology of the venous system, the nature of the discoloration of the skin, local hyperemia and hyperthermia, swelling of the limb. Severe hyperemia is typical for the first days of the disease, it gradually decreases by the end of the first week.

With the localization of thrombophlebitis in the small saphenous vein, local manifestations are less pronounced than with damage to the trunk of the great saphenous vein, which is due to the peculiarities of the anatomy. The superficial sheet of the own fascia of the lower leg, covering the vein, prevents the transition inflammatory process to the surrounding tissues. The most important point is to find out the period of appearance of the first symptoms of the disease, the speed of their increase, and whether the patient has attempted to influence the process with medication.

So, according to A.S. Kotelnikova et al. (2003), the growth of a thrombus in the system of the great saphenous vein goes up to 15 cm per day. It is important to remember that in almost a third of patients with ascending thrombosis of the great saphenous vein, its true upper limit is located 15-20 cm above the level determined by clinical signs (V.S. Savelyev, 2001), that is, this fact should consider each surgeon when consulting a patient with thrombophlebitis of a vein at the level of the thigh, so that there is no unreasonable delay in the operation aimed at preventing PE.

It should also be considered inappropriate to locally administer anesthetics and anti-inflammatory drugs to the area of a thrombosed vein on the thigh, since, by stopping pain, this does not prevent the growth of a thrombus in the proximal direction. Clinically, this situation becomes difficult to control, and duplex scanning can really only be used in very large medical institutions.

Differential Diagnosis should be carried out with erysipelas, lymphangitis, dermatitis various etiologies, nodular erythema.

Instrumental and laboratory diagnostics

Highly long time The diagnosis of thrombophlebitis of superficial veins was made by a doctor on the basis of only the clinical symptoms of the disease, since in fact there were no non-invasive methods for characterizing venous blood flow. The introduction of ultrasound diagnostic methods into practice has opened a new stage in the study of this common pathology. But the clinician must know that among the ultrasound methods for diagnosing venous thrombosis, duplex scanning plays a decisive role, since only with its help it is possible to determine the clear boundary of thrombosis, the degree of thrombus organization, the patency of deep veins, the state of the communicants and the valvular apparatus of the venous system. Unfortunately, the high cost of this equipment still sharply limits its practical use in outpatient and inpatient settings.

This study is indicated primarily for patients with suspected embologenic thrombosis, that is, when there is a transition of a thrombus from the superficial venous system to the deep one through the sapheno-femoral or sapheno-popliteal fistula.

The study can be carried out in several projections, which significantly increases its diagnostic value.

Phlebographic study

The indication to it is sharply narrowed. The need for its implementation arises only in the case of a blood clot spreading from the great saphenous vein to the common femoral and iliac vein. And this study performed only in cases where the results of duplex scanning are doubtful and their interpretation is difficult.

Laboratory diagnostic methods

In normal clinical analysis blood draws attention to the level of leukocytosis and the level of ESR.

It is desirable to study the C-reactive protein, coagulogram, thrombelastogram, the level of the prothrombin index and other indicators characterizing the state of the coagulation system. But the scope of these studies is sometimes limited by the capabilities of the laboratory service of a medical institution.

Treatment

One of the important points that determine the outcome of the disease and even the fate of the patient is the choice of tactics for the optimal treatment option for the patient.

With the localization of thrombophlebitis at the level of the lower leg, the patient can be treated on an outpatient basis, while under constant control surgeon. Under these conditions, it is necessary to explain to the patient and his relatives that if signs of thrombosis spread to the level of the thigh appear, the patient may need to be hospitalized in a surgical hospital. Delay in hospitalization is fraught with the development of complications, up to the occurrence of PE.

In cases where thrombophlebitis at the level of the lower leg, treated for 10-14 days, does not regress, there should also be a question of hospitalization and more. intensive care diseases.

One of the main issues in the treatment of patients with thrombophlebitis of superficial veins is the discussion the need for the patient to comply with strict bed rest .

Currently recognized fact is that strict bed rest is indicated only for patients who already had clinical signs of PE or have clear clinical data and results instrumental research indicate the embologenic nature of thrombosis.

The motor activity of the patient should be limited only to severe physical activity(running, lifting weights, performing any work that requires significant muscle tension limbs and abdominals).

General principles for the treatment of thrombophlebitis of superficial veins

These principles are indeed common for both conservative and surgical treatment of this pathology. The main goals of treatment these patients are:

To act as quickly as possible on the focus of thrombosis and inflammation to prevent its further spread.
Try to prevent the transition of the thrombotic process to the deep venous system, which significantly increases the risk of developing PE.
Treatment should be a reliable method of preventing recurrent thrombosis of the venous system.
The method of treatment should not be strictly fixed, since it is determined primarily by the nature of the ongoing changes in the limbs in one direction or another. That is, the transition or addition of one treatment method to another is quite logical.

Undoubtedly, conservative treatment shown to the vast majority of patients with "low" superficial thrombophlebitis of the saphenous veins.

Once again, it should be emphasized that reasonable motor activity of the patient improves the function of the muscle pump, which is the main determining factor in ensuring venous outflow in the system of the inferior vena cava.

The use of external compression (elastic bandage, stockings, tights) in the acute phase of inflammation can cause some discomfort, so this issue should be addressed strictly individually.

Quite controversial is the question of the use of antibiotics in this category of patients. The physician must be aware of possible complications this therapy ( allergic reactions intolerance, provocation of blood hypercoagulability). Also, the question of the advisability of using anticoagulants (especially direct action) in this group of patients.

The doctor must remember that the use of heparin after 3-5 days can cause thrombocytopenia in the patient, and a decrease in the number of platelets by more than 30% requires discontinuation of heparin therapy. That is, there are difficulties in controlling hemostasis, especially in outpatient settings. Therefore, it is more appropriate to use low molecular weight heparins (dalteparin, nadroparin, enoxaparin), since they rarely cause the development of thrombocytopenia and do not require such careful monitoring of the coagulation system. Positive is the fact that these drugs can be administered to the patient 1 time per day. 10 injections are enough for a course of treatment, and then the patient is transferred to indirect anticoagulants.

In recent years, ointment forms of heparin (lyoton-gel, Gepatrombin) have appeared for the treatment of these patients. Their main advantage is rather high doses of heparin, which are delivered directly to the focus of thrombosis and inflammation.

Of particular note is the targeted effect on the area of thrombophlebitic changes of the drug Hepatrombin ("Hemofarm" - Yugoslavia), produced in the form of an ointment and gel.

Unlike Lyoton, it contains 2 times less heparin, but additional components - allantoin and dexpanthenol, which are part of the Hepatrombin ointment and gel, as well as pine essential oils, which are part of the gel, have a pronounced anti-inflammatory effect, reduce the effects of skin itching and local pain in the area of thrombophlebitis. That is, they contribute to the relief of the main symptoms of thrombophlebitis. The drug Hepatrombin has a strong antithrombotic effect.

It is applied topically by applying a layer of ointment to the affected areas 1-3 times a day. In the presence of an ulcerative surface, the ointment is applied in the form of a ring up to 4 cm wide around the perimeter of the ulcer. Good tolerability of the drug and the versatility of its impact on the pathological focus puts this medicine to the fore in the treatment of patients with thrombophlebitis both on an outpatient basis and in hospital treatment. Hepatrombin can be used in a complex of conservative treatment or as a remedy aimed at stopping inflammation of the venous nodes after the Troyanov-Trendelenburg operation, as a method of preparing for the second stage of the operation.

The complex of conservative treatment of patients should include non-steroidal anti-inflammatory drugs also have analgesic properties. But the clinician should be mindful of extreme caution when prescribing these agents to patients with disease. gastrointestinal tract(gastritis, peptic ulcer) and kidneys.

Well-established in the treatment of this pathology is already well known to doctors and patients phlebotonics (rutoside, troxerutin, diosmin, ginkgo biloba and others) and disaggregants (acetylsalicylic acid, pentoxifylline). AT severe cases with extensive phlebitis, intravenous transfusions of 400-800 ml of rheopolyglucin intravenously are indicated for 3 to 7 days, taking into account the cardiac status of the patient due to the risk of hypervolemia and the threat of developing pulmonary edema.

Systemic enzyme therapy in practice has limited application due to the high cost of the drug and a very long course of treatment (from 3 to 6 months).

Surgery

The main indication for surgical treatment of thrombophlebitis, as previously mentioned, is the growth of a thrombus along the great saphenous vein above the middle third of the thigh or the presence of a thrombus in the lumen of the common femoral or external iliac vein, which is confirmed by phlebography or duplex scanning. Fortunately, the latter complication is not so common, only in 5% of patients with ascending thrombophlebitis (I.I. Zatevakhin et al., 2003). Although anecdotal reports indicate a significant frequency this complication reaching even 17% in this group of patients (N.G. Khorev et al., 2003).

Anesthesia methods - possible different variants: local, conduction, epidural anesthesia, intravenous, intubation anesthesia.

The position of the patient on the operating table is of some importance - the foot end of the table must be lowered.

The generally accepted operation for ascending thrombophlebitis of the great saphenous vein is Troyanov-Trendelenburg operation .

The surgical approach used by most surgeons is quite typical - an oblique incision below the inguinal fold according to Chervyakov or the inguinal fold. But at the same time, it is important to take into account the main clinical point: if there are instrumental data or clinical signs of a thrombus moving into the lumen of the common femoral vein, then it is more advisable to use a vertical incision that provides control over the thrombosed great saphenous vein and the trunk of the common femoral vein, when sometimes it is required to clamp it on time of thrombectomy.

Some technical features of the operation:

1. Mandatory isolation, intersection and ligation of the trunk of the great saphenous vein in the area of its mouth.

2. When opening the lumen of the great saphenous vein and detecting a thrombus in it that goes beyond the level of the ostial valve, the patient must hold his breath at the height of inhalation during surgery under local anesthesia (or this is done by an anesthesiologist with other types of anesthesia).

3. If the thrombus "is not born on its own", then a balloon catheter is carefully inserted through the sapheno-femoral fistula at the height of inspiration and thrombectomy is performed. Retrograde blood flow from the iliac vein and antegrade from the superficial femoral vein are checked.

4. The stump of the great saphenous vein must be sutured and tied up; it must be short, since a too long stump is an “incubator” for the occurrence of thrombosis, which creates a threat of pulmonary embolism.

In order to discuss options for this routine operation, it should be noted that some surgeons suggest performing thrombectomy from the great saphenous vein in the Troyanov-Trendelenburg operation, and then injecting a sclerosant into it. The feasibility of such manipulation is questionable.

The second stage of the operation - the removal of thrombosed varicose veins and trunks is performed according to individual indications within a period of 5-6 days to 2-3 months as local inflammation stops, in order to avoid suppuration of wounds in postoperative period especially in trophic disorders of the skin.

When performing the second stage of the operation, the surgeon must necessarily ligate the perforating veins after preliminary thrombectomy, which improves the healing process.

All conglomerates of varicose veins are to be removed in order to avoid the development of gross trophic disorders in the future.

Surgical treatment of this group of patients is carried out by a very wide range of general surgeons and angiosurgeons. The seeming simplicity of treatment sometimes leads to tactical and technical errors. Therefore, this topic is almost constantly present at scientific conferences.

Literature:

5. Revskoy A.K. "Acute thrombophlebitis of the lower extremities" M. Medicine 1976

6. Saveliev V.S. Phlebology 2001

7. Khorev N.G. "Angiology and vascular surgery» No. 3 (appendix) 2003, pp. 332-334.

The appearance of swelling, pain in the legs, seals palpable under the skin, may indicate that thrombophlebitis is developing. The disease is dangerous due to its unpredictable course and high risk of a blood clot detachment, which can lead to death.

Thrombophlebitis: what is it

The disease is an inflammation of the walls of blood vessels, in the lumen of which blood clots form. The lower limbs are affected. Thrombophlebitis develops in acute and chronic forms. Especially often it occurs against the background of progression varicose disease veins. In most cases, the disease spreads to the superficial veins, however, deep veins may be affected.

Chronic thrombophlebitis of the lower extremities is characterized by periods of exacerbation followed by relapses, the duration of which depends on the effectiveness of treatment and the implementation of preventive measures and prescriptions of a phlebologist. Its development is usually provoked by untimely and inadequate treatment of the acute form of the disease.

Acute thrombophlebitis occurs in several forms:

non-purulent - an inflammatory process in the superficial veins, rarely affects the deep ones;
purulent - inflammation affects the surrounding tissues and suppuration and abscess formation occurs;
ascending - associated with damage to larger vessels;
septic - occurs when decay products enter the bloodstream;
migrating - a non-purulent inflammatory lesion of the veins, which differs in that it subsides in one area, can manifest itself in another. Young men are especially susceptible to this form of thrombophlebitis.

In some cases, thrombophlebitis affects the external genitalia, in particular, in men, thrombophlebitis of the penis may occur. The disease develops against the background of varicose veins and previous infectious processes. Often observed as a complication of gonorrhea. Symptoms are manifested in the form of swelling of the penis, the appearance of a voluminous cord on the back surface, skin hyperemia. The swelling may affect foreskin and in some cases the scrotum. As a rule, these phenomena are transient.

Important! With timely access to a doctor and treatment, a favorable outcome is observed. The treatment regimen is similar for thrombophlebitis of the lower extremities.

The reasons

The occurrence of thrombophlebitis is associated primarily with the previous varicose veins. Prerequisites are formed against the background of venous insufficiency, weakness of the walls of blood vessels, deterioration of blood circulation, changes in the structure of the venous walls and increasing pressure in the vessels. Under such circumstances, any infection can provoke thrombophlebitis on the legs.

Also, the causes of the development of the disease include:

surgical intervention;
transferred infectious diseases;
traumatization of the venous walls;
inflammatory diseases internal organs;
oncological diseases;
hormonal disorders;
increased blood clotting;

With trauma to the veins, during surgical intervention, as a result of injections and droppers, post-injection thrombophlebitis is formed. The cause of the defeat can be: the length of stay intravenous catheter, the introduction of a large volume of drugs that cause irritation of the surface of the walls of blood vessels, a spasm caused by a violation nerve endings. Against this background, there is a narrowing of the lumen of the blood flow due to inflammatory processes and the formation of a blood clot.

Very often, post-injection thrombophlebitis develops after the use of droppers at home and non-compliance with the technique for placing a catheter and sterility of instruments.

Veins are predominantly affected upper limbs. Symptoms develop rapidly, there is tissue swelling, redness of the skin, an increase in body temperature up to 39 0, a slight increase and soreness of the lymph nodes in the armpit and elbow area. The vein becomes compacted, reminiscent of connective tissue. Acute pain appears, the patient's condition is rapidly deteriorating and urgent measures are required.

A number of factors increase the risk of thrombophlebitis:

the period of pregnancy and childbirth;
obesity;
unbalanced diet;
sedentary lifestyle.

Symptoms

The development of the disease begins with the manifestation of characteristic symptoms:

pain in the legs varying degrees intensity;
hyperemia of the skin, redness of the leg is observed, followed by a change in color to cyanotic;
an increase in the temperature of the skin in the area of the affected area;
thickening and soreness of the skin in the area of thrombus formation;
an increase in body temperature depending on the severity and form of the course of the disease;
swelling of the legs;
soreness when walking.

Deterioration of general well-being, high temperature, signs of intoxication of the body are observed in the purulent form of the course of the disease.

The development of thrombophlebitis occurs against the background of specific symptoms, so the diagnosis, as a rule, does not cause difficulties. The patient is examined, complaints and anamnesis of the disease are collected. Assigned passage Ultrasound diagnostics. In this case, it is possible to use two methods of this study:

ultrasound Doppler - during the study, the data are recorded in the form of a black and white image of the vessel as a line;
duplex angioscanning - during the study, the data obtained are presented in a color image of the vessel, based on the speed and movement of blood flow. The main advantage of the technique is the ability not only to determine whether there is a circulatory disorder, but also to establish its cause, in case of suspected thrombophlebitis, is there a thrombus.

In addition, it applies:

radiopaque phlebography;
rheovasography.

Additionally, a general blood test is prescribed, according to the results of which we can talk about the presence of inflammatory processes.

Complications

Timely treatment disease reduces the risk of complications to a minimum. The main threat in a complicated course of thrombophlebitis is the possible detachment of a blood clot and its entry into the bloodstream, which is most likely with damage to deep veins.

A fragment of a thrombus leads to blockage of the arteries and pulmonary thrombophlebitis or thromboembolism. On the further development disease is affected by the diameter of the thrombus. Complete blockage of the vessel ends in death, which occurs within 30 minutes.

Important! With a smaller thrombus, blockage entails severe disorder respiration and circulation. It is possible to help the patient only in a hospital, as urgent resuscitation measures are required.

Small blood clots in the small branches of the pulmonary arteries often cause the development of pneumonia, chronic heart failure.

AT advanced cases and in the absence of adequate medical treatment of thrombophlebitis, among the complications, the spread of inflammatory processes to the surrounding tissues is possible. The disease takes purulent character, an abscess or phlegmon of tissues is formed.

Both diseases are related by a common etiology, they are in most cases a complication as a result of the progression of varicose veins. By international classification ICD-10 diseases these diseases go under one code.

With thrombophlebitis, inflammatory processes occur mainly in the superficial veins of the lower extremities. Phlebothrombosis is characterized by damage to deep veins. Diseases are accompanied by the formation of blood clots and blockage of blood vessels and the risk of developing pulmonary embolism, stroke.

With some generality clinical picture the course of diseases, varicose veins and thrombophlebitis are two fundamentally different diseases that affect blood vessels. The main difference is based on comparing the state of the veins with these vascular lesions. With varicose veins, they undergo thinning, weakening of the walls, they lose their original strength and elasticity. Therefore, varicose veins may develop bleeding due to the weakness of the walls of blood vessels.

Thrombophlebitis is associated with inflammatory processes, which result in the formation of blood clots and blockage of blood vessels, as a result of which there is a violation of blood circulation.

During pregnancy, women have an increased risk of developing thrombophlebitis, especially in the presence of provoking factors. Changes in a woman's body during this period affect the circulatory system, the blood flow becomes thicker due to increased intra-abdominal pressure. First of all, the veins of the small pelvis and lower extremities are affected.

The treatment regimen is determined jointly by a vascular surgeon or phlebologist and a gynecologist who monitors pregnancy. Therapeutic measures also include both conservative and surgical treatments. The main goal is to restore venous blood flow.

Important! In acute thrombophlebitis, it is important to choose the most sparing treatment regimen.

Treatment

The treatment regimen depends on the severity of the disease. Mainly carried out ambulatory treatment, however, in the acute form of the course, hospitalization is indicated.

Treatment consists of a set of measures:

taking medications;
invasive therapy;
local therapy;
physiotherapy - UHF, SMT, electrophoresis with anti-inflammatory drugs is possible;
fixation of the affected area elastic bandages;

Also, one of the ways to treat thrombophlebitis is hirudotherapy - treatment with leeches. They are placed over the damaged part of the vein or on both sides of the affected vessel. You can't place leeches in inguinal region and below the knee. Hirudotherapy is contraindicated in the purulent form of the disease.

In severe cases and with a threat to the life of the patient and a high risk of a blood clot, surgical intervention is undertaken:

crossectomy - performed if the thrombus has reached the middle of the thigh, the trunk of the saphenous vein is ligated at the place where it flows into the deep one. The operation is performed under local anesthesia;
venous thrombectomy - performed if thrombophlebitis affects the femoral-popliteal region and there is a threat of separation of a blood clot;
mechano-thrombolysis (Trellis) - performed with iliac-femoral thrombophlebitis (phlegmasia), in this case, removable cava filters are installed, which are removed after thrombolysis or after fixation of a thrombus;
catheter thrombolysis (thrombus dissolution) - when diagnosing pulmonary embolism, it avoids life-threatening complications.

When withdrawing acute condition in the future, it is possible to remove the pathologically altered vein in a planned manner.

Medication treatment

With thrombophlebitis, several groups of drugs are prescribed.

non-steroidal anti-inflammatory drugs - used in the form of injections, rectal suppositories, creams and ointments - diclofenac;
antispasmodics - no-shpa, papaverine;
anticoagulants - prevent the formation of blood clots, reduce clotting - heparin, warfarin;
antiplatelet agents - help improve blood circulation due to blood thinning - aspirin;
preparations that strengthen and tonic blood vessels - phlebotonics - detralex;
drugs that improve blood circulation - pentaxifylline, actovigin, trental;
antibiotics.
local remedies, ointments and creams, based on routine - troxevasin, troxerutin;

Infusion therapy improves rheological properties blood, has anti-inflammatory, detoxifying effect. For this purpose, apply:

rheopolyglucin;
saline solutions;
5% glucose in the absence of contraindications.

Medical therapy is carried out in combination with elastic bandaging or wearing compression stockings. It is also necessary to limit mobility to necessary minimum, the leg should be at rest in an elevated position.

Treatment at home

Treatment of thrombophlebitis of the lower extremities at home is possible only after consulting a specialist, passing diagnostic procedures and getting a doctor's prescription. At the first signs of thrombophlebitis, it is necessary to call a doctor who will give a preliminary assessment of the patient's condition. If necessary, hospitalization is possible.

In addition to taking medication, the patient must comply with:

bed rest - depending on the nature and severity of the disease physical activity should be kept to a minimum. The leg is in horizontal position on an elevated surface;
balanced diet - a diet for thrombophlebitis excludes the use of fried, smoked, salted, fatty foods. The inclusion in the diet of foods that promote blood thinning is recommended.
wearing compression stockings or bandaging with elastic bandages. The degree of compression is selected by the doctor individually, as a rule, the second or third class. It can be stockings, stockings, tights;
doctor's prescriptions for taking medications.

Application of funds traditional medicine It is permissible only after the final diagnosis and consultation with a doctor. At the first signs of thrombophlebitis, it is impossible to carry out any manipulations in the area of \u200b\u200bthe damaged area: massage, applying compresses, using ointments and creams, since the risk of a blood clot breaking off can be increased.

Important! It is categorically not permissible to start taking medications and carry out treatment on your own.

Folk remedies

Alternative methods of treatment can effectively complement drug therapy, but they should be used only after consulting a doctor.

Nettle

Nettle infusion can help reduce pain, relieve inflammation. 3 art. l. dry plant pour 1 cup boiling water. Take 3 times a day for half a glass until the condition improves. Before taking, strain and add warm water.

Tomatoes

The juice of red tomatoes also contributes to a speedy recovery. For this, a compress is used, made from pieces or in the form of gruel from fruits. Apply to the affected area, fixing with a bandage for the night. The bandage should not be tight.

Mummy

Shilajit has useful properties - during the reception, the number of erythrocytes in the blood increases, the blood clotting time increases, it normalizes leukocyte formula. It is taken at 0.15 g, diluted in 1 tbsp. l. boiled water one hour before meals.

Golden mustache

The leaves of the golden mustache will help fight swelling and pain in the legs. To do this, you need to tie a clean, dry sheet of a golden mustache and leave it overnight.

Kalanchoe

For grinding helps tincture on kalanchoe leaves. For this, 2 tbsp. l. spoons of finely chopped leaves pour 1 glass of vodka. Close tightly with a lid and infuse in a dark, cool place for 10 days. Rub the legs in places where blood clots form with smooth soft movements.

Diet

An important role for both prevention and treatment of thrombophlebitis is played by proper balanced nutrition. In order to reduce the risk of blood clots, improve blood circulation and strengthen immunity, it is necessary to include in the diet:

fresh vegetables and fruits;
cereals;
nuts;
lean meats;
fish;
dairy and dairy products.

With diagnosed thrombophlebitis, special attention should be paid to products that thin the blood. Natural anticoagulants include: onion, garlic, fish, especially tuna, grapes, tea, red pepper and other spices, olive and linseed oil. It is also helpful to use more fresh vegetables and fruits rich in vitamin C.

Healthy daily use nuts, especially almonds. He possesses unique properties and anti-inflammatory action. It is necessary to consume 10-15 pcs per day. sweet almonds, 1-2 pcs. bitter.

fried food;
fatty meats;
sweets, muffins and sugar in general;
canned foods;
smoked meats;
alcohol;
carbonated sweet drinks;
fast food;
coffee.

For cooking, it is necessary to use gentle heat treatment methods: baking, cooking in the usual way and steaming.

Important! Must comply general rules healthy eating: eat often, in small portions, the number of meals is 4-5. Also, consume at least two liters of clean drinking non-carbonated water per day.

Thrombophlebitis is a serious disease that affects people of all social strata, different age groups, men and women. A pathological disease is directly related to inflammation of the walls of large veins and ...

The meaning of the term Acute Thrombophlebitis of the Saphenous Veins of the Lower Limbs in the Encyclopedia of the Scientific Library

Acute Thrombophlebitis of the Subcutaneous Veins of the Lower Limbs- Most often occurs as a result of mechanical and chemical damage to the venous wall, after intravenous administration of drugs, often as a reactive process with influenza infection, tonsillitis, pneumonia, tuberculosis, typhoid, etc. It is very often observed in persons suffering from varicose veins of the saphenous veins of the lower extremities, in particular in 31.5% of pregnant women with varicose saphenous veins.

The inflammatory process is mainly localized in the wall of the great saphenous vein of the leg, thigh and in their tributaries, mainly affects saphenous veins upper third of the lower leg, lower and middle thirds of the thigh and can be focal, segmental or widespread.

Clinic and diagnosis. Acute thrombophlebitis of the saphenous veins of the lower extremities manifested by moderate or severe pain and induration (infiltration) along the saphenous vein, hyperemia of the skin over it. When the surrounding tissues are involved in the inflammatory process, periphlebitis occurs, general well-being with limited, segmental thrombophlebitis of the saphenous veins does not suffer. With a widespread thrombophlebic process, the general condition of patients worsens, body temperature rises (up to 38 ° and more). There is a slight leukocytosis with a moderate shift of the formula to the left and increased ESR. An important pathognomonic sign acute thrombophlebitis of the saphenous veins is the absence of swelling of the affected limb. A few days later, the acute process becomes subacute, and after 2-3 weeks inflammatory phenomena are stopped, however, only after 2-4 months the lumen of the affected vein is restored. Acute thrombophlebitis of the saphenous veins can be the cause of severe complications that arise as a result of the spread of the thrombotic process from the saphenous to the main veins: a) through the mouth of the great saphenous vein of the thigh; b) through the mouth of the small saphenous vein of the leg; c) through the communicating veins.

The thrombotic process from the saphenous veins to the main vein most often spreads with insufficient fixation of the thrombus to the vein wall. In this case, a “floating thrombus” is formed, which can reach a length of 15–20 cm and penetrate into the femoral vein. With the spread of thrombosis in the proximal direction, pain is noted along the anteromedial surface of the thigh. Therefore, when clinical signs acute thrombophlebitis of the great saphenous vein of the thigh at the border of the middle and upper thirds, the question of emergency operation- phlebectomy of the great saphenous vein in the area of its mouth - as a prevention of the spread of thrombosis to the femoral vein. At the same time, it must be remembered that “floating thrombi” are a potential source of pulmonary embolism.

Treatment. In acute and subacute thrombophlebitis of the superficial veins, surgery is usually indicated, which in 90% of cases gives a stable cure. Only thrombophlebitis that has arisen in unchanged veins and is of a limited nature is subject to conservative treatment. Surgical treatment of acute thrombophlebitis is also contraindicated in: obstruction of the main veins, decompensated heart disease, myocardial infarction, inflammation in the lungs and abdominal cavity. With pronounced symptoms of acute thrombophlebitis, it is advisable to perform the operation after the acute inflammatory process subsides. Surgical technique for acute thrombophlebitis of the saphenous veins differs little from that of phlebectomy in the case of varicose saphenous veins. However, with thrombophlebitis of the proximal saphenous vein of the thigh with the spread of thrombosis to the femoral vein, resection of the great saphenous vein in combination with thrombectomy is indicated. With pronounced periphlebitic phenomena, covering a vast area of surrounding tissues, an incision is made that borders inflammatory infiltrate, and the thrombosed vein is removed along with the skin and subcutaneous tissue. It should be remembered that too large an incision can cause excessive skin tension with the development of its marginal necrosis. Thrombosed veins, without pronounced non-riflebitic phenomena, are usually removed with a linear or fringing incision and ligation of all branches of the main trunk of the saphenous vein. Unaltered veins are removed using the Bebcock method. At the end of the operation, a pressure bandage is applied to the limb and the operated limb is given an elevated position. On the 2nd - 3rd day after the operation, when the patient begins to walk, an elastic bandage is applied to the operated limb.

In the postoperative period, antibiotics and anticoagulants are indicated. Of the latter, finilin 0.03 g 1-2 times a day is most often used under the control of the prothrombin index and blood clotting time. In this case, blood prothrombin should remain at the same level - 0.60 - 0.70. It is necessary to cancel finilin by gradually reducing the daily dose to 1/4 table / day for 10 days from the moment of stabilization of the normal level of blood prothrombin. Patients after the abolition of finilin should receive acetylsalicylic acid (ASA) 0.25 g 4 times a day, which inhibits platelet aggregation and adhesion, in addition, does not require special monitoring of the state of the blood coagulation system.

Thrombophlebitis of the saphenous veins

Introduction

Thrombophlebitis of the saphenous veins(thrombophlebitis of superficial veins or superficial thrombophlebitis) is inflammatory disease superficial veins. Most often, thrombophlebitis damages the superficial veins of the lower extremities and inguinal region. Thrombophlebitis develops in people suffering from varicose veins.

Unlike deep veins, thrombophlebitis of the saphenous veins develops a pronounced inflammatory response, which is accompanied by strong painful sensations. In turn, inflammation damages the vein wall, which contributes to the development and progression of thrombosis. In addition, superficial veins are not surrounded by muscles, so muscle contraction does not increase the risk of thrombus destruction and migration of its pieces with the blood stream (embolism), so superficial thrombophlebitis is potentially not dangerous.

Sometimes thrombophlebitis can occur repeatedly, especially often with cancer or other serious diseases of the internal organs. When thrombophlebitis occurs as concomitant disease oncological process in the body, this condition is also called Trousseau's syndrome.

Symptoms of superficial thrombophlebitis

The first symptoms of thrombophlebitis are local pain and swelling, the skin in the region of the vein in which thrombophlebitis has developed becomes brown or red, and also hard. Since a blood clot has formed in the vein, it thickens along its length.

Diagnosis of superficial thrombophlebitis

The diagnosis is usually made after the collection of anamnestic data and examination. Color ultrasound duplex scanning is performed to confirm the diagnosis.

Treatment of superficial thrombophlebitis

In most cases, thrombophlebitis of the superficial veins resolves on its own. Treatment usually includes pain relievers, such as aspirin or other non-steroidal anti-inflammatory drugs, to help reduce pain and inflammation. Antiplatelet agents and anticoagulants (blood-thinning pharmaceuticals) are also used to reduce blood clotting. Used for severe thrombophlebitis local anesthesia, the thrombus is removed and then put on compression bandage to be worn.

If thrombophlebitis develops in the superficial veins in the pelvic area, then there is a high probability of migration of blood clots and the development of deep vein thrombophlebitis and pulmonary embolism. To prevent the development of these complications in thrombophlebitis of deep and superficial veins in the pelvic area, an emergency surgery in a hospital setting.

Thrombosis and thrombophlebitis of the saphenous veins

It is known that ascending thrombophlebitis in the system of the great or small saphenous vein accounts for up to 3% of all causes of deep vein thrombosis. At the same time, in emergency angiosurgical practice, the issues of diagnosis and treatment of this pathology remain controversial and not fully resolved, a good phlebologist should be guided in this matter.

Every year, up to 80 patients diagnosed with thrombophlebitis of the saphenous veins of the lower extremities are delivered by ambulance from polyclinics and various medical institutions of the city of Irkutsk to the admission department of the City Hospital No. 1. After examination by an angiosurgeon and ultrasound examination, 35 to 45 patients are hospitalized in the vascular surgery department. The most common diagnostic error is erysipelas lower limbs.

The predominant cause leading to thrombosis and thrombophlebitis of the saphenous veins was varicose disease with severe disorders of venous hemodynamics and gross morphological changes in the walls of the veins. In isolated cases, oncological diseases, injuries of the lower extremities, long-term surgical interventions using muscle relaxants, various skin dermatitis or thrombophilic conditions became the starting point for the development of venous thrombosis. In most cases, the system of the great saphenous vein was involved in the inflammatory process, and cases of thrombosis of the small saphenous vein were rare. The age of the patients ranged from 34 to 75 years, of which 55% of all patients were still over 55 years of age. Among total number admitted women of childbearing age accounted for 12%.

In the first day from the onset of the disease, as a rule, patients are admitted very rarely. In the period from 2 to 5 days (the most favorable for the operation), 45% were received. From 5 to 10 days - up to 35%, and at a later date - the remaining 25%. The disease was manifested by both local and general signs: induration along the saphenous veins, pain at the site of induration with or without palpation, hyperemia along the thrombosed veins, induration of soft tissues around the veins, both local and general hyperthermia. In the case of severe varicose veins and in the absence of adequate drug treatment, it took only a few days for thrombosis to spread to the mouth of the great or small saphenous vein, followed by the formation of a loose floating thrombus.

From 2000 to 2004 166 patients were operated on urgently in the Department of Vascular Surgery. Most of the operations were performed under local anesthesia. 25 patients underwent thrombectomy from the mouth of the great saphenous vein and removed a loose thrombus passing to the femoral vein. It was repeatedly confirmed intraoperatively that the level of thrombosis of the trunk of the saphenous veins was always significantly higher (by 10–15 cm) than that determined visually and by palpation before surgery.

Clinically reliably established cases of small-focal pulmonary embolism after such operations were isolated. There were no cases of massive pulmonary embolism after these operations. Most patients in the postoperative period underwent a comprehensive drug treatment, including heparinization, and an active motor regimen was prescribed.

Error in the diagnosis of thrombosis and thrombophlebitis of the saphenous veins of the lower extremities on prehospital stage is up to 50%, which causes further tactical and medical errors.
The most informative type of examination in the diagnostic process should be considered a duplex or three-dimensional examination of the patient's venous bed.
Only drug treatment, without risk, should be limited in cases of thrombosis of the saphenous veins of the lower leg or thrombosis of varicose veins of the lower third of the thigh.
In the case of a reliable diagnosis of thrombosis of the trunk of a large or small saphenous vein, reaching the point of confluence with the deep venous system, surgical treatment should be considered the only effective way to prevent deep vein thrombosis.
In the case of diagnosing a floating thrombus of the common femoral or external iliac vein, standard access to the main veins is required and their isolation is sufficient.
A full thrombectomy from the mouth of the great saphenous vein more than a week after the onset of thrombosis most often fails due to the tight fixation of thrombotic masses to the walls of the vein.
In the case of massive thrombosed venous conglomerates on the lower leg and thigh without a pronounced perivasal process, it is advisable either to remove these conglomerates immediately or to evacuate thrombotic masses through small venotomy openings.
In case of diagnosis of thrombosis at the level of the mouth of the great saphenous vein in pregnant women and within a period not exceeding 2-5 days, prompt surgical treatment.
The surgical stage is not the end of the treatment this disease. Without fail, after the operation, it is necessary to carry out complex medical treatment, since sometimes undiagnosed thrombosis of perforating veins, which can also be ways for the spread of thrombosis to deep veins, is overlooked.

The attitude to thrombophlebitis as a disease of the venous system is twofold:

some scientists consider it a common complication of varicose veins with the most frequent localization on the legs;
others claim that vein damage occurs even without varicose veins, a significant role is assigned to the allergic mood of the vascular endothelium (inner shell).

Summarizing both opinions, we will assume that thrombophlebitis of the superficial veins of the lower extremities is a manifestation of different causes, but the result is the same - an area of an inflamed loose wall with thrombotic masses that block the blood flow. The degree of circulatory disorders depends on the size of the thrombus. Timely treatment can minimize the consequences, prevent complications.

Connections of superficial and deep veins

Superficial veins are located outside at a depth of 2–3 cm. In practice, they lie in the thickness of fatty tissue. The network is branched. The largest is the great saphenous vein. It is in its channel that up to 95% of cases of thrombophlebitis are found. In the area of the small saphenous vein, blood clots and inflammation occur much less frequently.

Communication with deep venous trunks is carried out through perforating branches

The superficial part of the venous system of the lower extremities ensures the outflow of blood from the skin of the fingers, feet, small joints, lower leg and thigh. valve apparatus venous vessels much weaker than deep veins. In addition, there is no auxiliary "pump" from calf muscles to pump blood up. Subcutaneous vessels are very vulnerable, easily squeezed.

In 5-10% of cases, superficial thrombophlebitis simultaneously captures deep vessels.

What factors are involved in the development of thrombophlebitis

The appearance of inflammation (phlebitis), and then on the legs, is facilitated by the combination of several factors:

Wall injury- superficial localization puts the saphenous veins at significant risk. Any mechanical injury (bruise, cut) affects the structure of the vessel wall, destroys and weakens the connections of thin muscle fibers. Even "bruises" or, more correctly, small hematomas from bruises, may continue in the form of a loss of tone with the expansion of part of the vein. Traumatic factors include various intravenous medical procedures associated with the installation of catheters for long-term use, intravenous infusion of solutions, ligation of veins during operations on the bones and joints of the lower extremities.
Deceleration of blood flow- the speed of blood movement decreases with congestive heart failure, in cases of prolonged bed rest in patients with diseases of the heart, brain, with a fixed position of the leg in plaster cast after fracture.
Change in physical and chemical properties blood- clotting increases during fluid loss (vomiting, diarrhea, bleeding, taking a large dose of diuretics), from an increase in the proportion of coarse proteins, an increase in platelet agglutination (gluing). The viscosity of the blood increases with an increase in the level of glucose in it in diabetes mellitus. In the postoperative period, the fact that thrombokinase enzyme enters the bloodstream from destroyed tissues and its stimulating role in thrombosis has been proven.

These processes take place during long infectious diseases, hormonal disorders, malignant neoplasms, treatment with certain drugs.

Phlebitis of the vein wall can serve as a manifestation of the allergic mood of the body, proceed without the participation of infection. This process is called aseptic. More dangerous is the addition of a "sleeping" infection from existing untreated foci in the mouth, nasopharynx, and genitals. Depending on the microorganisms, phlebitis can turn into a purulent form.

The infection reaches the venous wall through the arteries, lymphatic ducts, from neighboring tissues. Of great importance are teeth affected by caries, influenza transferred on the legs, erysipelas, tuberculosis, pneumonia, septicopyemia (multiple pustules on the skin).

Causes of thrombophlebitis

The causes of thrombophlebitis of superficial and deep veins differ little. The most frequent are:

severe injuries, including surgery;
infectious diseases;
the presence of hypersensitivity and allergic reactions;
malignant tumors;
hormonal changes in obesity, contraceptives;
frequent intravenous procedures in the hospital and the introduction of drugs into the vein by drug addicts.

For women, a significant risk factor is the period of pregnancy, the condition after a medical abortion.

Thrombophlebitis in the small veins of the back of the foot often occurs against the background of wearing uncomfortable shoes, minor injuries

Classification of thrombophlebitis

All infectious thrombophlebitis, depending on the specific causes, is divided into:

postoperative;
postpartum (including after abortion);
associated with purulent processes;
complication of typhus.

Non-infectious forms (aseptic) are divided into the most frequent violations on the:

complication of varicose veins of the lower extremities;
post-traumatic;
concomitant pathology of the heart;
migratory.

Depending on the course of the disease, thrombophlebitis can be acute, subacute and chronic.

Features of the clinical course

Acute thrombophlebitis of the superficial veins begins suddenly with fever, pain in the legs along the veins. The pain syndrome is aggravated by movements, flexion in the joints. Local swelling is possible.

Examination by a doctor allows you to determine the redness of the skin, the seal over the site of inflammation is hot to the touch

Clarification of the anamnesis helps to establish a connection with trauma, recent surgery, abortion, respiratory infection. The duration of the acute form is up to a month.

The subacute form is not manifested by sharp pains, they are aching for a long time. The temperature does not rise. Seals along the veins are not painful. The color of the skin over the focus of inflammation changes, it becomes bluish-brown. The duration of the disease is 1-4 months.

Chronic superficial thrombophlebitis most often accompanies varicose veins of the legs. Against the background of symptoms of varicose veins (weakness, swelling, cramps in the calves, pain when walking), a dense cord appears along the course of the venous node. At the same time, the clinic of venous insufficiency is growing due to trophic ulcers on the foot. It is characterized by an undulating course with periods of exacerbation and remission.

The importance in the clinic is given to repeated thrombophlebitis in previously undamaged areas of the venous bed. This form is called migratory. It may indicate the development malignant neoplasm, systemic lupus erythematosus, thrombocytosis, erythremia.

Diagnostics

Diagnosis of thrombophlebitis in the superficial veins of the legs does not cause difficulties. All symptoms are clearly manifested and defined in the patient.

To clarify the degree of influence on the deep veins of the thigh, the following examination methods may be useful:

rheovasography - determines the degree of filling of blood vessels;
ultrasonic dopplerography - captures the reflected signal, sets the speed of blood flow in the vessel;
duplex scanning - allows you to visualize the contours of the vascular network, the diameter on different levels, thrombus size.

How is the treatment without surgery?

The objectives of the treatment of superficial thrombophlebitis:

prevent the transition of the inflammatory process and thrombosis into deep veins;
reduce the risk of thromboembolic complications;
remove inflammation and factors contributing to increased thrombosis.

The disease can be treated on an outpatient basis if the diagnosis has established the absence of a transition to deep veins. Otherwise, hospitalization is necessary.

The methods of conservative treatment include:

round-the-clock tight bandaging or wearing compression stocking in the first 10 days, then it is allowed to wear squeezing underwear only during the day;
local and internal drug therapy.

Locally used:

to relieve pain and limit inflammation - cold on a compacted and painful area of \u200b\u200bthe vein for 2-3 days;
Heparin ointment, Lyoton-gel, affecting small blood clots, Ketonal-gel to relieve inflammation.

Heparin ointment is much more effective in the form of a compress

Inside appoint:

preparations of venotonic action - Detralex, Troxevasin;
anti-inflammatory drugs - Reopirin, Butadion, Ibuprofen, antibiotics a wide range intramuscularly;
antiplatelet agents - Acetylsalicylic acid, Curantyl, Trental;
according to indications, it is possible to use drugs that relieve the increased sensitivity of venous vessels - Tavegil, Suprastin, Loratadin.

Anticoagulants are prescribed if there is a danger of the embolus breaking off. For this, Heparin is suitable for the acute stage with the transition to indirect drugs (Warfarin). The duration of treatment is several months. It is necessary to control blood clotting.

To dissolve an acute thrombus in the first 6 hours from the disease, it is possible to use fibrinolytic agents - Streptokinase, Fibrinolysin, Trypsin, Chymotrypsin, Urokinase.

During periods of remission in chronic thrombophlebitis, the possibilities of physiotherapy are used:

exposure to ultraviolet rays;
infrared procedures;
sollux.

Balneological therapeutic baths are shown in the remission stage. The resorts of Pyatigorsk and Sochi (Matsesta) have proven themselves well, where natural mud applications and hydrogen sulfide sources are used.

Natural sources of hydrogen sulfide in the Matsesta river valley have been curing thousands of patients for many years

Surgical methods

The use of surgery is possible in the absence of results from conservative treatment. The selection methods are:

ligation of the large superficial vein of the thigh;
crossectomy - additional isolation and intersection of tributaries to prevent the spread of infection;
radical phlebectomy - ligation and removal of all affected veins.

How does a thrombus change in a vessel?

Against the background of the development of superficial thrombophlebitis, the further course of the disease depends on the "behavior" of the thrombus. There are options here.

Under the influence of treatment or spontaneous inflammation decreases. The thrombus also becomes smaller in size. It partially or completely closes the lumen of the vein. With complete occlusion, the vein becomes empty and collapses. In this case, the risk of tearing off a piece of blood clot and turning it into an embolus is minimized.

If there is no effect from therapy, then phlebitis continues to develop and spread to other areas. The clot turns into a "floating" one. Its head is attached to the wall of the vein, and the other end moves freely in the cavity of the vessel. Loose walls cause a part of the thrombus to detach. The embolus most often moves towards the vena cava, to the right atrium and enters the pulmonary arteries. This is how dangerous complication- thrombosis of the pulmonary artery or its smaller branches.

The growth of a thrombus along the vessel can penetrate deep veins through venous shunts and contribute to the destruction of the valvular apparatus with development.

Complications of superficial thrombophlebitis

Thrombophlebitis of superficial veins does not often lead to complications. This is more typical of deep vein involvement. However, lack of or inadequate treatment can cause:

phlegmon and abscess on the leg;
dermatitis like eczema;
embolism in internal organs;
inflammation of regional lymph nodes (lymphadenitis more often in the inguinal region);
development of general sepsis;
ischemic neuritis.

Prevention

The basis for the prevention of thrombophlebitis in healthy person- maintaining mobility, fighting overweight. If necessary, bed rest is recommended to do active movements in the legs, even lying down, you can pull the socks towards you and back, forcing the calf muscles to work.

In the period after surgery, thrombophlebitis occurs in 13-21% of cases. The fight against postoperative thrombophlebitis is carried out in a hospital at the stage of preparation for a planned operation. Bandaging of legs is performed, sanitation of teeth is controlled, palatine tonsils and other possible chronic foci.

The treatment prescribed by the doctor must be carried out in courses in strict accordance with the recommended dosages of the drug. Don't switch to folk ways and outside advice.