Thrombophlebitis of the superficial veins of the lower extremities: signs, features and treatment methods. Thrombophlebitis of deep and superficial veins: acute and chronic. Diagnosis, treatment, prevention

Convex, voluminous, knotty veins on the legs indicate the presence of an unpleasant and painful disease- thrombophlebitis of the lower extremities, which is also called thrombosis of the veins of the legs. This disease can also affect the veins upper limbs, as well as the vessels of the chest and, but still, it is the defeat of the veins in the legs that is more common.

Thrombosis is a disease associated with the formation of a blood clot in the lumen of a vein, in which the blood flow in it becomes difficult or stops.

Unfortunately, it is not possible to unequivocally exact reason, which causes thrombosis of the superficial veins of the lower extremities.

There can be many of them, among them the most common are the following:

hereditary, or genetic predisposition to disease of the system. If there were cases of thrombosis in the family, it is possible that they can be inherited, so a predisposition to the disease can be one of the causes of thrombophlebitis.
Varicose veins, which causes a decrease in the movement of blood through the vessels, its stagnation and, as a result, the formation of a blood clot and edema of the surrounding tissues.
Injury to the walls of the veins. They can be called mechanical causes- bruises, blows, fractures, severe injury during sports, accidents and much more, as well as harmful effects internal factors, provoking weakness and fragility of the walls of blood vessels, violation normal functions vein valves.
Infections. The entry of pathogens into the bloodstream can also cause thrombophlebitis. Infection can be caused by injuries, domestic and sports injuries, surgical interventions and childbirth, injections and much more.

The danger of the disease lies in its secretive development and the danger of a blood clot breaking off. The trouble is that the disease proceeds completely imperceptibly, and openly manifests itself only when it already reaches a significant scale and goes very far. During the secret development of thrombosis, the number and size of blood clots can constantly increase, which carries the threat of raising the formation up circulatory system and the possibility of breaking it with getting into other departments and bodies.

The greatest threat and danger to the health and even life of the patient is the ingress of a broken blood clot into the pulmonary and cardiac vessels. Their blockage is called an embolism and can lead to the most dangerous options disease progression to sudden death.

Thrombosis of the superficial veins of the lower extremities initial stages may show nothing or almost nothing, then the patient has the following symptoms:

swelling of the lower extremities, for the most part minor, usually occurring when standing for a long time or with significant loads on them, for example, when walking.
Feeling of heaviness, fullness of lead in the legs, often accompanied by a burning sensation and a feeling of fullness.
Soreness of the legs, especially in the calves, increasing with the load on the lower limbs.
Redness of the skin, bruising and abrasions even with the lightest touch.

The further the disease develops without consulting a doctor, the more pronounced its symptoms become: pain intensifies, heaviness in the legs, veins appear, at first they are simply noticeable under the skin, then they become larger and more prominent.

When neglected, the legs are very swollen and painful.In the area of thrombus formation, the skin acquires a bluish tint, and the tissues become inflamed, redden, swell strongly, and the temperature rises.

Diagnosis of the disease

For a long time, it was possible to determine thrombophlebitis of superficial veins only with the help of an external, visual inspection an experienced specialist. Nowadays, the diagnosis of the disease has been greatly simplified and improved; duplex scanning is also used for it.

Using this method, you can identify the state of the venous system in the lower extremities, determine the location of blood clots, assess the condition of the valves and the entire system as a whole. The procedure is expensive and not available everywhere, therefore it is mainly used in cases where there is a threat or a blood clot has already migrated from the system of superficial veins of the lower extremities to deep ones.

Phlebographic research is used even less frequently, mainly in cases where the results duplex scanning are vague and make it impossible to get a precise definition.

It is prescribed if there is a threat of movement of a blood clot (thrombi) from a large saphenous vein into the femoral or iliac vein.

Another diagnostic method is. It studies the level and operation of the system. For an experienced specialist, a blood picture can give a lot useful information and help in the diagnosis of the disease.

Medical treatment

Thrombosis of the superficial veins of the lower extremities can manifest itself in two forms:

Acute thrombophlebitis. The acute form of the disease develops abruptly, suddenly, accompanied by severe pain, a rise in body temperature despite the fact that the skin of the affected limb is cold and cyanotic. The patient tries to raise the leg in such a way that it is as less painful as possible.
Chronic thrombophlebitis. The chronic form is manifested by pain during exercise, swelling and periodic exacerbations of the condition.

Acute thrombophlebitis is an inflammation of a vein with the formation of blood clots inside it.

Symptoms of acute thrombophlebitis of superficial veins and its diagnosis. Most typical features acute thrombophlebitis of the superficial veins of the upper and lower extremities are symptoms of a general inflammatory reaction, hyperemia, skin, infiltrates along the thrombosed veins, lymphadenitis and lymphangitis. Patients are concerned about an increase in body temperature up to 39 ° C, chills, weakness, malaise. Hyperemia and edema of the skin are noted along the affected vein. However, the swelling is minor. The diameter of the limb practically does not change. Movements in the joints remain free, but somewhat painful due to the presence of inflammation zones in the subcutaneous tissue. In the area of the thrombosed vein, a painful infiltrate with clear boundaries, soldered to the surrounding tissues, is palpated. In the initial period of the course of the disease lymphatic system not involved in the inflammatory process. Subsequently, especially with suppuration of thrombosed veins, lymphangitis and lymphadenitis are observed.

With localized thrombophlebitis, signs of the inflammatory process are determined only in a small area of \u200b\u200bthe saphenous veins. Migrating thrombophlebitis is characterized by the presence of many small foci of thrombosis in different segments of the limb. Ascending thrombophlebitis is accompanied by a gradual spread of the process with distal departments saphenous veins to the proximal ones.

Acute thrombophlebitis after a few days passes into subacute, followed by either a complete cure or the formation of chronic inflammation. Subacute thrombophlebitis is characterized by the absence of general inflammatory reactions, the disappearance of pain and flushing of the skin over the affected vein. However, pain does not occur during palpation of thrombosed veins, but periodically and independently. In persons with chronic thrombophlebitis, a continuous or bead-like cord is formed at the site of a thrombosed vein. Its palpation or physical activity is accompanied by the appearance of minor soreness. The prolonged existence of chronic thrombophlebitis of superficial veins contributes to the development of trophic tissue disorders.

When the effects of inflammation are stopped, the thrombosed superficial vein in most cases recanalizes, but loses its anatomical and physiological properties: it expands unevenly, its valvular apparatus is destroyed. The skin above it becomes hyperpigmented and indurated. With migrating thrombophlebitis, there are practically no violations of skin trophism.

The course of thrombophlebitis of the saphenous veins is often complicated by suppuration of thrombosed superficial veins with the formation of subcutaneous abscesses and phlegmon, the spread of thrombosis to deep veins through the sapheno-popliteal fistula, as well as through the communicating veins. Having penetrated into the main veins, the thrombus either completely blocks their lumen, or is in a floating state (oscillates under the influence of blood flow). The separation of blood clots leads to thromboembolism of the pulmonary artery. In the case of migration of infected thrombi, metastatic lung abscesses occur.

Differential diagnosis of acute thrombophlebitis of superficial veins. Thrombophlebitis of superficial veins must be differentiated from diseases that occur with a similar clinical picture: acute deep vein thrombophlebitis, lymphangitis, erythematous form of erysipelas, soft tissue phlegmon, etc.

Treatment of acute thrombophlebitis of superficial veins. Tactics in acute thrombophlebitis of superficial veins is determined by the localization of thrombosis, the state of the venous vessels involved in the inflammatory process, and the nature of the course of the disease.

Conservative treatment is carried out for acute thrombosis of the saphenous veins of the forearm and shoulder, as well as local thrombophlebitis of varicose veins of the lower leg and lower third of the thigh without a tendency to spread and in the absence of symptoms of pulmonary embolism; with subacute and chronic thrombophlebitis of varicose veins that are not altered, amenable to conservative measures; in severe condition of patients due to concomitant pathology.

Patients with acute thrombophlebitis of the superficial veins of the forearm and lower leg, subacute and chronic thrombophlebitis can be treated in outpatient settings. In all other situations, they are hospitalized. There is a general and local treatment. In the acute phase of the disease, conditional bed rest with elevated position of the diseased limb. Locally applied compresses with heparin, heparoid, butadion ointments, Vishnevsky ointment, 30% dimexide solution, semi alcohol compresses etc., cold. On top of the compresses, to accelerate the outflow of blood and thereby prevent the spread of the process, elastic bandaging of the legs is performed. Prescribed drugs that improve microcirculation and rheological properties blood (trental, theonicop, flexital, etc.); inhibitory effect on the adhesive-aggregation function of platelets (aspirin, chimes, indomethacin, etc.); corrective disorders of venous blood flow (detralex, venoruton, troxevasin, aescusan, etc.); having anti-inflammatory, antipyretic, analgesic effect (butadione, reopyrin, analgin, etc.); desensitizing agents (diphenhydramine, suprastin, etc.). used in the presence of a pronounced inflammatory process.

Anticoagulant therapy for thrombophlebitis of superficial veins, as a rule, is not carried out. Only with significant hyperprothrombinemia is it possible to use both indirect (phenylin, pelentan, neodicoumarin, etc.) and direct (heparin, fraxiparin, etc.) anticoagulants.

In the subsidence phase acute inflammation to accelerate the resorption of blood clots and infiltrates, physiotherapeutic procedures are prescribed. Effective iontophoresis of potassium iodide, proteolytic enzymes (trypsin, chymotrypsin, etc.), heparin; UHF; prolonged diathermy; solar lamp. After stopping acute thrombophlebitis, patients with varicose veins of the lower extremities are recommended to have elastic bandaging of the extremities and wearing elastic stockings for 2 months. At the same time, it is advisable to take drugs that have a phlebodynamic effect.

Surgical intervention is a radical method of treating thrombophlebitis of superficial veins, preventing the development of its complications and relapses. with thrombophlebitis of superficial veins are performed, in an emergency and planned manner.

Indications for emergency surgical intervention serve: 1) acute ascending thrombophlebitis of the great saphenous vein with the localization of the objectively determined upper border of the thrombus at or above the border of the upper and middle thirds of the thigh; 2) acute ascending thrombophlebitis of the small saphenous vein with the upper limit of thrombosis, located at or above the border of the middle and upper thirds of the posterior surface of the leg; 3) the presence of symptoms and the threat of repeated pulmonary embolism; 4) purulent fusion of a thrombus. If it is necessary to carry out preoperative preparation and special methods of examination, surgery in patients with a threat of recurrent pulmonary embolism may be delayed.

Planned operations are indicated for thrombophlebitis of varicose veins; with the failure of conservative treatment of acute thrombophlebitis of varicose veins, subacute and chronic thrombophlebitis.

Contraindications to radical surgery: occlusion or hypoplasia of the main veins; heart disease with symptoms of decompensation, myocardial infarction, hypertonic disease I - stage III, suppurative processes in the lungs, inflammatory diseases of the organs abdominal cavity; skin diseases (eczema, pyoderma). Relative contraindication is the advanced age of the patients.

Most often, the main trunk of the large or small saphenous vein involved in the inflammatory process is removed with the processing of its side branches.

The operation for acute thrombophlebitis of the superficial veins is performed in a certain sequence. Initially, a sapheno-femoral fistula is distinguished from an oblique or vertical incision. The oblique incision passes 3 cm below the inguinal fold and parallel to it, and the oblique incision is made on the border between the inner and middle thirds of the pupart ligament through the oval fossa or somewhat medially to the determined pulsation of the femoral artery. The fistula zone is examined. In the absence of blood clots in the area where the great saphenous vein flows into the common femoral vein, v.saphena magna and its tributaries are tied up and crossed (Troyanov-Trendelenburg operation). In the presence of a thrombus in the common femoral or external iliac vein, the external iliac, superficial and common femoral veins are initially isolated and clamped outside the zones of thrombosis. The tributaries of the great saphenous vein are ligated and crossed. Thrombectomy from its mouth is performed by transverse section of the great saphenous vein, and from deep veins - by longitudinal dissection of the rest of the valve and the wall of the common femoral vein. The effectiveness of thrombectomy is controlled visually and by the presence of retrograde blood flow from the iliac veins at the height of the Valsalva test.

Phlebectomy of thrombosed veins on the thigh and lower leg is performed from separate incisions 4-6 cm long (Narata operation by tunneling (F.K Sidorina operation) or by a continuous skin incision from the inguinal fold to the medial malleolus (Madelung operation). Babcock operation (removal of veins from using probes) is acceptable for phlebectomy of non-thrombotic vessels.In severe phlebitis and panniculitis, the thrombosed trunk is removed from the bordering incisions along with tissue and skin flap(operation by R.L. Askerkhanov). The communicants are bandaged subfascially (but according to Linton) or suprafascially (according to Cocket) only after preliminary removal of blood clots from their lumen.

The sapheno-subcutaneous anastomosis is exposed from a transverse, vertical or B-shaped access similar to the isolation of the sapheno-femoral anastomosis. The trunk of the small saphenous vein is removed by one of the methods described above. Small tributaries of the great and small saphenous veins are sutured according to Sheda (percutaneous suturing of the veins with tying the ends of the threads on the skin) or according to Sokolov-Klapp (intradermal suturing of the veins).

In severe patients with ascending thrombophlebitis of the saphenous veins of the lower extremities, only the intersection and ligation of the great saphenous vein and tributaries at the saphenofemoral (Troyanov-Trendelenburg operation) is performed, and the small saphenous vein is performed at the sapheno-popliteal fistula.

Phlebectomy of thrombosed veins of the upper extremities is performed according to Marat or Askerkhanov. AT postoperative period to improve regional blood circulation in the limb, to prevent recurrence of thrombophlebitis, continuation of antiplatelet therapy (10-15 days), bandaging the limb or wearing an elastic stocking for 3 months is indicated.

The article was prepared and edited by: surgeon

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 drugs, often as a reactive process in 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 their tributaries, mainly affects the saphenous veins of the upper third of the leg, lower and middle third 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 general state 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 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 may be the cause 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, with clinical signs of acute thrombophlebitis of the great saphenous vein of the thigh at the border of the middle and upper thirds, an emergency operation should be raised - 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. Surgical technique for acute thrombophlebitis of the saphenous veins differs little from that of phlebectomy in the case of varicose veins subcutaneous 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, the limb is applied pressure bandage 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 daily dose up 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, therefore, 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 recur, especially often with cancer or other serious illnesses internal organs. When thrombophlebitis occurs as concomitant disease the oncological process in the body, this condition is also called Trousseau's syndrome (Trousseau).

Symptoms of superficial thrombophlebitis

The first symptoms of thrombophlebitis are local pain and swelling, the skin in the area 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 a compression bandage is put on, which must 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 region, emergency surgical treatment in a hospital setting is recommended.

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 in admission department City Hospital No. 1 ambulance from polyclinics and various medical institutions up to 80 patients diagnosed with thrombophlebitis of the saphenous veins of the lower extremities are delivered to the city of Irkutsk. 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 veins with severe disorders of venous hemodynamics and gross morphological changes in the walls of the veins. In isolated cases, the starting point for the development venous thrombosis oncological diseases, injuries of the lower extremities, long-term surgical interventions using muscle relaxants, various skin dermatitis or thrombophilic conditions. 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 more late dates- 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. In the postoperative period, most patients underwent complex 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 the great or small saphenous vein, reaching the place of confluence with the deep venous system, surgical treatment should be considered the only effective way prevention of deep vein thrombosis.
In case of diagnosis of a floating thrombus of the common femoral or external iliac vein it is required to perform standard access to the main veins and their allocation for a sufficient length.
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 the 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.

What is thrombophlebitis? This term is called inflammation of the vein wall, which arose due to the fact that a focus of infectious etiology appeared. Such a focus is accompanied by the formation of a thrombus in the lumen of the vessel. There are cases when a blood clot does not form, another definition is applied to such a situation - phlebitis. There is thrombophlebitis of the superficial veins of the lower extremities, when the above actions occur in the veins of the lower extremities, which are located in fatty tissue under the skin at a depth of two to three centimeters.

In fact, the formation of blood clots in the veins requires close attention, as they can behave in different ways. Here are three options for the behavior of blood clots:

A thrombus can block the lumen of the vessel, thereby disrupting blood circulation.
A blood clot can break away from the wall and be transported with blood to other organs.
The best option for development is the resorption of a blood clot.

It is clear that of these three options, the first two are dangerous, so this disease must be studied very well. Let's start by explaining the reasons for this state of affairs.

Causes

The occurrence of thrombophlebitis is associated with a violation of the integrity of the venous wall, which is also related to infectious agents. Infections can move to the vessel wall from nearby inflamed tissues. In addition, this may occur in lymphatic vessels. As mentioned at the beginning, with thrombophlebitis there is a focus of inflammation of a chronic nature. It can be pneumonia, tonsillitis, flu, tuberculosis, carious teeth, septicopyemia. The most important cause is considered to be blood stasis, an increase in blood coagulation and a change in the chemical and physical composition of the blood.

Some of the reasons can be singled out.

Main symptoms

It is worth noting that thrombophlebitis affecting superficial veins can be of two types:

spicy;
chronic.

The acute form is so called because it develops suddenly. There are reasons for this state of affairs as well. viral infection, trauma, reception oral contraceptives and so on. In total, we can say that the causes are conditions in which blood clotting increases. How it looks externally, you can see in the photo.

In words, we can say that when involved in the process of dilated veins, varicose nodes become more dense and painful. In addition, they may increase in size. There are times when the limb begins to swell, but this happens only in the area where the vein is affected. Thanks to this, thrombophlebitis that affects superficial veins can be distinguished from the same disease that affects deep veins.

With damage to the superficial veins, the general condition of a person is usually kept at a satisfactory level, and local manifestations. The acute form is characterized by the following features:

drawing pain of a prickly acute nature, affecting the affected vein;
along the course of the vein, swelling and severe redness are observed;
hanging temperature, which can reach up to 38 degrees;
chills;
malaise;
enlargement of the lymph nodes.

Thrombosed veins differ from dilated varicose veins in the absence of redness, elevated temperature and pain in the area of the affected veins. Besides, varicose veins subside in horizontal position, because the blood goes further, that is, into the deep veins, and the thrombosed vein only increases in size with progression.

Examining the patient, the doctor usually pays attention to both lower limbs, starting with the groin and ending with the feet. It compares the color of the skin and analyzes puffiness, hyperthermia and pain. A bright reddening of the skin along the vein that is affected is observed in the first few days from the moment the disease began. After that, hyperemia begins to subside, and the skin becomes more calm in color.

With thrombophlebitis of the small saphenous vein, local manifestations are not as noticeable as with damage to the main trunk of the great saphenous vein. The explanation for this is the structure of the fascia and muscles of the lower leg.

The inflammatory process begins to subside after a few weeks, but it can take up to a month and a half. Then the patency of the vein is gradually restored. If at the same time there was no varicose veins, then soreness and an increased pattern of subcutaneous small veins can be observed for a long time.

Diagnostic methods

Diagnostics does not cause any problems. State determined by location pathological process, its prevalence, duration and degree. There are several methods for studying thrombophlebitis.

Doppler ultrasound. This method has its roots in the Doppler effect. A special sensor sends a signal that is reflected from objects in motion. It is captured by another sensor, which calculates the change in the speed of propagation of the signal generated from its contact with moving blood. The computer registers the changed frequency, processes it mathematically and draws a conclusion.
Reovasography. This is a non-invasive method that allows you to examine the blood circulation. The bottom line is that some area of the body is affected by a high-frequency current. At the same time, electrical resistance is recorded, which varies depending on how the tissue is saturated with blood.

Ultrasonic duplex angioscanning. In this case, two methods are combined - Doppler scanning and sound examination, which allows you to see the movement of blood, the structure of blood vessels, and also helps to measure the diameter of the vessel and the speed of blood flow.
Magnetic resonance imaging and computed tomography. These methods are used when ultrasonic methods do not provide enough information.
Venography. essence this method in that a special contrast agent is injected into the venous bed, which stains the vessel from the inside. This method of X-ray examination is rarely used, since the above methods have been widely developed.

Treatment of the disease

At the beginning of treatment, it is very important to choose the most suitable option for the patient. If superficial thrombophlebitis is localized at the level of the lower leg, then the treatment can take place on an outpatient basis under the regular supervision of a surgeon. But in this case, the patient must be aware that if the disease has moved to the level of the thigh, then, most likely, hospitalization is needed, otherwise serious complications. Hospitalization is also required when the treatment of the disease at the level of the lower leg does not positive results during two weeks.

Treatment should be under the constant supervision of a surgeon

It is very important for the patient to observe strict bed rest in the event that Clinical signs thromboembolism of the pulmonary artery or during instrumental research embologenic nature of thrombosis was revealed. In total, the patient's activity should be limited to marked physical activity, which includes heavy lifting, running, and strenuous work. abdominals and muscles.

Let us highlight the main points that should be taken into account in the treatment of thrombophlebitis.

Limitation of physical and motor activity.
Compliance with bed rest when prescribed by a doctor.
Usage elastic bandages, tights and stockings on the affected limb. What to apply and whether it is necessary to do it, the doctor decides.
The use of anticoagulant therapy: nadroparin, dalteparin, enoxaparin. Usually they are prescribed for one week, after which they begin to take antiplatelet agents and anticoagulants in the form of tablets: warfarin, acetylsalicylic acid.
Phlebotonics: diosmin, rutoside, troxerutin. These medicines actively fight inflammation inside.
Nonsteroidal drugs are aimed at combating the inflammatory process.
Heparin, ointment: hepatrombin, lioton-gel. Thanks to them, itching and pain subside. They also have a pronounced, otherwise ...
Enzyme therapy: phlogenzym, Wobenzym. These drugs provide anti-edema
Propolis. If used locally, they will have an analgesic effect, reduce swelling, strengthen the venous wall, fight itching and have an antimicrobial effect.

Surgical methods may be different. Let's take a look at the three most common options.

Thrombophlebitis can also be treated folk ways but before that you need to consult a doctor. Here are examples of some methods that do not include drug therapy.

the use of onions and garlic.
weight normalization.
a proper diet that includes plenty of fiber and minerals and limits the intake of high-calorie foods and animal fats.
use apple cider vinegar: One teaspoon per half glass.
the use of contrast baths for the legs, as well as rinsing the knees and thighs.
improvement of bowel movements.
drinking their yarrow tea, mountain arnica and Hypericum perforatum.
use of horse chestnut extract, medicinal comfrey and sweet clover, mountain arnica. These medicinal herbs have an anti-inflammatory effect.
giving the legs a higher position during sleep to improve the outflow of blood.
doing regular leg exercises.

Possible consequences

The most dangerous complication is the detachment of a thrombus, as it can contribute to the occurrence of thromboembolism. Thrombophlebitis can lead to inflammation in the walls of blood vessels, which also extends to surrounding tissues.

Thrombus separation is one of the possible consequences

But there is no need to be too afraid, since the possibility of a blood clot detachment in this form of the disease is not as great as with deep vein damage, since in the latter case, deep veins are surrounded by muscles, and when the vein moves, the veins and the thrombus itself are displaced. However, if the form of the disease we are discussing is not treated, it can just go to such a degree.

Some other complications are possible:

the transition of the disease to a chronic degree;
the spread of the infection.

Disease prevention

To avoid the occurrence of thrombophlebitis will help to follow a few simple rules.

Long periods during which the body and legs remain motionless should be avoided.
During the day, you should try to put your feet higher, for example, leaning them against a wall or placing them on a chair.
During the day, you should walk on foot, as this has a positive effect on vascular tone and facilitates venous blood flow.
Should be consumed throughout the day enough liquids.

Monitor bowel movements so that it is regular.
Control your weight.
Do a warm-up several times a day.
Alternate periods of sitting and standing.
Eat properly.
If you need to do intravenous injections, then it is desirable to alternate the veins.

Of course, with any suspicion of a disease, you should immediately go to the doctor in order to identify violations in time and start timely treatment. Thanks to this, it will be possible to avoid complications, and the legs will not lose their beauty.

Thrombophlebitis often occurs in superficially located veins, since the valves of these veins are somewhat weaker than the vessels located deep in the body. In addition, they are more susceptible to injury and influence. external factors. Thrombophlebitis of the superficial veins is inflammation of the venous wall with the formation of single or multiple blood clots in the lumen of the vessel (thrombosis).

There are several scenarios for the development of thrombosis:

completely clog the vessel and disrupt the blood circulation of a certain area;
blood clot can break away at any time vascular wall, which leads to embolism of various organs;
a favorable outcome is the independent resorption of the thrombus.

Thrombophlebitis of the superficial veins of the lower extremities occurs against the background of a combination of adverse factors:

Injuries of the vascular wall. Superficial vessels are at significant risk due to their location. All injuries, even minor ones, affect the walls of blood vessels, which, in turn, can lead to the development of the disease. Traumatic factors in this case: bruises, cuts, intravenous medical manipulations.
Decreasing blood flow rate. This condition occurs with prolonged forced immobilization of a person ( serious illnesses requiring strict bed rest), long-term wearing plaster cast on the leg, heart failure with congestion.
Changes in the properties and composition of blood. Thickening of the blood occurs when the body loses fluid (vomiting, taking foods and drugs that have a diuretic effect, diarrhea, heavy bleeding). Diabetes leads to an increase in blood glucose, which leads to an increase in blood viscosity.

The most common causes of this pathology are:

Diseases of an infectious nature.
Major injuries and surgical treatment.
Sensitization ( hypersensitivity) of the body to various allergens.
Tumors of a malignant nature.
Hormonal imbalance.
Obesity.
Frequent intravenous manipulations (especially if the execution technique is violated).
In women, a common cause of the development of pathology is the period after an abortion and pregnancy.

Classification

Thrombophlebitis, depending on the etiology, is divided into:

1. Infectious. Due to their occurrence, they are:

associated with inflammation of a purulent nature;
complications of infectious diseases;
postoperative;
postpartum.

2. Non-infectious are divided into:

complications of varicose veins;
migratory;
post-traumatic;
characteristic of cardiac pathologies.

In the course of the pathological process, thrombophlebitis is:

sharp;
chronic;
subacute.

Superficial thrombophlebitis of the lower extremities acute course develops against the backdrop full health suddenly. Its development is facilitated by conditions that lead to increased blood clotting (infections, hormonal contraceptives, injury).

With the development of the pathological process in the altered, dilated veins, the following signs are observed:

if there are venous nodes, then they become larger, thicken and hurt;
swelling of the leg in the affected area.

These signs are a distinguishing feature of superficial thrombophlebitis from deep.

With the defeat of superficially located veins, the patient's state of health does not change much, only local signs pathology. Signs of the disease in acute course:

The pain in the affected area is pulling, having an acute character.
There is hyperemia and swelling in the area of the pathologically altered vein.
General hyperthermia (body temperature up to 38.5 degrees).
Increase in regional lymph nodes.
General malaise.
The person may be cold.

The acute form of the disease lasts about a month.

At subacute course pains are aching. An increase in body temperature in this case not visible. Seals in the veins are not painful on palpation. Skin in the place of localization of the pathological process change their color. They become cyanotic (bluish) in combination with a brown tint. The disease lasts for about four months.

Chronic thrombophlebitis occurs against the background of existing varicose veins. In the area of the venous node, a tense dense formation is determined. Increased symptoms of varicose veins. The disease is undulating.

If the pathology occurs repeatedly in intact veins, then this form of the disease is called migratory. This may be a sign of the presence malignant tumors, systemic diseases and problems with hematopoiesis.

Diagnostic measures

Diagnostics of this pathological condition presents no difficulty experienced doctor easily diagnose. To study the pathological process and determine the tactics of treatment, it is necessary to carry out a number of diagnostic measures:

Ultrasound examination (dopplerography). The presence of blood clots is determined, the patency of pathologically altered vessels is assessed.
Reovasography. This method is not invasive, it allows you to study the blood circulation.
Magnetic resonance and computed tomography are applicable in a situation where previous studies have been uninformative.
Ultrasonic duplex angioscanning. This technique allows you to evaluate the structure of the vascular wall, determine the size of the vessels, the movement of blood flow and its speed.
Venography - X-ray method studies using a contrast agent.

Treatment of superficial thrombophlebitis

Where will the treatment take place? It depends on the location of the pathological process. If thrombophlebitis is localized in the lower leg, then treatment can be carried out on an outpatient basis. But if a pathology occurs on the thigh, it should be treated in a hospital. Hospitalization of the patient is also indicated in the absence of positive dynamics from conservative therapy leg pathology.

Treatment of this pathology is aimed at:

prevention of the transition of the inflammatory process to deep veins;
exclusion of the possibility of developing complications;
relieve inflammation and reduce the formation of blood clots.

If there is a suspicion of the development of an embolism, then the patient is shown strict bed rest. In all other cases physical activity the patient should be limited (running, lifting weights, any work associated with tension in the abdominal muscles is excluded).

Basic principles of conservative treatment:

Decreased physical activity.
If bed rest is prescribed, then strict adherence to it is necessary.
Wearing compression underwear or the use of elastic bandaging according to indications and after consultation with a specialist.
Anticoagulants are prescribed (they help thin the blood and prevent further formation of blood clots), for example, Enoxaparin. These drugs are prescribed for 7 days, then they switch to taking tablet preparations, for example, Aspirin cardio.
Phlebotics, help to eliminate the internal inflammatory process (Troxerutin).
Non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) are also used to eliminate inflammation.
Preparations for external use containing heparin: Heparin ointment, Lyoton-gel. These drugs eliminate itching and painful manifestations.
Enzymes are agents that have a decongestant effect (Wobenzym).
Propolis, when used locally, helps to reduce pain, reduce edematous syndrome, eliminate itching and destroy pathogenic microbes.

In case if conservative treatment does not give positive dynamics, then surgical methods of treatment are used:

Ligation of superficial veins. This operation is carried out using local anesthesia. It is carried out in order to stop the discharge of blood from deep-lying veins into superficial ones. This method surgical treatment completely safe and does not cause discomfort to the patient.
Venectomy is an operation aimed at excision of the affected part of the vein. Small incisions are made on the skin, through which, with the help of special hooks, a pathologically altered vein clings and is removed.
Removal of thrombosed nodes of superficially located veins.

After consulting with your doctor, you can contact folk methods treatment:

It is recommended to eat garlic and onions. They help thin the blood and strengthen the vascular wall.
Ingestion of apple cider vinegar. In half a glass of water, add one teaspoon of vinegar.
In folk medicine are widely used for the treatment of thrombophlebitis foot baths. Poured into one bowl warm water(38-39 degrees), and the other - cool water. Legs must be lowered alternately in one basin, then in another. The procedure must be completed warm water. After the bath, the feet must be wiped dry.
Brew and drink tea medicinal herbs(St. John's wort, yarrow, mountain arnica).
Medicinal plants such as sweet clover will help relieve inflammation, horse chestnut, mountain arnica and so on.
During a night's sleep, it is necessary to give the legs an elevated position.

When rich in fiber, cereals, fruits, vegetables and nuts. Beneficial effect on blood vessels following products plant origin: ginger root, garlic, hawthorn fruit, capsicum, valerian (root).

Complications of thrombophlebitis of the superficial veins of the lower extremities

The most dangerous complication in this pathology is thromboembolism, which develops due to a detached blood clot. A life-threatening condition is pulmonary embolism and thrombosis of cerebral vessels. However, such a complication with this type of pathology is quite rare.

Also, in case of untimely and improper treatment the following complications develop:

Abscess or phlegmon of the lower limb.
Eczema.
Inflammation of lymph nodes located close to the site of development of the pathological process (lymphadenitis).
Sepsis (generalized infection of the body) - the spread of infection throughout the body with blood flow.
Gangrene.
Thrombosis of deep veins of the lower extremities.