Phlebothrombosis: deep veins of the lower extremities, superficial, lower leg, inferior vena cava. What you need to know about occlusive thrombosis of deep and superficial veins Angioplasty of iliac vein narrowing with stenting

Phlebologist's consultation

Examination of the phlebologist of our center with ultrasound of the veins

Repeated consultation of a phlebologist

Post-treatment consultation

Reception (consultation) of a leading vascular surgeon

Consultation of a vascular surgeon - examination by a specialized specialist of patients with suspected diseases of the arteries and veins. In the process of consulting a vascular surgeon, it may be necessary for additional examinations in the form of ultrasound of the arteries or veins.

Reception (consultation) of a vascular surgeon, primary

A consultation with a vascular surgeon is carried out to diagnose diseases of the arteries and veins and to choose a method for treating vascular pathology.

Reception (consultation) of a vascular surgeon, repeated

It is carried out to assess the patient's condition after the treatment (conservative or surgical). At the second consultation, methods of additional diagnostics or treatment may be offered.

X-ray of the lungs

Plain radiography of the lungs - a general x-ray examination of the chest organs in a direct projection. It allows you to assess the state of the respiratory system, heart, diaphragm. It is a screening method to rule out serious lung and heart problems in preparation for major surgery. If any pathology is suspected, additional projections for x-rays are assigned.

Phlebography contrast

Examination of the deep venous system on an angiographic unit using intravenous administration of a contrast agent. In our clinic, it is used immediately before deep vein surgery, or to assess valve function in a retrograde version. Phlebography is applied before installing the cava filter.

Angioplasty of narrowing of the iliac veins with stenting

Stenting of the iliac veins is performed as part of the treatment of complicated forms of post-thrombotic deep vein disease. The meaning of the intervention is to pass a special conductor through the closed and narrowed segment of the iliac vein, through which a special balloon is then inserted, the inflation of which leads to the restoration of the patency of the venous vessel. After angioplasty, a special metal frame is installed - a stent to maintain patency. All interventions are performed under ultrasound and x-ray control. The price shown is for one stent. Additional stents are paid separately.

Removable cava filter implantation

Installation of a trap for the prevention of pulmonary embolism in deep vein thrombosis. It is carried out through a puncture in the subclavian or femoral vein.

Deep vein thrombectomy using Aspirex Straub technology

Operation of endovascular removal of blood clots from deep veins.

Phlebothrombosis is a disease of the veins of the lower extremities, caused by the formation of blood clots in the lumen of the vein and their deposition on the vascular wall from the inside. Phlebothrombosis should not be confused with, since in the latter case inflammation of the venous wall develops with necrosis (necrosis) and inflammation of the soft tissues of the lower leg and foot.

The danger of phlebothrombosis is not only that the nutrition of soft tissues is disturbed due to venous stasis of blood in the lower limb, but also that blood clots can “shoot” into other vessels, into the heart and lungs, while developing a heart attack or stroke. The patient may not even be aware of the presence of phlebothrombosis for a long time. if the skin color and skin sensitivity are preserved, but at one moment he develops the severe listed complications, the source of which was nothing more than the deposition of a blood clot on the vein wall.

They can be formed and fixed in many veins, but vessels in the lower extremities are most often affected by this pathology. A thrombus can completely block the vessel from the inside, but partial blockage of the vascular lumen is also fraught with complications. For example, the frequency of phlebothrombosis and (PE) after abdominal surgery is 68 and 57%, respectively, and after surgery on the femoral neck, PE occurs in more than half of all cases.

The reasons

Most often, phlebothrombosis occurs in the elderly, but it can also develop in young people, especially women.

All causes of phlebothrombosis of the lower extremities can be divided into three large groups:

1. Deceleration of blood flow in the lumen of the veins and venous congestion in the lower extremities:

1. Blood viscosity disorders:

• Congenital diseases of the blood system, characterized by its increased viscosity, which leads to a slowdown in blood flow in the microcirculatory bed, and, as a result, to increased thrombus formation in the venous lumen,
• Long-term use of steroid hormones and combined oral contraceptives (COCs), especially in women with existing varicose veins.

1. Damage to the vascular wall:

• Due to mechanical damage to the veins during operations,
• As a result of a long stay of an intravenous catheter or frequent intravenous injections.

Threatened by the development of phlebothrombosis categories of persons include such patients as:

1. Pregnant women, especially in the second - early third trimesters,
2. Overweight patients,
3. The elderly, especially those leading a sedentary lifestyle,
4. patients with cancer,
5. Women after delivery by caesarean section,
6. Patients with severe cardiovascular disease.

Symptoms of the disease

In the vast majority of cases, phlebothrombosis develops gradually, imperceptibly to the patient. Acute phlebothrombosis is considered within two months from the onset of thrombus formation. However, the first clinical manifestations occur acutely.

With phlebothrombosis of the superficial veins of the leg the patient notes soreness, swelling of the foot and the appearance of cyanotic (blue or blue) skin color on the lower leg and foot. In addition, there is an expanded venous network on the skin.

With phlebothrombosis of deep veins in addition to the above symptoms, there is severe soreness in the calves during the flexion movement of the foot and pain during palpation (palpation) of the deep muscles.

The difference between venous and arterial is skin staining - in the presence of a blood clot in the artery, the limb becomes white, waxy, cold, and when a blood clot is fixed in a vein, it becomes blue, purple or purple.

Pain with phlebothrombosis is less pronounced than with obliteration of an artery thrombus.

The difference between phlebothrombosis and thrombophlebitis is the temperature of the skin - in the first case, the limb is cool to the touch, in the second - hot due to the development of a local inflammatory reaction.

In addition to subdivision into superficial and deep, the clinic of phlebothrombosis differs in the level of damage - according to the principle of division of the venous bed in the system of the inferior vena cava. Therefore, we should dwell on these forms in more detail.

Phlebothrombosis of deep veins of the lower extremities

Acute phlebothrombosis, which has developed in one of the deep veins, is clinically manifested rather poorly and often causes difficulties in diagnosis. So, only a part of patients notes pronounced edema and cyanosis of the skin of the foot, in other cases, the only symptom is pain in the lower third of the lower leg, in the ankle and in the foot. To obtain more data in favor of phlebothrombosis of the lower leg, tests conducted by a doctor are used. For example, a test with dorsiflexion of the foot in the position of the patient lying down with legs bent at the knee joints. With complete relaxation of the calf muscles, there is a sharp pain in the lower leg and foot.

In addition, tests with anterior-posterior and lateral compression of the leg muscles are recommended. With phlebothrombosis, anterior-posterior compression is sharply painful. Some doctors use the calf compression test with a pressure cuff. Phlebothrombosis is more likely if pain in the lower leg and foot occurs when pressure is applied to less than 150 mm Hg. In most cases, patients experience pain when probing the inside of the ankle and heel.

If the patient has thrombosed all the deep veins, the clinical manifestations increase rapidly and are very pronounced. There is swelling, blueness and cyanosis of the entire lower leg and foot, and sometimes the lower third of the thigh.

Phlebothrombosis in the femoral-popliteal segment

The symptoms of this form of phlebothrombosis can be quite non-specific. So, for example, in some patients there is an effusion in the cavity of the knee joint with severe swelling and pain in the knee region. The difference from osteoarticular pathology is the presence of pronounced cyanosis of the lower leg and foot. In addition, there is a symptom of Louvel - if the patient is asked to cough or exhale sharply, similar to sneezing, the patient develops pain along the vascular bundle on the lower leg.

Ileofemoral phlebothrombosis

With this form, the formation of a thrombus develops in the iliac-femoral vein. It is clinically manifested by a sudden sharp cyanosis (blue) of the thigh and lower leg, and the intensity of the blue color of the skin increases towards the foot. Soft tissue swelling and severe pain in the inguinal and sacroiliac region are also noted. During examination, the doctor can see an expanded subcutaneous venous network and feel painful dense formations along the vein. After a few days, the swelling of the limb subsides, which is explained by the inclusion of collateral (bypass) veins in the bloodstream.

Phlebothrombosis of the inferior vena cava

This form of phlebothrombosis is one of the most dangerous. Due to the fact that the branches that carry blood from the liver and kidneys flow into, such phlebothrombosis is often fatal.

With phlebothrombosis, there is a sharp pain in the abdomen, veins of the anterior abdominal wall ("Medusa's head"), an increase in the abdomen due to the accumulation of fluid in the abdominal cavity (ascites), swelling of the thighs, legs and feet.

With phlebothrombosis of the renal veins, sharp intense pains in the lower back and abdomen, as well as tension in the abdominal muscles, develop. Bilateral defeat in the vast majority ends lethally. Renal failure occurs, characterized by a decrease or absence of urination with an increase in urea and creatinine in the blood.

With distal (lower) phlebothrombosis of the vena cava, edema and blue coloration of the skin extends from the lower extremities to the anterior abdominal wall and up to the ribs.

Diagnosis of the disease

A preliminary diagnosis can be established even in the process of examining and questioning the patient using the simple diagnostic manipulations listed above.

However, the following laboratory and instrumental methods are used to clarify the diagnosis. So, in phlebology, the use of such methods as:

• Ultrasound duplex scanning and Doppler examination of vessels, which allows to detect the presence of a thrombus, the degree of obliteration of the vessel, the extent of the thrombus and the presence of inflammatory changes in the venous wall.
• X-ray contrast study, or retrograde ileocavagraphy. It is carried out as follows - the patient is placed in a horizontal or inclined position, a radiopaque substance is injected by means of a puncture of the femoral vein, and after a series of images, the result is evaluated. In the presence of a thrombus, the degree of obliteration of the iliac and inferior vena cava, as well as the degree of blood flow through the collateral vessels, are specified.
• A chest x-ray is performed when thromboembolism is suspected. However, with thromboembolism of small branches, radiographic signs may not be present, therefore, the main role in the diagnosis of PE is given to clinical manifestations.
• A blood test for the presence (a product of degradation of fibrin in the blood) is a pathognomonic sign of thrombosis and PE, as well as a study of the blood coagulation system and platelet levels.

Treatment of phlebothrombosis

At the slightest suspicion of this disease, you should immediately contact the surgeon at the clinic or call an ambulance. In any case, hospitalization to the Department of Vascular Surgery for further diagnosis and treatment is indicated.

All methods of treatment can be divided into medical and surgical.

Medical therapy consists in the appointment of drugs that prevent increased thrombosis. This group includes heparin and warfarin. Heparin in the first 5-7 days is injected subcutaneously into the skin of the abdomen four times a day. Subsequently, the patient takes warfarin tablets or similar drugs every day for many months under control on a monthly basis.

From surgical methods the following methods are performed:

Implementation into the inferior vena cava is the best method of preventing PE due to the fact that such a device can “catch” a blood clot on its way from the extremities to the vessels of the lungs.

cava filter - a "trap" for blood clots in the inferior vena cava

The operation is performed under local anesthesia and is an endovascular (intravascular) method. The duration of the operation is no more than an hour, and the doctor's manipulations do not cause significant pain in the patient. At the beginning of the operation, after local anesthesia, the patient is given vascular access to the vein in the groin, after which, under the control of X-ray equipment, the introducer with a filter at the end is brought to the inferior vena cava under the confluence of the renal vein.

A cava filter is a wire structure that resembles an umbrella, and can also be in the form of a tulip or an hourglass. He is able to pass blood, but delay blood clots. The cava filter can be installed for a certain period of time or for permanent functioning in the body, depending on the initial pathology in the patient.

In addition to installing a cava filter, the following types of operations are also performed:

Creation artificial occlusion the affected vein by placing a small clip on the outside of the vein. It is used to avoid separation of a blood clot in the vessels of the lungs.

Removal parts veins, if the area of ​​damage to the vessel is insignificant. If phlebothrombosis has developed over a large area, vessel prosthetics can be used using your own vein.

Indications for surgery are the presence of a floating thrombus, which is not firmly fixed on the vessel wall and protrudes into the venous lumen with a high probability of its detachment; and past or current pulmonary embolism.

Contraindications for surgery are advanced age (over 70 years), pregnancy, as well as the general serious condition of the patient.

Risk of complications

The most formidable complication, occurring in 2% of cases in the first five years after phlebothrombosis, is TELA.

Symptoms - the patient suddenly develops shortness of breath at rest, aggravated by walking and lying down. There may be transient cyanosis of the skin of the face and fingertips. With thromboembolism of small branches, shortness of breath against the background of venous diseases, prolonged immobilization, or after operations is the only symptom that should alert the doctor.

With PE of large branches, a general serious condition develops, severe shortness of breath, diffuse (common) cyanosis and a decrease in saturation (oxygen saturation) of peripheral blood. If extensive thrombosis of the pulmonary artery has occurred, then death occurs within a few minutes.

Treatment and prevention consist in the use of anticoagulants and. In the first few days, the patient is prescribed heparin or fraxiparin in the form of subcutaneous injections, followed by a transition to oral forms (xarelto, phenylin, warfarin, aspirin, etc.).

The other most common complication is post-thrombotic syndrome(PTS).

Symptoms - during the first two to three months, the patient notes swelling and pain in the affected limb. This is due to the activation of blood flow through the perforating (perforating) veins of the lower leg and foot. Varicose veins may also occur if this has not been observed before.

Treatment and prevention consist in the use of compression stockings and in the application (phlebodia, rutoside, etc.).

Forecast and prevention of phlebothrombosis

The prognosis for ileofemoral thrombosis, as well as phlebothrombosis of the popliteal vein and veins of the leg, is favorable if the thrombus does not break off. Otherwise, the mortality from thromboembolism is high and amounts to 30% in the first hours. The prognosis for phlebothrombosis in the inferior vena cava is unfavorable.

Preventive measures to prevent phlebothrombosis are:

1. The use of oral contraceptives is not for a long time, but in courses,
2. Timely treatment of varicose veins,
3. Early activation of the patient after injuries, operations and myocardial infarction,
4. Use for the entire period of forced immobilization of the patient,
5. Taking prophylactic courses of anticoagulants as prescribed by a doctor.

Video: doctor about phlebothrombosis of deep veins of the legs

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBGU)

Level of education - Specialist

Additional education:

"Cardiology"

State Educational Institution "Institute for the Improvement of Doctors" of the Ministry of Health and Social Development of Chuvashia

Vessel occlusion is the medical term for an obstruction in blood flow. Occlusive thrombosis, respectively, causes a complete blockage of the passage of the vessel, blocking blood circulation. Such a condition threatens the development of severe complications that can provoke a fatal outcome.

Causes of occlusive thrombosis

The development of occlusive thrombosis can contribute to hereditary predisposition and the adverse effects of external causes. Specialists identify several factors that can provoke the development of thrombophlebitis and, in the future, occlusive thrombosis:

• operations carried over in the past;
• advanced age (over 60 years);
• trauma;
• previous exposure to chemotherapy;
• systemic diseases (lupus erythematosus);
• neoplasms;
• phospholipid syndrome;
• tuberculosis;
• varicose veins;
• hormonal disorders;
• paralysis of the legs;
• exacerbation of infectious diseases;
• smoking;
• hypodynamia;
• physical overload;
• frequent intravenous injections of drugs.

Non-occlusive thrombosis develops if the thrombus is located on one of the venous walls. The lumen of the vein usually remains open, which does not interfere with blood flow. Complete blockage of the lumen of the great saphenous vein can be facilitated by:

• negative changes in the blood flow system;
• venous congestion;
• disorders in the hemocoagulation system;
• metabolic pathologies;
• changes in the structure of the vascular wall.

Symptoms of the disease

Manifestations of occlusive thrombosis depend on the etiology and form of the pathological process. The most common acute occlusive phlebothrombosis, localized in the lower extremities, is characterized by:

• pronounced edema;
• cyanosis of the skin in the affected area;
• heaviness in the legs;
• enlarged veins;
• the occurrence of foci of inflammation;
• pain in the calf muscles;
• burning sensation in the legs;
• fever;
• fatigue, weakness.

The pains usually increase during bending of the legs, while walking they sometimes become unbearable. More often, the patient swells one limb, sometimes both. The severity of edema is often reduced in the morning, after sleep. Over time, the disease can cause a feeling of heat in the affected area and pain in the chest area. If the lumen of the great saphenous vein is blocked, there are:

• dilated vascular bed;
• swelling of the legs or feet;
• asthenic syndrome;
• severe pain in the ankle;
• enlarged lymph nodes;
• dense painful knots of veins;
• night cramps.

Diagnosis of occlusive thrombosis

Thrombosis therapy is prescribed only after a thorough diagnosis. It is especially important in the early stages of the pathology, with non-occlusive thrombosis, when the symptoms are not obvious. Usually used standard studies:

• analysis of anamnesis;
• general blood analysis;
• duplex scanning of the veins (allows you to assess the characteristic features of the disease);
• X-ray contrast phlebography or magnetic resonance imaging of blood vessels (in a hospital - if necessary).

Phlebography allows you to identify the dislocation of a thrombus. The signal reflects the nature of blood movement, shows areas with its absence.

Pathology therapy

Occlusive thrombosis involves the use of complex therapy. It is designed to eliminate the pronounced manifestations of pathology and normalize the general condition of the patient. It is necessary to prevent the further development of pathology and the occurrence of life-threatening complications. Treatment of the disease can be outpatient, using conservative approaches. It includes:

• providing dosed physical activity;
• constant use of medical knitwear;
• local impact;
• physiotherapy;
• the use of medicines.

Usually, patients are prescribed pharmaceutical drugs aimed at fixing blood clots. They stabilize blood circulation and have a beneficial effect on the most important processes of hemostasis. Pharmacotherapy involves the use of:

• phlebotonics;
• anticoagulants;
• angioprotectors;
• antibacterial agents;
• drugs that relieve pain.

Medications, their doses and the duration of the course of treatment should be prescribed only by a doctor - individually for each patient. When diagnosing the occlusive form of thrombosis of the lower extremities and acute occlusive phlebothrombosis of the saphenous vein, combined with complications, thrombolytic therapy is often used in a hospital setting. Medicines are administered to the patient through a special catheter (thrombolysis).

With damage to blood vessels localized deep under the skin, the most optimal method is surgery. Indications for surgical treatment are:

• thrombus compression by tumor formations or lymph nodes;
• high possibility of separation of a blood clot;
• rapid progression of inflammatory processes.

During the operation, specific synthetic tubes (arteriovenous shunts) are installed in the affected area, which create new blood flow paths. In some cases, the method of flashing the vessel is used. The stitched vein is actually excluded from the circulatory system, disappearing over time.

In addition to drug therapy and surgery, other methods of treating occlusive thrombosis are also used. Sometimes a special trap is injected into a patient's vein - a cava filter that resembles an umbrella frame. This "umbrella" catches blood clots. A similar method is used when the patient refuses surgery.

Prevention of occlusive thrombosis

In order for the therapy of occlusive thrombosis to be as effective as possible, the patient must adhere to certain recommendations:

• reduce the level of physical activity, creating complete rest for the affected limb;
• wear medical knitwear, use compression bandages to normalize blood flow;
• eat well, limiting the intake of fats, salt, alcoholic beverages.

As a preventive measure, you should change static postures more often, do a warm-up from time to time. Avoid postures that compress the vessels of the lower extremities (leg on leg). It is necessary to give preference to comfortable clothing that does not restrict movement, to give up belts.

The diet should be supplemented with foods enriched with vitamin E, and it is desirable to limit the intake of vitamin K. It is necessary to consume as many vegetables and fruits as possible - they are the main "suppliers" of fiber. It is important to limit fluid intake and avoid eating foods that provoke fluid retention in connective tissues (excessively salty foods). Seafood containing omega-3 fatty acids is very useful.

Predictions and Complications

If left untreated, a blood clot that has formed in a vein can break off and enter the pulmonary artery, provoking a quick death. Blockage of various vessels can cause the development of myocardial infarction, stroke, and a number of other pathologies and lead the patient to disability.

If occlusive thrombosis was the result of exposure to short-term factors, accompanied by forced restriction of movement (trauma, postoperative rehabilitation), the pathology usually no longer manifests itself after the root causes are eliminated. If the factors contributing to the progression of the disease continue to act (cancer, diabetes, heart failure), blood clots can form again - even after a successful course of therapy.

The occlusive form of thrombosis of blood vessels is fraught with disability, and sometimes even death. In order to avoid serious consequences, to eliminate the pain syndrome and minimize the possible risks of recurrence of the pathology, one should seek medical help at its first manifestations.

Julia ***, Woman, 36 years old

Hello, 5 days ago there was swelling and pain along the vein at the bottom of the leg. Two years ago, I had thrombophlebitis of the perforating vein (after an injury) while taking COCs, I thought something like that again, because after the operation, I was again prescribed COCs for women and I have been drinking them for the second month. On the same day as her leg hurt, she quit COC, started taking Nise, Aescusan, smearing with Heparin ointment and Indovazin gel. She bandaged the shin to the knee with elastic bandages. The vein turned red to about the middle of the lower leg and the pain was in the same area. Today I went to see the doctor. Sent to duplex. The conclusion shocked me: all the veins on the left leg are normal, on the right leg they are deep and passable, the perforator in the lower third of the lower leg is dilated and thrombosed, there is no blood flow. But it was quite expected. But in addition to this, the doctor diagnosed occlusive thrombosis of the GSV to the lower third of the thigh and valve failure. The blood flow in the vein to the lower third of the thigh is also absent. I went to the surgeon, he appointed tomorrow to take a blood test for coagulation and the following treatment: Nise continue 1t * 2r., Phlebodia 1t * 1r., Pentoxifylline 2t * 3r., Wobenzym according to the instructions, continue externally Lioton and Indovazin. Compression up to the knee to change to a stocking. And that's it. I have hysteria and panic, and here is such a conservative treatment. Tell me, please, can I add something? Maybe an operation is urgently needed? I'm hysterical. Thank you for your attention.

Hello, the formation of a blood clot in a vein is certainly a serious situation, your excitement is understandable. But if the thrombus tightly closes the vein and there is no flotation (does not move in the lumen of the vein), then it is quite acceptable to treat this condition conservatively. However, an obligatory component of treatment is anticoagulant therapy - blood-thinning! These can be injections (or fraxiparine) or tablets (xarelto). It is necessary to continue such treatment for 1-1.5 months. The second mandatory component of the treatment is a compression stocking. Everything else is secondary. After 7-10 days, you need to do a second duplex scan and make sure that the treatment has a positive effect. Now a few words about the reason that caused. You should not continue to take hormonal contraceptives. And you need to take blood tests to see if there is a predisposition to thrombosis and any disorders in the blood coagulation system. These tests are: D-dimer, APTT, thrombin time, fibrinogen, antithrombin III, homocysteine, protein C, genotyping for hereditary thrombophilia: F2 (prothrombin) and F5 (Leiden). You can send me the results of the tests, I will comment on everything. Health to you!

Hello, while I was waiting for your answer, I was treated according to the prescribed scheme, the surgeon considered that this was enough. Today I had another ultrasound. The thrombosis has not gone anywhere, the thrombus in the superficial vein has become a little smaller and has fallen below the knee. But the doctor saw a thrombosed posterior tibial vein from the perforator for 10-15 cm. Thrombosis is occlusive. I went to see another surgeon. He was admitted to the day hospital. He prescribed dripping pentoxifylline and REU for 5 days, clexane once a day for 7 days, thrombo ass 100 mg and phlebodia. It is obligatory to wear a stocking, compression class 2, you can take it off at night. As I understand it, the treatment that took place for 10 days did not bring any special results? What do you think is the right tactic now? And how dangerous is such a thrombosis?