Contents
Description of the disease
2 Causes and risk factors 3 Forms and types 4 Dangers and complications 5 Symptoms 6 Diagnosis 7 Treatment 8 Forecast 9 Prevention Description of the disease
The disease is very common. According to different data, is fixed from one to hundred cases per 1000 people. The probability of thrombosis increases dramatically after 40 years.
Thrombi form in deep veins of the legs or pelvis .They are dense blood clots and are more often formed in areas where the blood flows more slowly: near the venous valves, in the sinuses of the gastrocnemius and soleus muscles.
The parietal thrombi attach to the vascular wall and leave the lumen of the vein partially free, and the clogging clogs completely cover it. Blood flow disorder often causes edema or pain .The disease sometimes develops rapidly. Since the deep veins of the muscles of the legs fall into the lower vena cava, with the detachment of the thrombus gets first into it, and then into the small circle of blood circulation.
Acute DVT of the lower extremities is the cause of PE in more than 80% of cases.
Causes and risk factors Among the causes are primary, associated with hereditary disorders of blood clotting, and secondary, arising under the influence of external conditions.
vessel irritation, clotting disorders and blood flow disorders ( Virchow's triad).
The following risk groups for DVT and PE are distinguished:
Low risk of : patients under 40 years of age and those to whom small operations are performed; Moderate risk of : 40-60 years, small or large; High risk: after 40 years, large surgery; Very high risk of : after 60 years, large leg operations, hip fractures and other complicated injuries. About ¼ of all cases of the disease occurs after fractures of long tubular bones of the legs, large operations on the joints and peritoneum .Thrombosis threatens a person both in the early and late postoperative period.
Surgical procedures on the hip and knee joints increase the probability of DVT to 30-50%, and for small interventions lasting up to 30 minutes, the risk is less than 10%.
Main risk factors:
Continuous immobility : condition after a stroke, bed rest, lack of exercise, air travel;
Obesity of , accompanied by changes in fibrinolytic activity; General anesthesia with the use of muscle relaxants , when the muscle pump is turned off; Pregnancy and the postpartum period of , when changes in hemostasis and compression of the vessels by the growing fetus occur; Taking certain medications( thalidomide, heparin) and birth control pills with estrogen; Oncological diseases : a combination of the tumor process and DVT is known as the Tissot syndrome;elderly patients with DVT are necessarily examined for oncopathology; Disorders of hemostasis - thrombophilia; Ischemic heart disease along with chronic heart failure; Viral infections; Age-related changes of : weakening of blood circulation, weakness of venous wall, increase in blood viscosity; DVT in the medical history increases the risk of recurrence after injuries and surgeries. Hemostasis disorders that increase the likelihood of thrombosis are combined under the term thrombophilia. There are congenital genetic defects that determine the susceptibility to thrombosis : Leiden mutation, deficiency of antithrombin III, proteins S and C. Thrombophilia can be suspected if thrombosis occurred at a young age.
Forms and types of Thrombosis is distinguished by etiology, place of origin and types of thrombi:
Proximal thrombosis is localized in the popliteal or femoral vein and causes pain in the leg, edema and soreness when probing over the affected veins. But at times the first manifestation of it is PE. The distal thrombosis of affects the gastrocnemius veins. There is moderate pain and tenderness in the lower leg, but sometimes there are no symptoms. There is usually no edema. Ileofemoral thrombosis occurs in the iliac and femoral vessels. Pain is felt on the inner surface of the thigh, in the calves, in the groin. The leg swells noticeably from the foot to the groin. Palpation in the projection of the major veins of the thigh and groin is painful. Thrombi are more often formed in the femoral vein, somewhat less frequently in the popliteal and gastrocnemius, in the inferior vena cava - relatively rarely.
By origin, thrombosis is stagnant( with varicose veins, external clamping of blood vessels, internal obstructions to blood flow), inflammatory and associated with thrombophilia.
Also distinguish occlusive, parietal and flotation thrombosis .Flotation thrombus is diagnosed in about 10% of cases. It is attached to the venous wall with only one end and as it hangs in its lumen, therefore the probability of separation is very high.
Danger and complications Complete blockage causes instant death, partial - heart failure .As the cause of sudden death, PE falls in third place after ischemic disease and stroke.
After venous thrombosis of the proximal veins, chronic venous insufficiency is often formed. Increases venous pressure during movement, valves do not work well. Venous congestion is manifested by disorders of trophism : hyperpigmentation, dermatitis, seals, in severe cases trophic ulcers. To suspect a venous insufficiency it is possible on the swelling of the shins, depending on the position of the body.
More than half of the patients develop post-thrombotic disease. Almost a third of these patients become disabled .
Read more about the disease from the video:
Symptoms Sudden foot pain, worse on standing, walking is the most common symptom. Soon, soft tissue swelling, heaviness and bursting, the temperature can rise. The skin around the edema is cyanotic, shiny. After a few days, a network of superficial veins emerges.
Clots in the gastrocnemius and deep trunk veins sometimes do not manifest themselves. Blood flow disorders partially compensate for other veins. Attention should be paid to a small ankle edema and pain in the calf muscle .
These photos depict the symptoms of dangerous, neglected stages of thrombosis when urgent medical intervention is required:
Photo not for the faint of heart
Severe swelling of the leg with deep vein thrombosis.
Diagnostics The main diagnostic method is ultrasound duplex scanning , which determines how narrow the vein lumen, the size and mobility of the thrombus. Laboratory thrombosis is confirmed by a blood test for D-dimer.
Radiopaque phlebography is performed to clarify the diagnosis, as well as with thrombosis above the inguinal fold. In complex cases, magnetic resonance phlebography is done.
Treatment are treated permanently .Assign bed rest with a raised leg, anticoagulants. At the very beginning, thrombolytic therapy is indicated. Drugs for the dissolution of thrombi have serious side effects( bleeding) and are prescribed according to strict indications.
When diagnosing a flotation thrombus, a cava filter is placed in the vein, preventing it from moving upward. In severe condition with a risk of gangrene do thrombectomy - mechanical removal of thrombus.
Apply compression knitwear, reducing the likelihood of complications .After discharge, patients are recommended lifelong therapy.
More on the treatment of the disease, see the video:
Forecast Depends on the type and position of the thrombus. Occlusive thrombosis is not dangerous, since the thrombus is tightly attached and completely blocks the blood flow. The parietal thrombus is also not dangerous, but it can continue to grow and become flotation. The probability of detachment of a floating thrombus is very high.
Proximal vein thrombosis of approximately in half the cases is accompanied by PE, often asymptomatic .In a few months, in most patients, venous blood flow is restored, but the weakness of the valve apparatus develops.
In the distal veins, thrombi often dissolves themselves, but thrombosis can spread to the proximal veins.
For several years after the disease, more than half of the patients develop post-thrombotic syndrome, and in the absence or ineffectiveness of treatment asymptomatic PE.Chronic venous insufficiency worsens the quality of life and leads to disability.
Prevention
The following preventive measures are applied:
Fast onset of activity in the postoperative period, gymnastics, exercise therapy; Compression stockings or elastic bandaging; Anticoagulants; Avoidance of risk factors. After detection of the risk of thrombosis during long flights, many airlines began to inform passengers about preventive measures. It is advised to wear loose clothing, drink plenty of fluids, do exercises to fight stagnant blood in the legs, and massage the eggs.
When sitting for a long time, it is necessary to use foot restraints to prevent compression of the veins.
Acute DVT of the lower extremities presents a serious threat to life. When symptoms of the disease appear( sudden, sudden pain in the leg, swelling, bluish skin color) it is important to begin treatment as soon as possible. Timely treatment in the hospital prevents the development of PE .Along with medicines, an effective way of preventing the disease is an active lifestyle and gymnastics.
