From this article you will learn about the appearance of a clot in the leg: the symptoms, why it occurs, and what kinds of treatments are used. Complications of the disease and a prognosis for life.
Contents of the article:
- Causes of
- Symptoms
- Diagnosis
- Treatment of thrombus
- Forecast
The concept of "thrombus in the foot" includes several types of diseases, their basis is the formation of a clot in the vessels. Distinguish:
- Venous form of pathology: it is thrombophlebitis( subcutaneous veins) and phlebothrombosis( or deep vein thrombosis).
- Arterial thrombosis.
For venous thrombosis, clot formation is "on the spot": under the influence of causative factors, a thrombus is formed on the wall of the vessel, which can decay into fragments and migrate through the vessels.
Arterial thrombosis characterizes the migration of a clot from large vessels to small ones, where they completely block the flow of blood.
Principles of thrombus formation are unified for the entire vascular system, regardless of the localization of the clot( extremities, heart vessels, etc.).
Throats on the legs, depending on the type of the affected vessel, have different clinical manifestations:
- Thrombophlebitis occurs against the background of inflammatory changes in varicose veins. Strengthening the pain syndrome, the appearance of reddening of the skin over the enlarged vessels is the main signs of the disease.
- Single thrombi in deep veins below the knee are asymptomatic at first. Complete overlap of the lumen of the vein causes pain, swelling and cyanosis of the skin.
- In the first minutes, the arterial block manifests itself in severe pain below the lesion, the skin pales, the movement function is disrupted.
Danger clots are present in the arteries and deep veins. Violation of blood flow when turning off the artery leads to loss of the limb, if the blood flow is not restored within 1-1.5 hours( depending on the season).Asymptomatic and mobile clots in the venous vessels - the cause of the block of the arteries of the lungs. Violation of blood flow in small branches leads to inflammation of the lung tissue, and complete shutdown of large trunks - the cause of sudden death.
Vascular surgeons( angiologist, phlebologist) are engaged in treatment of pathology, general surgeons are in the regional centers.
Complete cure is possible with thrombi in the arteries and deep veins of the legs, thrombophlebitis in the background of varicose veins are prone to frequent relapses. The causes, symptoms and treatment of all kinds of blood clots in the legs are discussed in detail below.
Reasons for
Given the mechanisms of formation, the reasons for the formation of clots in the arterial and venous channel differ.
Venous thromboses
Group of causes and more detailed description:
| Slowing of blood flow | Long period without active walking( operation, air travel, etc.) Disturbance of venous valves in the intrauterine period Depression of large venous trunks from the outside( pregnancy, volumetric processes in the pelvis, enlarged lymph nodes) Varicose disease |
|---|---|
| Increased coagulation | Hereditary( thrombophilia) Severe forms of dehydration( infectious processes, abusedix alcohol); Oncological diseases( typical for pancreatic and stomach tumors) Receiving tableted contraceptives |
| Damage to the vessel wall | Injuries to bones, soft tissues and directly veins Infectious inflammatory processes in the surrounding vessels |
Clotting in the venous system of the lower limbs rarely occurs one by one, isolated, the reason, more often the factors act together.
Arterial thromboses
Group of causes and more detailed description:
| Cardiac factors | Cardiac arrhythmias Infectious inflammatory lesions of the inner lining of the heart( endocarditis) Valve defects, especially after surgical correction |
|---|---|
| Aneurysm( topical extension) | Left ventricle or aorta may be affected |
| Atherosclerosis | Vascular lesions with extensive "plaques"» |
Manifestations of
The signs of a thrombus in the leg depend on the type of vessel and the degree of block of its lumen. With incomplete disturbance of blood flow in the vein, there are no clinical manifestations, only the complications of the disease that arise can allow one to suspect and diagnose pathology. Arterial thrombosis always accompanies a specific symptomatology.
Excluding the asymptomatic course, the presence of a clot in the vessel has a number of characteristic features.
| Arterial thrombosis | 1 degree:
2 degree:
3 degree: pronounced edema of tissues, their necrosis. |
|---|---|
| Thrombophlebitis - an inflammatory process in the superficial veins with lumen formation | Venous wall seal Pronounced soreness when touched Redness of the skin above the vein and surrounding tissues |
| Phlebthrombosis - formation of clots in the deep veins of the legs | Shin region lesion:
Lesion of the ileum-femoral region:
|
In atherosclerotic lesions of the lower extremities, 70% of the patients have no clinical manifestations for a long time.20% note the progressive nature of the pathology with a gradual disruption of the habitual quality of life. In 10% of arterial thrombosis finishes amputation of the limb.
In 90% of thrombophlebitis - a complication of varicose veins, the remaining 10% occur against the background of the formation of clots in deep veins and are post-traumatic. The general state of health does not suffer. Thrombophlebitis associated with chronic venous insufficiency is often recurred and complicated by the transition of thrombosis to deep veins.
The formation of clots in the deep veins, associated with the short-term effect of the causative factor( surgery, pregnancy, etc.), subject to timely treatment are curable. Hereditary and chronic causes( thrombophilia, oncoprocess) lead to recurrence of the disease, a high risk of massive destruction of pulmonary tissue. With thrombosis of the lower leg vessels, the general state of health remains satisfactory. The formation of clots in the large veins of the femoral and pelvic region from the first hours accompanies a serious condition. Every year, 1 person per 1000 population of the globe dies from thrombi in the lung vessels.
As usual, a thrombus on the leg: by composition it is a mixture of platelets, fibrin fibers, white and red blood cells. A loose mass of shaped elements tends to decay in the first 10 days of formation( maximum risk of clot migration along the vascular bed), then connective tissue fibers develop in the thrombus, and it densely grows to the wall of the vessel.
Externally( outside) the thrombus is not visible, because it is inside the vessel.
Diagnostics
Diagnostic standard for suspected thrombus in the legs includes:
| Survey and examination of | Thrombophlebitis, arterial and high venous thrombosis forms are easy to establish even according to the clinical manifestations of If suspicion of lesion of deep venous vessels of the tibia is carried out, a number of samples are taken, in which pain syndrome is notedflexion of the foot in the back, circular pressure in the lower leg, etc.) |
|---|---|
| Laboratory tests | Changes in clinical analyzes are not specific Coagulogram: increased( |
| ) Duplex ultrasound of vessels( evaluation of blood flow movement) | Allows to accurately determine the level of the lesion, the degree of blood flow disturbance, to detect the presence of a mobile part of the clot |
| Phlebo- andarteriography( X-ray contrast test of vessels) | Confirmation of diagnosis in doubtful cases Solving the possibility of endovascular treatment |
| CT and MR angiogramI | Highly specific methods, the use of limited uneconomical |
Treatment Treat any thrombosis necessary in the surgical( vascular) hospital. In time and in full, conducted therapy leads to resorption of clots. A complete cure is possible in the absence of a primary circulatory disorder and a good response to treatment. With chronic vascular failure( arterial or venous), the risk of recurrence of the disease is high.
Arterial thrombosis
- Surgical removal of the clot( thrombectomy) is the main method. Conduct open and endovascular interventions.
- Treat the causative disease.
- Drug therapy is aimed at improving the blood supply of tissues( drugs that dilate the blood vessels that prevent the adhesion of platelets) and preventing the formation of new clots( Heparin and its derivatives, Warfarin).
Thrombophlebitis
- Apply medications to reduce inflammation in the vein wall, reduce blood viscosity( Detralex, Troxevasin, Heparin Ointment) - topically and tablet form.
- Use anti-inflammatory drugs( Nimesulide, Ketorolac).
- Compression of the lower extremities is carried out with the help of specialized knitwear.
- Make half-alcohol compresses at night.
- Treat the causes of the disease.
Deep venous thrombosis
What is done for therapy:
- use drugs to dissolve the clot and prevent the formation of new ones( Heparin group, Warfarin);
- medically corrected the impairment of tissue nutrition by improving blood supply( Trental, Reopoliglyukin, etc.);
- makes intravenous fluids for the dilution of blood;
- set a clot trap filter - in the lower vena cava if there are moving thrombi or episodes of migration of clots in the arteries of the pulmonary system;
- perform an operation to remove thrombus - thrombectomy - from large venous trunks if there is a technical capability.
Forecast
In the absence of chronic blood flow disorders in the vessels of the legs, 70-80% of the patients get complete cure, the rest in the first year after recovery develops post-thrombotic disease requiring further treatment.
The pulmonary arterial block is found in 20% of cases, in 3-5% it is lethal.
Thrombosis as a complication of chronic vascular insufficiency often recurs, and complete cure is impossible. Therapy includes the constant prevention of clot formation.
