Deep vein thrombosis of the lower extremities is an acute disease affecting the veins located under the muscles. In the veins, blood clots are formed, narrowing the lumen of the vessel until it completely clogs. Occlusion of vessels is noted in 15% of cases. Sometimes venous thrombosis develops rapidly, can lead to disability and even death.
The deepest vessels of the lower leg are most susceptible to thrombosis. Formed clots are attached to the walls of the vessels. During the first 3-4 days, blood clots are weakly retained, they can detach and migrate with the blood flow.
Gradually the blood clot solidifies and is firmly fixed on the vein wall, provoking thrombophlebitis of the deep veins of the lower extremities - inflammation of the venous wall in the thrombus area. Inflammation leads to the formation of new thrombi that settle above the primary clot. The transition of thrombosis to thrombophlebitis occurs about a week.
Causes of pathological
main causes of the disease - increased blood clotting, slowing of the venous blood flow and damage to vessel walls( triad of Virchow). Thrombosis development can provoke:
- Congenital malformations of veins;
- . Oncological diseases;
- Endocrine disorders;
- Pregnancy;
- Infections;
- Injuries and surgical interventions;
- Paralysis of the limbs;
- Admission of drugs that increase blood clotting;
- Prolonged bed rest;
- Obesity;
- Varicose veins.
Additional risk factors include smoking, severe physical exertion, prolonged sitting or standing , associated with the characteristics of professional activity, age more than forty years.
Signs and symptoms
Thrombosis of deep veins in the early stages may occur asymptomatically and its first manifestation is pulmonary thrombosis( pulmonary embolism, pulmonary embolism, PE).A typical development of the disease occurs in about every second patient.
The classic symptoms of deep vein thrombosis are:
- Local increase in temperature in the affected area.
- Increases the overall temperature to 39 degrees or more.
- Stiffening pain along the course of the affected vein.
- Heaviness in the legs.
- Edema below the clot attachment area.
- Glossy or cyanotic skin.
- Part of the volume of blood from the thrombosed vein is sent to the surface vessels, which become clearly visible.
During the first two days after the formation of thrombosis of the deep veins of the lower leg or thigh, the symptoms are poorly expressed .As a rule, these are mild pains in the gastrocnemius muscle, which increase during movement and during palpation. There is a slight puffiness in the lower third of the shin.
If thrombosis is suspected, Lovenberg and Homans tests .The patient is asked to bend the foot up. Confirmation of the diagnosis is the pain in the lower leg. When the injured leg is squeezed by a tonometer at values of blood pressure 80/100 mm Hg. Art.there is pain. Tenderness when squeezing a healthy limb is felt with a blood pressure of 150/180 mm Hg. Art.
Severity and localization of symptoms depends on the location of the thrombosed area. The higher the lesion is located, the more pronounced cyanosis, swelling and pain .This increases the risk of separation of thrombus and development of PE.
When thrombosed femoral vein edema is localized in the thigh area, thrombosis at the level of the iliac and femoral vein( ileofemoral thrombosis) is accompanied by edema of the entire limb, starting from inguinal folds. The skin of the affected limb acquires milky white or cyanotic color.
The development of the disease depends on the location of the thrombus .Ileofemoral thrombosis develops rapidly, pains appear, then the leg swells, the skin color changes.
Vessel thrombosis in the lower leg is manifested by mild pain. The intensity of pain during movement and exercise increases. The affected leg swells below the site of the thrombus localization, the skin turns pale, becomes a glossy , later acquires a pronounced cyanotic shade. Within a few days after the formation of a thrombus, superficial veins appear.
For a better understanding of what awaits the patient if they ignore the symptoms and signs of deep vein thrombosis of the lower extremities and lack of treatment, take a look at the photo:
When to call a doctor
Venous thrombosis is an insidious and deadly disease. The most serious is an occasion for a visit to the phlebologist - increased blood clotting irrespective of injuries, surgical interventions, wounds, etc.
Do not delay the visit to the doctor and if there are characteristic pains in the legs against one or more risk factors for deep vein thrombosis in the lower extremities. To disturb should also skin color changes, characteristic for thrombosis of veins.
Diagnostics
Basic methods for the diagnosis of vascular disease - duplex scanning and blood analysis for the D-dimer .If a doctor has doubts about the results of a duplex study or a thrombus is located above the inguinal fold, the method of radiopaque phlebography is used.
A radiopaque preparation is injected into the venous channel and a normal X-ray is taken. This method provides more reliable data than an ultrasound and can accurately determine the location of the thrombus.
The clinical picture of the disease resembles the development of other pathologies of , including those not associated with vascular lesions. Differential diagnosis is performed with Buerger's disease, Baker's cyst, acute ileal-femoral embolism.
The cause of pain in the calf muscles can be neuritis of the sciatic nerve of various etiology .The pain of a neurological origin is of a permanent nature and is often accompanied by impaired sensitivities, motor reactions or trophic tissue.
A clinical picture resembling deep vein lesions of the lower extremities can develop with lymphostasis, arthritis, myalgia, myositis, trauma, compression of veins from the outside( including tumor processes), superficial vein pathologies, arterial or venous insufficiency, and a number of other diseases.
Treatment of
When is diagnosed, immediately begins treatment. Depending on the specifics of the specific clinical case, the severity of the patient's condition and the stage of the disease development, the treatment is performed on an outpatient basis or in the hospital of the surgical department conservatively or operatively.
Conservative therapy
In the initial detection of thrombosis treatment lasts up to 6 months, with relapses - up to a year or more. In the acute period of the disease, the patient is placed in a hospital and is prescribed 10 days of bed rest .The bed in the foot rises approximately 20 degrees, to improve the outflow of blood from the distal parts of the limbs.
Patients are prescribed heparin therapy, thrombolytic and non-steroidal anti-inflammatory drugs. Thrombolytics are prescribed in the early stages of development of pathology, as long as there is no risk of fragmentation of clots. The course of treatment includes prostaglandin drugs, glucocorticoids, anticoagulants .If necessary, the affected leg can be immobilized, in some cases, patients are assigned to wear compression knitwear.
Surgical treatment
Operative treatment is subject to cases of flotation thrombosis, ie, those in which there is a high likelihood of separation of the thrombus, as well as complete blockage of the lumen of the vessels.
In the practice of surgical treatment of thrombosed veins apply:
- Cava filter. It is installed in the inferior vena cava for catching torn clots or fragments thereof and serves as prevention of blood clots.
- Calcification of the inferior vena cava. The wall of the affected vessel is stitched with metal clips.
- Fogarty catheter. It is used to remove poorly fixed thrombi during the first five days after clot formation.
- Thrombectomy. Operation to remove blood clots at early stages of development. In the transition of thrombosis to thrombophlebitis, thrombectomy is contraindicated.
Learn more about the methods of treating deep veins from thrombosis from a separate publication.
Forecasts
With timely adequate treatment, the prognosis of the course of the disease is favorable .In the absence of treatment in about 20% of cases lead to pulmonary embolism, in 10-20% of cases of PE is fixed lethal outcome. Among the possible complications of untreated vein thrombosis - gangrene, stroke, myocardial infarction. An untreated venous thrombosis leads to the development of PE during the course of three months in approximately half of the patients.
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