Thrombophlebitis of subcutaneous, or superficial veins, refers to the pathology of the vessels, which manifests itself in the vein wall by an inflammatory process simultaneously with the formation of a thrombus occluding the lumen of the vessel.
Disease is a consequence of malfunctions in the functioning of lymphatic and cardiovascular systems with simultaneous problems of hemopoiesis and blood clotting. The effect of these factors over time and the lack of treatment lead to sad consequences, one of which is thrombophlebitis.
Causes and risk factors
Thrombi are formed if three groups of factors are present:
- Venous wall is damaged. Subcutaneous veins because of their location are often subjected to mechanical stress, and if they have a thin wall, the injury is more likely.
Sometimes there is a harmful effect of medics with undesirable effects on the veins during surgery, infusions of concentrated solutions, such as glucose, or the installation of an intravenous catheter.
- The slowing down of the blood circulation .This risk factor is relevant for prolonged bed rest, compression of the veins by foreign objects or injuries of limbs during crushing.
In addition, there are conditions in which blood circulation is disturbed. For example, heart failure, in which the desired volume of blood is not pumped, and stagnant phenomena begin.
- Increased blood clotting .Happens congenital and acquired, arisen after infectious diseases, with problems in the hormonal system, after taking certain medications or oncological diseases.
Typically, edema vein is non-microbial, and is a consequence of vascular damage with the formation of a thrombus. But is often associated with thrombosis with purulent processes of due to microorganisms present in the blood or outside. Then purulent thrombophlebitis is diagnosed.
In combination of three conditions, a thrombus and edematous reaction of the vessel wall are formed, after which the process develops in two ways:
- The growth of a clotted blood clot in itself or during treatment can stop, and the swelling can pass .The thrombus decreases, and can completely or partially cover the vein. With complete overlap, the blood flow falls off, and the vessel becomes empty, while the probability that the clot will come off is the smallest.
- The second variant is characterized by the ongoing inflammation of .One end of the growing thrombus is attached to the vein, and the other is in the lumen, its condition becomes unstable. As a result, even a weak effect can tear it off, then a complication begins - thromboembolism of the artery of the lungs( more about it), when the closure of the lung vessels disrupts breathing, which often ends in death.
If the thrombus remains stable, its growth is directed upwards. Penetrating through the veins, it destroys the valves, provoking phlebotrombosis, which passes into chronic venous insufficiency. In almost all cases, problems occur with a large saphenous vein.
Forms and stages
Thrombophlebitis happens:
- Acute form of , developing for 2-3 days with edema at the site of thrombus and fever;
- Chronic form of , due to complication of venous varicose. Typical flaccid form of inflammation, when you click on a site with a thrombus, it increases. Noticeable pain syndrome and swelling of the limb;
- Purulent form of - occurs when there is a focal infection on the skin. The flow is accompanied by temperature and intoxication, sometimes is the cause of sepsis;
- The non-purulent form of is caused by a thickening of the blood or a violation of its movement. The general condition is satisfactory, but on the skin can be painful reddish stripes. This phase passes through the resolution of the thrombus or passes into the chronic stage.
At the site of inflammation, the disease is classified into:
- Endoflebitis , when the inner membrane of the veins is swelling;
- Thrombophlebitis , with inflammation of the vein;
- Perflebit , with swelling of surrounding tissues;
- Purulent phlebitis , in which suppuration occurs.
The Danger and Consequences of
What is the risk of thrombophlebitis of the lower extremities? The main danger of the disease is a possible separation of the thrombus, which inevitably falls into vital organs. If this occurs in the pulmonary artery, there is thromboembolism, which in most cases ends in a fatal outcome.
Symptomatics
The first and acutely felt symptom is the sharp pain sensation in the gastrocnemius muscle .Attempts to heal by massaging lead only to intensification. On the legs redness and swelling become noticeable, and bags appear under the eyes. As the disease progresses and depending on the location of the thrombus in the signs there may be differences.
Thrombophlebitis of the subcutaneous veins of the lower extremities is characterized by the strongly inflated vein , which is very painful when touched. To the touch it is dense, on top covered with swollen, swollen skin. Body temperature at such times reaches 38 and above degrees. Chills, weakness.
Simple varicose veins differ from thrombosed ones lacking near them soreness, redness, and a higher temperature. If you give your legs a horizontal position, then in such veins, the tension decreases, and the blood goes into deeper venous vessels. A vessel with a thrombus can only grow in size when the disease develops.
The chronic form of thrombophlebitis continues for a long time, periodically exacerbating. In the periods of remission, external symptoms may disappear. More about the symptoms of thrombophlebitis of deep and superficial veins of lower extremities read here( + photo).
Diagnosis
Diagnosing the disease is not difficult. From the first hours of its appearance, it exhibits characteristic symptoms characterized by pain, reddening and densening of the vein, blocked by a thrombus. For the acute form characteristic of sharp strong pain syndrome .Diagnosis of the disease is made after examination and data collection of anamnesis.
Methods of investigation are aimed at confirming the expected diagnosis, determining the location and size of the thrombus and assessing the risk of its separation. For this, ultrasound of the legs is enough. To confirm the diagnosis, conduct color ultrasound duplex scanning .
In addition to clinical data, other methods of diagnosing the venous system can be used. With venography, you can determine thrombosis. Laboratory studies establish some important factors of blood coagulability.
Treatment Methods
All stages of the disease should be treated comprehensively. For this, is used for conservative and operational methods of , the choice of which depends on the location of the focus, the extent of thrombosis and the location of the embolus. Conservative treatment is used for acute thrombophlebitis of the subcutaneous veins of the lower extremities, and for segmental thrombosis and the embolus, surgery is performed.
Conservative methods include:
- Apply ointments based on heparin , which slows down blood coagulation.
- Physiotherapy , consisting of their following forms of exposure:
- Ultraviolet irradiation, which has an anti-inflammatory and healing effect.
- Infrared radiation that removes the edema, which increases the protective properties of the cell, and reduces pain.
- Electrophoresis with the use of hypocoagulants and disaggregants, which activate enzymes that improve metabolism, removing inflammation and making blood more liable.
- Magnetotherapy, stimulating the muscular wall of the vein, which as a result of contractions pushes stagnant blood.
- Laser therapy, improving cell nutrition and accelerating tissue repair.
- Barotherapy, in which the method of changing the surrounding pressure improves cell nutrition and eliminates edema, and also cures trophic ulcers.
- Medical treatment of boils down to the use of:
- Non-steroidal decongestants.
- Angioprotector.
- Antiplatelet preparations.
- Enzymes.
- Antibiotics of the penicillin series.
Sometimes doctors allow people to resort to popular methods.
Surgery is considered the most effective method of to combat thrombophlebitis. Doctors treat the least traumatic way, while removing the entire damaged area of the vein. Many types of operations have been developed, which depend on the state of the vessel and the location of the thrombus.
Surgery for superficial thrombophlebitis is done with:
- Dangers of pulmonary thromboembolism;
- Ascending thrombophlebitis of superficial veins of lower limbs;
- Thrombus localization in the large or small saphenous vein;
- Threats of a thrombus in the deep vein;
- The presence of attacks of the acute phase of the disease;
- Blood drop from the deep veins into the subcutaneous.
Prognosis and prevention measures
In patients with superficial thrombophlebitis , in most cases, the prognosis is favorable .Worse is the condition of patients with unrestored veins. In this case, venous insufficiency, pronounced inflammatory and painful syndrome, trophic ulcers progress, which can lead to a complete loss of ability to work.
The most severe consequence of the disease is pulmonary embolism .If it happened in a large branch - a lethal outcome occurs, in a small branch with a correct timely treatment, the prognosis may be favorable.
To unspecific preventive measures, treat timely ailments that are complicated by thrombophlebitis , as well as restoration of water balance in the perioperative period, prevention of respiratory disorders and exercise therapy.
It is desirable to hold the feet on the elevation of and apply medications that correct the homeostasis system and rheological blood properties. In addition, do not allow the appearance of excess weight, wear shoes on a low heel, eat right, use vitamin complexes, especially in the spring. And the main thing is to remember that it is always harder to be treated than to prevent the disease.
