Scientific editor: Strokina OA, therapist, doctor of functional diagnostics. Practical experience since 2015.
October, 2018.
Thrombophlebitis - is inflammation of the lining of the vein walls, with the deposition on them thrombotic masses, which can completely occlude a vessel or positioned Parietal. In our country, it called thrombophlebitis superficial lesion of saphenous veins.
There is another concept - flebotromboz. This term is used when talking about the defeat of the deep veins of the lower extremities. it should be noted that in the International Classification of Diseases is no second term.
Causes
There are 3 groups of factors that may influence the development of thrombophlebitis:
Changing the properties of the blood (increased clotting).
Damage to the vascular wall.
Slowing blood flow.
The first group includes formulation of venous catheters, intravenous various manipulations, surgery, trauma and fractures, immobilization of limbs or the entire body.
Increased clotting may be observed in some diseases such as thrombophilia, cancer disease, myocardial infarction, stroke, obesity, heart failure. Also, when taking certain medications: oral contraceptives, hormone replacement therapy, chemotherapy.
It is also important age (over 40 years), smoking, dehydration and, of course, the existence of suffering a thrombosis.
As a rule, it is a complication of thrombophlebitis of varicose veins and develops in superficial varicose veins of the legs.
manifestations of thrombophlebitis
Thrombophlebitis of superficial veins begins with pain in the legs, is not very strong. It hurts the skin in the course of the saphenous veins. The skin over the thrombosed veins is red, inflamed, normal skin becomes warmer to the touch.
There is a slight increase in body temperature - up to 37.5 C, at least - up to 38 C. After a while (typically 5-6 days), the temperature returns to normal or is at a small increase. Sometimes, thrombophlebitis of the lower extremities occur without any fever.
Epiphenomenon of thrombophlebitis - a small swelling of the feet, where the clot formed. along the veins inflamed skin stripes. Then begin to appear compacted areas of the skin of various sizes. Their size depends on the diameter of thrombosed veins. These densified areas can be felt well and are in fact blood clots. However, it is not always sealed areas may show the border of the pathological process. The true prevalence it can reveal only instrumental diagnostic methods.
In addition to the visual symptoms, suffering is also a function of the lower limb. Walking is accompanied by tenderness.
Diagnostics
Diagnosis of thrombosis in most cases does not cause any significant difficulties. Used instrumental methods.
The most accurate diagnostic information is provided by ultrasound duplex scanning of the color-coded blood flow. This study is to evaluate the state of the walls and the lumen of the vein, the presence in them of thrombotic masses, the nature of the thrombus, and even approximately judge its "age", ie the degree of organization.
Ultrasonic scanning saphenous veins allows absolute precision to reveal the true extent of thrombosis.
The role of laboratory diagnosis is low. General blood test reveals moderately pronounced signs of inflammation. Sometimes in the hospital prescribed a blood test for D-dimer. But it is only a confirmation of the process of thrombus formation in the body and does not show the localization process or its prevalence.
treatment of thrombophlebitis
Most patients with thrombophlebitis can be treated conservatively in the outpatient setting.
Surgery
Emergency surgical hospitalization in hospitals (preferably in specialized vascular compartment or phlebological) needed when the uplink trunks thrombophlebitis forms large and small saphenous veins when the threat of thrombosis occurs at the transition deep veins. Such patients must be operated on an emergency basis after the ultrasonic scanning.
Surgical treatment includes subcutaneous vein ligation or removal of all varicose (thrombosed and netrombirovannyh) veins.
Conservative treatment
Conservative treatment of thrombophlebitis should be aimed at eliminating local inflammatory and thrombotic processes. Mode, which is prescribed to patients, should be active.
Mistake should recognize the appointment of bed rest, because the activities of the musculo-venous pump shin provides intensive blood flow in the deep veins, preventing the development of thrombosis in them.
In the early days of thrombosis, when the most pronounced inflammatory phenomena and requires active local treatment, advantageously in the first 7-10 days to form the bandage via elastic bandages moderate extensibility. As inflammation subsided for compression therapy can be successfully used medical knitwear - socks, stockings or tights compression grade 2-3.
A simple but effective measure is a local cooling, which gives a good analgesic effect.
Thrombophlebitis justified by the use of various forms of multiple classes of pharmaceuticals:
nonsteroidal antiinflammatory drugs (NSAIDs);
derivatives of rutin;
antiplatelet agents;
flebotonikov plant
anticoagulants.
Nonsteroidal anti-inflammatory agents in the treatment of thrombophlebitis
Of the NSAIDS group most effective in this disease are diclofenac and ketoprofen. These drugs have not only a powerful anti-inflammatory, but also a good analgesic effect.
Ketoprofen gel applied 2-3 times a day in an amount of 5.3 g (1 cm ointment extruded from a tube) directly on the affected area and limbs with light circular movements of fingers rub in skin.
Quick effect is given by intramuscular injection of NSAIDs, and their use in rectal suppositories. These methods of using these agents reduce the incidence and severity of complications.
Effective in treating thrombosis are derivatives of rutin (Rutoside, troksevazin, troxerutin) representing universal protectors venous wall and has a pronounced anti-inflammatory act. The daily dose is generally different troxerutin 1200 mg.
Heparin is an anticoagulant, has a powerful antithrombotic and anti-inflammatory effect. It is mandatory in the treatment of thrombosis. The dose is calculated according to the weight and analysis of blood coagulation.
Local therapeutic action is provided by applying heparin-NSAIDs and gels. The dosage and frequency of their use are similar to each other. At the same time, has proved itself alternation of these drugs, i.e. Gel application is carried out 4 times a day according to the scheme: heparin - NSAIDs - heparin - NSAIDs.
In carrying out conservative measures must be aware of the possibility of progression of thrombosis, despite treatment. Therefore, in the course of therapy should be carried out dynamic control (Clinical and Ultrasonographic) for the course of the disease.
prevention
The basic principle of prevention of thrombosis is a timely and adequate treatment of chronic venous diseases. This includes especially surgery early (uncomplicated) stages varicosity.
If the patient has already suffered a thrombosis, the doctor's task is to prevent its recurrence.
Upon cancellation of the operation or the patient's inability to perform its conducting clinical observation and systematic courses conservative treatment of venous insufficiency.
Patients should always use compression stockings or bandages 2-3 times a year undergoing treatment flebotonikami NSAIDs.
Specific value is the diet: should limit consumption of animal fats, more use in the diet vegetable oils, eat more vegetables and fruits rich in ascorbic acid, rutin.
Of great importance is the right choice of profession, the organization of work and rest. If the work involves prolonged sitting or standing, it is necessary to periodically conduct discharge pause exercises for the legs, the adoption of the lying position with a slightly raised legs. Lifestyle changes should include regular exercise: daily walks, swimming, water aerobics.
sources:
- Russian Association of Phlebology. RUSSIAN clinical guidelines for the diagnosis and treatment of chronic venous diseases. - Phlebology, 2 (7), 2013.
