Deep vein thrombosis
Deep vein thrombosis - a condition in which blood clots form (blood clots).Basically it formed deep vein thrombosis in the lower extremities and much less common with the other sites.Women have greater susceptibility to the disease because of the reception combined oral contraceptives.The cause of death can be a pulmonary embolism, if the treatment is not available.In 20% of the population is found deep vein thrombosis.Postthrombotic syndrome may occur as a late complication.Also the formation of blood clots may in the surface veins, but tend to be quite rare in this case, there are complications.
Deep vein thrombosis causes
If damaged the lining of vein walls due to chemical, allergic, mechanical effects, as well as the presence of an infectious disease, there is the likelihood of deep vein thrombosis.More it can occur during deceleration of blood clotting disorders or current.
Deep vein thrombosis occurs when the legs of stagnation, that is, when the stillness o
primary deep vein thrombosis is phlebothrombosis, characterized in that the fixation of unstable blood clot.The secondary deep vein thrombosis is thrombosis, in which inner sheath becomes inflamed veins.
People most susceptible to the disease:
- in old age;
- the surgical intervention;
- when the presence of tumors of the pancreas, lung and stomach;
- when inactivity;
- during pregnancy, the postpartum period;
- if present antiphospholipid syndrome;
- if overweight;
- when tobacco use;
- if you have lupus;
- when taking hormone preparations;
- in polycythemia vera;
- with a high level of homocysteine and fibrinogen;
- deficiency of protein C, S and antithrombin.
Muscle provides a slight return of blood through the veins.Postoperatively, the patient having a chronic disease that maintains a fixed position for a long time, resulting in formation of clots.
Deep vein thrombosis may occur in the upper extremities in the following cases:
- in the presence of the catheter.The catheter, which has been present for a long time and starts to irritate the vein walls, causing the formation of blood clots;
- in the presence of an implanted pacemaker or kardiofibrilyatora;
- in the presence of malignant tumors;
- Overloading athletes (weightlifters, swimmers, baseball).When compression of the veins in the upper limbs trained muscles of the shoulder girdle, the disease develops.
significant hemodynamic causes deep vein thrombosis leg and for this reason diagnosis more difficult.The patient does not suffer from the general condition and may have asymptomatic.
Deep vein thrombosis symptoms
Deep vein thrombosis is always accompanied by a number of symptoms that indicate a violation of the venous outflow, while maintaining the arterial inflow.The symptoms always depend on the location of the lesion (mesenteric, portal veins of the retina).A visible sign is the swelling and discoloration of the skin at the site of the formation of a blood clot.It may also be redness and a feeling of heaviness and heat in the feet.Pain will accrue daily.There may be severe pain that is accompanied by retrosternal pain, fits of coughing, fever.This facilitates separation and migration of clots in blood vessels of the lungs.Deep vein thrombosis feet can be asymptomatic and lead to complications with fatal consequences.
Deep vein thrombosis can occur shin pain in the muscles (gastrocnemius), which will be amplified in the ankle joint motion.This disease is clinically quite meager.Perhaps the only manifestation of pain on palpation or pain will be local arching.The appearance of the limb remains unchanged, occasionally the temperature may rise due to increased blood flow in the superficial vein associated with hypertension.Basically there in significant swelling of the ankles and in the lower leg or thigh.With electric thermometer can obtain accurate information regarding the healthy limb asymmetry and skin temperature of the patient.
patient will experience an overflow of subcutaneous veins.Stiffness in the movements is not typical for deep vein thrombosis, however, many patients may have signs of aseptic phlebitis and periflebita.Thrombosis of the femoral vein is more pronounced.It depends on the restriction of the vessel lumen and distribution of blood clots.The patient will be increased femur and tibia in the volume.Possibly increase the inguinal lymph nodes, the body temperature will reach 38 ° C.
Depending on the shape and location of thrombosis will manifest corresponding symptoms.The swelling occurs in the region of the eyes.The most commonly affected subcutaneous veins.Appear severe pain at the site of passage of the vein.On palpation Vienna hard and swollen, causing pain.
thrombus localization not only in the damaged vessel wall and in the lumen, can be seen in acute deep vein thrombosis.In this case, the blood flow is blocked.If deep vein thrombosis is often blood flow in saphenous vein is through communicative.The disease is asymptomatic, however, will be visible venous collaterals in the leg, abdomen, on the hips, thighs.
the presence of thrombus in the femoral vein in the patient will manifest more severe symptoms.Pain will be in the inner part of the thigh, the skin will gain pripuhnet and red, while the pain is acute.Superficial veins swell.If the clearance is partially blocked, are not strong pain in the leg, groin, anterior abdominal wall, the gluteal region.Skin acquire a bluish color in the case of complete closure of the lumen.Patient restricts movement, he has a weakness.
acute deep vein thrombosis
This inflammation of venous walls, resulting in formed thrombus, which closes the lumen.Acute DVT is capable of hitting different departments.Women are most prone to this disease.Contribute to the development of allergies, infectious diseases (pneumonia, tonsillitis, osteomyelitis, boils, cellulitis, etc.), Trauma.
Virchow Triad brings together the major pathogenetic factors: slowing of blood flow, the changed structure of the walls of blood vessels, blood coagulation enhanced properties.On the inner shell venous inflammation begins, thereby forming the thrombus.
begins deep vein thrombosis with a slight swelling and severe pain in the saphenous vein.They can spread throughout the lower extremity or localized in the thigh, feet, legs.The body temperature reaches 39 ° C, patients experience weakness.In the inflamed part of the visible red stripes.The skin is shiny and tense, formed by swelling due to which the leg is increased by 2 cm. Also, increased skin temperature.
have an acute onset of acute thrombosis of the lower leg with intense pain.After a few days noticeable expansion of the surface vessels.Collateral circulation begins to develop.Cold extremities.With a high lifting limbs decreases pain and bloating.Enhanced pain in the affected part provokes a deep breath and cough.Restrict the movement of the ankle joint.
To be diagnosed at an early stage reveal symptoms:
- Biskhard.The pain will intensify when pressed with your finger on the area of the inside of the heel and ankle.
- Homans.When dorsiflexion any sharp pains in the muscles (calf).
- Opitz-Raminesa using the device with cuff pressure.Air is blown up to 50 mm pear and inflammation occur in the presence of a sharp pain in the veins, which decreases with a decrease in pressure in the cuff.
- Lovenberg.In the middle third of the lower leg and put the cuff pressure is supplied by 80 mm, which can cause an intense buildup of pain in the calf muscles.
With the defeat of the veins of the pelvis and thigh segments of the trunk and limbs appear swelling, pain radiating to the groin, there is cyanosis.The body temperature can reach 40 ° C and is accompanied by drenching sweat and chills.Expanding the superficial veins of the anterior abdominal wall and thighs, pale skin on the side of the affected limb begins to increase sharply.Edema can go and on the genitals.When movements are observed severe pain in the joints.
ileofemoralny acute deep vein thrombosis include the following clinical forms:
1. Blue flegmaziya, which is accompanied by severe swelling of the limbs and a decrease in the bcc.
2. White flegmaziya, accompanied by the absence of an arterial pulsation, as well as the presence of reflex arterial spasm.
In this case, all the veins of limbs susceptible.The limb is increased by several times, the skin becomes purple.On the accession of infection will testify fetid and filled with a dark liquid petechiae.Skin temperature decreases.The distal extremity arteries in the absence of fluctuations.There is shortness of breath, tachycardia, anemia.Blood pressure is lowered, developing septic condition and hypovolemic shock.It is possible the development of gangrene.
There is always the danger of rupture of a blood clot and its migration in the heart blood vessels, blood vessels of the brain, eyes, lungs.As a rule, they are infected and are a source of the spread of infections, such as cellulitis, abscesses, sepsis.It will also increase respiratory failure.Symptoms will evolve from a few hours to several days.
Deep vein thrombosis diagnosis
main task in the diagnosis of deep vein thrombosis is a blood clot, and localization of the degree of damage.Proper diagnosis enables to achieve maximum effect in the treatment and detection of disease at an early stage.Signs indicating the presence of a blood clot:
- Fever and redness at the site of varicose veins;
- pain on palpation;
- Appears painful cord along the affected areas;
- After seating and long distance, in the legs, pain pulling character;
- The swelling.
the presence of one or more symptoms, an accurate diagnosis can not be determined.Need CBC, research on tumor markers, coagulation, as well as the study of D-dimer, as it confirms the presence of thrombosis.
A blood test can detect the inflammatory response: increased rate ESR, increased C-reactive peptides and fibrinogen, leukocytosis.Coagulation precise shift points to increase blood clotting.With deep venous thrombosis deep vein increased concentration of D-dimer in the first seven days remains high.
Duplex scanning is the most common method of examination.However, if there are thrombi above the groin and in case of doubt when the duplex study uses radiopaque venography.Unlike ultrasound studies, thus obtaining a more accurate information.The patient is administered a contrast agent into the vein, after which they look at X-ray.This allows you to locate blood clots.Perhaps holding a CT or MRI - angiography.
mural on deep vein thrombosis will indicate the presence of the wall and the imposition of the free flow of blood after duplex scanning that does not overlap the venous lumen.In case of suspicion for the development of pulmonary embolism conducted a study using X-rays, including a radioactive marker.In addition assigns echocardiography and ECG.
Doplerografija allows you to obtain reliable information about the femoral vein.However, exploring the deep veins of the lower leg, reliable information will be much less.Also, this method allows to determine the presence of asymptomatic thrombus.This arises in the case of incomplete closure of the lumen.
The presence of deep venous thrombosis will indicate the following features:
- No change in blood movement on the femoral artery during inhalation.This indicates that it exists between the myocardium and the femoral vein.
- After the expulsion of the blood from the veins of the lower leg doctor, blood flow is not strong in the femoral part.This indicates the presence of a blood clot between the femur and tibia.
- In front, popliteal, tibial and femoral vein slow the velocity of the blood.
- The movement of blood differ in different extremities.
phlebography - veins study by introducing them based contrast agent which includes iodine.It is not harmful to health.The presence of deep venous thrombosis will testify:
- sharply narrowing of the vessel;
- obstruction of a contrast agent into a vein;
- the presence of plaques and varicose veins indicate uneven vascular contours;
- mural thrombus rounded shape and dyed substance.
Today, with the help of devices conduct research in several ways.The basis of the study is the X-ray and ultrasonic radiation.They differ in radiation dose, degree of invasiveness, duration and cost of the procedure.The most common:
- Ultrasonic angiography, based on the different abilities of absorption and reflection of ultrasonic waves.During the used color flow mapping.The downside of this method is the large dependence of the results of the technical characteristics of the device, and medical skills.
- direction and speed of blood flow in different areas of vascular Doppler ultrasound to determine.This method is about the anatomy and structure does not provide any data.
- Flebostsintigrafiya.A drug that contains radioactive isotopes decay with minimal period into a vein.The device registers as a contrast agent is spread through the bloodstream.
- To study the veins in the lower extremities using a contrast agent containing iodine, used venography.
most modern methods of diagnosis of deep vein thrombosis is multislice computed tomography and magnetic resonance imaging.These methods doctors use only in the case when you do not get accurate results due to other diagnosis.
In ultrasonography, be aware that the accuracy of the information depends on the sensitivity of color Doppler system.This method allows to reveal deep vein thrombosis, density, fixing a blood clot in the coronary walls, the length, the presence of the floating portion, the degree of obstruction.A study to determine the formation of a blood clot, studying the presence of detours and ehoplotnost.Duplex scanning in the US study reveals damaged venous valves.
In case of suspected deep vein thrombosis legs always diagnosed both limbs.Diagnosis exposed: inferior vena cava, iliac, femoral, tibia veins, perforating veins and superficial.In the case of the lower leg edema, diagnosed two vessels of the limbs.This is due to the fact that the formation of thrombus on one site may trigger the formation of asymptomatic blood clots in other parts of the venous system.
for detecting deep venous thrombosis apply compression technique that is based on the pressing leg portion which is deep Vienna.