phlebothrombosis - is a vascular disease characterized by the formation of thrombotic layers in the lumen of the veins.Has developed a blood clot in a position to fully occlude the vessel lumen or partially obturated vein. phlebothrombosis dangerous because for a long time there are no clear clinical manifestations.Often the disease is complicated by pulmonary embolism, it is not always the clot firmly fixed to the vessel wall.
In any veins may form a clot, but most often occurs phlebothrombosis iliac and femoral veins (ileofemoralny phlebothrombosis) and vessels of the lower extremities.
phlebothrombosis lower extremities
phlebothrombosis veins of the lower extremities is a serious disease in the surgical field, as this pathology is characterized by high mortality rates of patients from complications.The share of thrombosis in the inferior vena cava segment accounts for 95% of all phlebothrombosis.Phlebothrombosis often affects women of reproductive age.
Complications include phlebothrombosis - pulmonary embolism, chronic venous insufficiency and trophic skin changes.
There are several options for the outcome of the disease, which depend on timely diagnosis and adequate treatment of:
- Complete clot lysis;
- Formation of post-thrombotic syndrome as a result of the partial thrombolysis;
- Progression phlebothrombosis;
- Relapse phlebothrombosis;
- Separation of thrombus and its migration in the pulmonary artery.
The main risk factors for phlebothrombosis leg veins include: older age, delivery was by Caesarean section and pregnancy, obesity, sedentary lifestyle, smoking, trauma and surgery, cancer.
phlebothrombosis superficial veins do not have a clear clinical and asymptomatic for a long time.When deep vein thrombosis of the lower limbs develops bright symptoms, and there are common diagnostic symptoms: a symptom of Homans (occurrence of bursting pain in the projection of the calf muscles during flexion of the foot), a symptom of Moses (painful palpation of the lower leg), symptom Payra (irradiation of the pain on the inner surface of the leg and foot).
main etiological factors of clot formation in venous lumen of the vessel are: increase in blood viscosity, pathological changes of vascular endothelium of veins and a significant slowing of blood flow in a limited area of the venous vessel.
impaired blood flow in the vessels of the venous system is observed during prolonged immobilization of patients after injuries of various origin and after surgical interventions.In addition, venous stasis provoke diseases such as insufficiency of venous valves and chronic diseases of the cardiovascular system, accompanied by heart failure.
no less important factor in the development phlebothrombosis is to change the rheological properties of blood in the form of increased rates clotting (thrombophilia).There are two forms of thrombophilia - a congenital (hereditary systemic blood diseases) and acquired (thrombocytosis, erythremia and others).Activation coagulative properties of blood occurs also when taking drugs (hormones and oral contraceptives), and when exposed to the blood cells and bacterial infectious agents.
process of thrombus formation at ileofemoralnom thrombosis and deep vein phlebothrombosis limited and never accompanied by inflammatory changes in the walls of blood vessels, which is a fundamental difference from his vein thrombophlebitis.
damage the walls of the veins is mechanical in nature and is the result of iatrogenic effects - during surgery, intravenous catheter installation or administration of drugs through intravenous infusions.
phlebothrombosis long time, asymptomatic and has no clear clinical picture.This is due to the fact that the blood clot at the onset of the disease is not completely occlusive venous lumen of the vessel and no symptoms of blood circulation in the affected segment.At this stage phlebothrombosis manifested in the form of pulling pain in the affected limb without a clear localization, as well as pain in the projection of the vascular bundle.Pain in extremity amplified dorsiflexion of the foot.
By increasing the size of the thrombus to the forefront of the clinical picture phlebothrombosis symptoms appear circulatory disorders.There have been visible changes of the skin in the form of cyanotic color, clear vascular pattern of superficial veins, as well as an increase in the volume of the soft tissues of the affected limb due to swelling.
palpation of soft tissues of the affected limb is extremely painful, and the superficial veins when phlebothrombosis become denser to the touch.
When ileofemoralnom phlebothrombosis an acute pain not only in the affected limb, but in the lumbar and abdominal region.Skin damaged limbs sharply swollen and has a marble cyanotic color.Often ileofemoralny thrombosis combined with dynamic intestinal obstruction, making it difficult to diagnose early.
nonspecific clinical symptoms that can accompany phlebothrombosis are: general weakness, rise in temperature, and tachycardia.
There are two clinical variants phlebothrombosis deep veins: white and blue flegmaziya.A common symptom for both forms is a sharp pain in the affected segment.The principal difference between white flegmazii is that in the foreground are the symptoms of disorders of blood circulation in the arteries - pale skin, cold extremities, lack of pulsation of blood vessels in the projection.If there is a blue flegmazii abrupt cessation of the blood flow in all venous vessels that triggers the rapid development of gangrene of the limb.
Acute thrombosis develops within two months after the start of thrombus formation and is characterized by sudden and stormy clinical picture.
dangerous is phlebothrombosis deep veins (iliac, femoral, popliteal and tibia), since these areas are often formed floating thrombus, which may at any moment break and cause life-threatening condition - pulmonary embolism.
Localization phlebothrombosis classified into acute peripheral (thrombosis in the femoral-tibial segment) and a center (thrombosis ileokavalnom segment) form.
all symptoms of acute phlebothrombosis due to violation of the outflow of venous blood in the affected segment with the stored blood circulation.
characteristic clinical manifestations of acute phlebothrombosis is a strong swelling and blueness of the skin of the affected limb, and pain Expander nature in the calf muscles, and palpation alone.The local increase in the temperature of the skin indicates accession of inflammatory changes in the blood vessels, that is, thrombophlebitis.
complex diagnostic procedures required for the diagnosis of "phlebothrombosis" presented by such kinds of research:
- ultrasound duplex scanning, in which the localization is determined by a blood clot, his length and mobility.This type of study is informative with regard to the establishment of an acute deep vein phlebothrombosis limbs;
- for the diagnosis of acute ileofemoralnogo phlebothrombosis produced contrast X-ray - retrograde ileokavagrafiya.
- mandatory method of investigation for suspected acute phlebothrombosis a radiation diagnosis of the chest cavity (radiography, computed tomography) to exclude pulmonary embolism.
main directions in the treatment of phlebothrombosis are: the lysis of a blood clot and prevent progression of thrombosis, prevention of complications, prevention of inflammatory changes in the venous vessels and the prevention of recurrence of the disease.
phlebothrombosis treatment of superficial veins is performed on an outpatient basis, while phlebothrombosis acute deep vein is an indication for hospitalization in the surgical department.
all patients with established phlebothrombosis shown to bed, and elastic compression bandaging a limb with an elastic bandage.Bandaging should be made early in the morning in a horizontal position.
phlebothrombosis Treatment should be timely and integrated with various therapies.
Anticoagulant therapy is prescribed to all patients with a confirmed diagnosis and involves a consistent anticoagulation direct and indirect action.
daily dose unfractionated heparin, calculated according to patient body weight - 450 units per 1 kg of body weight, i.e. an average of 35,000 units per day.Heparin produced by intravenous infusion, bolus being used method of administration (intravenous heparin 5000 units and the remainder of the daily dose is administered via infusomats).The average duration of heparin is 10 days and is accompanied by daily monitoring indicators in the blood coagulation (thrombin time and activated partial thromboplastin time).
alternative to unfractionated heparin is low molecular weight heparins (Clexane - 80 mg per day, Fraksiparin - 0.6 mg per day).These drugs are widely used due to ease of use and a short list of side effects.The daily dose is divided into 2 doses and the preferred method of drug administration is subcutaneous injection into the anterior abdominal wall.
On the seventh day the patient receiving heparin added indirect anticoagulants, because the pharmacological activity of these drugs occurs on the third day after the first dose.Warfarin is considered the drug of choice, the daily dose is 6 mg single dose is appropriate.The average duration of use of warfarin is 3-6 months.Indirect anticoagulants are a number of contraindications to be considered in the selection of individual treatment regimens: age over 70 years, pregnancy, viral hepatitis and alcohol abuse.
Thrombolytic therapy is justified only when the existing high-rise phlebothrombosis in the acute period (no more than eight days) with streptokinase in a daily dose of 500,000 IU.Recently surgery widely used method regional thrombolysis in which the drug is administered directly into the thrombus.
antiinflammatory therapy is used to prevent complications such as thrombosis and suppurative is the use of non-steroidal anti-inflammatories (diclofenac by intramuscular injection of 2 ml per day, or in the form of rectal suppository).
now widely used endovascular surgery if there is a floating thrombus that can cause pulmonary embolism.The most effective endovascular operations are - installation cava filter, thrombectomy and implication inferior vena cava.Postoperatively, the patient is prescribed disaggregants (Aspirin 150 mg per day) and spend heparin.
In addition to the medical and surgical treatments phlebothrombosis patient shows a topical treatment with anti-inflammatory ointment on the basis of diclofenac and gels containing heparin.
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