deep vein thrombosis - a secondary form phlebothrombosis that strikes deep-seated veins.Deep thrombophlebitis is a rare phenomenon and mainly occurs as a result of sepsis, which is located near the affected veins. With deep thrombophlebitis clot is fixed to the vessel wall is firmly and thereby reduces or nearly eliminates the possibility of pulmonary embolism (pulmonary embolism).
When using instrumental methods of examination as a result of an active search for a deep thrombophlebitis manage to find almost 10% of patients with a diagnosis of thrombophlebitis.Deep thrombophlebitis may develop independently, and can be a complication of thrombophlebitis, which affects the veins, which are located on the surface.This applies mainly to the lower leg deep veins and vein localized under the fold of the knee and hip area.
deep thrombophlebitis of the lower limbs
Most often the disease develops in people at an advanced age who suffer from SSS diseases, diabetes, obesity a
reason for the development of deep thrombophlebitis of the lower limbs is modified vascular endothelium of the affected limb.This injury promotes the release interletskinov that activate the coagulation cascade and platelets.As a result, the endothelium is characterized by increased thrombogenic and adhesive that causes blood clots.
The formation of a blood clot affects thromboplastin, located in the tissues, which in large quantities enters the blood stream from a variety of tissue damage.Almost 89% of the blood clot forms in the veins suralnyh sinuses, which ends blindly in the cavities of the calf muscles, and then open into the deep-seated veins in the leg.In a relaxed state of the muscles in these sinuses blood flows passively, and during contraction they are emptied.Thus, when the patient is motionless and gastrocnemius muscles are pressed to the table at the time of surgery, or just as he lies in bed, the suralnyh sinus congestion processes occurring blood contribute to the formation of blood clots.
In addition, changes in the properties of the blood as a result of injury during surgery and damaged venous wall, only to favor this process.Therefore, an acute form of deep thrombophlebitis of the lower leg in patients who have undergone surgery, usually begins to develop more on the operating table.
For six months, 70% of patients restored patency of venous trunks, but in 44% of damaged blood vessels that nourish the venous wall.As a result of the deep veins are thin and unable to prevent the process of reverse flow, which leads to the development of CVI.
cancer patients present hypercoagulation, which significantly increases the risk of blood clots.When malignant tumors of the kidneys pathological tissue spreads renal vein in the lower part of the vena cava, and can completely block the lumen.Such a clot can grow to PP heart.
Symptoms deep thrombophlebitis of the lower extremities for two days did not have a clear picture.The general condition of the patient is satisfactory with a slight pain in the muscles of the lower leg, that increases with movement, appears small swelling on the lower third of the leg.A characteristic feature of the disease is pain in the calf muscles during flexion of the foot from the rear side (a symptom Homans).
Symptomatic picture becomes pronounced when thrombosis of the three pairs of deep-seated veins of the lower leg.It is characterized by the appearance of a sharp pain, bursting with feeling, stress, puffiness shin, which is combined with cyanosis of the skin and the rise in temperature.
When distributing vein thrombosis in the thigh, formed his edema, which is almost always negligible in the case of blocking the mouth of the deep femoral vein, which has numerous anastomoses with branches of the veins.On palpation stunned by Vienna painful.And with deep vein thrombophlebitis in the thigh and behind the knee develops swelling, pain and limitation of motion in the knee.
thrombosis ileofemoralnogo character of patients complain of pain in the front of the thigh and the inside, in the muscles of the leg and groin.This limb becomes voluminous, it swells itself from the foot to the groin, and sometimes swelling extends to the buttocks.The color may be pale limbs, and can go into cyanotic.
deep thrombophlebitis sometimes begins quite suddenly with the appearance of pain in the legs acute pulsating character.This certainly can be cold and numb, and then there is a rapidly growing swelling, it is difficult to move the fingers, reduced temperature sensitivity and virtually no palpable pulse in the foot.With widespread disease has been a sharp increase in the limbs, it looks edematous and quite dense.The skin is purple and sometimes black bubbles with hemorrhagic or serous fluid.Moreover, there is a very strong pain and vomiting character with the absence of pulsations in the periphery.For heavy flow of deep thrombophlebitis of the lower extremities characterized by the development of shock and venous limb gangrene.
To diagnose this disease used such methods of examination as venography, Doppler, manometry, rheography.
acute deep vein thrombosis
This pathological process is characterized by inflammation of the venous wall and thrombosis in its lumen.In acute deep vein thrombosis a blood clot formed, tightly fixed to the wall of the inflamed vein.In addition, it can spread to perivazalnuyu paravasal and fiber.
Predisposing factors of acute deep thrombophlebitis include: decreased blood fibrinolytic activity of nature;the affected vascular wall;hypercoagulation;Slow down and modified the bloodstream;impaired blood rheology;allergies;advanced age;cancer pathology;pregnancy;obesity and varicose veins available.Quite dangerous characterized phlebothrombosis formed in the postoperative period, which contribute to the emergence of many contributing factors.
acute deep vein thrombosis often develops in the lower limbs, due to the characteristic morphological and functional features of the veins located in the lower leg - suralnyh veins.
This disease is characterized by the sudden appearance of a Expander feelings back side of the lower leg, and then marked swelling of the back of the foot and ankle.In the future, there is a pain in the heel of the spontaneous nature.Skin virtually unchanged with little or cyanosis in the leg and foot.Palpable edematous area painless and significant pain occurs only in the area of the affected vein.Movement of the ankle joint is also limited due to pain and symptom Homans observed.
Common symptoms of acute deep thrombophlebitis develops a sense of malaise of the patient, rise of temperature, loss of appetite and a broken state.
main method of treatment of acute deep thrombophlebitis is carrying out correction of hemostasis, which can stop the progressing process of thrombus formation.To do this, appointed under strict bed rest for two weeks;It eliminates the pain;reflex spasm of vessels removed;appointed by the direct and indirect anticoagulants;fibrinolytic therapy is performed, antibiotics and fibrinolizina;appoint Aktovegin, Trental, dextran, Eufillin that improve blood composition.
deep thrombophlebitis causes
This pathological process is a serious threat to the life of the patient.Therefore, for the treatment of the disease it is fundamental to timely expert advice, the definition of the causes contributing to the formation of the pathology and the appointment of an appropriate combination therapy.
deep thrombophlebitis diagnosed in both sexes, with the advantage of women.In addition, this pathology today occupies a leading position among the youth, which is associated with a feature of modern life rhythm.
Many people as a result of their professional activities for a long time have to be on my feet.For most women, provoking factors of deep thrombophlebitis is a preference for standing wearing high-heeled shoes and pregnancy.
In addition, the weak walls of the veins as a result of a certain type of collagen;reduced blood flow, which promotes the formation of blood stagnation in the veins (cardiac pathology, obesity);increased blood clotting as a result of hereditary factors in conjunction with hypercoagulability, dehydration, infections of all this relates to the factors contributing to the development of deep thrombophlebitis.
also pathological process of thrombosis may occur as a result of prolonged immobilization, which provokes stagnation.But a variety of tumors, some groups of preparations of hormonal nature and allergic conditions may cause increased blood clotting.
The development of the inflammatory process veins impact trauma, surgery, wound, intravenous medications, micro-organisms from the environment.
deep thrombophlebitis treatment
For the treatment of this disease apply treatments such as conservative and much less rapid.When defective treatment of deep thrombophlebitis held almost 50% of patients may develop pulmonary embolism within three months.Adequate methods for therapeutic treatment of diseases ostroprotekayuschih anticoagulants reduce the possibility of spread of the thrombus embolism, and up to five percent.
Most patients treated with deep thrombophlebitis begin bolus intravenous administration of heparin to further his intravenous drip.As a rule, an adequate method of heparin used 30000-40000 ED drug a day for seven or ten days.And in the last four days in addition prescribe anticoagulants indirect action for three months.In addition, in this scheme the therapeutic treatment of normal heparin can be replaced by a low molecular weight, which is administered subcutaneously.
Conservative measures include bed rest, appointed fibrinolytic drugs (Fibrinolizin, celiase, Streptodekaza, streptokinase), anticoagulants indirect action (pelentan, bishydroxycoumarin, Fenilin) disaggregants and preparations rheological action (Reoglyuman, Reopoliglyukin, Trental, Polifer), diuretics (Furosemide, Lasix), antibiotics and antiseptics.
Conservative treatment of deep thrombosis in the complex is carried out with methods of early activation of patients.At the same time lift the foot of the bed at an angle of 20 degrees, and bed rest is recommended only in the beginning of the pathological process in the existing swelling and pain.Between the disappearance of pain and reduce swelling prescribe gymnastic exercises, which improve venous outflow.All classes are conducted under strict monitoring Methodist LF.
Operative treatment of deep thrombophlebitis preferably carried out in the early stages of the pathological process in the presence of flegmazii, ileofemoralnogo thrombosis or suppurative thrombophlebitis.In the first two cases performed thrombectomy, and the last - opened an abscess.As a result of the frequent development of venous retrombosis preference is given to the method of fibrinolytic therapy.
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