Deep vein thrombosis is a condition in which blood clots (blood clots) form in the veins, preventing normal blood flow. The clinical symptoms of deep vein thrombosis include bursting pains, swelling, cyanosis of the skin, superficial hyperthermia, soreness during palpation of the affected vein, swelling of the superficial veins. The final diagnosis is established according to the ultrasound of the veins of the lower extremities and duplex scanning; rheovasography is performed to assess microcirculation. Disease is treated with heparin under the control of a coagulogram; if necessary, surgical removal of the formed thrombus is carried out.
I80.2 Phlebitis and thrombophlebitis of other deep vessels of the lower extremities
Deep vein thrombosis is a pathology based on a violation of venous circulation due to blockage of a vessel by a blood clot. In clinical phlebology, deep vein thrombosis of the lower extremities is more common than venous thrombosis of other localizations. Blood clots can form not only in deep, but also in superficial veins, however, superficial vein thrombosis (superficial thrombophlebitis) rarely becomes a source of serious problems. Unlike thrombophlebitis, deep vein thrombosis requires urgent medical care due to the risk of developing life-threatening complications for the patient.
For the development of the disease, a combination of several factors is necessary:
- damage to the inner lining of the venous wall as a result of exposure to a mechanical, chemical, allergic or infectious agent;
- violation of the blood clotting system;
- slowing down the blood flow.
Under some circumstances, the viscosity of the blood increases. If there are obstacles to normal blood flow on the walls of the vein, the risk of blood clots increases. A small blood clot formed on the venous wall causes inflammation and further damage to the vein wall, which causes the formation of other blood clots.
The occurrence of pathology is facilitated by congestion in the veins of the lower extremities. The reason for stagnation is the immobility or inactivity of a person for a long time. Triggering factors in deep vein thrombosis:
- injury, surgery, excessive physical exertion;
- infectious disease;
- prolonged immobility in conditions after surgery, neurological and therapeutic diseases;
- postpartum period;
- taking oral hormonal contraceptives;
- malignant tumors (especially cancer of the stomach, lungs and pancreas);
- DIC syndrome.
The risk of developing the disease increases with prolonged immobility with legs down. So, in the West there are the terms “economic class syndrome” and “TV thrombophlebitis”. In the first case, we are talking about people who have deep vein thrombosis developed after a long flight. The second one is about elderly patients who have the disease after sitting in front of the TV for a long time. In both cases, the trigger factor was a prolonged stay in a sitting position with bent legs, which creates obstacles to normal venous outflow.
The return of blood through the veins is largely ensured by muscle contraction. After operations and with some chronic diseases, the patient remains practically motionless for a long time. As a result, congestion develops in the lower extremities, leading to deep vein thrombosis.
When taking oral contraceptives, blood diseases, malignant tumors, thrombosis is largely due to hypercoagulation (increased blood clotting). In some cases, a violation of blood flow in deep veins may indicate Burger’s disease (obliterating thrombangiitis of allergic genesis).
As a rule, deep vein thrombosis develops in the lower extremities. However, sometimes there are deep vein thrombosis in the hands, which occur when exposed to the following triggering factors:
- catheterization of the veins of the upper extremities. A catheter located in a vein for a long time causes irritation of the venous wall and leads to the formation of a blood clot;
- implanted cardiofibrillator or pacemaker;
- malignant neoplasm in the vein area;
- excessive load on the upper limbs of athletes (baseball players, swimmers, weightlifters). The disease develops due to compression of the deep veins of the upper extremities by the trained muscles of the shoulder girdle.
Deep vein thrombosis symptoms
Symptoms depend on the location of the blood clot. In about half of the cases, blood flows through the system of communicating veins into the subcutaneous veins, blood flow is partially restored, and deep vein thrombosis is asymptomatic. The remaining patients have one or more of the following symptoms in various combinations:
- bursting pains in the affected limb;
- pain during palpation, increasing along the vein in which a blood clot has formed;
- local hyperthermia;
- cyanosis of the skin of the affected limb;
- swollen superficial veins.
Developed venous collaterals in the lower abdomen, in the hip joints, hips and lower legs may indicate a transferred thrombosis.
The outcome of deep vein thrombosis may be chronic venous insufficiency, as a result of which edema of the lower extremities and trophic disorders (lipodermatosclerosis, eczema, trophic ulcers) develop.
The most dangerous complication of deep vein thrombosis is pulmonary embolism. The detached pieces of blood clots together with the blood flow move into the lungs, enter the pulmonary artery and cause its embolism (blockage). Violation of blood flow in the pulmonary artery leads to the development of acute respiratory and heart failure and can cause the death of the patient. In the case when a small branch of the pulmonary artery is clogged with a piece of a blood clot, a lung infarction develops.
Modern phlebology has a good technical base for assessing venous blood flow and diagnosing deep vein thrombosis. As a rule, the diagnosis is made by a phlebologist. He conducts tourniquet tests (elastic bandaging of the legs according to a special technique), including a marching test, in which an elastic bandage is applied to the patient’s leg from the toes to the groin. Then the patient walks for a while. Bursting pains and subcutaneous veins that did not sleep after the test indicate thrombosis.
Phlebography, duplex scanning and ultrasound of the veins of the lower extremities and radionuclide scanning are used to assess blood flow in deep veins. The assessment of the microcirculation state is carried out according to the rheovasography of the lower extremities.
Deep vein thrombosis treatment
Due to the risk of developing dangerous complications, patients with deep vein thrombosis are necessarily hospitalized. Strict bed rest is prescribed. The affected limb is given an elevated position. To prevent the formation of new blood clots, the patient is prescribed heparin (usually within a week). Then the patient is transferred to “soft” anticoagulants (warfarin). The course of treatment with warfarin lasts 6 months. To monitor the condition of the blood coagulation system, the patient is periodically given a coagulogram.
Thrombolytic drugs are effective only in the early stages of thrombus formation. In the late stages, thrombolytic therapy is dangerous because of the possible fragmentation of the thrombus and the development of pulmonary embolism. With severe circulatory disorders in the limb, thrombectomy is indicated.
Measures aimed at preventing deep vein thrombosis consist in the exclusion of risk factors, the use of elastic stockings, early motor activity of patients in the postoperative period. In some cases, after surgery, small doses of acetylsalicylic acid and heparin are prescribed, which reduce blood clotting.
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