Thrombophlebitis is an inflammatory process in the internal venous wall with the formation of a blood clot. It is characterized by compaction and redness along the course of the dilated vein, sharp soreness, swelling, and an increase in local and general body temperature. With the spread of thrombophlebitis to deep veins, such a formidable complication as PE may occur. To diagnose thrombophlebitis, characteristic clinical symptoms, ultrasound angioscanning, ultrasound of veins, rheovasography help. Conservative treatment of thrombophlebitis is aimed at preventing its spread and resorption of the formed thrombus. Modern surgical treatment allows you to remove the affected vein along with thrombotic masses.
I80 Phlebitis and thrombophlebitis
Thrombophlebitis is characterized by compaction and redness along the course of the dilated vein, sharp soreness, swelling, and an increase in local and general body temperature. In most cases, it requires surgical treatment due to the high probability of developing serious consequences: septic complications, separation of a thrombus leading to deep vein thrombosis or thromboembolism of the branches of the pulmonary artery. Thrombophlebitis can occur acutely or chronically. If the patient did not receive adequate treatment during the manifestation of acute thrombophlebitis, it is likely that the disease will take a chronic relapsing character. Often acute thrombophlebitis turns into chronic even with timely adequate therapy. By the nature of the pathological process, non-purulent thrombophlebitis is isolated.
Under certain conditions, thrombophlebitis can develop in the veins of any localization, however, most often the pathological process occurs in the vessels of the lower extremities. As a rule, thrombophlebitis affects varicose superficial veins. In about 10% of cases, deep veins are involved in the process, along with superficial ones. A number of factors are important in the development of thrombophlebitis of various localization: changes in the composition of blood and an increase in its coagulability, slowing of blood flow, damage to the venous wall of any genesis (injuries, diseases, endocrine and neurotrophic disorders).
There is a risk of developing thrombophlebitis in the following diseases and conditions:
- varicose veins;
- local purulent processes;
- post-thrombophlebitic disease;
- chronic diseases of the cardiovascular system;
- some blood diseases;
- conditions after surgical interventions and medical intakes;
- postpartum period;
- oncological diseases;
- long-term venous catheterization;
- infectious diseases.
Acute thrombophlebitis of superficial veins is most often localized in the varicose veins of the upper third of the shins and the lower third of the thighs. In approximately 95% of cases, the trunk of the great saphenous vein and its tributaries are affected. The patient complains of acute pulling pain along the affected vein, which increases when walking. It is possible to increase the temperature to 37.5-38 ° C. There is hyperemia in the form of stripes. When palpating a thrombosed vein, a local increase in temperature, a compacted painful weight is determined.
Acute thrombophlebitis of superficial veins can develop in two directions. With a favorable course, the phenomena of thrombophlebitis gradually disappear (recovery occurs within 10 days to 3 or more months). In most patients, the lumen of the vein is subsequently restored, in some patients, the outcome is complete obliteration of the damaged vessel.
An unfavorable variant of the development of the disease is possible. In this case, the process captures deep veins or spreads proximally (ascending thrombophlebitis). The risk of deep vein thrombosis increases with varicose veins, accompanied by valvular insufficiency of perforant veins (vessels connecting deep and superficial veins).
When the process spreads to deep veins, deep vein thrombophlebitis (phlebothrombosis) develops, the clinical symptoms of which depend on the localization of the thrombus. In some cases, phlebothrombosis is asymptomatic. It should be borne in mind that deep vein thrombophlebitis is a serious disease that poses a danger to the patient’s life. The most formidable complication of phlebothrombosis is pulmonary embolism. The outcome of the disease may be chronic venous insufficiency.
Acute superficial and deep thrombophlebitis of the lower extremities, as a rule, occurs in patients with varicose veins. Varicose veins usually affect both limbs. With any variant of the development of thrombophlebitis, the formation of blood clots in the deep and superficial veins of the second lower limb is possible. Therefore, when choosing treatment tactics, it is necessary to have complete data on the state of the venous system of both lower extremities. Chronic thrombophlebitis is the outcome of an acute process (the transition from acute to chronic form is noted in 60% of patients), is prone to a prolonged recurrent course.
Clinical manifestations of thrombophlebitis are determined by the localization of the thrombus, the prevalence of the pathological process, the duration of the disease and the severity of inflammation of the surrounding soft tissues. When determining the extent of a blood clot during an external examination, the limit of vein soreness should be taken as its endpoint, and not the end of a dense string along the course of the affected vessel.
Instrumental studies (rheovasography, ultrasound angioscanning, ultrasound of the veins of the lower extremities) are carried out, with the help of which the nature, localization and extent of the thrombus are established, the state of the venous wall and the degree of preservation of the lumen of the thrombosed vein are determined.
Conservative therapy is carried out by a phlebologist when a process occurs in previously healthy veins, with limited damage to the superficial vessels of the foot and lower leg. UHF and bandages with heparin ointment are applied topically. Patients are prescribed anti-inflammatory drugs and drugs that help reduce congestion in the veins (troxerutin, dihydroergocristine, hydroxyethylrutoside). With severe local inflammation, antibiotic therapy is recommended. Elastic bandaging of the affected limb is shown.
Superficial ascending thrombophlebitis affecting the large and small subcutaneous veins is an indication for hospitalization due to the threat of further spread and involvement of deep veins in the process. The patient is transferred to bed rest (4-5 days), the limbs are given an elevated position. In the early stages, fibrinolytic drugs (chymotrypsin, trypsin, urokinase, streptokinase, fibrinolysin) are used to dissolve the thrombus. Anti–inflammatory drugs, anticoagulants, phlebotonics, locally heparin-containing gels and ointments are prescribed.
If there are contraindications to anticoagulants (ulcers, fresh wounds, hemorrhagic diathesis, liver and kidney diseases, open forms of tuberculosis), hirudotherapy (treatment with leeches) is recommended. Novocaine lumbar blockade according to Vishnevsky is used to improve collateral circulation and reduce pain. Severe hyperthermia and suspicion of purulent thrombophlebitis are indications for antibiotic therapy.
Contrary to popular belief, patients with superficial vein thrombophlebitis should not stay in bed for a long time. Muscle contractions contribute to increased blood flow in deep veins, thereby reducing the likelihood of blood clots. During motor activity, the patient is recommended to use an elastic bandage to fix a blood clot in the superficial vein.
Modern phlebology successfully applies new low-traumatic surgical treatment techniques. Due to this, most clinicians have recently preferred surgical methods for the treatment of acute superficial thrombophlebitis of the thigh and lower leg. Early surgical intervention eliminates the further spread of the process through the communicating veins to the deep vein system, reduces the duration of treatment and prevents the transition of the disease into a chronic form.
Emergency surgical treatment is indicated for acute ascending thrombophlebitis of the lower leg veins and for primary localization of the thrombus in the area of the superficial veins of the thigh, since in these cases the risk of developing deep vein thrombophlebitis increases. In septic thrombophlebitis, a Troyanov-Trendelenburg operation is performed.
In the long-term period, patients who have suffered acute thrombophlebitis are recommended spa treatment with the use of hydrogen sulfide and radon baths. Treatment of exacerbation of chronic superficial thrombophlebitis is carried out similarly to therapy of the acute process. Patients with chronic thrombophlebitis should be referred to sanatorium treatment only in the absence of trophic disorders and signs of exacerbation.
It is necessary to treat chronic venous diseases in a timely manner. Patients who have suffered thrombophlebitis in the past should constantly use means of elastic compression, limit the amount of animal fats in the diet, eat foods with a high content of rutin and ascorbic acid (berries, fruits, vegetables). To prevent relapses, a course of treatment is prescribed 2-3 times a year, including phleboprotectors and physiotherapy procedures (treatment with currents and alternating magnetic fields).