Acute thrombophlebitis of the veins of lower extremities

Thrombophlebitis is characterized by the presence of inflammatory changes in the walls of the vein. In the end result, a thrombus is formed on the damaged surface. This process is subject to the vessels of any localization. Most often, the defeat covers the lower limbs. So the acute thrombophlebitis of the veins of the lower extremities is a serious inflammatory process. Sometimes the formed thrombus leads to blood flow disturbance. In some cases, it migrates along the vascular bed.

ICD-10 code

According to the international classification of diseases, thrombophlebitis is marked with the code I80. Phlebitis and thrombophlebitis (I80). In this category fall: endoflebit venous inflammation periflebit purulent phlebitis. Phlebitis and thrombophlebitis of the complicating course, abortion, ectopic or molar pregnancy are completely excluded (O00-O07, O08.7). Pregnancy, childbirth and the puerperium have their own code for mb 10 (O22, O87). Intracranial and cerebrospinal septic or OBD (G08). Intracranial non-pyogenic (I67.6), spinal neopyogenic (G95.1), portal vein (K75.1) postphlebitic syndrome (I87.0) migrating thrombophlebitis (I82.1). In order to identify the drug, the use of which led to such consequences, use an additional encoding (class XX).

I80.0 Phlebitis and thrombophlebitis of superficial vessels of lower extremities. I80.1 Phlebitis and thrombophlebitis of the femoral vein. I80.2 Phlebitis and thrombophlebitis of other deep vessels of the lower extremities. These include: deep venous thrombosis of the BDU. I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified. Included: embolism or thrombosis of the lower extremities of the BDU. I80.8 Phlebitis and thrombophlebitis of other sites. I80.9 Phlebitis and thrombophlebitis of unspecified site.

Causes of acute thrombophlebitis of the veins of lower extremities

For the formation of thrombus, three specific factors are sufficient. The main cause of thrombophlebitis of the veins of the lower limbs is damage to the venous wall. Surface veins, due to their location, are often amenable to mechanical action. Sometimes damage can be caused during surgical operations, as well as during the administration of concentrated solutions.

The second reason is slow motion of blood. To implement this risk factor, it is sufficient to maintain a long bed rest. The person does not move, resulting in compression of the veins and their traumatization. A similar condition is typical for people with heart failure. When observing the bed rest, stagnant phenomena begin to form. Eventually, the blood flow velocity decreases significantly.

The next reason is increased blood clotting. This condition can appear from birth, or arise due to certain factors. Some people from birth have a defect in the normal functionality of the blood system. As for the acquired condition, it is associated with the transmitted infectious diseases, as well as hormonal imbalance.

The inflammatory process in the vein is aseptic, it develops against the background of damage to the wall or the formation of the thrombus itself. If there are microbes in the bloodstream, the process becomes purulent. When all of the above factors are present, thrombophlebitis develops. In the process of treatment or just simply spontaneously, the thrombus stops growing and the inflammation gradually subsides. The danger of separation in this case becomes minimal.

[1], [2]

Pathogenesis

The main pathogenetic factors in the formation of the disease are: a slowdown in the total blood flow, the presence of changes in the structure of the vascular wall, and an increase in the coagulation properties of the blood. All this is united in the triad of Virchow. These factors are the main pathogenesis of the disease.

The inflammatory process originates in the vein from its internal membrane. Thus, endophlebitis manifests itself. Then begins the formation of a thrombus, the process can be observed from the outer shell, this is the so-called pereflebit.

Thrombophlebitis is both simple and purulent. Purulent process develops against the background of penetration into the body of microbes. By the location of veins, the disease is superficial and deep. Naturally, with the flow it also differs. There are 3 types of thrombophlebitis: acute, subacute and chronic. All inflammatory processes start alike, but differ in the severity of the symptoms manifested.

Symptoms of acute thrombophlebitis of the veins of lower extremities

Depending on the nature of the process itself, there are two main types: acute and chronic thrombophlebitis. So, the symptoms of acute thrombophlebitis, originating from the veins of the lower extremities are characterized by a sudden onset. And there are no visible reasons for this state. Sometimes this is preceded by the presence of trauma to the lower extremities. Often the patient suffers from an inflammatory infection, takes oral contraceptives. All this can lead to a disruption of the function of blood coagulability. Most often the disease develops due to the complication of varicose veins.

Local manifestations are able to prevail. At the same time, the person's condition is normal, nothing disturbs him at all. During walking, minor pain may appear, and limb movements may develop over time. The lesion area turns red, the disease progresses gradually, and the symptomatology becomes more acute. There may be an increase in body temperature, as well as minor redness. In the affected area, a painful and dense disease is revealed. If the enlarged veins are involved in the general process, then the soreness of the varicose nodules is observed, as well as the change in their size. Often marked edema of the lower extremities. The main manifestation of the disease is an increase in body temperature. A person suffers from general malaise and chills.

First signs

First, minor swelling of the legs begins to manifest. Over time, everything is supplemented by painful sensations in the calves, it is not excluded the feeling of burning and heaviness in the legs. These are the first signs of thrombophlebitis, it is highly undesirable to ignore them. In the lesion site, reddening of the skin can be observed.

In most cases, patients do not focus on such symptoms. For help to the doctor, they go during the progression of the disease, when the symptoms are obvious. In this case, the legs begin to swell strongly. In the place where the thrombus was formed, the skin can take a bluish shade. If the condition is extremely severe, then the limb can blacken. The main localization of the thrombus is the thigh, shin or ankle.

Ignore the manifestation of the disease is not worth it, it can lead to really deplorable complications. Timely detection of thrombophlebitis and its qualitative treatment will return a person to their former life.

[3], [4], [5], [6]

Acute thrombophlebitis of superficial veins

The most common form of the disease is the varicose type. It is characterized by intense pain, as well as redness at the site of inflammation. For acute thrombophlebitis of superficial veins, the presence of pronounced edema is characteristic, while the vein itself becomes strained. As the thrombus begins to develop, the swelling gradually moves to deeper veins. Such a symptom carries a heightened danger. Soreness accompanied by increased body temperature, as well as weakness.

Varicosity and thrombophlebitis have always been considered interrelated diseases. Often, varicose itself is a provocateur of thrombus development. After all, this condition is characterized by a slow flow of blood. As for thrombophlebitis, it is simply a serious complication of this process.

It is important to notice the localization of inflammation in time and begin treatment. For this, anti-inflammatory therapy is widely used, which not only helps to cope with pain, but also significantly reduces edema.

[7], [8]

Acute thrombophlebitis of deep veins

This condition is characterized by a sudden onset. It is characterized by severe pain in the affected limbs, as well as a fever. If you begin to feel the vein, there is excessive soreness. By the end of the first day the limb can begin to swell, while the skin pale and becomes elastic. The pulse weakens, the affected area is colder and glossy. With acute deep vein thrombophlebitis, the lymph nodes in the inguinal region become enlarged and painful. Edema of the limb is maintained for 3 months. When the acute symptomatology subsides, the so-called post-phlebitic syndrome develops.

It is important not to let the condition worsen. If the first symptomatology is present, immediate treatment should be started. After all, such "attacks" can be repeated all the time. There is nothing good in this, because thrombophlebitis can lead to serious complications.

[9], [10], [11]

Acute ascending thrombophlebitis of the subcutaneous veins

Ascending thrombophlebitis is an inflammatory process that originates at the walls of the veins. This disease has a varicose nature, as a result of which a thrombus can form. Most often, acute ascending thrombophlebitis is a complication after varicose veins. A similar condition occurs in the transition of the inflammatory process from low-lying veins to the inguinal region. If thrombophlebitis has passed from the superficial vein to the deep vein, the risk of separation and migration of the thrombus increases. This can cause pulmonary embolism.

The ascending thrombophlebitis manifests itself in the form of soreness in the lower extremities, the feeling of the lower leg, as well as the reddening of the skin along the varicose veins. Over time, there is swelling of the legs, the body temperature increases significantly, a person feels a general malaise. Often there are: hyperemia, lymphadenitis and lymphangitis. The presence of such a disease carries a special danger to life. If you do not start treatment in time, a fatal outcome is possible.

[12], [13],

Effects

Serious complications after superficial thrombophlebitis are not found. The only serious consequence is the risk of tearing the clot with a further change in its location. The thrombosis is characterized by the presence of a serious inflammatory process, as a result of which the thrombus adheres to the wall of the vessel. The likelihood of its detachment and entry into the bloodstream is negligible, but everything is there.

Surface veins are not surrounded by muscles, so the probability of contraction and movement of the thrombus is simply impossible. But if a person has deep vein thrombophlebitis, then the probability of this process is not excluded. In this case, there is a risk to life. Especially dangerous is an ascending thrombophlebitis, it can lead to death.

Any changes in the skin can indicate the presence of a serious inflammatory process. Ignore it is not worth it, because it can develop serious consequences.

[14], [15], [16], [17]

Complications

Deep vein thrombophlebitis in most cases is asymptomatic. It can only be suspected of the development of complications. This is typical for cases when the thrombus has already attached to the wall of the vein with its head, and its tail part can freely mix under the action of blood flow. The most serious complication may be the development of thromboembolism of the pulmonary artery. This condition is characterized by the presence of shortness of breath, lack of air, as well as the development of cyanosis of the face and limbs. In this case, thrombus must be surgically removed or dissolved with the help of special preparations. If you do not resort to this measure, you may develop pneumonia.

Another serious complication is blue phlegmase. This condition is characterized by a thrombosis of all veins on the limbs. Therefore, the symptomatology is more pronounced. The person is being tormented by intense pain, the swelling begins to gradually increase. Limbs can increase in volume several times. Vessels are dilated, the skin can become purple. Very quickly, the infection joins this state. If this complication is not started, there may be a development of gangrene, which entails amputation of the limb.

[18], [19]

Diagnosis of acute thrombophlebitis of the veins of the lower extremities

The first step is to collect the history data. For acute thrombophlebitis of the veins of the lower extremities, a rapid and sudden onset is characteristic, which greatly facilitates the diagnosis. You can diagnose with modern methods of examination. Inflammation of the subcutaneous veins in some cases may be accompanied by the development of lymphadenitis. The point is that the lymph nodes pass near the veins. Therefore, the inflammatory process most often captures them. Determine the presence of the disease can be by external signs. So, the lymph nodes become painful.

If the inflammation is erysipelous, then on the skin are visible formations of red color. An inflamed place has clear boundaries. With phlegmon, the condition of the victim is severe. He suffers from chills, fever, there is swelling of the affected area, swelling and a significant increase in lymph nodes.

As additional studies resort to ultrasonic dopplerography and computed tomography. In addition, an overall blood test is performed to determine the level of leukocytes.

[20], [21], [22], [23]

Analyzes

Before you make a diagnosis, a person needs to undergo all the necessary diagnostic measures. The first step is to take tests. Laboratory research allows one to study human blood and to identify changes in certain parameters in it. An increase in the number of leukocytes most often indicates the presence of an inflammatory process in the body. That is why, based on a general blood test, you can do a preliminary analysis.

In addition, blood coagulability is analyzed. If there is an increased coagulation activity, it is also a symptom of the presence of an inflammatory process in the body. There are no additional laboratory tests. It is impossible to diagnose by analysis alone, this requires information on other studies, in particular differential diagnosis. All received data are combined, and on their basis a preliminary diagnosis is confirmed.

[24], [25]

Instrumental diagnostics

In addition to meeting anamnesis and taking tests, you need to resort to additional methods of research. So, for obtaining certain information it is necessary to perform instrumental diagnostics. Among its methods include: ultrasound dopplerography and computed tomography - angiography.

Ultrasonic dopplerography of vessels of the lower extremities. This procedure allows you to assess the blood flow and permeability of veins. In addition, the degree of flotation of thrombus and the level of its damage are determined. This allows you to get a real assessment of what is happening.

Computed tomography - angiography. This technique is carried out using contrast medium. Thanks to him it is possible to get a clear picture. After all, the contrast medium obscures the affected areas and thereby facilitates the diagnosis process. This technique allows you to assess the state of the vessels. These procedures are carried out either individually or together.

Differential diagnostics

The main symptoms of thrombophlebitis manifest themselves visually. So, the skin becomes rough and inflamed. It starts to form a red spot, which has clear boundaries. Over time, it can increase in size and in different directions. The diagnosis can be made on the basis of differential diagnosis and examination. In some cases, the skin has a purulent inflammation. This process is accompanied by an increase in lymph nodes and a sudden rise in temperature. This state is characterized by an extremely difficult situation.

It is impossible to make a diagnosis against the background of an anamnesis. Should resort to additional research. A person needs to take a blood test. This will reveal the level of leukocytes and check the coagulated activity. If these indicators are increased, it means that the body has an inflammatory process. The obtained data are compared with the results of instrumental diagnostics, and on their basis the diagnosis is made.

[26], [27], [28], [29]

Treatment of acute thrombophlebitis of the veins of lower extremities

Treatment consists in preventing the spread of the process to deep veins, reducing the inflammatory process and relapse of the disease. To this end, a whole range of effective measures has been developed. So, the treatment of acute thrombophlebitis of the veins of the lower limbs can be done at home, but it is better to go to the hospital. This will avoid the development of possible complications. Regardless of the treatment regimen, it is necessary to resort to the medicinal method, local treatment and elastic compression.

The medicinal method involves the use of specific drugs. So, to strengthen the walls of the vessels resorted to the help of Troxevasin, Detralex and Ginkor Fort. Use of funds to prevent the formation of blood clots, such as Aspirin. Ketoprofen and Diclofenac are used as anti-inflammatory drugs. Place the ointments that lead to the dissolution of the thrombus, it can be Lyoton-gel and Heparin ointment.

They resort to the help of hirudinotherapy, in other words, the use of leeches. Apply them only in the acute course of the disease. This is possible if the patient can not use anticoagulants. Hirudin, produced from the glands of leeches, penetrates into the blood. He can reduce its viscosity and coagulability. Together with this, the risk of developing arterial spasm is significantly reduced. Leeches can be "applied" to the site of damage, in an amount of 10 pieces. The procedure should be carried out for 6 days. If the effect of conservative treatment is absent, the affected vein is removed surgically.

Particular preference is given to physiotherapy methods. Among them are infrared rays, ultraviolet irradiation and solux. Apply them in chronic course of the disease, during the period of thrombus formation. It is important to undergo treatment at the resorts. People suffering from venous diseases will benefit from Pyatigorsk and Sochi.

Medications

To treat thrombophlebitis, medications are used. They allow not only to remove puffiness, but also to dissolve the formed thrombus. Many of them prevent the development of a new thrombus. As frequently used drugs, preference is given to: Troxevasin, Detralex and Ginkor Fort. In the future, use Aspirin and anti-inflammatory drugs Ketoprofen and Diclofenac. Locally used ointments, such as Lyoton-gel and Heparin ointment.

• Troxevasin. The agent is applied to the affected area with a thin layer. The gel is not greasy, so it leaves no residue on the clothes. In severe cases, the gel is combined with the capsules of the drug. Dosage is prescribed by a doctor. Use the product is not possible with hypersensitivity, as well as severe lesions of the skin. Perhaps the development of local allergic reactions.
• Detralex. The drug is used during eating food 2 tablets 2 times a day. The dose can be adjusted by the attending physician. Duration of admission does not exceed one week. Use the drug is not possible with hypersensitivity. May lead to the development of nausea, vomiting, diarrhea and skin rash.
• Ginkor fort. The drug is applied on a single capsule 2 times a day. Duration of treatment is 2 weeks. The drug is not used for hyperthyroidism. There were no side effects.
• Aspirin. The drug is used 2-3 times a day for one capsule. Dosage is prescribed by a doctor, depending on the severity of the pain syndrome. Use the drug is not possible with hypersensitivity, as well as impaired functionality of the liver and kidneys. Can lead to nausea, vomiting and allergic reactions.
• Ketoprofen. Dosage is prescribed individually, depending on the severity of the course of the disease. On average, the daily dose is 300 mg. Use the product is not possible with impaired functionality of the liver and kidneys, during pregnancy. Local use prohibits this action if there are open wounds. May lead to the development of allergic reactions and disorders of the gastrointestinal tract.
• Diclofenac. The agent is used in the form of tablets. In a day is enough to use one piece, 2-3 times a day. Dosage depends on the severity of a person's condition. Do not use the drug for people with increased sensitivity to diclofenac. A special risk group is people with impaired functionality of the liver and kidneys. The drug can lead to the development of gastrointestinal disorders.
• Lyton-gel. The gel should be applied to the affected area 2-3 times a day, with a thin layer. If necessary, the number of applications increases, such a decision can only be made by a doctor, based on the state of a person. Use the remedy is not possible with severe skin lesions, with open wounds. The gel may cause local allergic reactions.
• Heparin ointment. Ointment is applied several times a day, depending on the site of the lesion and the necessary therapeutic effect. Use it is not possible on open wounds and with the sensitivity of the skin. May cause allergic reactions.

Alternative treatment

Alternative methods have in their arsenal many effective ways to eliminate thrombophlebitis. But before you use them, it is worth consulting with your doctor. So, alternative treatment is not always appropriate. Elimination of the problem, thus, can lead to an aggravation of the situation.

• Honey compress. To make it, you need to take honey and smear it on linen cloth and attach it to the affected area. For the first time three days the compress is left for 2-4 hours. Then it can be imposed for the whole night. In this case, the affected leg needs to be wrapped around something, over the honey cloth.
• Cabbage Compress. This remedy is most effective in thrombosis. It is necessary to take a cabbage leaf slightly to discourage it and knead it with a sharp knife. Then, on the one hand, it is smeared with honey or vegetable oil. This remedy is applied to the affected area and fixed in a natural cloth. Keep such a compress should be as long as possible, up to a day. Even if the main symptomatology has disappeared, it is still used for a whole month.

Herbal Treatment

Against thrombophlebitis effectively apply many medicinal herbs. Positive properties are bitter and silver wormwood, fern grass, Kalanchoe and rhizome of ayr. For the treatment of these herbs should consult with a doctor, so that there is no risk of complications.

• Recipe number 1. It is necessary to take a tablespoon of herb verbena medicinal and pour it with a glass of boiling water. The facility needs time to stand. The resulting infusion should be consumed within a day.
• Recipe number 2. At night you can put a lilac leaf on the affected area. This will remove swelling and inflammation. It is advisable to use a fresh sheet.
• Recipe number 3. Grass cudweed should be lowered into a bucket of boiling water. Enough 200 grams of the main ingredient. After that, the agent should be wrapped and left to be infused. Once it is ready, it is possible to lower the affected limbs by 30 minutes. It is advisable to do this before going to bed.
• Recipe number 4. A tablespoon of nettle is poured into a glass of boiling water. After that, leave the remedy for 40 minutes, insist. Then it is filtered and used three times a day for 2 tablespoons. It is advisable to do this before eating.
• Recipe number 5. As a raw material for compresses, grass wormwood can be used, ground with yogurt. The compress is done at night.

Homeopathy

Homeopathic preparations are very popular today. They are widely used for the treatment of thrombophlebitis. Before applying homeopathic medicines, it is worth trying the treatment with traditional methods. Homeopathic remedies do not undergo clinical studies and can carry a danger to the human body.

Witch-hazel. This agent is released in the form of granules, suppositories and ointments. Apply it mainly to eliminate thrombophlebitis, varicose veins and neuralgia. The composition of the drug includes natural ingredients. It is used in 1, 2, 3, and 6 divisions. With thrombophlebitis, the drug is applied externally. It is necessary to make a lotion of tincture in half with water. The drug actively affects the veins. Thus, it promotes their relaxation and prevents the development of stagnation. It is used even with open wounds, it perfectly stops the bleeding. Purified extract preparation is used exclusively locally.

There are other drugs, you can read them at a doctor's homeopathic reception. Independently to start treatment and even more so to prescribe dosages is not recommended.

Operative treatment

Operative intervention is possible only with thrombophlebitis of the lower extremities. In other cases, everything is eliminated medically. Conservative methods of treatment perfectly cope with these inflammatory processes. In turn, surgical treatment can prevent deep vein thrombosis, as well as a possible relapse.

True, not all patients will be able to undergo surgical intervention. This is due to the peculiarities of the inflammatory process. Sometimes an operation is simply impossible. In total, there are two types of surgery: radical and palliative.

• Radical operation. This procedure involves the removal of all varicose veins, as well as the dissection of significant inadequate perforators. This type of intervention is justified and expedient only in the case of varicose veins. In the period of post-thrombophlebitic disease, this can aggravate the situation on the contrary. Radical surgery allows you to quickly get rid of thrombophlebitis, because this eliminates the main cause of its occurrence.
• Palliative surgery. This procedure does not lead to acceleration of the healing process, it prevents the development of a blood clot. To accelerate the process of recovery of the patient, there may be applications of percutaneous puncture thrombectomy. Absolute indication for this procedure is the presence of complications.

Prevention

The main task of preventive measures is to prevent the separation of the thrombus and its migration into the lungs. To date, widely used the introduction of a special device, called a cava filter. It allows you to catch a severed thrombus and prevent its migration through the body. This is not the end of the prophylaxis, the use of surgical skills is widely used.

Thrombectomy can remove the formed thrombi from the veins, thereby preventing serious consequences. This intervention is surgical, it gives excellent results, even in the treatment of deep venous thrombosis.

All this is applicable in the event that venous diseases are already present. But you can not prevent their development. For this purpose it is enough to move a lot, not to overload limbs and in time to treat diseases. When pain in the legs, as well as the veins, should consult a doctor. Timely elimination of the disease will avoid consequences.

Forecast

It must be understood that acute thrombophlebitis is capable of transitioning into a chronic form. To do this, simply do not eliminate the main symptomatology and wait 15 days. In this case, the prognosis will be unfavorable, because the risk of serious complications is great.

If a person has noticed strange symptoms and turned to a doctor for help, everything is eliminated quite quickly. And there is a possibility of preventing the development of a thrombus and eliminating the disease at the root itself. If conservative treatment is prescribed correctly, the inflammatory process recedes. Many medicines allow not only to remove the blood clot, but also prevent the disease from appearing again. It all depends on how quickly the person started treatment. The prognosis is compared with the period of detection of thrombophlebitis and its elimination. It is unambiguous to say how the restoration process will not be possible. This is an individual process, conclusions on it are made with respect to each case.

[30], [31], [32], [33], [34], [35], [36]