Superficial thrombophlebitis of the lower extremities

What is a superficial thrombophlebitis of the lower extremities? It is a tendency to form blood clots in venous vessels located closer to the skin surface, which leads to an inflammatory process. Thrombophlebitis usually occurs as a secondary disease after varicose veins.

ICD Code 10

• I 80.0 - phlebitis and thrombophlebitis of superficially located vessels of the legs.

Causes of superficial thrombophlebitis of lower extremities

The formation of a thrombus in the vessel can be caused by the presence of one of the factors:

• Damaged vein wall. Venous vessels located closer to the skin surface are at greater risk of injury than deep veins. Damage can occur during medical manipulation, with intravenous catheterization, with mechanical injuries, etc.
• Slow blood circulation. Slowing down the blood flow can be a consequence of hypodynamia, forced compliance with bed rest, squeezing the veins with bandages (including gypsum). Also, slow blood flow can develop in case of cardiac failure, atherosclerosis - in any conditions, which are accompanied by stagnant phenomena in the vascular system.
• Increased blood clotting. Acceleration of coagulability can be a hereditary pathology, or a consequence of infectious diseases, failure of the hormonal level, the intake of certain medications, the development of tumors in the body.

Surface thrombophlebitis often occurs in pregnant women, as well as after childbirth, after surgery, as a result of trauma, septic conditions, severe and prolonged hypothermia, etc.

In general, the inflammatory process of the venous wall proceeds without multiplying and developing bacteria inside the vein. Only in rare cases, thrombosis is complicated by a purulent reaction. In such cases, purulent thrombophlebitis occurs.

[1], [2], [3], [4]

Pathogenesis

So, we have already found out that due to certain reasons a blood clot forms simultaneously with the inflammatory process in its wall. Further development of pathology can occur in two versions.

• By itself, or as a result of the treatment, the thrombus stops growing and the inflammation stops. The size of the thrombus decreases slightly, but it is quite capable of covering the vascular lumen. Complete closure of the lumen leads to a cessation of blood flow through the vessel, which subsides and ceases to function. In such a situation, a thrombus does not come off.
• The inflammatory process does not subside, the thrombus continues to form - one edge "sticks" to the wall of the vein. Such a thrombus usually has a loose structure, and its location is unstable: at the slightest mechanical impact it can come off and move with the bloodstream. As a consequence, thromboembolism may occur.

Most often thrombophlebitis affects a large subcutaneous vein, and much less often - a small subcutaneous vein.

Symptoms of superficial thrombophlebitis of lower extremities

The beginning of the inflammatory process in the veins can be evidenced by the first signs that must be recognized in time:

• the appearance of swelling of the lower extremities;
• pain in the calf muscles under normal load;
• feeling of discomfort and heaviness of the legs;
• redness on the skin of the legs.

Unfortunately, most of the patients turn to doctors only when the disease begins to progress. Usually this is expressed in the development of an acute process of thrombophlebitis, or the transition of the disease into a chronic course with the stages of exacerbation.

• Acute thrombophlebitis of superficial veins of the lower extremities is characterized by a sudden onset (seemingly without a specific cause). In rare cases, the disease begins as a result of a leg injury, which necessarily marks the patient. There may also be a connection with viral infections, the use of oral contraceptives, etc. Most often, acute thrombophlebitis is associated with varicose veins.

In most cases, patients immediately pay attention to the external signs of pathology, since the general condition may not be disturbed. Patients note the appearance of pain along the affected venous vessel, the inability to walk fully. The skin over the vein noticeably reddens, the local temperature rises, which indicates the development of an inflammatory reaction.

If you try to feel the affected vein, you can find a tight, cord-like cord: touching it causes a strong pain. When lesions of varicose veins, the nodes also become denser and can visually increase in volume. In the affected area, inflammatory edema may form (with thrombophlebitis of deep veins it usually does not).

The overall clinical picture can be presented by raising the temperature to subfebrile figures, a sense of discomfort.

• The chronic form of thrombophlebitis is characterized by a prolonged course, with regular exacerbations. Relapse (exacerbation) is a clinic of acute thrombophlebitis, and during the process of the process the symptoms can disappear almost completely.

Repeated inflammatory processes in different localized veins are called migrating thrombophlebitis. Such an unstable phlebitis requires careful diagnosis, as sometimes it is observed against the background of cancer.

With the progression of an acute or chronic form, the pathology can expand its presence along the large superficial vein to the inguinal region. This development of the disease is defined as an ascending thrombophlebitis of the superficial veins of the lower limbs. A similar situation can occur in the iliac venous vessel, which poses an immediate threat of detachment of a piece of thrombus and the onset of pulmonary embolism.

In addition, secrete septic purulent thrombophlebitis occurs with the attachment of infection (as a result of injuries or systemic infectious diseases). Septic inflammation can lead to abscesses, phlegmon and sepsis.

Consequences and complications of thrombophlebitis of superficial veins

Complications of superficial thrombophlebitis do not develop very often. Of course, the greatest danger is the detachment of a part of the thrombus and the consequence of such a detachment is thromboembolism. However, doctors note that the inflammatory process, characteristic of superficial lesions, contributes to "clinging" the thrombus to the vascular wall, which reduces the possibility of its detachment and getting into the bloodstream to a minimum (which can not be said about the defeat of deep veins, for which inflammation is not typical) . In addition, superficially located vessels are not exposed to the muscles, since they are located closer to the skin. This favors the calm position of the thrombus, without dislocations and contractions.

Despite the possible favorable course of the disease, you need to be very attentive to its manifestations. If signs of pathology do not pass and even progress, it is necessary to consult with a doctor. Should be alerted to symptoms such as fever, pallor and swelling of the skin of the legs, a general chill. In the absence of treatment (or inadequate treatment), trophic disorders can develop, which will manifest as skin rashes, eczema, abscesses and phlegmon. The inflammatory process can affect the lymphatic system, nerve fibers, somatic organs. Sometimes a general septic condition develops.

[5], [6], [7], [8], [9], [10]

Diagnosis of superficial thrombophlebitis of lower extremities

The clinical picture of the disease is so typical that the diagnosis usually does not cause difficulties. The doctor makes a visual assessment of the entire limb, which starts from the toes to the groin, drawing attention to the vascular nets and knots, skin color, local temperature changes (cold snap or areas of hyperthermia), swelling. A significant reddening of the lesion is usually present only in the first few days from the onset of the disease, gradually decreasing.

The doctor can ask the patient a few questions to determine the duration of the pathology:

• When did the first signs of the disease appear?
• How quickly did they progress?
• Did the patient take any medications to eliminate symptoms?

Laboratory examination includes such analyzes:

• general blood test (signs of inflammation - leukocytosis and accelerated ESR);
• C-reactive protein;
• coagulogram;
• thrombelastogram;
• prothrombin index.

Most of the tests are performed to monitor the state of blood coagulation in order to determine the likelihood of thrombus formation.

Instrumental diagnostics includes a sufficiently large number of methods for evaluating the functionality of the veins of the lower extremities:

• method of ultrasound dopplerography;
• duplex scanning method;
• phlebography;
• CT-phlebography;
• method of photoplethysmography;
• method of phleboscintigraphy;
• phlebomanometry.

Of the listed procedures, duplex scanning can be considered the most common method - this method helps to distinguish the exact localization of thrombosis, the degree of thrombogenesis, the degree of patency of the anastomoses, the function of the venous valves. The most informative is angioscanning by ultrasound - this procedure helps to assess the condition of the venous vessel and nearby tissues, to isolate the location of the blood clot and its type.

All of these methods allow you to determine as precisely as possible the treatment scheme.

Differential diagnostics is conducted taking into account the following criteria:

• Since one of the main symptoms of thrombophlebitis is edema on the affected leg (as a result of a lack of venous function), the disease should be differentiated with heart failure, cirrhosis, myxedema, and nephrosis. You should also consider the possibility of squeezing the veins with tumors, the iliac artery, or injuries and vascular fistulas.
• Lymphadenitis (another indirect sign of thrombophlebitis) can be observed in infectious diseases, injuries, oncology.

[11], [12], [13]

Treatment of superficial thrombophlebitis of lower extremities

The therapeutic regimen for superficial thrombophlebitis should consist of a set of measures, including medication and surgical intervention.

The main goals of the treatment are a rapid impact on the site with a thrombus, the removal of the inflammatory process, the prevention of the progression of the disease.

Drug treatment is permissible only with a limited process. However, it is also necessary to observe the surgeon here. Prescribed drugs to improve blood flow, eliminate inflammation, stabilize hemostasis.

An important therapeutic principle is to provide an affected resting limb: showing the observance of a lax bed rest and periodic lifting of the limb. In the 1-2 days, ice is applied to the inflamed area.

After cupping an acute period, it is recommended to bandage the leg with an elastic bandage or use compression stockings.

If the treatment does not work for 2 weeks, the patient is hospitalized.

To eliminate inflammatory phenomena and to alleviate the condition with superficial thrombophlebitis, drugs with anti-inflammatory, antihistaminic and spasmolytic activity, nicotinic acid, horse chestnut-based products, as well as medications that relieve venous stasis (aspirin, rheopyrine, troxevasin, venoruton, anavenol, etc.) are used. ). When the infection is attached, antimicrobial and sulfanilamide agents are indicated.

To accelerate the resorption of blood clots can be with the help of ointments. Ointment with thrombophlebitis of superficial veins has a local effect, which in most cases is quite effective:

• Ointment heparin has anti-inflammatory and anti-edematous action, preventing thrombus formation. It is used up to 3 times a day, gently rubbing into the skin over the affected area.
• Cream Ketonal is a non-steroidal anti-inflammatory drug that helps to eliminate puffiness, pain and inflammatory reaction. For treatment, it is sufficient to apply a cream (approximately 2 cm) to 3 times a day for 14 days.
• Gel Lyoton (Gepatrombin) is applied in the course of the affected vein 2 times a day. You can alternate with Ketonal cream. Lyoton prevents the penetration of fluid into the tissues, lowers blood coagulation and eliminates signs of inflammation.

If signs of tissue trophism have appeared on the skin at the lesion site (for example, trophic ulcers), then it is appropriate to use such external drugs as Levomikol or Vishnevsky ointment.

Conservative treatment can be successfully supplemented by physiotherapy, but only after the acute inflammatory process is eliminated. As a rule, patients are recommended to use magnetotherapy, hirudotherapy, diadynamic currents.

If the therapeutic choice of the patient becomes homeopathy, then experts advise to eliminate symptoms of the disease three times a day for half an hour before meals such drugs:

• at the initial stage of treatment "Witch-hazel 3", "Esculus 3", "Arnica 12";
• with the stabilization of the condition, you must continue treatment "Hamamelis 12", "Esculus 12", "Arnica 30".

With pronounced venous stasis, you can additionally take homeopathic remedy "Pulsatilla 4".

Alternative treatment of superficial thrombophlebitis

• Cabbage compress helps to relieve inflammation and reduce the local temperature. Take a sheet of white cabbage and lightly beaten with a hammer, a little oiled with sunflower oil and put on the affected area for the night, under the bandage. In the morning, the compress is removed and the skin wiped with a clean damp cloth.
• The leaf of the colchancho heals and repairs the tissues, tones up the vessels, eliminates the inflammatory process. The leaf of the colanchoe is grinded through a meat grinder, poured with the same amount of good vodka, it is insisted for 1 week. Filter and use for rubbing the legs in the place of injury. The course of treatment is not less than one month.
• Compress from the fern, rich in essential oil, stops the development of an inflammatory reaction. The fern leaves are ground and mixed with the same amount of curdled milk. The mass is applied to a napkin and applied to the affected area by covering it with a film and applying a bandage. Leave for the night. Duration of treatment - 4 days. If necessary, you can repeat, withstood a break of 3 days.
• Apple cider vinegar strengthens the walls of blood vessels and lowers blood coagulability. One tablespoon of vinegar is bred in 200 ml of water and added 1 tbsp. Spoon of honey. Drink 100 ml before meals in the morning and in the evening. Apple cider vinegar with water (50 ml of vinegar per 200 ml of water) is used to lubricate the skin at the lesion, up to 5 times a day.

Herbalism can also be used:

• Prepare a mixture based on 20 g of birch bark, the same number of oak bark, the same amount of horse chestnut seed, 50 g of horsetail, 10 g of raspberry leaf, 30 g rhubarb rhizome, 30 g immortelle. For 2 tablespoons of the mixture take ½ liter of water, cook for 5 minutes and cool. Take 200 ml three times a day for two weeks. If necessary, the treatment is repeated, withstood the gap of 1 month.
• Take a tincture of horse chestnut (you can buy ready in the pharmacy, or do it yourself). Take the skin of horse chestnut (50 g), pour ½ liter of vodka and insist 14 days. Ready tincture is used for 35 drops (diluted in 50 ml of water) for half an hour before meals three times a day. Continue treatment for 20 days. Then you can take a break 1 week and go back to treatment.
• Prepare a medicine from onions white onions with honey. Squeeze onion juice (1 glass) and mix with 1 glass of natural honey. The mixture is aged for three days at ambient temperature, then placed in a refrigerator for 10 days. Take medicine for 1 tbsp. L. Half an hour before meals three times a day. Duration of treatment - 1 month, with a break in one week.

Surgical treatment of superficial thrombophlebitis

Operative intervention is the most effective way to cure thrombophlebitis. The choice of the type of operation is carried out individually: a method of cleaning the vessel from a blood clot can be chosen, or a radical method for removing a vein segment.

Indications for the appointment of surgical treatment are:

• the probability of thromboembolism;
• advancement of the clot along the ascending path;
• localization of thrombus in the large or small saphenous vein;
• probability of thrombus migration to deep vessels;
• phlebeurysm.

Along with the indications, there are also a number of contraindications to the operation:

• old age;
• decompensation of cardiac activity, severe pulmonary pathologies;
• the period of bearing of the child;
• propensity to allergies to the drugs used in anesthesia.

With thrombophlebitis, gentle and radical operations can be carried out: one of them is aimed at preventing complications and alleviating the course of the disease, while others are aimed at completely eliminating the problem.

1. The operation of thrombectomy is the removal of a thrombus with a special catheter inserted into the vein. Carried out under local anesthesia.
2. Surgery for dressing a large saphenous vein (a crosectomy) - is a dressing and cutting out of a venous vessel, using local anesthesia.
3. The operation to remove a large or small saphenous vein with a special metal probe is called the Bebcock method and is considered quite traumatic. Sometimes it can lead to inflammatory processes and loss of sensitivity in the affected area.
4. The operation of inversion stripping is the removal of the entire vein by turning it outward. It is used in relation to veins, whose diameter does not exceed 10 mm.
5. The method of intraoperative stem catheter sclerobliteration is the introduction into the affected vein of a special fluid that destroys and glues the vascular walls. Used for veins with a diameter of less than 8 mm.

Prevention of thrombophlebitis

Any person should be careful about their health, and especially if he is at risk for developing thrombophlebitis. Experts phlebologists have developed a number of recommendations that will allow the feet to stay healthy longer:

• to lead an active life, to avoid hypodynamia;
• a lot of walking and physical education;
• welcome swimming and cycling;
• wear comfortable shoes;
• follow the body weight;
• correctly eat, periodically drink multivitamin preparations;
• time to treat infectious and viral diseases.

It is advisable to avoid prolonged sitting or standing, not to visit the steam room and sauna. It is necessary to drink a sufficient amount of liquid, since dehydration promotes blood thickening. During rest, it is preferable to give the legs an elevated position.

Forecast

With adequate treatment, the prognosis of thrombophlebitis is usually favorable.

Surface thrombophlebitis can result in dissolution of the blood clot, or by clogging the veins. However, in most cases this does not lead to a violation of blood flow.

In some cases, the clots become calcified.

With a purulent complication, ascending thrombosis and sepsis may develop.

However, in most cases, the inflammatory process is eliminated, and patients return to their normal lifestyle. Do not forget that the superficial thrombophlebitis of the lower extremities is quite amenable to treatment. To do this, doctors have a large number of therapeutic and surgical techniques. The main condition is the timely application for medical assistance.

[14], [15], [16], [17], [18], [19], [20], [21], [22]