Superficial thrombophlebitis of the lower extremities

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

ICD 10 code

• I 80.0 – phlebitis and thrombophlebitis of superficial vessels of the legs.

Causes of superficial thrombophlebitis of the lower extremities

The formation of a thrombus in a 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. Injury can occur during medical procedures, intravenous catheterization, mechanical household injuries, etc.
• Slow blood circulation. Slow blood flow can be a consequence of physical inactivity, forced bed rest, compression of veins by bandages (including plaster). Slow blood flow can also develop with cardiac insufficiency, atherosclerosis - in any conditions that are accompanied by congestive phenomena in the vascular system.
• Increased blood clotting. Acceleration of clotting can be a hereditary pathology, or a consequence of infectious diseases, hormonal imbalances, taking certain medications, or the development of tumors in the body.

Superficial thrombophlebitis often occurs in pregnant women, as well as after childbirth, after surgeries, as a result of injuries, septic conditions, severe and prolonged hypothermia, etc.

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

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Pathogenesis

So, we have already found out that due to certain reasons a thrombus is formed in the vessel simultaneously with the inflammatory process in its wall. Further development of the pathology can proceed in two variants.

• The thrombus stops growing on its own or as a result of treatment and the inflammation is stopped. The thrombus size decreases slightly, but it is quite capable of closing the vascular lumen. Complete closure of the lumen leads to the cessation of blood flow through the vessel, which collapses and stops functioning. In such a situation, the thrombus does not break away.
• The inflammatory process does not subside, the thrombus continues to form – one edge of it “sticks” to the wall of the vein. Such a thrombus usually has a loose structure, and its location is unstable: with the slightest mechanical impact, it can break off and move with the blood flow. As a result, thromboembolism can occur.

Most often, thrombophlebitis affects the great saphenous vein, and much less often the small saphenous vein.

Symptoms of superficial thrombophlebitis of the lower extremities

The first signs that indicate the onset of an inflammatory process in the veins may be:

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

Unfortunately, most patients seek medical attention only when the disease begins to progress. This is usually expressed in the development of an acute thrombophlebitis process, or the transition of the disease to a chronic course with exacerbation stages.

• Acute thrombophlebitis of the 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 the patient necessarily notes. 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 external signs of pathology, since the general condition may not be affected. Patients note the appearance of pain along the affected venous vessel, the inability to walk fully. The skin over the vein noticeably turns red, the local temperature rises, which indicates the development of an inflammatory reaction.

If you try to palpate the affected vein, you can find a compacted, cord-like cord: touching it causes severe pain. When varicose veins are affected, the nodes also become compacted and can visually increase in volume. Inflammatory edema can form in the affected area (it is usually absent with deep vein thrombophlebitis).

The general clinical picture may be represented by an increase in temperature to subfebrile levels and a feeling of discomfort.

• Chronic thrombophlebitis is characterized by a long course, with regular exacerbations. Relapse (exacerbation) is a clinical picture of acute thrombophlebitis, and during the period of subsidence of the process, the symptoms may disappear almost completely.

Repeated inflammatory processes in veins of different localizations are called migratory thrombophlebitis. Such unstable phlebitis requires careful diagnostics, as it is sometimes observed against the background of oncological diseases.

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

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

Consequences and complications of superficial vein thrombophlebitis

Complications in 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 - thromboembolism. However, doctors note that the inflammatory process characteristic of superficial lesions promotes the "sticking" of the thrombus to the vascular wall, which reduces the possibility of its detachment and entry into the bloodstream to a minimum (which cannot be said about deep vein lesions, for which inflammation is not typical). In addition, superficially located vessels are not exposed to muscle action, since they are located closer to the skin. This favors a calm position of the thrombus, without displacement and compression.

Despite the possible favorable course of the disease, you need to be very attentive to its manifestations. If the signs of pathology do not go away and even progress, then it is necessary to consult a doctor. Symptoms such as high temperature, pallor and swelling of the skin of the legs, general chills should alert you. In the absence of treatment (or with insufficient treatment), trophic disorders may develop, which will manifest themselves in the form of skin rashes, eczema, abscesses and phlegmon. The inflammatory process can affect the lymphatic system, nerve fibers, somatic organs. Sometimes a general septic condition develops.

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Diagnosis of superficial thrombophlebitis of the lower extremities

The clinical picture of the disease is so typical that diagnosis is usually not difficult. The doctor conducts a visual assessment of the entire limb, starting from the toes to the groin area, paying attention to vascular networks and nodes, skin color, local temperature changes (cold feet or hyperthermia areas), swelling. Significant redness of the affected area is usually present only in the first few days from the onset of the disease, gradually decreasing.

The doctor may ask the patient several questions to determine the duration of the pathology:

• When did the first signs of the disease appear?
• How quickly did they progress?
• Has the patient taken any medications to relieve symptoms?

Laboratory examination includes the following tests:

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

Most tests are done to monitor your blood clotting status to determine the likelihood of blood clots.

Instrumental diagnostics includes a fairly large number of methods for assessing the functionality of the veins of the lower extremities:

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

Of the listed procedures, the most common is duplex scanning - this method helps to identify the exact location of thrombosis, the degree of thrombus organization, the degree of anastomosis patency, the function of venous valves. The most informative is angioscanning with ultrasound - this procedure helps to assess the condition of the venous vessel and nearby tissues, identify the location of the blood clot and its type.

All of the listed methods allow you to determine the treatment plan as accurately as possible.

Differential diagnostics is carried out taking into account the following criteria:

• Since one of the main symptoms of thrombophlebitis is considered to be swelling of the affected leg (as a result of venous insufficiency), the disease should be differentiated from heart failure, liver cirrhosis, myxedema, nephrosis. It is also necessary to consider the possibility of compression of veins by tumors, the iliac artery, or injuries and vascular fistulas.
• Lymphadenitis (another indirect sign of thrombophlebitis) can be observed in infectious diseases, injuries, and oncology.

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Treatment of superficial thrombophlebitis of the lower extremities

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

The main goals of treatment are rapid action on the area with the thrombus, relief of the inflammatory process, and prevention of disease progression.

Medication is only acceptable for a limited process. However, even here, surgeon supervision is necessary. Medicines are prescribed to improve blood flow, eliminate the inflammatory reaction, and stabilize hemostasis.

An important therapeutic principle is to provide the affected limb with rest: non-strict bed rest and periodic elevation of the limb are recommended. Ice is applied to the inflamed area for 1-2 days.

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

If the treatment does not produce an effect within 2 weeks, the patient is hospitalized.

To eliminate inflammatory phenomena and alleviate the condition in superficial thrombophlebitis, drugs with anti-inflammatory, antihistamine and antispasmodic activity, nicotinic acid, horse chestnut-based products, as well as medications that relieve venous congestion (aspirin, reopyrin, troxevasin, venoruton, anavenol, etc.) are used. When an infection occurs, antimicrobial and sulfanilamide agents are indicated.

You can speed up the resorption of blood clots with the help of ointments. Ointment for thrombophlebitis of superficial veins has a local effect, which in most cases is quite effective:

• Heparin ointment has anti-inflammatory and anti-edematous effects, preventing thrombus formation. It is used up to 3 times a day, gently rubbing into the skin over the affected area.
• Ketonal cream is a non-steroidal anti-inflammatory drug that helps eliminate swelling, pain and inflammation. For treatment, it is enough to apply the cream thinly (about 2 cm) up to 3 times a day for 14 days.
• Lioton gel (Gepatrombin) is applied along the affected vein 2 times a day. Can be alternated with Ketonal cream. Lioton prevents fluid from penetrating into tissues, reduces blood clotting and eliminates signs of inflammation.

If signs of tissue trophic disorder (for example, trophic ulcers) appear on the skin at the site of the lesion, then it is appropriate to use external preparations such as Levomekol or Vishnevsky ointment.

Conservative treatment can be successfully supplemented with physiotherapy, but only after the acute inflammatory process has been eliminated. As a rule, patients are recommended to use magnetic therapy, hirudotherapy, and diadynamic currents.

If homeopathy becomes the patient's therapeutic choice, then experts advise taking the following medications three times a day, half an hour before meals, until the symptoms of the disease are eliminated:

• at the initial stage of treatment "Hamamelis 3", "Aesculus 3", "Arnica 12";
• When the condition stabilizes, you need to continue treatment with Hamamelis 12, Aesculus 12, and Arnica 30.

In case of severe venous congestion, you can additionally take the homeopathic remedy “Pulsatilla 4”.

Folk treatment of superficial thrombophlebitis

• A cabbage compress helps relieve inflammation and reduce local temperature. Take a cabbage leaf and lightly beat it with a hammer, lightly grease it with sunflower oil and apply it to the affected area overnight, under a bandage. In the morning, remove the compress and wipe the skin with a clean damp cloth.
• Kalanchoe leaf heals and restores tissues, tones blood vessels, eliminates inflammation. Kalanchoe leaf is ground through a meat grinder, poured with the same amount of good vodka, infused for 1 week. Filter and use for rubbing the feet in the affected area. The course of treatment is at least one month.
• A compress of fern, rich in essential oil, stops the development of an inflammatory reaction. Fern leaves are ground and mixed with the same amount of sour milk. The mass is applied to a napkin and applied to the affected area, covered with a film on top and a bandage. Leave overnight. Duration of treatment is 4 days. If necessary, it can be repeated, after a break of 3 days.
• Apple cider vinegar strengthens the walls of blood vessels and reduces blood clotting. One tablespoon of vinegar is diluted in 200 ml of water and 1 tablespoon of honey is added. Drink 100 ml of the drink before meals in the morning and evening. Apple cider vinegar with water (50 ml of vinegar per 200 ml of water) is used to lubricate the skin at the site of the lesion, up to 5 times a day.

Herbal treatments can also be used:

• Prepare a mixture based on 20 g of birch bark, the same amount of oak bark, the same amount of horse chestnut seeds, 50 g of horsetail, 10 g of raspberry leaf, 30 g of rhubarb rhizome, 30 g of immortelle. For 2 tablespoons of the mixture, take ½ liter of water, boil for 5 minutes and cool. Take 200 ml three times a day for two weeks. If necessary, repeat the treatment after an interval of 1 month.
• Take horse chestnut tincture (you can buy it ready-made at the pharmacy or make it yourself). Take horse chestnut peel (50 g), pour in ½ liter of vodka and leave for 14 days. Take the finished tincture 35 drops (diluted in 50 ml of water) half an hour before meals three times a day. Continue treatment for 20 days. Then you can take a break for 1 week and return to treatment again.
• Prepare a medicine from white onions with honey. Squeeze out the onion juice (1 glass) and mix with 1 glass of natural honey. Keep the mixture for three days at normal temperature, then put it in the refrigerator for 10 days. Take the medicine 1 tbsp. half an hour before meals three times a day. Duration of treatment is 1 month, with a break of one week.

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Surgical treatment of superficial thrombophlebitis

Surgery is the most effective way to cure thrombophlebitis. The choice of the type of surgery is made individually: a method of cleaning the vessel from a blood clot or a radical method of removing a section of the vein can be chosen.

Indications for surgical treatment are:

• probability of thromboembolism;
• advancement of the clot along the ascending path;
• localization of the thrombus in the great or small saphenous vein;
• the likelihood of thrombus migration into deep vessels;
• varicose veins.

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

• old age;
• decompensation of cardiac activity, severe pulmonary pathologies;
• period of bearing a child;
• tendency to allergies to agents used in anesthesia.

In case of thrombophlebitis, gentle and radical operations can be performed: some of them are aimed at preventing complications and alleviating the course of the disease, while others are aimed at completely eliminating the problem.

1. Thrombectomy surgery is the removal of a thrombus using a special catheter inserted into a vein. It is performed under local anesthesia.
2. The operation to ligate the great saphenous vein (crossectomy) is the ligation and cutting off of a venous vessel using local anesthesia.
3. The operation to remove the large or small saphenous vein using a special metal probe is called the Babcock method and is considered quite traumatic. Sometimes it can lead to inflammation and loss of sensitivity in the affected area.
4. Inversion stripping surgery involves removing the entire vein by turning it inside out. It is used on veins whose diameter does not exceed 10 mm.
5. The method of intraoperative trunk catheter sclerotherapy is the introduction of a special liquid into the affected vein, which destroys and glues the vascular walls. It is used for veins with a diameter of less than 8 mm.

Prevention of thrombophlebitis

Any person should pay close attention to their health, especially if they are at risk for developing thrombophlebitis. Phlebologists have developed a number of recommendations that will allow your legs to stay healthy longer:

• lead an active life, avoid physical inactivity;
• walk a lot and do physical exercise;
• swimming and cycling are encouraged;
• wear comfortable shoes;
• monitor your body weight;
• eat right, periodically take multivitamin supplements;
• treat infectious and viral diseases in a timely manner.

It is advisable to avoid prolonged sitting or standing, and not to visit the steam room or sauna. You should drink enough fluids, as dehydration contributes to thickening of the blood. When resting, it is preferable to elevate your legs.

Forecast

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

Superficial thrombophlebitis may result in the dissolution of the blood clot or blockage of the vein. However, in most cases this does not lead to a disruption of blood flow.

In some cases, the clots become calcified.

In case of purulent complications, ascending thrombosis and sepsis may develop.

However, in most cases, the inflammatory process is eliminated, and patients return to their normal lifestyle. It should not be forgotten that superficial thrombophlebitis of the lower extremities is quite treatable. For this, doctors have a large number of therapeutic and surgical methods. The main condition is timely seeking medical help.

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