Syndrome of the inferior vena cava

Sometimes, during pregnancy and not only, diagnose the syndrome of the inferior vena cava. Call this syndrome disease is not entirely correct: rather, it is a violation of the body's adaptation to uterine enlargement or other changes in venous circulation.

In most cases, the syndrome is found in women with multiple birth, polyhydramnios, large fetuses, in pregnancy, combined with vascular hypotension, as well as tumors and disorders of blood coagulability.

Causes of the syndrome of the inferior vena cava

The original cause of the syndrome has not yet been finally established. Nevertheless, it is proved that provoking factors can be:

• high blood coagulability;
• altered biochemical composition of blood;
• infectious venous diseases;
• hereditary factor.

In addition to the period of bearing the child, the syndrome of the inferior vena cava can develop much more rarely with echinococcosis, tumor processes in the abdominal cavity. Patients with similar pathologies should be especially vigilant about their health.

[1], [2], [3], [4], [5], [6]

Pathogenesis

The pathogenesis of the syndrome is specific, but depends on the characteristics of the particular organism. Most often there is a violation of the patency of the base of the inferior vena cava, which can often be combined with the formation of a thrombus in the affected area of the vessel.

[7], [8]

Symptoms of the syndrome of the inferior vena cava

Symptoms of this syndrome depend on the degree of clamping or blockage of the lumen of the inferior vena cava. The most pronounced signs are observed with the maximum blockage of the vessel in combination with deterioration of the permeability of the veins of the liver and kidneys.

The first signs of the syndrome, which you should pay attention to are the sensations of "crawling" in the legs, followed by numbness.

Further, the disease develops depending on the localization of occlusion of the inferior vena cava.

• If the inferior vena cava overlaps above the site of divergence of the renal arteries, the following manifestations can occur:
  • nephrotic syndrome;
  • swelling of the lower extremities;
  • protein in the urine;
  • renal insufficiency.
• If the occlusion occurs below the site of divergence of the renal veins, then the appearance of such symptoms:
  • hemorrhages under the skin (bruises);
  • edema of lower extremities and genital organs;
  • phlebeurysm;
  • pain and weakness in the legs.

In addition, blood pressure may rise, weakness and a feeling of anxiety may appear, and palpitation may intensify.

Upper and inferior vena cava syndrome

There is a syndrome of the upper and inferior vena cava due to a circulatory disorder in the superior vena cava.

Physiologically, through the upper vena cava, venous blood flows from the upper part of the trunk. Normal blood flow can be disturbed by tumor processes, aneurysm, enlarged lymph nodes, thrombi.

Usually a similar syndrome develops gradually. The patient may notice periodic headaches, sleep disturbances, nose or throat bleeding, vision impairment, difficulties with falling asleep in a lying position. Over time, the patient develops swelling, blueing, and discharge of the veins of the upper body. At the same time, the symptoms of the underlying pathology are revealed, which initially provoked obstruction.

Treatment of the syndrome of the upper and lower hollow veins is assigned depending on the degree of occlusion and its localization. Conservative therapy involves the reception of fibrinolytic, anticoagulant and disaggregant drugs.

Complications and consequences

Syndrome of the inferior vena cava in pregnant women does not always lead to any negative consequences. The fact is that in a larger number of patients the outflow of venous blood from the lower part of the body occurs through the unpaired and vertebral veins, so the syndrome of the inferior vena cava can not be accompanied by a violation of the circulation.

The danger is represented by a situation in which a collap- toid state develops. Usually this happens during the "caesarean section" operation and is taken into account by the doctors.

With a significant depression of the inferior vena cava by the uterus, blood circulation directly in the uterus and kidneys worsens. As a consequence, the condition of the unborn child suffers, as well as the glomerular filtration of a woman is impaired. The listed processes can serve as the causes of premature detachment of the placenta, the formation of thrombi and varicose veins.

[9], [10], [11], [12], [13], [14], [15], [16]

Diagnostics of the syndrome of the inferior vena cava

Laboratory methods: general blood and urine tests, blood biochemistry, evaluation of blood coagulability.

Instrumental diagnostics:

• phlebography (type of X-ray examination, which is performed after intravenous injection of contrast medium, which allows to determine the place of narrowing of the vessel);
• Doppler ultrasonography;
• duplex scanning;
• method of magnetic resonance or computer phlebography.

[17], [18], [19], [20]

Differential diagnosis

Differential diagnosis is aimed at excluding extravasal squeezing of the inferior vena cava by a tumor or inflammatory process. It is important to determine the presence or absence of a tumor by ultrasound, CT or phlebography.

[21], [22], [23], [24], [25]

Treatment of the syndrome of the inferior vena cava

At the moment, there is no clear scheme for treating the syndrome of the inferior vena cava. In most situations, conservative therapy is used with the mandatory prescription of drugs that affect the blood coagulation, both direct and indirect effects.

When prescribing a medicine, it is necessary to take into account the duration of the disease, which for this syndrome can not be practically determined. It is known that antithrombotic agents have the greatest effect only at the initial stages of occlusion formation.

Equally important is the maintenance of normal functioning of the kidneys and liver.

	Mode of application	Side effects	Special instructions
Fraxyparin	Applied before and after surgery, more often by 0.3 ml injection p / k.	Bleeding, subcutaneous hematomas, hemorrhages.	The drug is not used intramuscularly.
Warfarin	Most often taken orally, from 2 to 10 mg per day.	Bleeding, hemorrhage, anemia, dermatitis, headache.	During the therapeutic course, the degree of clotting of the blood should be monitored.
Streptokinase	Means for infusion therapy. The dose of the drug is selected only individually.	Bleeding gums, bruises, redness of the skin, internal bleeding.	Assign cautiously in diseases of the liver and kidneys, as well as in old age.
Reforton	Enter intravenously drip, from 10 to 1000 ml per day.	Vomiting, itching of the skin, soreness in the lower back.	During treatment, renal function is always monitored.
Currantil	Take 75 mg three times a day.	Heart palpitations, dyspepsia, thrombocytopenia, tinnitus, a sense of weakness.	It is not recommended to take concurrently with caffeine containing drinks.

The main vitamins that help strengthen the venous walls are tocopherol and ascorbic acid. Food rich in these vitamins reduces the likelihood of blood clots and clogging of the inferior vena cava.

Tocopherol (E) is present in beans, cereals, liver, broccoli, and vegetable oils.

Ascorbic acid is in sufficient quantity in berries, grapes, kiwi and citrus.

In addition, it is desirable to eat foods rich in carotene, routine, and also trace elements such as copper, iron and zinc. To do this, you need to cook more often dishes from cabbage, nuts, red fruits and vegetables, meat.

Of the pharmaceuticals, Aevit and Ascorutin are especially recommended, and they prescribe 1 tablet or capsule twice a day for 3-4 weeks. At pregnancy it is necessary to select a vitamin preparation only under the control of the doctor.

Physiotherapeutic treatment for the syndrome of the inferior vena cava is extremely rare. Perhaps the appointment of physical therapy, manual therapy (according to the testimony).

Homeopathy for many years has been treating diseases of this kind, like the syndrome of the inferior vena cava. Doctors of homeopathy in this case are advised to use funds that strengthen the vascular walls, regulate blood circulation and improve blood properties. Tactics of treatment are usually determined depending on the disease or condition that could provoke a blockage of the vein.

Recently, the following homeopathic medicines are of interest:

• Crotalus (striped rattlesnake) - Heel means, such as Crotus Heel and Crotus Heus forte, are used in dilutions of 12, 30, 200;
• Aesculus (horse chestnut extract) - is given in the form of injections (preparations Aesculus Ingeel and Aesculus Ingeel Forte), or in the form of solutions Aesculus Heel, Arnica Heel or Arteria Heel for 10-15 drops three times a day;
• Vipera berus (a preparation from venom of a viper) - it is used in the form of injections of preparation Vipera berus Ingeel. Dosage D-15, 30, 200.

In addition, preparations prepared on the basis of clotting factors: thrombin, fibrinogen, fibrin, etc. Can be prescribed. In the long term, it is recommended to use Aorta suis Ingeel, Arteria suis Injeel, Vena suis Ingeel, which are made of thrombotic material.

Operative treatment is prescribed for thrombosis of the inferior vena cava:

• in the presence of thromboembolism of the lumen of the inferior vena cava;
• with the blocking of venous vessels of the liver or kidneys with a violation of the function of organs;
• coarctation of the inferior vena cava;
• with a "preset thrombosis" (more than 14-20 days).

Operations are not recommended if the patient has cardiac decompensation, a fresh stroke of cerebral vessels.

The operation is performed under intubation anesthesia with the use of drugs of muscle relaxant action. The surgeon conducts a median laparotomy, thoracophrenolumbutomy, or various types of extraperitoneal access. The trunk of the inferior vena cava is excreted, the clamps are applied and a radical removal of the thrombus is made, or another cause that prevents normal blood circulation in the vessel. If a narrowed area is detected, then a balloon dilatation with further stenting is performed.

Alternative treatment

In consultation with the doctor, you can use the following alternative recipes:

• Take 15 g of verbena leaf, brew in a glass of boiling water. Take 1 tbsp. L. Every hour, until the condition improves.
• Drink a third of a glass of infusion from St. John's wort, plantain, cassia, coriander, rhizome and licorice. To prepare the infusion, you need 2 tbsp. L. An equivalent mixture of the listed plants and 220 ml of boiling water. The medicine is taken half an hour before a meal.
• Take ground nutmeg, squeezed with plain warm water or tea.
• Take inside 0.3 g of mummy twice a day, can be combined with honey and milk. Duration of admission - up to 25 consecutive days.

Herbal treatment often includes complex multicomponent recipes:

• Prepare a mixture of 25 g of herb yarrow, 100 g of color immortelle, 50 g of cranberry leaves, 50 grams of buckthorn bark and the same number of birch leaves. Brewed 1 tbsp. L. Collecting 250 ml of boiling water, insist in a thermos for at least 4 hours. Drink 100 ml three times a day before meals.
• Prepare an equivalent mixture of sage leaf, chamomile color, althea rhizome and flaxseed. Two tablespoons of the collection is poured with boiling water (250 ml), drunk throughout the day.
• Prepare a collection of equal parts of horsetail, cones of hops, grass sweet clover. Brewed 2 tbsp. L. Collection in 250 ml of boiling water, stand for 2 hours. Drink 100 ml three times a day before meals.

[26], [27]

Prevention

Prevention can be based on the likely causes of the syndrome of the inferior vena cava. It is important to prevent the onset of the problem, and also to prevent exacerbations.

• It is necessary to control the degree of blood coagulability. If there are any abnormalities, consult a doctor about further treatment or preventive measures.
• It is desirable to promptly treat any diseases of the cardiovascular system and hemopoiesis.
• At the first signs of the syndrome of the inferior vena cava, you need to see a doctor. Self-medication in this case is unacceptable.

[28], [29], [30], [31], [32], [33], [34], [35]

Forecast

Doctors in most cases give a relatively good prognosis of the disease. The only condition: the syndrome of the inferior vena cava should be detected in a timely manner.

[36]