Ascending thrombosis of the great saphenous vein. What is ascending thrombophlebitis Thrombosis of the great saphenous vein of the leg treatment

Thrombophlebitis of the saphenous veins of the lower extremities or superficial thrombophlebitis is a disease in which blood clots appear in the lumen of the saphenous veins. Since the veins are located close to the skin, this phenomenon is accompanied by inflammation - redness of the skin, pain, local swelling.

In fact, thrombophlebitis of the saphenous vein is a "double" disease. Because, firstly, the venous walls themselves become inflamed. And secondly, a blood clot is formed in the vein - a thrombus.

Superficial thrombophlebitis in the vast majority of cases manifests itself as an acute disease.

More often, varicose-transformed tributaries of the large (and / or small) saphenous vein, as well as perforating veins, are thrombosed. But if untreated, thrombosis extends to the great (small) saphenous vein itself, and further to the deep veins.

Causes of thrombophlebitis of superficial veins

The cause of any thrombosis is a combination of three factors:

change in the configuration of the vein (for example, varicose transformation) and, as a result, "swirls" of blood in the lumen of the vessel;
"thickening" of the blood - a tendency (hereditary or acquired) to thrombosis;
damage to the vein wall (injection, trauma, etc.).

The main and most common cause of superficial thrombophlebitis is varicose veins. Also, the most common risk factors are:

genetic predisposition;
pregnancy and childbirth;
obesity, hypodynamia;
endocrine and oncological diseases.

Superficial thrombophlebitis: symptoms and manifestations

In the initial stages, superficial thrombophlebitis of the lower extremities may not be very noticeable in the manifestations. Slight reddening of the skin, burning, insignificant swelling - many patients simply do not pay attention to all this. But the clinical picture changes very quickly, and signs of thrombophlebitis of superficial veins become noticeable and very uncomfortable:

the appearance of "nodules" and seals in the vein;
edema;
sharp pain;
local increase in temperature;
discoloration of the skin in the area of the inflamed vein.

Treatment of superficial thrombophlebitis

For the treatment of thrombophlebitis of superficial veins, different methods and their combinations are used.

More often it can be conservative treatment:

compression therapy - wearing compression stockings, special elastic bandaging;
taking non-steroidal anti-inflammatory and analgesic drugs;
locally, in the area of inflammation - cold;
according to indications - taking drugs that "thinn" the blood.

Emergency surgical treatment of acute thrombophlebitis of the saphenous veins is prescribed, as a rule, in cases where thrombosis does not affect the tributaries, but directly the large or small saphenous veins. So, with ascending thrombophlebitis of a large or small saphenous vein, the trunk of the main saphenous vein is thrombosed directly. With the spread of thrombosis of the great saphenous vein to the thigh, thrombophlebitis is considered ascending. For the small saphenous vein, this is the middle and upper third of the lower leg.

In this case (if technically possible), either endovenous laser obliteration or crossectomy is used - ligation of the large (small) saphenous vein along with its tributaries.

If ascending thrombophlebitis has already led to the penetration of a blood clot into deep veins, this is fraught with the occurrence of pulmonary embolism - separation of a blood clot and blockage of the pulmonary artery. This situation occurs when thrombosis spreads from the saphenous veins into the deep (“muscular”) veins.

In this situation (if technically possible), a thrombus is removed from the deep veins and a crossectomy is performed - ligation of the saphenous vein at the mouth.

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Thrombosis of the GSV

Thrombosis of the great saphenous vein or in contraction cvp thrombosis- occurs very often with varicose veins of the saphenous veins of the lower extremities. A clot forms in the great saphenous vein, which blocks the flow of blood. Blood begins to collect in a certain area and fill the vein.

Causes of thrombosis of the great saphenous vein

Cause thrombosis bvp most often is the expansion of the veins and their deformation. Blood begins to circulate more slowly and forms clots that clog the vein. There are several factors contributing to the formation of this disease:

Age. Often the disease occurs in people over 60 years of age;

Obesity. Excess weight is a heavy physical burden for the body. The person is inactive, the blood begins to circulate more slowly and becomes thicker. As a result, blood clots form in the vessels and veins;

Long bed rest;

Serious injuries, due to which a person cannot move normally for a long time;

Operations performed in the region of the lower extremities and pelvis;

Pregnancy, childbirth and the postpartum period;

The tendency of the body to thrombosis. This is a congenital disease;

Long-term use of hormonal drugs.

A varicose thrombus can form anywhere in the saphenous vein, very often in the thighs and lower legs. The great saphenous vein is affected by blood clots along with tributaries. The result of thrombosis can be different. In rare cases, it resolves on its own or after therapy. It also happens that a thrombus begins to germinate with connective tissues and resolves, destroying the valvular apparatus of the vein. In some cases, the thrombus completely clogs the vein, causing sclerosis as a result, or the thrombus gradually grows in size, becomes larger. This result of the disease is the most unfavorable, because such thrombosis turns into thrombophlebitis and can spread to the deep venous system, causing pulmonary thromboembolism, a serious illness that very often ends in death.

Signs of the disease

It often happens that thrombosis of the great saphenous vein manifests itself unexpectedly. But there are also classic signs of the disease:

Sharp pain when probing a sore spot;

Redness in the area of the modified vein;

Feeling of heaviness in the affected area;

Injury in the area of the veins;

Viral diseases such as the flu.

Symptoms depend on the location of the thrombus, the complexity and neglect of the process. Basically, the patient does not feel bad. He has slight pains and heaviness in the legs, especially when walking, sometimes feeling slightly unwell, which is expressed by weakness, chills and a slight increase in temperature. But, in general, there are no serious complaints. The most important thing is to determine the exact location of the thrombus. It should also be taken into account that if thrombosis begins to spread to the area of the popliteal vein, this process often does not have any symptoms, since the thrombosis is floating. Therefore, when diagnosing, it is better to use the instrumental method.

Treatment depends on the location of the thrombus. But in any case, the disease is serious, and the patient must be under the supervision of doctors and lie in the hospital. But strict bed rest is not provided. Only for those who have relapses of the disease. You can move, you can not run, lift weights, play sports and various types of physical activity.

The most important thing in the treatment process is to prevent the spread of thrombosis as soon as possible. Treatment must be very effective so that there is no subsequent recurrence or thrombosis in other areas. Before prescribing treatment, it is necessary to take into account the place, part of the body on which thrombosis of the great saphenous vein has formed. You can combine several treatment methods, if necessary.

If thrombophlebitis occurs in a mild form, you can get by with medication and compresses. It is imperative to apply a bandage of an elastic bandage or golf on the affected limb. If the disease is in the acute phase, bandages can cause discomfort. If a blood clot in a vein grows in size, an operation is urgently needed. After the operation, you must follow the instructions of the doctor. Our clinic will help you recover and completely get rid of the disease. We will do our best to make you healthy and happy again!

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Endovasal laser coagulation of veins. 1st category of difficulty. including anesthesia allowance (local anesthesia).

The course of lymphopressotherapy 10 procedures. Accepted Phlebologist Candidate of Medical Sciences

The reception is carried out by a surgeon of the highest category, Doctor of Medical Sciences, Professor Komrakov. V.E.

A single session of sclerotherapy within the entire lower limb (foam sclerotherapy, microsclerotherapy).

Varicose veins, blood clots, valvular insufficiency, swelling in the legs

- all this is a reason to perform an ultrasound of the veins of the lower extremities

and consult with a phlebologist.

Lymphopressotherapy is indicated for

edema of the lower extremities, lymphostasis.

It is also used for cosmetic purposes.

Thrombosis of the great saphenous vein

Varicose veins are a rather serious disease that cannot be ignored. Varicose veins are formed in the lower extremities and affect the deep saphenous veins. Gradually, the blood fills the veins, because of which they become less elastic and lengthen, knots form, the valves in the vessels begin to work poorly and cannot normally push the blood up to the heart.

This disease occurs for the following reasons:

High venous pressure due to a sedentary lifestyle;

The female gender, since most often this disease occurs in women. Women often wear high heels, wear uncomfortable shoes, carry children and give birth. All this contributes to the appearance of diseases of the veins;

Heredity. If someone in the family already has varicose veins, the disease can be inherited by the younger generation;

Heavy physical activity. Gradually, the blood begins to linger in the lower extremities, normal blood circulation is disturbed. Instead of rising up towards the heart, the blood stays in the legs and gradually accumulates in the veins.

Symptoms of varicose veins

Symptoms include:

Heaviness in the legs;

Bursting pains in the calf area;

Leg cramps;

Veins overflowing with blood become visible through the skin, they are twisted, blue in color.

If varicose veins are ignored and not treated, serious complications often begin - the formation of thrombosis in the area of the great saphenous vein. Thrombosis is the formation of blood clots in the veins and blood vessels. Blood clots attach to the walls of blood vessels and interfere with blood flow. Gradually, there are more and more blood clots, and they can finally block the lumen of the vessel. Thrombi are of various shapes, there are also long ones, similar to leeches, they hold only one part of the vessel wall, the rest is in free movement. At any moment, such a blood clot can break off and enter large veins or arteries with blood. This is dangerous, because often blood clots clog the arteries of the lungs, the patient develops respiratory failure, pulmonary thromboembolism. It happens that such a disease ends in the death of a person. Symptoms thrombosis of the great saphenous vein the following:

Pain in the legs, especially in the area of the vein affected by blood clots. There is pain even when the legs are at rest, and when probing;

Overflow of a vein with blood;

You can feel blood clots in the vein;

Often the process of the disease begins in the upper region of the lower leg and gradually, and sometimes very quickly, in just a few hours, begins to spread to the region of the great saphenous vein. It happens that the causes of thrombosis are blood clots that have come off the walls of blood vessels and penetrated into the great saphenous vein with blood. A sick person needs the help of a specialist, so you can’t hesitate, you definitely need to contact a phlebologist - a doctor who diagnoses diseases of the veins and blood vessels. He will examine the affected limb and after the diagnosis will be able to prescribe an effective treatment. Often thrombosis of the great saphenous vein urgently operate, removing diseased veins and blood clots. Gradually, blood circulation improves, and blood can move normally through the veins.

After the operation, the patient must wear an elastic bandage, especially if he needs to walk somewhere. You always need to monitor the veins of the legs, take care of your health, do special exercises for prevention, it is advisable to raise your legs up after each busy day and lie in this position for a while, this helps blood circulate better. It is useful to swim, run short distances. If a person is forced to constantly be in one position at work, standing or sitting, after work you can walk on foot, instead of traveling by transport. For any indicators indicating problems with the veins, you need to be examined by a doctor. After all, the earlier the disease is detected, the easier it is to cure it without surgery with the help of medicines. Come to our clinic! Our doctors will help you cope with thrombosis, if necessary, they will perform an operation, after which your legs will be healthy again.

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Thrombosis - general concepts.

Thrombosis - the formation of blood clots in the lumen of the vessel, distinguish between venous and arterial thrombosis. Taking into account the subject of the site, we will talk about venous thrombosis.

Usually, the term thrombophlebitis is understood as superficial vein thrombosis, the terms - thrombosis, phlebothrombosis- deep vein thrombosis.

Blood clots can form in any veins - veins of the upper and lower extremities, veins of the abdominal cavity, etc.

With deep vein thrombosis, there may also be a slight increase in temperature, an increase in the venous pattern, etc.

Treatment of thrombophlebitis of superficial veins.

The main therapeutic measures are reduced to elastic compression ( elastic bandage or compression stockings), prescribing drugs.

Of the drugs, phlebotropic drugs (Detralex, Phlebodia), antiplatelet agents (thrombo-ACS), anti-inflammatory drugs (Voltaren) are used. Lioton-gel is applied locally.

All patients need Ultrasound of the veins to exclude concomitant deep vein thrombosis and to clarify the prevalence of superficial vein thrombophlebitis.

Treatment of deep vein thrombosis.

Almost all cases of deep vein thrombosis are treated in a hospital. An exception may be deep vein thrombosis of the lower leg, provided there is no threat of thromboembolism. Determine the risk of thromboembolism is possible only with ultrasound.

If deep vein thrombosis is suspected, the patient should be hospitalized immediately. In the hospital, an examination is carried out to clarify the prevalence of thrombosis, the degree of threat of pulmonary embolism, and immediately begin treatment.

Usually prescribe agents that reduce blood clotting (anticoagulants), antiplatelet agents, anti-inflammatory drugs, phlebotropic prapraty.

With massive thrombosis, in the early stages, it is possible to carry out thrombolysis - the introduction of agents that “dissolve” thrombotic masses.

With recurrent thrombosis, a genetic study is carried out, with positive tests, the issue of lifelong prescription of anticoagulants is decided.

Thrombosis in the system of the superior vena cava (veins of the upper extremities).

Occurs quite rarely. Almost never gives pulmonary embolism.

Causes of thrombosis in the system of the superior vena cava

- basically the same as other venous thrombosis. It may also develop as a complication of venous catheterization (cubital, subclavian catheter), sometimes occurs as a result of prolonged compression or an uncomfortable position of the upper limb (for example, in sleep).

Thrombosis of the axillary or subclavian vein is most common ( Paget-Schretter syndrome). During the day, there is swelling of the entire upper limb with a pillow-shaped edema of the hand. There may be slight bursting pains. The color of the limb is not changed, or slightly cyanotic.

Treatment of Paget-Schretter Syndrome

- the same as other venous thrombosis.

Thrombosis of the superficial veins of the upper extremities.

Usually occurs after intravenous injections, taking blood from a vein. It is characterized by compaction along the vein, slight redness, moderate pain.

Treatment usually does not require, but with severe symptoms, lyoton-gel can be applied topically and anti-inflammatory drugs (nimesil, voltaren, etc.) inside.

Treatment of thrombosis, thrombophlebitis of veins - cost of services

Consultation of a phlebologist (c.m.s.) (survey, examination, appointment of examination and treatment) - 15 00 rubles

Ultrasound of the veins of the lower extremities - 2000 rubles

You can see a detailed route map.

In fact, thrombophlebitis of the saphenous vein is a "double" disease. Because, firstly, the venous walls themselves become inflamed. And secondly, a blood clot is formed in the vein - a thrombus.

Superficial thrombophlebitis in the vast majority of cases manifests itself as an acute disease. More often, varicose-transformed tributaries of the large (and / or small) saphenous vein, as well as perforating veins, are thrombosed.

Important! If untreated, thrombosis extends to the great (small) saphenous vein itself, and further to the deep veins.

Causes of thrombophlebitis of superficial veins

The cause of any thrombosis is a combination of three factors:

change in the configuration of the vein (for example, varicose transformation) and, as a result, "swirls" of blood in the lumen of the vessel;
"thickening" of the blood - a tendency (hereditary or acquired) to thrombosis;
damage to the vein wall (injection, trauma, etc.).

The main and most common cause of superficial thrombophlebitis is varicose veins. Also, the most common risk factors are:

genetic predisposition;
pregnancy and childbirth;
obesity, hypodynamia;
endocrine and oncological diseases.

Superficial thrombophlebitis: symptoms and manifestations

the appearance of "nodules" and seals in the vein;
edema;
sharp pain;
local increase in temperature;
discoloration of the skin in the area of the inflamed vein.

Treatment of superficial thrombophlebitis

For the treatment of thrombophlebitis of superficial veins, different methods and their combinations are used.

More often it can be conservative treatment:

compression therapy - wearing compression stockings, special elastic bandaging;
taking non-steroidal anti-inflammatory and analgesic drugs;
locally, in the area of inflammation - cold;
according to indications - taking drugs that "thinn" the blood.

Emergency surgical treatment of acute thrombophlebitis of the saphenous veins is prescribed , as a rule, in cases where thrombosis does not affect the tributaries, but directly the large or small saphenous veins. So, with ascending thrombophlebitis of a large or small saphenous vein, the trunk of the main saphenous vein is thrombosed directly. With the spread of thrombosis of the great saphenous vein to the thigh, thrombophlebitis is considered ascending. For the small saphenous vein, this is the middle and upper third of the lower leg.

In this case (if technically possible), either endovenous laser obliteration or crossectomy is used - ligation of the large (small) saphenous vein along with its tributaries.

In this situation (if technically possible), a thrombus is removed from the deep veins and a crossectomy is performed - ligation of the saphenous vein at the mouth.

Venous thrombosis (phlebothrombosis) is an acute disease that is characterized by the formation of a thrombus in the lumen of a vessel (a blood clot that obstructs the lumen of the vessel) with a more or less pronounced inflammatory process and a violation of normal blood flow.

Often, thrombosis and thrombophlebitis are diagnosed in the veins of the thigh. Consider this disease.

Damage to deep, superficial and perforating veins of the thigh

The entire venous system of the thigh can be divided into deep, superficial and perforant (connects deep and superficial). Thrombus formation in the femoral veins most often occurs in the deep system. The defeat of the superficial vein system most often occurs with thrombophlebitis.

For thrombus formation to occur in the femoral veins, the following changes must occur:

Slowing of blood flow in a vessel (stasis). Most often observed with prolonged immobilization of the limb (for example, after an injury).
Changes in the rheological properties of blood (increased clotting). It may be due to hereditary pathologies (for example, a lack of factors that prevent blood clotting) or to previous surgical interventions.
Damage to the inner surface (endothelium) of the vein. It can be provoked by various medical manipulations (for example, setting venous catheters, various surgical interventions).

Distinguishing symptoms and signs

For thrombophlebitis of the superficial veins of the thigh, the following points are characteristic:

soreness along the course of the venous vessel (the vein is palpable as a cord with nodes);
swelling around the painful area (sweating of the liquid part of the blood into the surrounding tissues);
hyperemia (redness) of the skin over the affected area of the vein (associated with the expansion of subcutaneous capillaries);
an increase in local temperature over the affected area of the vessel;
an increase in body temperature (the body's response to an existing infectious and inflammatory process);
general malaise.

The presence of a thrombus - a blood clot that blocks the lumen of the vessel, in the deep vein system can be characterized by:

bursting soreness in the area of the affected vein segment;
gradually increasing intensity of the pain syndrome;
cyanosis of the skin (occurs due to circulatory disorders, stagnation of blood in the venous vessels);
tension of the skin;
swelling of superficial veins.

Features of central and ascending femoral vein thrombosis

Phlebothrombosis can be divided into:

central (originates from the venous system of the pelvis);
ascending (begins with the veins of the lower leg).

With the ascending variety, the veins on both sides are affected with the same frequency. A long latent course of the pathological process is characteristic. The emerging edema is of an “ascending” character (a gradual increase in edema is noted, which originates from the foot, gradually spreads to the lower leg and then to the thigh).

Changes during the transition to thrombophlebitis

Thrombophlebitis is an inflammatory process that occurs in the inner wall of the vein. The resulting blood clots attach to the vascular wall. During the first 3-4 days, the forming blood clots do not hold well on the wall, so their detachment and migration along the bloodstream is possible. If this does not happen, then the thrombus is fixed on the vessel wall, which provokes the development of an inflammatory reaction. The latter leads to the formation of new blood clots.

To the clinical picture of phlebothrombosis (swelling, soreness, cyanosis of the skin), manifestations of thrombophlebitis (fever, increased local temperature, redness) are added.

How to diagnose a disease

The following methods are used for diagnosis:

Physical examination. This includes palpation. Changes in the temperature of the skin of the thigh, swelling of the tissues are noted. It is also characterized by a change in skin color.
Ultrasound duplex examination. The analysis of the reflected signal is performed, according to which the nature of the venous blood flow is assessed. It is possible to determine the location of the formed thrombus, its nature and size. With thrombophlebitis, a change in the thickness and structure of the walls of the venous vessel is detected.
thermography. It is based on the fact that during the formation of thrombosis, the temperature of the tissues becomes higher than in the normal state.
Plethysmography. Its action is based on the fact that in the presence of a thrombus, an increase in blood deposition occurs. This leads to a change in the electrical resistance of tissue structures, which is displayed graphically.
Phlebography. An X-ray contrast agent is introduced into the venous bed, followed by its visualization. The presence of an obstructive blood clot is evidenced by the "amputation" of the vein - the breakage of the shadow of the radiopaque preparation.
Analysis for D-dimers. D-dimers are a breakdown product of the fibrinogen protein, which is involved in the process of blood clotting. Its level increases with thrombosis.

Conservative and surgical therapy

The main tasks in the treatment of deep femoral vein thrombosis are:

restoration of normal venous outflow;
reduced risk of developing pulmonary embolism - pulmonary embolism;
prevention of further growth of an existing thrombus;
prevention of damage to the valve apparatus of the veins;
prevention of the development of re-development of thrombosis.

Therapeutic tactics for this pathology is determined directly on the basis of the pathology clinic and the results of instrumental studies.

For conservative therapy,:

Anticoagulant drugs (reducing blood clotting ability). Heparin, low molecular weight heparins (Enoxaparin, Deltaparin, Fraxiparin) are used.
fibrinolytic drugs. These are the drugs that are able to dissolve the formed blood clot. They are used in the first few days after thrombosis, after their use is ineffective. These include Alteplase, Tenecteplase.
Antispasmodics. Papaverine, Drotaverine.
Venotonics. Detralex, Phlebodia 600.

With the existing inflammatory process affecting the wall of the vein, the treatment process consists in the use of the following drugs:

Anticoagulants. Most often used topically in the form of heparin ointment.
Venotonics. Troxerutin, Detralex, Phlebodia 600.
Non-steroidal anti-inflammatory drugs. The most commonly used Diclofenac, Nimesulide.
Antibiotic therapy. They resort to it with a pronounced inflammatory process.

Also recommended are warm compresses, the use of physiotherapy (UHF). Bed rest should not be observed for a long time, since physical activity improves blood flow, which is the prevention of blood clots. For the period of physical activity, the use of elastic compression (elastic bandaging, compression stockings) is recommended.

Operative treatment of thrombophlebitis is indicated only if there is:

ascending thrombophlebitis;
formed thrombus in the superficial system of the veins of the thigh.

Possible complications and prognosis

Possible complications of thrombophlebitis and thrombosis of the veins of the thigh include:

chronic venous insufficiency;
TELA;
formation of trophic ulcers;
lipodermatosclerosis.

Without treatment, the risk of complications is high. In the absence of taking anticoagulant drugs, approximately 30% of patients experience a relapse of the pathology within 3 months, after a year - in 70%. After the treatment of thrombosis, the probability of recurrence after 1 year is about 4-5%.

Thrombosis and thrombophlebitis are dangerous pathologies that can lead to the development of formidable complications. To avoid this, timely diagnostic procedures are necessary, as well as the correct choice of treatment tactics.

Thrombophlebitis of the superficial veins of the lower extremities is a disease characterized by the formation of blood clots on the wall of these vessels and blockage of their lumen. The disease leads to circulatory disorders, muscle weakness and dysfunction of the lower limb. Pathology should not be ignored, since there is a risk of developing serious complications. Consider what superficial thrombophlebitis is - the nature of the pathology and methods of treatment.

How pathology develops

For the development of thrombosis of superficial veins in the legs, a change in blood viscosity, a violation of the vital activity of white blood cells, a decrease in blood flow and damage to the venous wall are necessary. In a certain area, a precipitate forms, which gradually thickens and forms a clot that closes the lumen of the vessel. Later, inflammation joins, and signs of the disease appear. Sometimes a thrombus breaks off and acute thrombophlebitis of the saphenous veins is formed.

According to ICD 10, this pathology is assigned the code "I 80".

Etiology

Superficial thrombophlebitis is a complex pathology that progresses gradually. For its development, a single pathological chain is needed, to which the following reasons can lead:

Deep vein thrombosis of the leg - when blood clots appear in these areas, they can migrate with the blood flow to the superficial vessels;
Limb injuries - any damage to the skin, muscles and other tissues destroys the integrity of the wall of the saphenous vein and can lead to the development of thrombosis;
Burdened heredity - according to scientific data, there is a genetic predisposition to increased "gluing" of white blood cells and the formation of blood clots;
Varicose veins - with this pathology, stagnation occurs in the venous bed, which can provoke thrombophlebitis;
Infections - when the body is infected with microbial agents, complex protective mechanisms are simultaneously triggered by the rapid formation of blood clots at the sites of cell damage;
Allergy - can provoke an autoimmune attack of white blood cells;
Overeating and excess weight - in this case, the concentration of substances that increase its viscosity increases in the blood;
Operations - when interfering with the internal environment of the body, the risk of blood clots and damage to blood vessels increases;
Pregnancy period - a change in the hormonal background can adversely affect the regulation of the tone of the vascular system and the qualitative composition of the blood.

In addition to the reasons described, the side effects of certain drugs during treatment, various types of poisoning can lead to disruption of local blood flow in the lower extremities. Increased blood viscosity can also develop when taking contraceptives, plasma transfusions. The vascular wall is damaged by frequent drips or during intravenous injections.

Disease classification

In addition to ICD, thrombophlebitis is divided into several forms depending on the severity of symptoms and the nature of local changes.

According to the severity of clinical signs, they distinguish:

Acute thrombophlebitis is characterized by rapid progression and severity of symptoms: pain appears sharply, rapidly increases, swelling of the lower limb progresses, its function is impaired. This condition requires urgent treatment;
Chronic thrombophlebitis - develops slowly, moderate symptoms are present, it may take several months for the patient's condition to completely deteriorate.

Depending on the pathogenesis, two forms of thrombosis of the veins of the lower limb are distinguished:

Purulent thrombophlebitis - characterized by the involvement of microbes and the development of purulent inflammation. A very dangerous condition requiring additional antibiotic treatment;
Non-purulent thrombophlebitis is a classic variant of the pathology, proceeds with signs of circulatory disorders in the lower limb.

If the patient has a purulent variant of the pathology and there is no open injury, it is necessary to be examined for the presence of a chronic focus of infection in parallel with the treatment.

Clinical picture

The first signs of the disease usually develop gradually, when the thrombus slowly increases in size and clogs the lumen of the saphenous vein, causing circulatory disorders in the lower limb. If the clot breaks away from the wall, an acute condition occurs that requires immediate treatment.

Classical symptoms of thrombophlebitis of superficial veins:

Pain in the affected area, aggravated by movement or touch;
Under the skin, the outline of the vein is visible along the “inflated” contour and the characteristic cyanotic color - this indicates its blockage when it increases under pressure;
Subcutaneous red nodules appear along the vessel;
Edema of the lower limb develops, an increase in local temperature;
With a long course of thrombosis, ulcers appear that bleed and hurt.

Often these lesions are called ascending thrombophlebitis, as the saphenous veins rise up to the heart and swell.

The most common two types of thrombophlebitis of the lower limb:

Ascending thrombophlebitis of the great saphenous vein (GSV) is characterized by edema mainly on the inner side. Under the skin, you can find a seal rising up, around which redness forms, later ulcers appear. Thrombosis of the great saphenous vein of the thigh develops quite often, requires special attention of the attending physician;
Thrombophlebitis of the small saphenous vein - the symptoms are more blurred than in the previous case. It is characterized by classical manifestations of the disease and the defeat of the upper parts of the lower limb.

With varicose veins, thrombosis of the GSV on the right is very often observed.

Establishing diagnosis

For diagnosis, it is necessary to visit the attending physician - the doctor will conduct an external examination and detect subcutaneous changes. You can also recognize blood clots on your own if you look at the photo of superficial thrombophlebitis of the lower extremities - swelling and discoloration of the skin will be noted in the picture, swollen cyanotic outlines can be seen along the vein.

For further detection of thrombosis, the following research methods are relevant;

Doppler ultrasound;
Reovasography;
Ultrasonic duplex angioscanning;
Venography;
contrast radiography.

Treatment

Treatment of superficial thrombophlebitis of the lower extremities involves strict bed rest and limited mobility. This rule should be followed to reduce the risk of thrombus detachment from the wall of the subcutaneous vessel. For the same purpose, the use of an elastic bandage is shown to reduce congestion.

Drug treatment of thrombophlebitis of the superficial veins of the lower extremities should be comprehensive and include drugs that strengthen the vascular wall, thin the blood and prevent the formation of blood clots.

The most famous medicines

Heparin - relieves swelling and inflammation, prevents thrombosis. Rubbed three times a day, quickly absorbed and acts on the subcutaneous tissue;
Gel Lyoton - has similar properties, is applied 2 times a day;
Cream Ketonal - treatment should be carried out twice a day to relieve local symptoms and anesthesia in the affected area.

The second stage of treatment is to strengthen the walls of the subcutaneous vessels. For this purpose, venotonics are used:

Phlebodia - you should drink 1 tablet per day for 2-3 months;
Venarus - used three times a day, perfectly strengthens the venous wall;
Troxevasin - treatment is allowed both with tablets and the application of ointments to strengthen the superficial veins of the lower limb;
Venoruton is an effective drug, available in the form of capsules or gel.

To increase the effectiveness of drug treatment of thrombosis, it is allowed to use alternative recipes for thrombophlebitis, but only under the supervision of the attending physician.

Physiotherapy

This type of treatment is more likely to prevent the formation of blood clots in the saphenous veins of the lower limb and is aimed at strengthening their walls. For this purpose, the following is shown:

Medicinal electrophoresis with therapeutic ointments;
warming up;
laser treatments;
magnetotherapy;
Shock wave therapy.

Surgical treatment

Surgery is indicated in case of poor effectiveness of conservative treatment or the presence of serious complications from thrombosis of the superficial vessels of the lower limb. To remove a thrombus, the following types of operations are shown:

Crossectomy - ligation of the saphenous vein;
Radical intervention - complete removal of the saphenous veins;
Palliative surgical treatment - removal of a thrombus from the lumen of the vessel.

Forecast

If the first signs of the disease are detected, you should immediately seek medical help - if there is appropriate treatment, it is possible to dissolve the thrombus and return the function of the lower limb. You should also follow the doctor's recommendations for the prevention of thrombophlebitis.

The formation of blood clots in the superficial veins leads to thrombosis, and in the presence of inflammation, to thrombophlebitis of the subcutaneous vessels of the lower limb. In most cases, the pathology develops gradually and requires examination. Do not delay with treatment, in the early stages it is very effective.

Ascending thrombophlebitis

Symptoms

Feeling of heaviness;
Temperature increase.

Acute form of leakage

Risk group

Basic principles of treatment

in a conservative way;
Surgical intervention.

Basic principles of therapy

Thrombus location;
Location of affected veins.

Local therapy includes:

Fixation with elastic bandage.
Taking inhibitors.

Thrombus dissolution.

Preventive actions

Ascending thrombophlebitis

Many scientific works, encyclopedic data are devoted to the disease of ascending thrombophlebitis. People want to know about the nature of the disease, methods of treatment.

Symptoms

The symptoms of the disease are often brightly presented, they do not cause difficulties in diagnosing.

The constant presence of a feeling of fullness of the thigh, lower leg;
Feeling of heaviness;
The skin along the length of the affected leg vein is red, inflamed;
Pain in the lower leg, thigh, aggravated by movement;
Weakness, constant feeling of malaise;
Temperature increase.

With such damage to the vessels, swelling of the lower extremities rarely appears. To the touch along the affected area, an infiltrate is felt, resembling a dense cord that creates pain. When diagnosing, it is important to determine the presence of a thrombus in the vein, its exact location.

The disease poses a danger to life, so it is important to seek medical help from a phlebologist in time. They will help to cope with the disease, prevent complications in time.

Acute form of leakage

Acute ascending thrombophlebitis #8212; a complex consequence of varicose veins. This form of the disease carries the risk of death #8212; there is a floating thrombus in the vein, the disease quickly moves from the small saphenous vein to the deep vein of the thigh. This threatens to damage the pulmonary artery.

Signs of an acute form of ascending thrombophlebitis:

Risk group

There are people prone to the development of ascending thrombophlebitis of the veins of the lower extremities. They have a high chance of developing the disease.

If a person has found himself on the list, you should be attentive to the state of your veins, make adjustments to your lifestyle.

Basic principles of treatment

At the first manifestations of ascending thrombophlebitis of the saphenous vein, you should contact a medical facility #8212; Doctors will diagnose and prescribe treatment. The fight against the disease is carried out:

in a conservative way;
Surgical intervention.

Sometimes complex treatment of thrombophlebitis of the veins of the lower extremities is advisable.

Basic principles of therapy

Treatment of ascending thrombophlebitis is complex.

In case of pathology of the great saphenous vein, when the clot is located above the middle of the thigh, or if the small saphenous vein is affected, treatment in the form of an operation is prescribed.

Treatment of the acute form of the disease

The treatment of the acute form of the disease is influenced by factors:

The state of the vessels of the lower extremities;
Thrombus location;
Location of affected veins.

Often used conservative treatment with medication, local therapy, often in a hospital.

Local therapy includes:

Use of ointments with heparin.
Semi-alcoholic, cold compresses.
Fixation with elastic bandage.
Taking drugs that stabilize blood circulation.
Taking inhibitors.
Painkillers.

The operation is carried out in the following cases:

Thrombus dissolution.
risk of developing pulmonary embolism.
The defeat of the acute form of a large, small saphenous vein, when the thrombus is located above the middle of the thigh.

To remove a thrombus, laser obliteration is often used, based on heating the vessel wall above the location of the thrombus. Crossectomy operation #8212; ligation of a superficial vessel at the point of transition to a deep vessel is performed under local anesthesia.

Preventive actions

People who are at risk of developing ascending thrombophlebitis should heed the recommendations of a phlebologist:

Thrombophlebitis of the saphenous veins

Thrombophlebitis of the saphenous veins

What is subcutaneous vein thrombophlebitis?

In fact, thrombophlebitis of the saphenous vein is a "double" disease. Because, firstly, the venous walls themselves become inflamed. And secondly, a blood clot is formed in the vein - a thrombus.

Superficial thrombophlebitis in the vast majority of cases manifests itself as an acute disease.

More often, varicose-transformed tributaries of the large (and / or small) saphenous vein, as well as perforating veins, are thrombosed. But if left untreated, thrombosis extends to the great (small) saphenous vein itself, and further to the deep veins.

Causes of thrombophlebitis of superficial veins

The cause of any thrombosis is a combination of three factors:

A change in the configuration of a vein (for example, varicose transformation) and, as a result, a "swirl" of blood in the lumen of the vessel.

- "thickening" of the blood - a tendency (hereditary or acquired) to thrombosis

- damage to the vein wall (injection, trauma, etc.)

The main and most common cause of superficial thrombophlebitis is varicose veins. Also, the most common risk factors are:

- pregnancy and childbirth;

- endocrine and oncological diseases.

Superficial thrombophlebitis: symptoms and manifestations

- the appearance of "nodules" and seals in the vein;

— local increase in temperature;

- discoloration of the skin in the area of the inflamed vein.

Treatment of superficial thrombophlebitis

For the treatment of thrombophlebitis of superficial veins, different methods and their combinations are used.

– compression therapy – wearing compression stockings, special elastic bandaging;

- taking non-steroidal anti-inflammatory and analgesic drugs;

- locally, in the area of inflammation - cold;

- according to indications - taking drugs that "thinn" the blood.

In this case (if technically possible), either endovenous laser obliteration or crossectomy is used - ligation of the large (small) saphenous vein along with its tributaries.

In this situation (if technically possible), a thrombus is removed from the deep veins and a crossectomy is performed - ligation of the saphenous vein at the mouth.

Inflammation of the veins located above the fascia, which is usually accompanied by thrombosis of varying severity.

Inflammation of varicose veins:≈90% of all cases of phlebitis of the superficial veins, more often affects the great saphenous, much less often the small saphenous vein of the lower limb; stagnation of venous blood in varicose veins and changes in the vein wall → thrombosis → inflammation of the vessel wall.

Spontaneous thrombophlebitis of superficial veins usually involves the small saphenous vein or the great saphenous vein, but can develop in any superficial vein.

Painful limited swelling with reddening of the skin; in case of inflammation of varicose veins, they are easy to palpate as a nodular or cord-like thickening. In the case of catheter-associated phlebitis of the superficial veins, symptoms appear in the area of the catheterized vein; it is impossible to take blood from the catheter if the thrombus leads to its occlusion; sometimes the course of the disease is asymptomatic (5-13%). With purulent thrombophlebitis of the superficial veins, additional fever, severe redness, pain and the presence of purulent content at the site of the affected vessel.

Untreated disease resolves after a few days or weeks. Usually, after a few months, varicose veins undergo at least partial recanalization. In the case of phlebitis of the great saphenous vein of the lower extremity and the spread of thrombosis proximally, there is a risk of thrombosis moving into the superficial femoral vein (namely, proximal deep vein thrombosis). Phlebitis of superficial veins is associated with a high risk of venous thromboembolic disease (VTEB). The frequency of coexistence of deep vein thrombosis and superficial vein phlebitis is highest in the case of damage to the near segment of the saphenous vein.

Is put on the basis of clinical symptoms; in the case of inflammation associated with the presence of a catheter/cannula in a vein, culture (the material is usually the tip of the removed catheter) can reveal the etiological factor. In a limited form, especially associated with the presence of a catheter in the vessel or the action of irritants, diagnostic studies are not needed. In case of inflammation of the veins (varicose veins) of the lower extremities, perform an ultrasound examination to localize the top of the thrombus and determine the distance from the mouth of the deep vein system, since inflammation within the proximal saphenous vein (above the knee joint) can go into the deep vein system. In patients with migrating phlebitis without an obvious cause, conduct a detailed diagnosis to rule out cancer. In patients with phlebitis of a previously unchanged vein (non-varicose) in whom the etiological factor has not been determined, consider diagnosis in the direction of hypercoagulability or cancer.

1. Catheter-associated phlebitis of superficial veins: in the case of a short peripheral catheter, stop the administration of drugs through this catheter and remove it from the vein; in case of severe pain → NSAIDs (po or topical; drugs →) or heparin (topical gel) until symptoms subside, but no longer than 2 weeks.

The use of heparin at a therapeutic dose is not recommended, and antithrombotic prophylaxis (using heparin SC) should be used in patients who are weighed down by an increased risk of venous thrombosis, for example. immobilized, after episodes of VTEB or with oncological disease → . Consider anticoagulant treatment also in patients with thrombosis of the proximal segment of the medial saphenous or lateral saphenous vein in whom symptoms of inflammation persist despite catheter removal. The duration of therapy depends on the clinical picture and the result of ultrasound.

Superficial venous thrombosis is not an indication for routine removal of a central catheter, especially if it is functioning normally.

2. Purulent thrombophlebitis of superficial veins→ remove the source of infection (e.g. catheter) and apply antibiotic therapy is best targeted, and if this is ineffective, consider opening, draining, or excising a segment of the affected vein.

3. Thrombosis of superficial veins: if it concerns a segment of the superficial vein of the lower limb ≥5 cm long → fondaparinux s / c 2.5 mg / day. or low molecular weight heparin at a prophylactic dose (drugs → , dosage →) for ≥4 weeks. or a vitamin K antagonist (acenocoumarol or warfarin) at a dose that maintains an INR of 2–3 for 5 days with heparin, then on its own for 45 days. Anticoagulant treatment also substantiates: extensive thrombosis, thrombosis involving the veins above the knee, especially near the saphenofemoral orifice, severe clinical symptoms, thrombosis covering the great saphenous vein, history of VTEB or superficial vein thrombosis, active oncological disease, recent surgery.

In the case of phlebitis of the great saphenous vein and proximal spread of thrombosis, due to the risk of thrombosis transferring to the superficial femoral vein, refer the patient to the surgeon to ligate the great saphenous vein. There is no need to immobilize a patient with phlebitis of the superficial veins of the lower extremities, however, unconditionally apply a multilayer compression bandage from an elastic bandage and use this treatment until the acute inflammatory process disappears. After acute inflammation and swelling subsides, consider fitting appropriate compression socks or stockings.

Limited superficial vein thrombosis(thrombosis of a short vein segment<5 см или далеко от соединения большой подкожной вены с бедренной) вероятно не нуждается в антикоагулянтном лечении. Применяйте НПВП (п/o или местно) с целью облегчения симптомов.