Thrombophlebitis — inflammatory process in an internal venous wall with formation of blood clot. It is characterized by consolidation and reddening on the course of an expanded vein, sharp morbidity, hypostasis, increase in local and general body temperature. At spread of thrombophlebitis on deep veins emergence of such terrible complication as TELA is possible. Characteristic clinical symptoms, data of an ultrasonic angioskanirovaniye, UZDG of veins, reovazografiya help to diagnose thrombophlebitis. Conservative treatment of thrombophlebitis is directed to the prevention of its distribution and a rassasyvaniye of the formed blood clot. Modern surgical treatment allows to remove the affected vein together with trombotichesky masses.
Thrombophlebitis — inflammatory process in an internal venous wall with formation of blood clot. It is characterized by consolidation and reddening on the course of an expanded vein, sharp morbidity, hypostasis, increase in local and general body temperature. In most cases demands expeditious treatment in view of high probability of development of terrible consequences: septic complications, a separation of the blood clot leading to thrombosis of deep veins or a thrombembolia of branches of a pulmonary artery.
Thrombophlebitis can proceed sharply or chronically. If during a demonstration of sharp thrombophlebitis the patient did not receive adequate treatment, the probability that the disease will accept chronic recidivous character is high. Quite often sharp thrombophlebitis passes in chronic even at timely adequate therapy. On the nature of pathological process allocate not purulent and purulent thrombophlebitis.Please Help us - click on the advertisement
Under certain conditions thrombophlebitis can develop in veins of any localization, however, most often pathological process arises in vessels of the lower extremities. As a rule, thrombophlebitis affects varikozno expanded superficial veins. Approximately deep veins are involved in 10% of cases in process, along with superficial.
In development of thrombophlebitises of various localization a number of factors matters: change of composition of blood and increase in its coagulability, delay of a blood-groove, damage of a venous wall of any genesis (trauma, disease, endocrine and neurotrophic frustration).
There is a danger of development of thrombophlebitis at the following diseases and states:
- local purulent processes;
- posttromboflebitichesky disease;
- chronic diseases of cardiovascular system;
- some diseases of blood;
- states after surgical interventions and medical abortions;
- postnatal period;
- oncological diseases;
- long kateterization of veins;
- general infectious diseases.
Sharp thrombophlebitis of superficial veins is most often localized in varikozno expanded veins of the top third of shins and the lower third of hips. Approximately in 95% of cases the trunk of a big hypodermic vein and its inflows is surprised. The patient complains of the acute nagging pain on the course of the affected vein amplifying when walking. Temperature increase to 37,5-38 °C is possible. Hyperaemia in the form of strips is noted. At a palpation of a trombirovanny vein local temperature increase, condensed painful is defined.
Sharp thrombophlebitis of superficial veins can develop in two directions. At a favorable current of the phenomenon of thrombophlebitis gradually disappear (recovery occurs from 10 days to 3 and more months in time). At most of patients the vein gleam in the subsequent is restored, some patients have an outcome a full obliteration of the damaged vessel.
The adverse option of development of a disease is possible. In this case process takes deep veins or extends proksimalno (the ascending thrombophlebitis). Danger of thrombosis of deep veins increases at the varicose veins which are followed by valvate insufficiency of perforantny veins (the vessels connecting deep and superficial veins).
At distribution of process on deep veins thrombophlebitis of deep veins develops () which clinical symptomatology depends on localization of blood clot. In some cases proceeds asymptomatically. It is necessary to consider that thrombophlebitis of deep veins – the serious disease posing hazard to life of the patient. The most terrible complication of a flebotromboz is the thrombembolia of a pulmonary artery. Chronic venous insufficiency can become an outcome of a disease.
Sharp superficial and deep thrombophlebitis of the lower extremities, as a rule, arises at patients with a varicosity. The varicose veins usually affect both extremities. At any option of development of thrombophlebitis formation of blood clots in deep and superficial veins of the second lower extremity is possible. Therefore at the choice of tactics of treatment it is necessary to have full data on a condition of venous system of both lower extremities. Chronic thrombophlebitis is the result of sharp process (transition of a sharp form in chronic is noted at 60% of patients), is inclined to a long recidivous current.Please Help us - click on the advertisement
Diagnosis of thrombophlebitis
Clinical displays of thrombophlebitis are defined by localization of blood clot, prevalence of pathological process, duration of a disease and expressiveness of an inflammation of surrounding soft fabrics. When determining extent of blood clot during external survey it is necessary to take for its final point limit of morbidity of a vein, but not the termination of a dense tyazh on the course of the struck vessel.
Tool researches (reovazografiya, ultrasonic angioskanirovaniye, UZDG of veins of the lower extremities) by means of which establish character, localization and extent of blood clot are conducted, define a condition of a venous wall and degree of safety of a gleam of a trombirovanny vein.Please Help us - click on the advertisement
Treatment of thrombophlebitis
Conservative therapy of thrombophlebitis is carried out by the phlebologist at emergence of process in earlier healthy veins, at limited defeat of superficial vessels of foot and a shin. Locally apply UVCh and bandages with geparinovy ointment. To patients appoint the anti-inflammatory medicines and means promoting reduction of stagnation in veins (, , hydroxyethylrutoside). At the expressed local inflammation antibiotic treatment is recommended. Elastic bandaging of the affected extremity is shown.
The superficial ascending thrombophlebitis affecting big and small hypodermic veins is the indication to hospitalization in connection with threat of further distribution and involvement in process of deep veins. The patient is transferred to a bed rest (4-5 days), extremities give sublime situation. In early terms apply medicines of fibrinolytic action to dissolution of blood clot (chymotrypsin, trypsin, an urokinaza, streptokinase, ). Appoint anti-inflammatory medicines, anticoagulants, flebotonik, locally – geparinsoderzhashchy gels and ointments.
In the presence of contraindications to anticoagulants (ulcers, fresh wounds, hemorrhagic diathesis, diseases of a liver and kidneys, open forms of tuberculosis) the girudoterapiya is recommended (treatment by bloodsuckers). Novokainovy lumbar blockade according to Vishnevsky is applied to improvement of collateral blood circulation and reduction of a pain syndrome. The expressed hyperthermia and suspicion of purulent thrombophlebitis are the indication to antibiotic treatment.
Contrary to popular belief, sick thrombophlebitis of superficial veins it is not necessary to observe a bed rest long. Muscular contractions promote strengthening of a blood-groove in deep veins, reducing thereby probability of formation of blood clots. For the period of physical activity to the patient recommend to use elastic bandage for fixing of blood clot in a superficial vein.
The modern flebologiya successfully applies new low-traumatic technicians of surgical treatment. Thanks to it recently most of clinical physicians gives preference to operational techniques of treatment of sharp superficial thrombophlebitis of a hip and shin. Early surgical intervention excludes further distribution of process through kommunikantny veins on system of deep veins, reduces terms of treatment and prevents transition of a disease to a chronic form.
The emergency expeditious treatment is shown at the sharp ascending thrombophlebitis of veins of a shin and at primary localization of blood clot in superficial veins of a hip as in these cases danger of development of thrombophlebitis of deep veins increases. At septic thrombophlebitis Troyanov-Trendelenburga operation is performed.
In the remote period resort treatment with application of hydrosulphuric and radonic bathtubs is recommended to the patients who had sharp thrombophlebitis. Treatment of an exacerbation of chronic superficial thrombophlebitis is carried out similar to therapy of sharp process. With chronic thrombophlebitis it is necessary to direct to sanatorium treatment of patients only in the absence of trophic frustration and signs of an aggravation.Please Help us - click on the advertisement
Prevention of thrombophlebitis
It is necessary to treat in due time chronic diseases of veins. Patients who in the past had thrombophlebitis should use constantly means of an elastichesky compression, to limit amount of animal fats in a diet, to eat products with high content a routine and ascorbic acid (berries, fruit, vegetables). For prevention of a recurrence 2-3 times a year are appointed the course treatment including reception of fleboprotektor and physiotherapeutic procedures (treatment currents and variation magnetic fields).