Ascending thrombophlebitis of the great saphenous vein treatment. Is thrombophlebitis dangerous ⋆ Heart Treatment

How to escape from thrombophlebitis, and what processes are hidden under this medical term? Thrombophlebitis is inflammation of the veins accompanied by the formation of blood clots.

Extremely dangerous. Since detached blood clots lead to disruption of arterial flow. Or blood clots “wander” inside the circulatory system, threatening to clog the lung or heart.

More often the disease affects the superficial vessels of the extremities than the internal ones. Large and small superficial veins pass through the lower and upper extremities.

If the inflamed superficial veins of the arms or legs have some palpable nodules (blood clots), then you need to go to the hospital. In this case, the disease is classified as thrombophlebitis of the great saphenous veins (GSV).

Possible causes of the disease

A dangerous disease can occur accidentally, as a result of the insertion of a catheter into a vein. And sometimes it develops over years due to chronic venous insufficiency.

Venous insufficiency, as well as varicose veins, should be constantly treated and not neglected. Women over 45 years of age are at risk. Especially those whose grandmother or mother has thrombophlebitis.

The most common reasons:

  • clotting disorder;
  • venous insufficiency;
  • taking certain medications;
  • varicose veins;
  • work in a permanent sitting position;
  • long stay of the catheter in the vein;
  • lack of physical activity.

The following factors provoke the development of the disease and aggravate the course of the disease:

  • gynecological operations;
  • vein surgery;
  • obesity;
  • oncology;
  • use of hormonal contraceptives;
  • prolonged compression of blood vessels, leading to blood stagnation;
  • dehydration of the body;
  • age-related changes in the circulatory system;
  • heart problems.

If you are predisposed to varicose veins, you need to walk often, take prescribed medications, and wear special underwear. This will reduce the risk of developing thrombosis with inflammation. My patients used it, thanks to which they can get rid of varicose veins in 2 weeks without much effort.

Symptoms and diagnosis of thrombophlebitis

To clearly know the diagnosis, you need to make an appointment with a phlebologist. A phlebologist specializes in vein diseases. After examination, he will accurately determine which vessels are affected. Thrombophlebitis of the bvv corresponds to the following symptoms:

  • swollen veins;
  • pain when palpating blood clots;
  • headache;
  • aching pain in the joints when walking and sitting for long periods of time;
  • hyperthermic skin nearby;
  • bluish skin in the lower leg area;
  • the vein itself is enlarged and hard to the touch;
  • in the acute stage, temperature up to 38C°

The severity of these symptoms increases the more serious the disease. Chronic is characterized by the presence of a large number of blood clots and a temperature that appears from time to time.

The superficial blood vessels of the lower extremities run along the back of the leg. It starts from the internal vessel with venous blood of the foot, and ends on the thigh.

Each superficial large vein flows into the femoral vein. Diagnosis is not difficult; swollen shins are visible immediately. And blood clots are easily palpable.

Ascending thrombophlebitis develops quickly. Inflammation moves from the lower leg to the lower third of the thigh, and higher. The legs become inflamed up to the groin, swell and the vessels become dark blue.

But blood clots cannot be felt in this type of disease. Not only the saphenous vein, but also the femoral vein swells. When the femur swells, ascending thrombophlebitis of the GSV can lead to pulmonary embolism.

It means. That the blood clots had reached the lungs. And they already interfere with the flow of blood in the large pulmonary artery or its branches. The clot can also travel to the heart artery.

Since the process of inflammation in the upper parts of the large vein of the thigh is already difficult to stop, in these cases surgery is inevitable. Often, acute ascending thrombosis progresses to a more severe stage without the necessary treatment.

Through the saphenofomoral anastomosis, inflammation passes into the deep vessels. To monitor whether the inflammation extends to the middle of the leg, angiography or ultrasound examination is required.

Thrombophlebitis of the hands is recorded much less frequently. Due to compression of the main vein, the entire forearm is affected. The indicated factors that aggravate the course also occur here.

The main symptoms of the disease in the upper extremities are the same as those in the lower extremities. Inflammation from these important vessels can spread to the chest area, which is extremely dangerous and can cause death.

Treatment of GSV thrombosis

The patient should know that immediate contact with a phlebologist guarantees a cure. As long as the inflammation has not spread, the vessels can be cleaned and the inflammation painlessly removed.

The patient is put on a special diet that excludes fatty foods and the veins are tied with an elastic bandage. The following drugs are prescribed:

  • drugs that prevent the formation of blood clots (anticoagulants);
  • painkillers;
  • anti-inflammatory;
  • phlebotonics;
  • gels containing heparin.
  • compresses at night;
  • the limb should be elevated so that the blood does not stagnate.

The diet is required to cleanse the blood of cholesterol. For some time, until the inflammation subsides, you need to lie without moving. Do not strain the affected limbs.

But when all methods of caring for diseased veins are useless, it’s time for surgical intervention. The surgeon performs plication of the affected vessels. This is necessary to avoid complications.

So, if the duct of the superficial veins is disrupted due to thrombosis and inflammation, this is thrombophlebitis. Incorrect treatment, or its absence, can cause the inflammatory process to spread to other healthy vessels. The so-called ascending thrombophlebitis of the bvv.

Treatment methods

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Interesting things about phlebology

Ascending thrombophlebitis. Treatment of ascending thrombophlebitis

Our center specializes in the treatment of thrombophlebitis. Numbers:

  • 16 years work experience
  • 5200 patients cured
  • 2392 emergency operations performed
  • 2808 cured without surgery
  • 100 % Pulmonary embolism was avoided

About ascending thrombophlebitis

Ascending thrombophlebitis is an inflammatory disease of the walls of varicose veins, as a result of which a blood clot forms in the veins, closing the lumen of the vein. Ascending thrombophlebitis is most often a complication of varicose veins. Ascending thrombophlebitis is a condition of the body when thrombophlebitis of the great saphenous vein moves from the low-lying sections of the vein on the lower leg upward to the inguinal fold.

When the inflammatory process moves from the superficial vein to the deep veins, there is a threat of detachment and migration of a blood clot, which causes the development of the most dangerous, life-threatening complication - pulmonary embolism.

Symptoms of ascending thrombophlebitis

The main symptoms of ascending thrombophlebitis:

  • Feeling of the lower leg being full;
  • Redness of the skin along the varicose vein;
  • Pain along the saphenous vein;
  • The presence of a dense painful cord;
  • Increased body temperature;
  • Weakness and malaise.

The presence of ascending thrombophlebitis poses a serious threat to the patient’s life, therefore, at the first symptoms of this disease, you should immediately seek quality medical care from our experienced specialists, who have extensive practical experience in treating and preventing the development of complications of venous diseases.

Acute ascending thrombophlebitis

Acute ascending thrombophlebitis is a fairly common complication of varicose veins.. The acute form of ascending thrombophlebitis poses a huge threat to the life and health of the patient, since there is a risk of rapid transition of inflammation to the deep veins of the lower extremities, the formation of a floating thrombus and the development of pulmonary embolism.

The main symptoms of the acute form of ascending thrombophlebitis:

  • General inflammatory symptoms (pain, swelling, hyperemia, lymphadenitis, infiltrates of thrombosed veins, lymphangitis);
  • Increased body temperature (up to 39C);
  • General weakness and malaise;
  • In the area of ​​the thrombosed vein, an infiltrate with clear boundaries is easily palpable.

Treatment of ascending thrombophlebitis

At the first symptoms of ascending thrombophlebitis, you should immediately contact our modern phlebology center for timely, high-quality and effective treatment.

Ignoring the issue of treating ascending thrombophlebitis is dangerous due to serious consequences for the body, sometimes even death.

Ascending thrombophlebitis is treated with:

  1. Conservative treatment;
  2. Surgical treatment.

Conservative treatment is aimed at eliminating inflammation and the spread of vein thrombosis. The phlebologist individually selects medications and compression stockings for the treatment of ascending thrombophlebitis. Conservative treatment can be applied only when there is no threat of inflammation spreading to the deep veins, in the presence of a local inflammatory process within the lower leg. At the slightest threat of inflammation spreading to the deep veins, acute ascending thrombophlebitis requires immediate surgical treatment.

Experienced doctors at our center for modern phlebology operate on patients with acute ascending thrombophlebitis on an emergency basis after ultrasound scanning of the veins. The main method of surgical treatment of ascending thrombophlebitis is Crossectomy.

A crossectomy is an operation in which the great saphenous vein and its main tributaries are ligated and divided where it enters the deep veins of the thigh. To perform this operation, a small incision is made at the level of the inguinal fold. After the operation, a cosmetic suture is applied, the scar from which is almost invisible. Our center for modern phlebology has a narrow specialization in the treatment of vein diseases. Taking into account our many years of experience and high skill, we confidently speak about successful results in the treatment of diseases.

Make an appointment for a consultation about ascending thrombophlebitis

Questions from users on our website about ascending thrombophlebitis

  • There is a genetically determined risk of blood clots during strip operations and HRT; the diagnosis of acquired thrombophilia is questionable. Is sclerotherapy possible?

    In our city they refused me, citing a high degree of risk. Thank you

    Doctor's answer:
    Hello! Yes, it's possible. Thrombophilia is not an absolute contraindication for sclerotherapy. It all depends on the scale and nature of the manifestations for which this manipulation will be performed (there are many options for sclerotherapy). This can be assessed by a specialist who has more complete information about the goals of sclerotherapy and your medical history. Based on everything, a decision is made on the advisability of sclerotherapy.

  • How dangerous is the diagnosis: subacute ascending thrombophlebitis of the GSV and tributaries on the right leg, embolic (free segment of the head 15 cm)

    Doctor's answer:
    Hello! It all depends on the nature of the blood clot and the level of thrombophlebitis (how close the upper border of the blood clot is to the saphenofemoral junction). The above criteria make it possible to assess the risk of developing pulmonary embolism and make a decision on emergency surgical treatment to prevent this complication (we are talking about ligation of the mouth of the GSV).

  • Is the appearance of thrombophlebitis common after sclerotherapy? I read on the Internet that this happens when sclerosant comes into contact with blood. Now I'm scared to go to sclerotherapy

    go. Thanks for the answer

    Doctor's answer:
    Hello. The effect of sclerotherapy is based on chemical damage to the vein wall with the drug, which leads to its inflammation (which is thrombophlebitis) and subsequently to complete resorption. The larger the diameter of the vein, the more pronounced the symptoms of inflammation (thrombophlebitis), which subsequently resolve without a trace. Currently, sclerotherapy in most cases is used to eliminate the so-called “aesthetic varicose veins,” that is, it is aimed at eliminating intradermal veins of small diameter, so specially caused inflammation of the vein wall is not fraught with complications.

  • Is this ACUTE ASCENDING THROMBOPHLEBITIS? Ultrasound: RIGHT EVERYTHING IS EXCELLENT. left leg: SPS: dilated minimally when straining. Anastomosis valves

    minimal degree of deficiency. GSV: not dilated. The move is straightforward. The sensor compresses completely. Passability: passable. On the inside, in the area of ​​the knee joint, varicose veins have a thickened wall, are compressible, and passable. CONCLUSION: Varicose vein transformation of the left side. hvn. Is this ACUTE ASCENDING THROMBOPHLEBITIS? Is surgery necessary here, or can it be treated with medications? thank you in advance.

    Doctor's answer:
    Hello! Thickened walls in the area of ​​varicose nodes are indirect signs that there was previously phlebitis (inflammation of the venous wall) in this area. Considering the presence, as you say, of varicose nodes, it is possible that ultrasound underestimates the degree of hemodynamic impairment. It is recommended to consult a phlebologist.

  • HELLO, DOCTOR. Thrombophlebitis of the right saline vein thrombosis. Can you please tell me if it is possible to operate?

    Doctor's answer:
    Hello! We don't understand the essence of your question. If we are talking about the need for surgery for popliteal vein thrombosis, then no, due to the anticoagulant therapy, a good treatment effect is noted. If we are talking about whether thrombosis of the popliteal vein is a contraindication for some other operation, then it depends on the volume of the planned operation, the presence or absence of flotation of the tip of the thrombus in the popliteal vein.

The meaning of the term Acute Thrombophlebitis of the Saphenous Veins of the Lower Extremities in the Encyclopedia of the Scientific Library

Acute Thrombophlebitis of the Saphenous Veins of the Lower Extremities- Most often occurs as a result of mechanical and chemical damage to the venous wall, after intravenous administration of drugs, often as a reactive process during influenza infection, sore throat, pneumonia, tuberculosis, typhus, etc. It is very often observed in people suffering from varicose veins of the saphenous veins of the lower extremities, in particular in 31.5% of pregnant women with varicose veins of the saphenous veins.

The inflammatory process is mainly localized in the wall of the great saphenous vein of the leg, thigh and in their tributaries, mainly affects the saphenous veins of the upper third of the leg, lower and middle thirds of the thigh and can be focal, segmental or widespread.

Clinic and diagnosis. Acute thrombophlebitis of the saphenous veins of the lower extremities manifested by moderate or severe pain and thickening (infiltrate) along the saphenous vein, hyperemia of the skin above it. When surrounding tissues are involved in the inflammatory process, periphlebitis occurs; general health does not suffer with limited, segmental thrombophlebitis of the saphenous veins. With a widespread thrombophlebic process, the general condition of patients worsens, body temperature rises (up to 38° or more). There is a slight leukocytosis with a moderate shift of the formula to the left and an increased ESR. An important pathognomonic sign acute thrombophlebitis of the saphenous veins is the absence of swelling of the affected limb. After a few days, the acute process becomes subacute, and after 2 - 3 weeks the inflammatory phenomena stop, but only after 2 - 4 months the lumen of the affected vein is restored. Acute thrombophlebitis of the saphenous veins can cause severe complications that arise as a result of the spread of the thrombotic process from the saphenous to the main veins: a) through the mouth of the great saphenous vein of the thigh; b) through the mouth of the small saphenous vein of the leg; c) through the communicating veins.

The thrombotic process from the saphenous veins to the main vein most often spreads when there is insufficient fixation of the thrombus to the vein wall. In this case, a “floating thrombus” is formed, which can reach a length of 15–20 cm and penetrate into the femoral vein. When thrombosis spreads proximally, pain is noted along the anteromedial surface of the thigh. Therefore, if there are clinical signs of acute thrombophlebitis of the great saphenous vein of the thigh at the border of the middle and upper thirds, the question of emergency surgery should be raised - phlebectomy of the great saphenous vein at its mouth - as a preventive measure for the spread of thrombosis to the femoral vein. It must be remembered that “floating blood clots” are a potential source of pulmonary embolism.

In the postoperative period, antibiotics and anticoagulants are indicated. Of the latter, the most commonly used is finilin 0.03 g 1 - 2 times a day under the control of the prothrombin index and blood clotting time. In this case, blood prothrombin should remain at the same level - 0.60 - 0.70. It is necessary to discontinue finilin by gradually reducing the daily dose to 1/4 tablet/day within 10 days from the moment the normal blood prothrombin level stabilizes. After discontinuation of finilin, patients should receive acetylsalicylic acid (ASA) 0.25 g 4 times a day, which inhibits platelet aggregation and adhesion, in addition, does not require special monitoring of the state of the blood coagulation system.

Thrombophlebitis of the saphenous veins

Thrombophlebitis of the saphenous veins(thrombophlebitis of the superficial veins or superficial thrombophlebitis) is an inflammatory disease of the superficial veins. Most often, thrombophlebitis damages the superficial veins of the lower extremities and groin area. Thrombophlebitis develops in people suffering from varicose veins.

Unlike deep veins, with thrombophlebitis of the saphenous veins, a pronounced inflammatory reaction develops, which is accompanied by severe pain. In turn, inflammation damages the vein wall, which contributes to the development and progression of thrombosis. In addition, the superficial veins are not surrounded by muscles, therefore, with muscle contraction, the risk of destruction of the blood clot and migration of its pieces with the bloodstream (embolism) does not increase, so superficial thrombophlebitis is potentially not dangerous.

Sometimes thrombophlebitis can occur again, this especially often occurs with cancer or other serious diseases of the internal organs. When thrombophlebitis occurs as a concomitant disease with an oncological process in the body, this condition is also called Trousseau syndrome.

Symptoms of superficial thrombophlebitis

The first symptoms of thrombophlebitis are local pain and swelling; the skin in the area of ​​the vein in which thrombophlebitis has developed becomes brown or red and hard. Since a blood clot has formed in the vein, it becomes denser along its length.

Diagnosis of superficial thrombophlebitis

The diagnosis is usually made after collecting anamnestic data and examination. To confirm the diagnosis, color duplex ultrasound scanning is performed.

In most cases, thrombophlebitis of the superficial veins goes away on its own. Treatment usually includes pain relievers such as aspirin or other non-steroidal anti-inflammatory drugs, which help reduce pain and inflammation. Antiplatelet agents and anticoagulants (blood thinning medications) are also used to reduce blood clotting. In case of severe thrombophlebitis, local anesthesia is applied, the blood clot is removed and then a compression bandage is put on, which must be worn.

If thrombophlebitis develops in the superficial veins in the pelvic area, then there is a high probability of migration of blood clots and the development of deep vein thrombophlebitis and pulmonary embolism. To prevent the development of these complications in thrombophlebitis of the deep and superficial veins in the pelvic area, emergency surgical treatment in a hospital setting is recommended.

Thrombosis and thrombophlebitis of the saphenous veins

It is known that ascending thrombophlebitis in the system of the great or small saphenous vein accounts for up to 3% of all causes of deep vein thrombosis. At the same time, in emergency angiosurgical practice, the issues of diagnosis and treatment of this pathology remain controversial and not fully resolved; a good phlebologist must navigate this issue.

Every year, up to 80 patients diagnosed with thrombophlebitis of the saphenous veins of the lower extremities are delivered to the emergency department of City Hospital No. 1 by ambulance from clinics and various medical institutions in the city of Irkutsk. After examination by an angiosurgeon and ultrasound examination, from 35 to 45 patients are hospitalized in the vascular surgery department. The most common diagnostic error is erysipelas of the lower extremities.

The predominant cause leading to thrombosis and thrombophlebitis of the saphenous veins was varicose veins with severe disturbances of venous hemodynamics and gross morphological changes in the walls of the veins. In isolated cases, the trigger for the development of venous thrombosis was cancer, injuries to the lower extremities, long-term surgical interventions using muscle relaxants, various skin dermatitis or thrombophilic conditions. In most cases, the system of the great saphenous vein was involved in the inflammatory process, and cases of thrombosis of the small saphenous vein were isolated. The age of the patients ranged from 34 to 75 years, of which 55% of all patients were still over 55 years of age. Among the total number of admissions, women of childbearing age made up 12%.

From 2000 to 2004 In the Department of Vascular Surgery, 166 patients were operated on as an emergency. Most operations were performed under local anesthesia. In 25 patients, thrombectomy was performed from the mouth of the great saphenous vein and a loose thrombus extending to the femoral vein was removed. It was repeatedly confirmed intraoperatively that the level of thrombosis of the trunk of the saphenous veins was always significantly higher (by 10-15 cm) determined preoperatively visually and by palpation.

Clinically reliably established cases of small focal pulmonary embolism after such operations were isolated. There were no cases of massive pulmonary embolism after these operations. Most patients in the postoperative period received complex drug treatment, including heparinization, and were prescribed an active motor regimen.

What are the symptoms and how to treat thrombophlebitis of the superficial veins of the lower extremities

Thrombophlebitis of the superficial veins of the lower extremities is a disease characterized by the development of an inflammatory process in the superficial venous trunks of the legs and the formation of blood clots in this place. Inflammation and thrombus formation are closely related and form a vicious circle of disease. Professions associated with prolonged standing, prolonged bed rest, diseases of the hematopoietic organs and blood, varicose dilatation of the superficial veins of the legs, pregnancy are risk factors for the development of thrombophlebitic lesions of the venous vessels of the lower extremities.

Thrombophlebitis of the superficial vessels of the legs significantly reduces the patient’s quality of life and causes a lot of problems and inconveniences. In addition to a pronounced cosmetic defect, there is pain in the legs, a feeling of heaviness and a symptom of distension. All this requires immediate initiation of treatment for the disease. At the initial stages of development of lesions of the superficial veins of the legs, drug treatment is predominantly prescribed. A long-term disease rarely resolves without surgical intervention.

Clinically, thrombophlebitic damage to the superficial vessels of the lower extremities is a disease of the great saphenous vein. The small saphenous vein is included in the process much less frequently. Usually the disease develops against the background of varicose dilated venous trunks.

You can understand whether thrombophlebitis has begun or whether it is varicose dilatation by the following signs: with varicose veins, the skin is not red, the temperature of the body and skin over the nodes is normal, there is no pain. In a lying position, the blood filling the varicose nodules will go into deeper veins and the nodules themselves will become smaller.

Acute superficial thrombophlebitis is characterized by pain in the lower extremities, swelling, redness and the appearance of dense and painful venous trunks under the skin. During the chronic course, periods of remission and health alternate with periods of an acute process, which is characterized by all of the above symptoms. Due to long-term superficial thrombophlebitis, trophic skin ulcers often develop, and the color of the skin over the affected veins changes. During the period of remission, external signs of the disease may not be detected.

Thrombophlebitis of the superficial veins is rarely accompanied by any complications. The inflammatory reaction is more pronounced in superficial vessels than in deep ones, which ensures the adhesion of the thrombotic mass to the venous wall. This process is why the likelihood of a blood clot breaking off in a superficial vein is lower, although it still exists. Inflammation from superficial vessels is often accompanied by the spread of the process to nearby subcutaneous fat or arteries.

Conservative therapy of thrombophlebitis

Considering all the clinical manifestations of thrombophlebitis of the superficial veins of the legs, the risk of possible complications and the development of concomitant pathologies, it becomes clear that treatment must begin with the earliest signs of the disease. Treatment is usually prescribed by a phlebologist or therapist. Therapeutic measures are aimed at reducing blood viscosity, stopping the ascending spread of thrombophlebitic lesions, as well as the transition of inflammation and thrombosis from superficial venous vessels to deep veins or arteries, relieving the inflammatory reaction, preventing repeated episodes of the disease and its complications.

Treatment of thrombophlebitis can be general and local. If superficial venous vessels are affected, therapeutic measures can be carried out at home. The exception is a condition threatening pulmonary embolism.

The acute course of superficial thrombophlebitis requires strict bed rest to reduce the risk of blockage of the pulmonary artery. The optimal posture to improve the outflow of venous blood is with an elevated position of the lower extremities. Plenty of fluid intake is indicated, up to three liters per day, but only if there are no contraindications (kidney disease, heart disease). In case of chronic thrombophlebitis, heat compresses can be used. They improve peripheral blood circulation. In case of acute damage to the veins, heat compresses are contraindicated. To reduce pain during an acute process, a blockade with novocaine according to Vishnevsky and cold compresses are used (only if there is pulsation of the arteries of the foot).

Therapeutic treatment has been successfully used for superficial thrombophlebitis with occlusive thrombi. Therapy consists of the following activities:

  • Elastic compression.
  • Drug treatment.
  • Physiotherapy.
  • Hirudotherapy.

Elastic compression for thrombophlebitis involves the use of special compression garments and bandaging with elastic bandages. This technique reduces the symptoms of edema and pain by eliminating their cause - weak venous function.

Drug therapy can be general and local. The following medications are used:

  • strengthening the venous wall;
  • antiplatelet agents and anticoagulants;
  • improving microcirculation;
  • dissolving thrombotic masses;
  • non-steroidal anti-inflammatory drugs;
  • antibiotics.

Antibacterial therapy is used for septic thrombophlebitis (caused by any viral or bacterial pathogen). Damage to the superficial veins is usually infectious. Also, such complications as trophic leg ulcers require antibacterial treatment. Antibiotics are not prescribed for prophylactic purposes, as some of them can provoke increased blood clotting and the formation of blood clots.

Anticoagulant therapy helps reduce blood viscosity, thins it, reduces the deposition of thrombotic masses and prevents thrombosis. It is mandatory to prescribe anticoagulants for ascending lesions of the superficial veins of the lower extremities and postthrombophlebitic syndrome. The most common anticoagulants are low molecular weight heparins. The reasons for this: dosages are easy to select, there is no need for coagulation tests, and it is approved for use in pregnant women. With mild damage to the superficial veins of the lower extremities, local anticoagulation therapy is sufficient. To dissolve thrombotic masses and relieve symptoms of vascular blockage in such cases, heparin ointment is used. In addition to reducing blood clotting, the ointment reduces inflammation and reduces the amount of swelling.

Nonsteroidal anti-inflammatory drugs relieve swelling and pain. Non-steroidal drugs relieve inflammation in a short time. If the process is acute, then they are prescribed in the form of intramuscular injections, and then the patient is transferred to tablet forms. The most commonly used drugs from this group are diclofenac, ibuprofen, meloxicam (it can be used for ulcerative lesions of the intestines, stomach and asthmatic disease). To enhance the effect of general non-steroidal anti-inflammatory therapy, topical preparations (ointments, gels) are used.

Angioprotectors, together with non-steroidal anti-inflammatory drugs, quickly eliminate the symptoms of an acute inflammatory process by reducing the permeability of the vascular walls. The most common angioprotector is troxerutin. The duration of therapy with troxerutin is 20 days. It protects the vascular wall. Angioprotectors are available in various dosage forms: tablets, ointments, gels.

They improve the flow properties of blood and effectively thin it with antiplatelet agents. Most often, acetylsalicylic acid preparations (aspirin) are used for these purposes. Aspirin, as a non-steroidal anti-inflammatory drug, not only reduces blood viscosity, but also relieves symptoms of inflammation. Anticoagulants and aspirin should not be used at the same time, as this may cause bleeding.

Polyenzyme preparations dissolve thrombotic masses. These include Wobenzym and Phlogenzym.

Thrombolytics for superficial thrombophlebitis are used in the case of an ascending process or if there is a risk of developing pulmonary embolism. These drugs include the following: streptokinase, urokinase and alteplase. Thrombolytic agents dilute the formed thrombus and restore blood flow through the vessels. Thrombolytics can cause bleeding, so they are used only for life-threatening conditions.

Advanced thrombophlebitis of the superficial veins of the legs is often complicated by trophic ulcerations of the skin. To treat trophic ulcers, systemic antibacterial drugs are prescribed. Damaged tissue is removed, the surface of the ulcer is treated with antiseptics. Ointments are applied to the dried surface of the ulceration to accelerate healing. The most common and effective remedy is Vishnevsky ointment.

Physiotherapy is used as an additional treatment method. Physiotherapeutic effects are aimed directly at the inflamed area with a formed blood clot, as well as areas of the skin affected by trophic ulcers.

  1. UHF therapy. Relieves swelling, inflammatory symptoms, improves lymphatic drainage.
  2. Electrophoresis with drugs. Under the influence of an electric current, medications are delivered to the affected veins.
  3. Magnetotherapy. It has a beneficial effect on the rheological properties of blood, thins it, and has an analgesic and anti-inflammatory effect.

Drug therapy should be based on the individual characteristics of patients. Only a doctor should select the dosage of medications and the necessary combinations. Attempts at self-therapy can result in the development of severe complications: from bleeding from arteries and veins to blockage of the pulmonary trunk.

Acute thrombophlebitis of the superficial vessels of the legs can be treated with hirudotherapy. Treatment with medicinal leeches is especially important if there are contraindications for the use of anticoagulants. Leeches produce a substance that reduces blood viscosity and clotting, and reduces spasm of arteries and veins. Typically, 5 to 10 leeches are placed along the affected vein. Hirudotherapy is used once a week under the supervision of a doctor.

Surgical interventions for thrombophlebitis

Surgical treatment is resorted to if there is no effect from conservative therapy, when there is a high probability of developing pulmonary embolism and when there are symptoms of thrombus melting with purulent exudate.

The following types of surgical intervention are used:

  • thrombectomy;
  • ligation of a venous vessel or suturing of a vessel;
  • the imposition of intervascular anastomosis (connection of arteries and veins);
  • installing a filter in large venous vessels (inferior vena cava).

An operation aimed at removing thrombotic masses from a vessel is called thrombectomy. This method of restoring blood flow is considered one of the most gentle and does not pose any significant difficulty in implementation.

A modern method of removing blockages from blood vessels is thrombolysis (used for damage to both veins and arteries), carried out using a special catheter. A tube is inserted into the vascular trunk, through which the thrombolytic drug is delivered directly to the location of the thrombus. In this way, large deposits of thrombotic masses can be removed, eliminating the symptoms of complete blockage of veins or arteries.

Prevention of thrombophlebitis

Patients in the postoperative period or forced to remain on bed rest for a long time definitely need preventive measures against blockages of the superficial veins:

  • long-term use of anticoagulants;
  • compression products (elastic bandaging, medical underwear);
  • early rise of patients after surgery, physical therapy.

Thrombosis of the left SVC Good afternoon! Please help me accept.

Good afternoon!. Please help me make the right decision. Ultrasound of the lower extremities on the left: GSV, GSV, GSV, popliteal vein, WSV, patent, the lumens are free, collapse with compression. At the level of the lower leg there is a non-expanded inflow of the GSV. The SVC is dilated. Insufficiency in the SPS and at the level of the trunk. in the middle/3rd leg along the posterior surface, a varicose transformed inflow flows into the trunk, is visualized distally at the level of the entire lower leg. In the middle/3rd leg in the lumen of a filamentous shape, hyperechoic parietal masses, the blood flow is visualized, the lumen collapses during compression. Perforators with valve insufficiency in the v/3, n/3 of the leg. Thrombosis of the left SVC in the stage of incomplete recanalization. Some doctors say to operate, others to treat. What should we do? The man is 42 years old.

Apparently these are traces of thrombosis (that is, when you suffered thrombophlebitis). Treatment options, including laser, are determined in such cases only during a face-to-face consultation.

Thrombosis of the small saphenous vein

Discarding unnecessary speculation about the pathogenesis of these diseases, we note that

in both cases, a blood clot forms in the lumen of the venous vessel and inflammation of the vessel wall and perivasal tissues occurs. The condition of the blood clot is of fundamental importance, namely its fixation and the likelihood of separation. Currently, thrombophlebitis is commonly referred to as thrombosis of the superficial veins, since inflammation is absolutely clearly defined. And phlebothrombosis is venous thrombosis of the vessels of the deep system. And again, we repeat that in both cases there may be a floating thrombus without signs of inflammation. In clinical practice, controversy and opposition between these two conditions also has negative consequences. The presence of thrombophlebitis of the saphenous veins should not be considered a mild pathology, since the spread of a blood clot to the deep system or the parallel independent occurrence of phlebothrombosis and thrombophlebitis pose a real danger of pulmonary embolism and death. Also important is the formation of a blood clot in the deep venous system with subsequent, in fact, disability of patients. Chronic venous insufficiency and postthrombophlebitic disease require regular, long-term and expensive treatment.

Hospitalization in a hospital, Elastic bandaging for at least 7-10 days around the clock, Non-steroidal anti-inflammatory drugs (NSAIDs - ketorol, ketonal, diclofenac, nimulide) initially parenterally, then in tablets, Phlebotropic drugs - detralex (venorus) up to 6 tablets in the first days, troxevasin , Local NSAIDs and heparin ointments, Antiplatelet agents - aspirin, pentoxifylline (trental), according to indications, anticoagulants - enoxaparin, nadroparin, dalteparin, warfarin, Exanta (melagatran/ximelagatran).

Localization or spread of a thrombus in the GSV at the level of the middle and upper third of the thigh. Localization of the thrombus in the SVC at the level of the popliteal fossa.

Hospital, operation for emergency indications - Ligation and intersection, respectively, of the GSV or SSV and tributaries at the point of entry into the femoral vein. Further treatment as in the previous paragraph.

spread of thrombosis through anastomosis or perforators to the deep venous system

Installation of a cava filter or plication or clipping of the inferior vena cava, thrombectomy from the main veins or from perforators, intersection and ligation of the GSV and SSV at the mouth.

Thrombophlebitis of deep veins

Emergency hospitalization, Bed rest

Bellera splint, Reopoliglyukin 400.0 + 5.0 trental,

troxevasin 1 cap x 4 times, aspirin ¼ tab x 4 times, heparins, installation of a cava filter, phlebotropic drugs and NSAIDs.

Additionally, it should be noted that to clarify the location of the thrombus, it is necessary to perform an ultrasound examination of the veins. Elastic bandages for phlebothrombosis should be applied with caution after ultrasound scanning. By squeezing the subcutaneous vein system, we either increase the blood volume by 20% in the deep system, or completely block the outflow of blood from the lower limb. In the first case, the likelihood of a blood clot breaking off increases; in the second, the clinical picture of acute phlebothrombosis is aggravated.

Thrombophlebitis of the saphenous veins

What is saphenous vein thrombophlebitis?

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, saphenous vein thrombophlebitis is a “double” disease. Because, firstly, the venous walls themselves become inflamed. And secondly, a blood clot forms 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 great (and/or small) saphenous vein, as well as perforating veins, are thrombosed. But if left untreated, thrombosis spreads to the largest (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, “swirling” 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 considered to be varicose veins. Also, the most common risk factors are:

  • genetic predisposition;
  • pregnancy and childbirth;
  • obesity, physical inactivity;
  • 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 its manifestations. Mild redness of the skin, burning, minor swelling - many patients simply do not pay attention to all this. But the clinical picture changes very quickly, and the signs of thrombophlebitis of the superficial veins become noticeable and very uncomfortable:

  • the appearance of “nodules” and compactions in the vein;
  • edema;
  • acute pain;
  • local increase in temperature;
  • change in skin color in the area of ​​the inflamed vein.

Treatment of superficial thrombophlebitis

To treat thrombophlebitis of the superficial veins, different techniques and their combinations are used.

More often this may be conservative treatment:

  • compression therapy – wearing compression stockings, special elastic bandaging;
  • taking non-steroidal anti-inflammatory and painkillers;
  • locally, in the area of ​​inflammation - cold;
  • according to indications - taking medications that “thin” 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. Thus, with ascending thrombophlebitis of the great or small saphenous vein, the trunk of the main saphenous vein is thrombosed directly. When thrombosis of the great saphenous vein spreads to the thigh, thrombophlebitis is considered ascending. For the small saphenous vein, this is the middle and upper third of the leg.

Purulent thrombophlebitis of the superficial veins: develops in patients with bacteremia that persists for >72 hours despite appropriate antibiotic therapy, especially in patients with an intravascular catheter. The most common etiological factors: Staphylococcus aureus, streptococci, gram-negative bacilli.

CLINICAL PICTURE AND NATURAL COURSE to top

Painful localized swelling with redness of the skin; in case of inflammation of varicose nodes, 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 draw blood from the catheter if a blood clot leads to its occlusion; sometimes the disease is asymptomatic (5–13%). With purulent thrombophlebitis of the superficial veins, there is additionally fever, severe redness, pain and the presence of purulent content at the site of the affected vessel.

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

Diagnosed based on clinical symptoms; In cases of inflammation associated with the presence of a catheter/cannula in a vein, culture (usually the tip of the removed catheter) may reveal the etiological factor. In a limited form, especially associated with the presence of a catheter in the vessel or the action of irritating substances, diagnostic studies are not necessary. For inflammation of the veins (varicose veins) of the lower extremities, perform an ultrasound examination to localize the apex of the thrombus and determine the distance from the mouth of the deep vein system, since inflammation within the proximal portion of the great saphenous vein (above the knee joint) can spread to the deep vein system. In patients with migratory phlebitis without an obvious cause, conduct a detailed diagnosis to exclude cancer. In patients with phlebitis of a previously normal vein (non-varicose vein) in which the etiological factor is unknown, consider diagnostic work towards hypercoagulability or malignancy.

1. Catheter-associated phlebitis of the superficial veins: in the case of a short peripheral catheter, stop administering drugs through this catheter and remove it from the vein; in case of severe pain → NSAIDs (PO or topical; drugs →Table 16.12-1) or heparin (topically in the form of a gel) until symptoms go away, but not longer than 2 weeks.

The use of heparin in a therapeutic dose is not recommended, and antithrombotic prophylaxis (using heparin subcutaneously) is used in patients with an increased risk of venous thrombosis, for example. immobilized, after episodes of VTEB or with cancer →section. 2.33.3. Also consider anticoagulant treatment 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 ultrasound results.

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

2. Purulent thrombophlebitis of the superficial veins → remove the source of infection (eg catheter) and use antibiotic therapy, preferably targeted, and if ineffective, consider opening, draining or excision of a segment of the affected vein.

3. Superficial vein thrombosis: if it concerns a segment of the superficial vein of the lower limb ≥5 cm long → fondaparinux subcutaneously 2.5 mg/day. or low molecular weight heparin in a prophylactic dose (preparations → section 2.33.1, dosage → table 2.33-12) for ≥4 weeks. or a vitamin K antagonist (acenocoumarol or warfarin) at a dose maintaining an INR of 2–3 for 5 days with heparin, then on its own for 45 days. Anticoagulant treatment is also justified by: extensive thrombosis, thrombosis involving veins above the knee, especially near the saphenofemoral ostium, severe clinical symptoms, thrombosis involving the great saphenous vein, history of VTE or superficial vein thrombosis, active cancer, recent surgery.

In case of phlebitis of the great saphenous vein and extension of thrombosis proximally, due to the risk of transfer of thrombosis to the superficial femoral vein, refer the patient to a surgeon for the purpose of ligation of the great saphenous vein. There is no need to immobilize a patient with phlebitis of the superficial veins of the lower extremities, but unconditionally apply a multi-layer compression bandage made of an elastic bandage and use this treatment until the acute inflammatory process disappears. Once acute inflammation and swelling have subsided, consider appropriate compression socks or stockings.

Video (click to play).

When thrombosis occurs, the vein becomes blocked and blood flow becomes obstructed. Thrombosis of the great saphenous vein most often occurs due to damage to the venous wall. The most difficult and dangerous option in terms of the development of complications is considered to be acute ascending thrombophlebitis of the great saphenous vein. There are three options for the course of events with blood clots:

  • possible blockage of the vessel and disruption of blood circulation;
  • may break off and pass with blood to other organs;
  • may resolve.

The disease requires immediate treatment under regular supervision of a specialist.

In Europeans, thrombosis of the saphenous veins of the lower extremities occurs much more often than in Asians. After forty years, this disease is observed in every fifth woman and every fourth man. In obese people, the risk of thrombophlebitis is significantly higher.

Ascending thrombophlebitis of the superficial veins of the lower extremities

Ascending thrombophlebitis is diagnosed in situations where thrombophlebitis from part of the great saphenous vein of the leg moves to the area of ​​the inguinal folds.

Ascending may be complicated by an acute form of the disease. When inflammation of the deep veins occurs, there is a huge risk of blood clot rupture. The worst outcome is inflammation of the pulmonary artery.

Causes

Thrombophlebitis of the great saphenous vein is formed due to inflammation of the vein. Also the reasons for the occurrence:

  • Deep vein thrombosis;
  • Heredity;
  • Varicose veins;
  • Tuberculosis;
  • Cancerous formations;
  • Change in blood, stagnation;
  • Antiphospholipid syndrome;
  • Obesity;
  • Surgical interventions;
  • Pregnancy;
  • Administration of drugs intravenously;
  • Sedentary work, passive lifestyle.

Signs and treatment

Damage to the great saphenous vein can be:

  • Spicy;
  • Chronic.

Acute thrombophlebitis of the saphenous veins develops suddenly due to sudden blood clotting. The reasons can be very different - infection, injury, pregnancy and others. Signs of acute ascending thrombophlebitis:

  • Varicose nodes become painful and dense;
  • The leg swells and increases in size;
  • Sharp pain may occur when walking;
  • Chills and fever appear;
  • General weakness persists;
  • Lymph nodes enlarge.

It can last for a couple of years in a row. Often accompanied by pain and heaviness in the legs. If one of the symptoms appears, you should immediately consult a phlebologist.

With ascending thrombophlebitis of the saphenous vein, there may be no edema. Most often, heaviness is felt when palpating the inflamed vein, and the skin has a reddish tint. There is a feeling of heaviness in the lower leg. However, in the acute form of the disease and further spread of the disease, damage occurs:

  • Great saphenous vein;
  • Common femoral vein;
  • Sapheno-femoral anastomosis.

Thrombophlebitis of the saphenous veins of the lower extremities - treatment

Thrombophlebitis of the saphenous veins - treatment is prescribed only by a phlebologist based on the individual characteristics of the patient. If thrombophlebitis appears at the level of the lower leg, then treatment can occur at home under the supervision of a doctor. If ascending thrombophlebitis occurs, treatment is carried out strictly in a hospital; thrombosis in this case can create serious risks to life.

During the examination, the doctor compares the two limbs completely and, if necessary, measures the inflamed leg in diameter. The doctor also evaluates the skin, swelling and pain. An ultrasound scan of the leg veins is required.

With thrombophlebitis, you need to limit activity and physical activity. You can't run or strain your legs. It is advisable to observe bed rest; in acute forms of the disease, permanent bed rest is prescribed, and the legs should be elevated.

Also prescribed:

  • Using elastic compression garments;
  • To reduce pain, the doctor may prescribe ice compresses (apply for 20 minutes throughout the day);
  • Use of antigulant therapy: nadroparin, enoxaparin;
  • Non-steroidal anti-inflammatory drugs: Diclofenac, ketoprofen;
  • Angioprotectors – improve the condition of the venous wall: rutoside, diosmin;
  • Antibiotics;
  • Antiplatelet drugs: Dipyridamole, acetyl acid;
  • Blood thinning drugs: Fragmin, Phlebodia;
  • The use of ointments containing heparin, which has an anti-inflammatory effect and relieves swelling: heparin ointment, ketonal 5%, lyoton gel and others;
  • Physiotherapy: ultraviolet radiation, infrared radiation, electrophoresis, magnetic therapy, laser therapy, DArsonval, barotherapy.

My patients used it, thanks to which they can get rid of varicose veins in 2 weeks without much effort.
If conservative therapy is unsuccessful, the doctor may prescribe surgery. The essence of this operation is to prevent blood from moving from deep to superficial. The veins located below the knee are ligated. Surgery is safe and is most often performed under local anesthesia.

There are several types of surgical intervention:

  • Venectomy – removal of a vein;
  • Removal of thrombosed vein nodes;
  • Thrombectomy;
  • Crossectomy – ligation of the great saphenous vein;
  • Removal of the trunk of the great saphenous vein using a Babcock probe.

Prevention of thrombosis

To avoid thrombosis, you must initially adhere to simple rules:

  • To live an active lifestyle;
  • Drink at least 2 liters of clean water per day;
  • To refuse from bad habits;
  • Establish proper nutrition (eat more garlic and onions);
  • Monitor your weight;
  • At night, keep your legs elevated for better blood flow;
  • If varicose veins appear, lubricate your legs with heparin ointment;
  • When working sedentarily, do exercises and warm up for at least 15 minutes.

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Thrombosis - general concepts.

Thrombosis is the formation of blood clots in the lumen of a vessel; venous and arterial thrombosis are distinguished. Taking into account the topic of the site, we will talk about venous thrombosis.

Typically, the term thrombophlebitis refers to thrombosis of the superficial veins, and 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, increased venous pattern, etc.

Treatment of thrombophlebitis of superficial veins.

The main therapeutic measures are reduced to elastic compression ( elastic bandage or compression stockings), prescription of medications.

Medicines used include phlebotropic drugs (detralex, phlebodia), antiplatelet agents (thrombo-ACC), and anti-inflammatory drugs (Voltaren). Lyoton-gel is applied topically.

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

Treatment of deep vein thrombosis.

In almost all cases, deep vein thrombosis is treated in a hospital. An exception may be deep vein thrombosis of the leg, provided there is no threat of thromboembolism. The danger of thromboembolism can only be determined by ultrasound examination.

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 treatment is started immediately.

Usually, drugs that reduce blood clotting (anticoagulants), antiplatelet agents, anti-inflammatory drugs, and phlebotropic agents are prescribed.

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

In case of recurrent thrombosis, a genetic study is carried out; if the tests are positive, the issue of lifelong prescription of anticoagulants is decided.

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

Occurs quite rarely. Almost never causes pulmonary embolism.

Causes of thrombosis in the superior vena cava system

– basically the same as other venous thromboses. It may also develop as a complication of venous catheterization (cubital, subclavian catheter), sometimes arising as a result of prolonged compression or uncomfortable position of the upper limb (for example, during sleep).

The most common thrombosis of the axillary or subclavian vein ( Paget-Schroetter syndrome). Within 24 hours, swelling of the entire upper limb occurs with cushion-like swelling of the hand. There may be slight bursting pain. The color of the limb is unchanged or slightly cyanotic.

Treatment of Paget-Schroetter syndrome

– the same as other venous thromboses.

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, and moderate pain.

Treatment usually does not require, but if symptoms are severe, you can use Lyoton-gel topically and anti-inflammatory drugs (Nimesil, Voltaren, etc.) orally.

Treatment of thrombosis, venous thrombophlebitis - cost of services

Consultation with a phlebologist (candidate of medical sciences) (questioning, examination, prescribing examination and treatment) - 15,00 rubles

Ultrasound of the veins of the lower extremities - 2000 rubles

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