Thrombophlebitis - what is this disease, symptoms, signs and treatment

Medical Consultant Vessels and Heart Thrombophlebitis: first signs, symptoms, diagnosis and treatment

What is thrombophlebitis? Inflammatory reactions in the venous walls, accompanied by the formation of blood clots in their lumens, are called thrombophlebitis (thrombosis) in medicine. In 90% of cases, the disease affects the vessels of the legs - the superficial and deep venous networks and the perforating veins connecting them.

As a closely related disease, we can note phlebothrombosis, characterized by the same signs (thrombi in the venous cavities), but without the influence of inflammatory reactions. This disease does not have a long course, because any vascular pathology always ends with inflammation and the development of thrombophlebitis.

Most often, the pathology manifests itself as thrombosis of the superficial saphenous veins, which develops accompanied by varicose veins or CVI syndrome (impaired venous outflow). In this case, the disease often recurs, progresses, and is fraught with various complications.

Types of thrombophlebitis
The first signs of thrombophlebitis, photo
Symptoms of thrombophlebitis, clinical picture
Diagnosis and treatment of thrombophlebitis

Causes and risk factors

The pathogenesis of thrombophlebitis of the lower extremities is quite complex. Several factors are simultaneously involved in it:

increased viscosity and blood clotting;
slowing down venous blood flow;
damage to the valve apparatus or vein wall;
addition of infection.

The most dangerous is thrombophlebitis of the deep veins of the lower extremities. This is due to the characteristics of the blood clot that forms here. A sharp slowdown in blood flow in the affected vein system, combined with increased blood clotting, causes the formation of a red blood clot consisting of red blood cells, a small number of platelets and fibrin strands. One side of the thrombus is attached to the venous wall, while its other end floats freely in the lumen of the vessel. As the pathological process progresses, the thrombus can reach a significant length (20–25 cm). Its head in most cases is fixed near the venous valve, and the tail fills almost the entire branch of the vein. Such a thrombus is called floating, i.e. floating.

In the first few days from the moment the formation of a blood clot begins, its head is poorly fixed to the wall of the vein, so there is a high risk of its separation, which, in turn, can lead to the development of thromboembolism of the pulmonary artery or its large branches.

After 5-6 days from the onset of thrombus formation, an inflammatory process begins in the affected vein, which promotes better adhesion of the blood clot to the venous wall and reduces the risk of thromboembolic (caused by the separation of a blood clot) complications.

In the absence of adequate treatment, in 20% of cases the disease ends in the development of pulmonary embolism, which causes death in 15-20% of patients.

Predisposing factors to the development of thrombophlebitis of the lower extremities are:

Varicose veins;
venous stasis caused by prolonged bed rest, pelvic tumors, pregnancy, excess body weight;
local or systemic bacterial infection;
postpartum period;
taking oral contraceptives (in this case, the risk especially increases in women who smoke);
malignant neoplasms (cancer of the pancreas, stomach, lungs);
disseminated intravascular coagulation syndrome (DIC syndrome);
postthrombophlebitic disease;
injuries;
chronic diseases of the cardiovascular system;
condition after abortion or other surgical intervention;
long-term venous catheterization;
systemic diseases.

Symptoms

The clinical picture differs depending on the case. But its essence is always approximately the same.

Among the possible manifestations:

Severe pain in the area of inflammation. It begins abruptly, what is called “out of the blue,” without previous signs.

The intensity of the syndrome is high and unbearable. In rare cases, somewhat weaker. Requires the use of powerful painkillers.

The latent course of the disorder is extremely rare. Symptoms of thrombophlebitis are of local origin, usually affecting the lower extremities.

Heaviness. Accompanied by a feeling as if a huge weight was hung on the arm or leg. Distension from the inside is also detected, which is caused by increasing phenomena of inflammation and swelling.
Redness and hyperemia of the skin over the affected area is a characteristic sign of thrombophlebitis. Looks like stripes or spots. Color - from pink to deep burgundy, crimson.

The latter is a negative sign, almost 100% guaranteed to indicate the development of thromboembolism.

Increase in general body temperature. The levels are different. Usually the thermometer numbers are within 38 degrees, rarely higher. Which indicates a severe course of the disorder.
Symptoms of general intoxication. Headache, nausea, vomiting, weakness, drowsiness, chilliness. Doesn't always happen. More often during the acute course of the pathological process.
Impaired motor activity of the limb. The ability to control an arm or leg decreases significantly. This is mainly due to pain; it is impossible not only to walk, but also to simply change position.
Swelling at the local level is an atypical manifestation of thrombophlebitis; its essence is an increase in the volume of soft tissues. The reason is a violation of the outflow of blood.

Manifestations must also be assessed in the system. Because individually they are not very informative.

Forms of the disease

Thrombophlebitis of the lower extremities, depending on the activity of the inflammatory process, is divided into acute, subacute and chronic. The chronic form of the disease occurs with periodically alternating stages of remission and exacerbation, so it is usually called chronic recurrent thrombophlebitis of the lower extremities.

Depending on the location of the pathological process, thrombophlebitis of the superficial and deep veins of the lower extremities is distinguished.

Thrombophlebitis of the veins of the lower extremities can be superficial and deep

What is the difference between thrombophlebitis and thrombosis?

The disease in question should not be confused with one that has a similar name. The difference between thrombosis and thrombophlebitis lies in several points:

In the first case, there is no inflammation. While in the second it is an integral part of the disorder and accompanies it throughout the entire period of its course.
The essence of the second is blockage of the vessel with subsequent problems at the local level, depending on where the clot stops.

Thrombophlebitis, therefore, is a broader concept. It includes inflammation, further formation of a dangerous accumulation of formed blood cells. In addition, it is considered an independent diagnosis requiring treatment.

Thrombosis, in turn, is a consequence of a narrow nature. It consists of blockage of an artery or vein, the development of a corresponding dangerous clinic. But it is not a diagnosis. Read more about the types and methods of treating thrombosis in this article.

An assessment of the causes of thrombophlebitis must be carried out in the system so as not to miss the etiological factor (root cause).

If the origin of the process is not determined, there is a possibility of relapse followed by disability or death of the patient. Treatment in such a situation is a pointless waste of time.

Signs of thrombophlebitis of the lower extremities

The clinical picture of thrombophlebitis of the lower extremities is largely determined by the form of the disease.

Acute thrombophlebitis of the superficial veins of the lower extremities occurs suddenly. The patient's body temperature rises sharply to 38-39 °C, which is accompanied by severe chills (shaking chills). On palpation, the affected vein is felt as a painful cord. The skin over it is often hyperemic. Subcutaneous tissue may be compacted, which is explained by the formation of infiltrate. The inguinal lymph nodes on the affected side are enlarged.

Symptoms of thrombophlebitis of the lower extremities in the subacute form are less pronounced. The disease usually occurs at normal body temperature (some patients may experience a slight fever of up to 38 ° C in the first days). The general condition suffers little. When walking, moderately severe pain occurs, but there are no local signs of an active inflammatory process.

Acute thrombophlebitis of the lower extremities is accompanied by fever and swelling of the skin

The recurrent chronic form of thrombophlebitis of the superficial veins of the lower extremities is characterized by an exacerbation of a previously occurring inflammatory process or the involvement of new areas of the venous bed into it, i.e., it has symptoms similar to the acute or subacute course. During the period of remission there are no symptoms.

In case of chronic recurrent thrombophlebitis of the lower extremities, it is necessary to conduct quarterly preventive treatment of the disease aimed at preventing exacerbations.

Thrombophlebitis of the deep veins of the lower extremities is asymptomatic in half of the patients. The disease is diagnosed, as a rule, retrospectively after the development of thromboembolic complications, most often pulmonary embolism.

In the remaining 50% of patients, signs of the disease are:

feeling of heaviness in the legs;
persistent swelling of the lower leg or the entire affected lower limb;
bursting pain in the calf muscle;
increase in body temperature to 39-40 ° C (in acute form of thrombophlebitis of the lower extremities);
Pratt's sign (glossy skin over the lesion, on which the pattern of the subcutaneous venous network is clearly visible);
Payra's symptom (pain spreads along the inner surface of the thigh, lower leg and foot);
Homans' symptom (dorsiflexion of the foot is accompanied by pain in the calf muscle);
Luwenberg's symptom (compression of the lower leg by the cuff from a tonometer when creating a pressure of 80–100 mm Hg leads to pain, although normally they should appear at a pressure above 150–180 mm Hg);
the affected limb feels colder to the touch than the healthy one.

Classification

Typification is carried out for several reasons. They play a key role in determining treatment tactics, prognosis, and further management of the patient during the outpatient period.

The first criterion is etiology, that is, the origin of the disease.

Highlight:

Septic thrombophlebitis. Its essence is the damage to the venous walls by pathogenic flora and viruses. According to statistics, this particular variety is especially common.

The condition can be treated relatively easily if you react in time. Otherwise, there is a high probability of transition to the chronic phase.

Non-infectious thrombophlebitis. It is of autoimmune origin. It is caused by a hereditary factor or a disruption of the functioning of protective forces during life itself.

It is more difficult to treat and becomes chronic almost immediately. But there may not be a single relapse for the entire time. Depends on the approach to therapy and the specific case.

The second criterion is the course of the pathological process.

Accordingly they are called:

Sharp form. The clinical picture is vivid and painful for the patient. Accompanied by a pronounced increase in temperature, pain when walking and when in any position. Requires urgent hospitalization and surgical treatment. The clock is counting.
Chronic type. Usually the disease progresses to it after the acute phase, but a sluggish onset is possible, because the patient does not understand what is going on. Relapses (exacerbations) approximately 1-2 times a year, possibly more often, depending on the provoking factor.

Therapy is extremely difficult; the question comes down not to complete elimination, but to achieving remission, when the pathology steadily subsides and in no way bothers the patient.

Thrombophlebitis is classified in these ways; there are no generally accepted ways of typing other than those presented.

The second criterion is rather arbitrary; a subacute phase can also be distinguished, when the clinical picture persists, but as such there is practically no danger.

Typically, the transition of the disease from one stage to another takes about 12-20 days. That is, a full course of therapy requires about several months, if everything goes well.

Diagnostics

Diagnosis of thrombophlebitis of the superficial veins of the lower extremities is not difficult and is carried out on the basis of data from the characteristic clinical picture of the disease, an objective examination of the patient and the results of laboratory tests (in the blood there is an increase in the prothrombin index, leukocytosis with a shift in the leukocyte formula to the left, an increase in ESR).

Thrombophlebitis of the superficial veins of the lower extremities is differentiated from lymphangitis and erysipelas.

The most accurate diagnostic method for thrombophlebitis of the deep veins of the lower extremities is distal ascending venography. An X-ray contrast agent is injected into one of the saphenous veins of the foot below the level of the tourniquet that compresses the ankle, which allows it to be redirected to the deep vein system, after which radiography is performed.

Distal ascending venography is the most accurate method for diagnosing thrombophlebitis

The following instrumental diagnostic methods are also used in the diagnosis of this form of the disease:

Doppler ultrasound;
impedance plethysmography;
scanning using fibrinogen labeled with iodine 125.

In the overall structure of the incidence of thrombophlebitis, the lower extremities account for approximately 80-90%, i.e., the vast majority of cases.

Thrombophlebitis of the deep veins of the lower extremities must be differentiated from a number of other diseases and, first of all, with cellulite (inflammation of the subcutaneous tissue), rupture of a synovial cyst (Baker's cyst), lymphatic edema (lymphedema), compression of the vein from the outside by enlarged lymph nodes or a tumor, rupture or muscle stretching.

Chronic thrombophlebitis

Chronic thrombophlebitis is characterized by less severe symptoms than the acute form of the disease.
Such patients are concerned about pain and swelling in the affected area. Chronic thrombophlebitis is not accompanied by such pronounced symptoms as the acute form. The patient is bothered by periodic painful sensations in the area of the affected veins and slight swelling, which occur after prolonged exercise and practically disappear with rest. If the patient is in no hurry to seek medical help, he may develop complications: deep vein thrombophlebitis, thrombosis of the great vessels, post-thrombophlenic syndrome and chronic venous insufficiency.

Treatment of thrombophlebitis of the lower extremities

Treatment of thrombophlebitis of the lower extremities can be surgical or conservative.

Conservative therapy begins with providing the patient with bed rest for 7-10 days. The affected limb is bandaged with elastic bandages, which reduces the risk of blood clot detachment and the development of thromboembolic complications and gives it an elevated position. Prolonged stay in bed is unjustified. As soon as the inflammation begins to subside, the patient's motor regimen should be gradually expanded. Physical activity and muscle contractions improve blood flow through the deep veins and reduce the risk of new blood clots.

Compresses with Vishnevsky ointment, semi-alcohol or oil compresses, as well as ointments and gels with heparin are used locally.

Compresses with Vishnevsky ointment are used as local therapy for thrombophlebitis.

Non-steroidal anti-inflammatory drugs are prescribed for anti-inflammatory purposes. In case of high body temperature or the development of purulent thrombophlebitis of the lower extremities, broad-spectrum antibiotics are used.

Fibrinolytic drugs can only be used in the very early stages of the disease, which usually remain undiagnosed. Subsequent attempts at thrombolysis can lead to thrombus fragmentation and the development of pulmonary embolism. Therefore, thrombolytic therapy is contraindicated in patients without installed vena cava filters.

In the scheme of conservative treatment of thrombophlebitis of the lower extremities, a significant role is given to anticoagulant drugs, which reduce blood clotting time and thereby reduce the risk of blood clots. If the patient has contraindications to the prescription of anticoagulants (open form of tuberculosis, peptic ulcer of the stomach and duodenum, fresh wounds, hemorrhagic diathesis), then in this case hirudotherapy (treatment with leeches) is possible.

To improve the condition of the venous wall in patients with thrombophlebitis of the lower extremities, venotonic agents are used.

When a floating thrombus forms, accompanied by a high risk of developing thromboembolic complications, surgical intervention is indicated, the purpose of which is to install a vena cava filter in the inferior vena cava at a level below the renal veins.

For purulent thrombophlebitis of the superficial veins of the lower extremities, the Troyanov-Trendelenburg operation is performed.

Purulent thrombophlebitis of the veins of the lower extremities - an indication for surgical intervention

After acute inflammatory phenomena subside, patients with thrombophlebitis of the lower extremities are referred to sanatorium-resort treatment (hardware physiotherapy, radon or hydrogen sulfide baths are indicated).

Thrombophlebitis: symptoms and treatment

In all patients with thrombophlebitis, but especially in the case of non-varicose superficial thrombophlebitis, a complete clinical examination is necessary. Attention is mainly focused on the specific causes of inflammation of the veins. First of all, thrombophilia and cancer are excluded, since superficial thrombophlebitis may be one of the first signs of another, not yet diagnosed disease.

In a retrospective analysis of 140 consecutively observed patients, a connection between superficial thrombophlebitis and malignant disease was identified (in 18 patients, which amounted to 12.9%).

Superficial thrombophlebitis is manifested by erythema, pain, induration and other signs of inflammation of the superficial veins. As a rule, the disease develops as a result of infection or thrombosis of a vessel. The pathology is most often a localized problem, but in some cases there is an association with an increased risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), especially when the great saphenous vein is affected.

Most often, superficial thrombophlebitis affects the lower extremities, but with the increased use of intravenous catheters and injections into the arm, the prevalence of thrombophlebitis of the upper extremities has increased sharply.

Signs and symptoms of DVT are caused by a blockage of blood returning to the heart through the venous system. This causes blood to accumulate in the affected leg. The classic symptoms of DVT are:

Swelling
Feeling of warmth or heat
Redness
Leg cramps, often starting in the calves
Pain in the affected limb that increases with bending the leg
Bluish or whitish discoloration of the skin

People with DVT may have all or only some of the symptoms. Sometimes there are no signs of illness at all. Symptoms may also mimic an infection or cellulitis on an arm or leg.

When treating thrombophlebitis, the following methods of influence are considered:

Compression – special compression garments or bandages are used to compress the affected area as much as possible. As a result, pain decreases and inflammation subsides.
Mobilization is important because it allows the patient to recover faster and avoid serious complications such as pulmonary embolism.
Pharmacological effect - in case of severe clinical symptoms or threat of thromboembolism, the patient is individually prescribed medicinal treatment, which, depending on the indications, may include drugs from the group of anticoagulants, NSAIDs, thrombolytics, etc.

As a last resort, surgery is performed. First of all, surgery is indicated for those patients who have not been helped by drug therapy.

Treatment of deep thrombophlebitis

Treatment for deep vein thrombophlebitis is anticoagulation or “blood thinning” using individually selected medications.

The recommended duration of treatment for uncomplicated DVT is three months. Depending on the patient's situation, underlying medical indications and the cause of thrombophlebitis, longer anticoagulant therapy may be required. After three months, the patient’s condition is assessed in terms of the likelihood of a blood clot forming in the future.

If the decision is made to continue anticoagulant therapy long-term, the doctor will weigh the risk/effectiveness of preventing blood clots versus the risk of bleeding.

Drugs used to treat deep thrombophlebitis

Anticoagulation prevents the blood clot from expanding further and prevents the development of an embolism that can travel to the lung. There are different types of medications that can be used to anticoagulate and treat DVT:

Unfractionated heparin
Low molecular weight heparin: enoxaparin (Lovenox)
New oral anticoagulants (NOACs), also known as direct oral anticoagulants (DOACs)
Warfarin (Coumadin, Jantoven)

Current guidelines identify medications that are best used in different situations. For example, patients with DVT who do not have active cancer are most often prescribed drugs from the NOAC group. If any cancer is detected, DVT should be treated with enoxaparin as the first-line drug.

Drugs from the NOAC group work almost immediately, thinning the blood and exhibiting their anticoagulant properties. There is no need for a blood test to monitor dosage. NOAC medications currently approved for the treatment of deep vein thrombosis include:

Apixaban (Eliquis)
Rivaroxaban (Xarelto)
Edoxaban (Savaysa)
Dabigatran (Pradaxa)

All four medications are also indicated for the treatment of pulmonary embolism. Additionally, they can be prescribed to patients with anticoagulation for non-valvular atrial fibrillation. This helps prevent stroke and systemic embolism.

Warfarin (Coumadin, Jantoven) is an anticoagulant drug that acts as a vitamin K antagonist by blocking clotting factors II, VII, IX, and X. Historically, it was a first-line drug for the treatment of blood clots, but its role has been reduced due to the availability of new medicines. Although warfarin can be prescribed immediately after DVT is diagnosed, it takes a week or more for it to reach a therapeutic level in the blood to adequately thin the blood.

Low molecular weight heparin (enoxaparin, Lovenox) is administered at the same time. Enoxaparin thins the blood almost immediately and is used as a bridge therapy until warfarin begins to take full effect. Enoxaparin injections can be given on an outpatient basis. For those patients who have contraindications to enoxaparin (eg, renal failure does not allow the drug to be metabolized properly), intravenous heparin may be used as the first drug in combination with warfarin. Such treatment requires admission to the hospital. The dose of warfarin is monitored using blood tests that measure prothrombin time.

Surgical treatment of deep thrombophlebitis

Surgery is rarely used to correct large, deep-seated venous thromboses. Most often, surgery is indicated in the following cases:

The patient cannot take a blood thinner
The patient developed blood clots again while taking anticoagulant medications.

Surgery on the lower extremities usually involves placing a filter in the inferior vena cava to prevent clots from entering the lung.

If a blood clot forms in the iliac vein of the pelvis and femoral vein of the leg, surgery to remove the clot may be considered, but the patient should also take anticoagulant medications. Stents may also be needed to keep the vein open and prevent subsequent collapse of the vessel.

Complications of deep thrombophlebitis

Pulmonary embolism is the main complication of deep vein thrombosis. If symptoms such as chest pain and shortness of breath are present, the patient's life is in danger. Most often, pulmonary embolisms occur while a person is on their feet.

Postphlebitic syndrome can occur after deep vein thrombosis. The affected leg or arm may become chronically swollen and painful, with skin discoloration and ulcers forming around the foot, hand, or joint.

Superficial thrombophlebitis: treatment

In the acute phase of superficial thrombophlebitis (STP), several treatment options are available, although reliable recommendations based on proven information about the best effectiveness are not yet available. The most important thing to remember is that PTF is not a benign condition.

Compression

There is general agreement that compression is beneficial in relieving symptoms and may promote healing of the thrombotic process. Fixed compression used as the sole treatment modality has been shown to improve duplex examination results in 81% of patients.

Both bandages and graduated dressings are quite useful. Elastic compression stockings can be used. In extensive cases, different types of compression may be used.

It is recommended that the compression band exceed the thrombosed area by at least 10 cm. Compression should be applied for at least 2 weeks, but in patients with varicose veins it should be continued as a long-term treatment.

Mobilization

The concept of mobilization has completely changed the treatment of PTF. It has long been believed that patients in the acute phase of thrombosis should rest and avoid any movement of the leg. The reasoning was clear and mainly consisted of helping the clot stabilize and avoid the danger of its individual parts entering the bloodstream.

Current views differ significantly from each other. It is currently believed that bed rest promotes the progression of thrombus formation, mainly towards the deep venous system. Thus, the general consensus is that patients should walk regularly and avoid long periods of time in bed, sitting, or even standing.

Although there are no controlled studies to support the validity of this approach, clinical experience shows beneficial effects, including a clear improvement in the quality of life of patients with thrombophlebitis. Physical activity resembles therapeutic physical exercises for peripheral arterial disease and coronary heart disease.

Pharmacological effects

Anticoagulation is often done first. Additional treatment depends on the duration of thrombosis, which should be determined using ultrasound examination performed by well-trained specialists with extensive experience.

When treating superficial thrombophlebitis, the following strategies are followed:

If the thrombosis is 5 cm or less, treatment is with nonsteroidal anti-inflammatory drugs (NSAIDs). They can be entered locally or systemically. They help reduce pain and, most likely, relieve perivenous inflammation. However, NSAIDs should not be prescribed in addition to anticoagulants.
If the size of thrombosis is up to 10 cm (as determined by ultrasound), regular anticoagulant therapy is indicated, including low molecular weight heparin (LMWH), unfractionated heparin (UFH) and vitamin K antagonists. LMWH can be prescribed in a prophylactic or therapeutic dose.
In cases of extensive thrombosis (more than 10 cm), especially in the presence of several other risk factors, fondaparinux may be prescribed to reduce the likelihood of death, symptomatic deep vein thrombosis, and prolongation/recurrence of superficial thrombophlebitis. Clinical experience and several case studies have reported improvement in local signs and symptoms following the use of topical medications such as diclofenac, ibuprofen, and other gels. Their effects are often well accepted and appreciated by patients, although local irritation or allergies may occur.

In the future, new classes of anticoagulants may be developed that will reduce the incidence of deep vein thrombosis and PTF enlargement. To date, there is only limited information regarding deep vein thrombosis.

Surgery

Surgery is rarely performed for superficial thrombophlebitis; it is most often used for its acute form. Excision of the affected vein may be performed when symptoms persist after 2 or more weeks of intensive medical treatment. If the physician has concerns about further expansion of the thrombosis, vein ligation and eventual excision may be considered. This method of intervention has little support and almost no controlled randomized studies have been conducted on its effectiveness.

Treatment of thrombosed venous segment of chronic course

Compression and mobilization remain the main aspects of treatment of the chronic form of the disease, and control of the patient's environment both at home and at work is important. It is generally believed that constant immobility is a precipitating factor for venous insufficiency.

Unlike acute thrombophlebitis, in the chronic phase there are sufficient indications for surgical treatment, including stripping and dressing. When small segments of veins are affected, foam sclerotherapy , which is most often safe and useful when performed under ultrasound guidance.

It is important to know that in all cases the recommendations for mobilization and compression of the affected area, which are detailed above, should be followed.

Video: Treatment of varicose veins without surgery. Laser treatment of varicose veins without surgery. CELT

Thrombophlebitis of the hands: treatment

On the upper limb, the brachial, axillary and subclavian veins are identified. The internal jugular veins and the more distal radial and ulnar veins are less commonly affected. As in the case of the lower extremities, thrombophlebitis of the hand can also be superficial and deep. It is DVT of the arm that requires more thorough and prolonged treatment.

There are two forms of thrombophlebitis of the deep veins of the upper limb:

Primary
Secondary

The primary form is known as Paget-Schroetter syndrome and typically occurs among young athletes involved in activities requiring excessive and repetitive movement of the upper extremities. In particular, injury often occurs during intense participation in wrestling, swimming, gymnastics, and sports involving repetitive throwing of a ball (i.e., football, baseball, and basketball).

The secondary form most often occurs in patients with central venous catheterization or in patients with malignant neoplasms. In this form of the disease, catheterization destroys the endothelial membrane and also activates a similar coagulation cascade. In addition, congenital and acquired cases of bleeding disorders, such as factor V Leiden mutation or malignancy, also increase the risk of DVT in the upper extremity.

Upper extremity DVTs currently account for 5% to 10% of all DVTs, with incidence increasing annually.

Treatment of DVT of the upper extremities depends on the clinical picture. Most patients experience swelling of the extremities at the site of central venous catheterization.

Basic principles of treatment of thrombophlebitis of the hand:

If the vessel is associated with general peripheral nutrition, it should remain in place, and then anticoagulant therapy is carried out.
If the vessel is not the main one, it is removed, but only after completing 3-5 days of anticoagulant therapy.
The hospital may prescribe warfarin with unfractionated heparin. However, patients should continue taking warfarin for 3–6 months after diagnosis.

The role of new oral anticoagulant drugs (eg, dabigatran) is currently being investigated. Recent data from the Swedish National Quality Registry for Atrial Fibrillation and Anticoagulation suggest that these drugs can be used to treat upper limb DVT with acceptable efficacy and safety.

Treatment for the secondary form is different because acute thrombosis usually occurs in this case. Thus, patients develop significant pain and swelling requiring intravenous thrombolysis. This therapy helps relieve pain and swelling, but does not treat the underlying cause. Therefore, patients with secondary DVT of the upper extremity will require urgent surgical intervention to remove the first rib. This provides additional space in the chest to prevent future compression of the neurovascular bundle.

Thrombophlebitis of the leg: treatment

Today, thrombophlebitis of the lower leg is quite common, especially among young people who engage in professional sports such as weightlifting, boxing, martial arts, etc. The disease is most often not complicated by pulmonary embolism, but still in 30% of cases, thrombosis of the veins of the lower leg can spread to the proximal areas and then be complicated by pulmonary embolism. This risk especially increases in the absence of necessary treatment.

The word “proximal” refers to the deep veins above the knee. Everything below the knee is “distal”. Although anatomical variability often occurs, these distal veins include the paired peroneal, posterior tibial, and anterior tibial veins, which accompany the corresponding crural arteries.

1 - external iliac vein; 2 - common femoral vein; 3 - great saphenous vein; 4 - deep femoral vein; 5 - superficial femoral vein; 6 - popliteal vein; 7 - anterior segment of the tibia; 8 - posterior segment of the tibia; 9 - peroneal draining segment; 10 - anterior tibial veins; 11 - posterior tibial veins; 12 - venous veins; 13 - gastrocnemius muscle veins (medial head); 14 - venous muscles. (From Palareti G, Schellong S. Isolated distal DVT: what we know and what we are doing. J Thromb Haemost. 2012; 10: 11-19).

In modern medicine, there is no consensus regarding the treatment of thrombophlebitis of the leg. The guidelines are very vague. For example, current American College of Chest Physicians guidelines make no mention of how to treat calf vein thrombosis. However, as a general guideline, the same immediate and long-term (at least 3 months) anticoagulant treatment for all diagnosed DVTs (without any distinction between proximal and distal sites) has been recommended.

In addition to anticoagulant therapy, compression and mobilization are used, as is the case with other types of thrombosis treatment. The only thing is that in case of severe swelling and inflammation, for the first time it may be necessary to raise the leg above the level of the heart, and when the severity of symptoms decreases, perform moderate physical exercise to prevent relapse of the disease.

Diet for thrombophlebitis of the lower extremities

Properly organized nutrition creates the necessary prerequisites for improving the condition of patients, shortens rehabilitation time, and reduces the risk of relapse. The diet for thrombophlebitis of the lower extremities should provide:

strengthening the venous wall;
improvement of rheological properties of blood;
normalization of the patient's body weight.

Patients must carefully observe the water regime. You should drink at least two liters of liquid during the day. It is especially important to control the amount of fluid consumed in hot weather, as excessive sweating can cause blood to thicken.

With thrombophlebitis, it is important to drink at least 2 liters of water per day to avoid blood thickening

The diet of patients with thrombophlebitis of the lower extremities should include fresh vegetables and fruits in sufficient quantities, which provide the body with vitamins and microelements, which is necessary to improve the tone of the venous wall.

The diet for thrombophlebitis of the lower extremities includes the following products:

cold-pressed vegetable oils (it is advisable to use flaxseed oil daily for dressing salads);
melons (watermelon, melon, pumpkin);
ginger, cinnamon;
onions, garlic, leafy vegetables;
cocoa, chocolate;
all types of fruits, berries;
fatty varieties of sea fish.

Cherries and raspberries are especially useful for thrombophlebitis of the lower extremities. They contain a natural anti-inflammatory substance - salicylic acid, which not only reduces the activity of the inflammatory process, but also has some anticoagulant effect.

Thrombophlebitis during pregnancy and the postpartum period

During pregnancy, varicose veins of the lower extremities and thrombophlebitis often develop, since during this period of life women experience a physiological change in blood composition and intrauterine pressure increases. The first weight gain occurs in the second trimester of pregnancy, and many expectant mothers develop spider veins in the lower legs, ankles and thighs. Women experience pain and swelling in their legs. In some cases, seizures may occur.

The greatest likelihood of developing thrombophlebitis and pulmonary embolism is observed in the first days after childbirth, since the process of giving birth to a child causes a significant overload of the cardiovascular system:

increase in intra-abdominal pressure by 2-3 times;
compression of the pelvic veins while the baby’s head passes through the birth canal;
a sharp decrease in the tone of the veins of the lower extremities and their expansion.

The changes described above lead to disruption of normal blood circulation in the legs and provoke the formation of blood clots. When the first symptoms of varicose veins or thrombophlebitis appear, a pregnant woman must be examined by a phlebologist and undergo a series of diagnostic examinations that will allow the doctor to take measures to prevent the development of more severe complications.

TV show “New Day”, Dr. A. Kantarovsky, a specialist in vascular surgery, talks about superficial and deep thrombophlebitis:

Possible consequences and complications

Complications of thrombophlebitis of the lower extremities can be:

pulmonary embolism;
streptococcal lymphangitis;
white painful phlegmasia (associated with spasm of the artery running next to the thrombosed vein);
blue painful phlegmasia (develops in the affected limb with almost complete blockage of the venous outflow of blood);
purulent melting of a blood clot, which can lead to the formation of an abscess, phlegmon, and in severe cases cause sepsis.

Post-injection thrombophlebitis

Sometimes, if the rules for performing compression sclerotherapy are violated, a complication such as post-injection thrombophlebitis develops. In such cases, a vein with reduced compression becomes inflamed in the area of sclerosant injection, and a blood clot begins to form in its lumen, which can migrate with the bloodstream into the pulmonary artery and lead to pulmonary embolism.

Compression sclerotherapy may be accompanied by the formation of intravenous hematomas, which consist of sclerosant and blood clots. Subsequently, the area of hemorrhage becomes inflamed and leads to the development of post-injection thrombophlebitis. Also, the development of this form of the disease can be provoked by trauma to the vein during puncture or insertion of a catheter.

Forecast

The prognosis for thrombophlebitis of the lower extremities is serious. In the absence of adequate treatment, in 20% of cases the disease ends in the development of pulmonary embolism, which causes death in 15-20% of patients. At the same time, timely administration of anticoagulant therapy can reduce mortality by more than 10 times.

Cherries and raspberries are useful for thrombophlebitis of the lower extremities. They contain a natural anti-inflammatory substance - salicylic acid, which reduces the activity of the inflammatory process and has some anticoagulant effect.

Development mechanism

The essence of the pathology is an organic disorder of the circulatory system. It is based on an inflammatory process of an infectious (septic) or other kind.

Septic

The culprits are viruses, bacteria, and much less often fungi. Staphylococci (representatives of the pyogenic flora) are particularly aggressive, followed by herpetic agents in frequency, and candida is in an “honorable” third place (fungal structures).

Phlebitis develops. That is, the actual inflammation of the internal lining of the vein. It is accompanied by typical symptoms with pain, burning, redness of the skin above the level of the lesion.

The clinical picture is indistinguishable from other forms of vasculitis in the early stages (the named disease is generalized and represents inflammation of blood vessels in general).

After a few hours, thrombosis (blockage of a vessel) begins. The blood at the site of the lesion thickens, becomes more viscous, and is supplemented with fibrin fibers.

For some time this formation remains in one place and does not move. By itself, it can clog a vein and cause gangrene with the need for urgent surgical treatment.

In approximately 20% of cases, this happens if correction is not started within at least 6-8 hours. In another 35-40% of situations, the blood clot breaks off and begins to move throughout the body.

It’s hard to say where he’ll stop. The most common locations are the coronary and pulmonary arteries. When these vessels are completely blocked, the patient's death occurs almost instantly.

Nonseptic

The second variant of thrombophlebitis is non-infectious. In such a situation, inflammation of the inner wall of the vein occurs due to an autoimmune process.

That is, the body’s defenses attack the lining, mistaking its cells for invaders that need to be destroyed.

This form of the pathological process is initially much worse to treat, can be generalized in nature, that is, spread to many veins of the body, is more often chronic and requires constant monitoring by doctors and systematic therapy.

With due attention, there is every chance to recover and avoid dangerous consequences. Moreover, the symptoms of the process are obvious, it is difficult not to notice them.

Attention:

If suspected thrombophlebitis develops, it is strongly recommended to call an ambulance, describing the situation to the dispatcher so that the team can correctly prioritize.

Prevention

Prevention of the development of thrombophlebitis of the lower extremities should include the following measures:

timely detection and active treatment of diseases of the veins of the lower extremities;
sanitation of foci of chronic infection in the patient’s body;
early activation of patients in the postoperative period;
active lifestyle;
proper nutrition;
compliance with the water regime;
mandatory wearing of compression hosiery for varicose veins of the lower extremities.

In case of chronic recurrent thrombophlebitis of the lower extremities, it is necessary to conduct quarterly preventive treatment of the disease aimed at preventing exacerbations. It should include the prescription of phleboprotectors and physiotherapeutic procedures (laser, magnetic therapy).

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Causes

The development of thrombophlebitis is almost always associated with a number of reasons:

infection of tissues adjacent to the vein or injury to the venous wall;
stagnation of blood in the vessels;
changes in blood composition;
blood clotting disorder.

In most cases, thrombophlebitis develops against the background of varicose veins. The following can also lead to the development of the disease:

vascular injuries (during puncture or catheterization of a vein, operations, injuries, intravenous administration of certain drugs);
neurotrophic diseases;
endocrine diseases;
infectious diseases: influenza, tonsillitis, tonsillitis, scarlet fever, erysipelas, pneumonia, caries, tuberculosis, etc.;
local purulent processes;
chronic diseases of the cardiovascular system;
blood diseases;
long bed rest;
motionless body position when traveling by plane or vehicle);
stroke accompanied by paralysis of the limbs;
oncological diseases;
radiotherapy and chemotherapy;
pregnancy and childbirth;
taking medications based on sex hormones (or oral contraceptives);
surgeries in the hip joint area;
gynecological operations and abortions;
allergic reactions;
dehydration.

Those at risk for a high probability of developing thrombophlebitis include:

patients with varicose veins;
patients who have undergone surgery and are forced to remain in bed for a long time;
people who remain in a stationary sitting position for a long time (due to professional activities, long journeys by road or air transport);
pregnant and postpartum women;
elderly people;
obese people;
people leading a sedentary lifestyle.

How to eat now?

Always keep in mind: excess weight is a heavy burden for the veins. Due to the fact that fatty tissue compresses blood vessels, atherosclerotic plaques form, which lead to congestion in the blood flow. As a result, inflammation occurs in the vascular walls.

The first rule: do not overeat, limit your consumption of foods with a lot of fats and carbohydrates. Healthy diet - vegetables and fruits, fermented milk products, boiled, stewed, baked fish and meat.

Products that strengthen the walls of blood vessels and reduce blood clotting:

Fish, inhabitants of the sea;
Onions, garlic, capsicum, seaweed;
Ginger, cinnamon;
Tomatoes, carrots, beets;
All cereals;
Nuts, raisins, dried apricots;
Cottage cheese, kefir, yogurt;
Melon, watermelon, cranberry, lingonberry, grapes, sea buckthorn.

Main causes of deep vein thrombosis

Thrombosis of the lower leg is diagnosed most often during prolonged sitting or standing, which may be associated with the type of work (for example, hairdressers, office workers), with a sedentary lifestyle, in case of serious disorders of the blood clotting process.

The manifestations of this pathology of blood vessels can be considered quite characteristic, which allows for their timely detection and identification of the disease.

Also, the reason for the formation of this pathology of the veins in the lower leg should include:

Increased blood thickness and viscosity, which leads to the formation of small blood clots. The pathological anatomy of deep vein thrombosis of the leg is expressed in damage by this thrombus to the walls of the veins, which begin to become inflamed; blood clots also begin to form at the site of irritation, which can cause further aggravation of the pathological situation.
Several places in the vein in one area begin to become inflamed, which leads to multiple damage and further deterioration of the blood circulation process.
The development of phlebothrombosis, in which blood clots do not have a strong structure. This should be considered the initial stage of the disease in question, which can then develop into thrombophlebitis, characterized by the onset of an inflammatory process in the vein wall.

The combination of these reasons may vary in different patients, since it plays a role as a hereditary factor, expressed in congenital weakness of the veins and arteries, as well as the body’s tendency to form blood clots due to the peculiarities of the blood composition (its increased viscosity, tendency to thrombus formation).

Also, this vein pathology can be observed when using hormonal drugs, being overweight, smoking, or after surgery.

Thrombosis of the leg

Causes of thrombophlebitis of superficial veins

With thrombophlebitis of the superficial veins, playing sports becomes, to put it mildly, difficult, since the flow of blood through the affected vessels is disrupted.

It goes without saying that the more pronounced the pathological process, the greater the obstacles to normal blood flow.

Since the superficial veins are not always included in the work, they become inflamed much less often.

However, there are still a number of diseases and conditions for which thrombophlebitis of the superficial veins of the lower extremities is very characteristic.

It often develops against the background of long-term intravenous injections.

Although the superficial veins of the upper extremities are most often used for this purpose, especially the veins of the elbow, in some patients they are very poorly expressed, and then the medical staff is forced to look for other injection sites.

Many medications have a direct damaging effect on the inner lining of the vein, causing inflammation and subsequent thrombus formation.

The development of thrombophlebitis of the superficial veins of the lower extremities in experienced injection drug addicts is very typical.

Due to long-term intravenous drug use, almost all such individuals become affected by the veins of the upper extremities, and they begin to inject drugs into the veins of the lower extremities.

The further fate of the vessels is the same: irritation of the vein wall - its inflammation - thrombosis.

Thrombophlebitis of superficial veins treatment

Most often, inflammation of the superficial veins of the lower extremities is observed with varicose veins.

This disease is characterized by insufficiency of the valvular apparatus of the veins, impaired vascular elasticity and dysfunction of the communicating veins (vessels connecting the deep venous system with the superficial).

In some patients, especially those who are weakened and suffering from long-term illnesses, the superficial veins become very vulnerable to infectious agents and other damaging factors.

An inflammatory process develops in the walls of the vessel, which is inevitably accompanied by the appearance of blood clots.

In the development of thrombophlebitis of the superficial veins of the lower extremities, infection plays a special role.

Very often, local infectious and inflammatory diseases, such as erysipelas, abscess, phlegmon and others, are complicated by the spread of the pathological process to the venous wall.

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This is also observed in severe systemic diseases, for example, sepsis (“blood poisoning”).

The occurrence of thrombophlebitis of the superficial veins is characteristic of injuries of the lower extremities, especially with open fractures. The mechanism of inflammation development in this case is twofold.

On the one hand, pathogenic microorganisms can penetrate into the damaged area. On the other hand, damage to the vein itself at the time of injury can trigger a complex cascade of biochemical reactions that will lead to inflammation and blood clots.

Finally, the occurrence of thrombophlebitis of the superficial veins “out of the blue” may be the body’s first signal that a malignant tumor is growing somewhere inside it.

A similar mechanism is observed in autoimmune diseases such as systemic lupus erythematosus, antiphospholipid syndrome and many others.

Traditional methods of treatment

A tablespoon of verbena is poured into 500 ml of boiling water and allowed to brew for 3 hours. Take 50 ml three times a day, an hour before meals.
Fresh leaves of white cabbage are applied overnight as a compress. Cabbage relieves inflammation and swelling.
For 3 liters of boiling water you need to take three tablespoons of dried lavender, chamomile, dried cinnamon and calendula. The raw materials are poured with boiling water and infused for an hour. Used in the form of foot baths at the rate: a liter of decoction is diluted with 2-3 liters of warm water.
A glass of chestnut flowers and its peeled fruits are crushed and poured with one liter of vodka. Next, let it brew in a dark place for 10-15 days and take 20-30 drops three times a day before meals. Additionally, the tincture is used as a rub on the affected area of the leg.

Types of operations for deep vein thrombophlebitis

The most effective treatment for deep thrombophlebitis is considered to be surgical intervention. It is the operation that reduces the development of complications and relapse of pathology to almost zero. As a rule, they resort to minimally invasive procedures under the control of an ultrasound or X-ray machine. The following types of vascular surgery are currently practiced:

Installation of a vena cava filter . The filter is a type of umbrella, the task of which is to normalize blood circulation in the affected vein, but at the same time, to prevent a blood clot from entering the bloodstream. The manipulation is carried out when there is a high risk of blood clot passage; after a few weeks, the filter can be removed.
Sewing a vein . If it is not possible to install a filter, the surgeon stitches the vein and places a special clip on the outside. With this procedure, the vein is not completely blocked, leaving room for blood to pass through, but not for a blood clot.
Endovascular thrombectomy . The manipulation involves clearing the vein of the blood clot present in it and normalizing blood circulation in it. For these purposes, special catheters are used.

During the rehabilitation period, the patient is prescribed to wear compression stockings, which will be selected by a phlebologist. For the first few weeks, wearing this jersey is mandatory, which will prevent the recurrence of a blood clot.

Massage

Self-massage, performed exactly according to the doctor’s instructions, will not harm the affected veins. It has a positive effect on thrombophlebitis due to the following therapeutic effect:

Strengthening muscles;
Normalization of skin tone;
Reducing vein deformation;
Activation of metabolic processes;
Reducing the feeling of heaviness and swelling;
Improving blood flow;
Reducing the risk of blood clots.

It is important to perform massage for thrombophlebitis correctly. It is better to entrust the first sessions to a competent specialist. At home, you can combine the superficial technique of simple massage with Troxevasin or Heparin ointments. Typically recommended at home:

Kneading the toes, gradually moving to the ankle joint;
Alternate stroking with rubbing;
Massaging the ankle joint is performed towards the knee from the foot. In this way, upward blood flow is stimulated;
Rubbing the calves with periodic shaking;
The thigh is massaged by rubbing, intermittent vibration, and light tapping.

If during the massage you feel heaviness, swelling increases, and the veins dilate, then you should stop treatment and consult a doctor. You can perform hydromassage at home in the form of a classic contrast shower. During the procedure, it is allowed to alternate between warm water and moderately cold water, with the water flow directed from the feet to the calves and thighs.

Important!
In case of deep vein thrombosis, it is prohibited to perform any massage manipulations.

Massage for thrombophlebitis of the legs

Is there a risk that I will get thrombophlebitis?

Who is at risk:

As age increases, the risk of morbidity also increases. Therefore, persons in the age category of 40 years and older should take their health seriously. This occurs due to a slowdown in blood flow and thickening of the walls of the circulatory system.
Overweight people. In many cases, obesity and thromboembolic complications go together. The risk increases significantly in people with degree 3 obesity and above.
Carrying and giving birth to a child, especially caesarean section. In the presence of minor pathologies of the venous system, pregnancy is fraught with serious consequences due to constant stress on the lower body.
Active smokers.
People who frequently drink alcoholic beverages. Alcoholism. Drug addict.
People who have in the past had fractures of leg bones, vascular damage due to injuries at home, in heavy work, in the event of road traffic accidents and gunshot wounds. The risk of thrombophlebitis increases in 60% of cases.
Uncomfortable body position during long trips on buses, planes and trains.

Thrombophlebitis and vein blockage may occur without any symptoms. Most often, the disease manifests itself after a few years, although outwardly everything looks normal.

A careful examination of the patient’s life reveals violations of daily routines and nutrition, as well as other factors that contribute to the formation of pathologies.

Description of acute thrombophlebitis of superficial veins

Acute thrombophlebitis is inflammation of the venous walls, provoked by a focus of infection near the affected vessel. A thrombotic mass forms in the lumen of the vein.

This thrombus increases, threatening to move into the lumen of the pulmonary artery when it breaks off. Most often, thrombophlebitis affects the legs, less often the upper limbs.

Most often, acute thrombophlebitis of the superficial veins of the lower extremities appears against the background of varicose veins.

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Only a DOCTOR can give you an ACCURATE DIAGNOSIS!
We kindly ask you NOT to self-medicate, but to make an appointment with a specialist!
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In addition, there may be the following reasons for the appearance of pathology:

infectious diseases, sepsis;
extensive limb injuries;
consequences of surgery in the area of the main venous trunks;
long postoperative period of bed rest;
pathologies of the heart and blood vessels;
hemiplegia and hemiparesis;
taking hormonal contraceptives;
oncological lesion (paraneoplastic syndrome);
excess weight;
alcohol and smoking abuse;
complicated pregnancy and childbirth;
allergy.

In 20% of cases, deep vein thrombosis is associated with damage to the superficial veins.

Provoking factors for thrombophlebitis of the upper extremities are usually a long stay in the vein of a catheter or numerous punctures for administering medication, purulent wounds and hand injuries.

The causes of increased thrombus formation are combined into Virchow's triad.

violation of the structure of the vein wall;
slowing blood flow;
increased blood clotting.

A common acute respiratory infection can provoke thrombophlebitis in a patient with varicose veins of the venous system. This disease occurs at any age, from 17 years of age and older. The largest percentage of cases are in the age category from 40 to 46 years.

Most often, the lesion is localized in the upper and middle third of the leg, as well as in the lower third of the thigh.

Symptoms of acute thrombophlebitis of the superficial veins:

If thrombophlebitis has limited localization, then damage to the limb occurs in a small area of the vein. With the migrating form of thrombophlebitis, a large number of small lesions of the vein occur throughout the limb.

The ascending form of thrombophlebitis is characterized by the involvement of the proximal veins in the process. Complications of thrombophlebitis of the saphenous veins can include suppuration, abscess formation, and phlegmon under the skin.

By the end of the first week from the onset of the disease, hyperemic phenomena and swelling of the skin decrease.

The further development of the pathology has the following variants of the course of the disease:

When thrombophlebitis passes into a subacute state, spontaneous pain in the affected area of the limb, independent of palpation of the vein, is characteristic.

In the case of chronic thrombophlebitis, during exercise or palpation, slight pain persists throughout the entire length of the formed cord.

The consequences of the chronic form of thrombophlebitis are trophic lesions of the skin and other tissues of the limb.

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Prevention of thrombophlebitis

To prevent the formation of blood clots, the following precautions should be taken:

Maintain hygiene. You need to wash your feet thoroughly every day and take baths (with sea salt) once a week.
Temper yourself. The best method is a contrast shower, dousing, visiting the bathhouse less often.
Follow a diet for thrombophlebitis. You need to give up excessive consumption of fatty, salty foods, and reduce the amount of food consumed.
Quit alcohol and smoking.
If you are prone to blood clots, you should wear special compression stockings.
Perform basic leg exercises and special gymnastics.

Watch a video with a set of exercises for the prevention of thrombophlebitis:

Varicose veins - a set of exercises for treatment