Diagnosis and treatment of superficial (saphenous) vein thrombosis

Thrombophlebitis

– a disease characterized by inflammation of the vein wall and the formation of a blood clot. A thrombus is a blood clot that blocks the lumen of a vein and impedes the outflow of blood. The process can develop both from inflammation to the formation of a blood clot, and from a blood clot to inflammation. In the first case, inflammation from the tissues surrounding the vein can spread to the vein wall and a blood clot forms in the place where the wall tissue is changed. In the second case, the blood clot causes blood stagnation, which contributes to the development of inflammation.

If inflammation of the vein walls is observed without the formation of blood clots, they speak of phlebitis

.
Thrombophlebitis more often affects the vessels of the legs, while with superficial vein thrombosis, inflammation of the walls is observed more often than with deep vein thrombosis, therefore, thrombophlebitis of the superficial veins
from
deep vein thrombosis of the lower extremities
, which is a more dangerous disease.

What is thrombophlebitis

Thrombophlebitis

(acute thrombophlebitis, superficial vein thrombosis, TPV) is an inflammation of the venous walls with further formation of blood clots. The thrombus is tightly attached to the inflamed vessel. If treatment is started in time, the blood clot will resolve, the inflammation will go away, and the venous lumen will be restored and will not affect blood flow.

The incidence of thrombophlebitis is determined by many factors, one of which is age. Thus, superficial vein thrombosis debuts annually in 0.3-0.6 per 1000 people under 30 years of age and in 0.7-1.8 per 1000 elderly patients. There are also gender differences. In men under 30 years of age, acute thrombophlebitis occurs in 0.05 cases per 1000 patients annually. For women, these figures are significantly higher. Thus, in the first 30 years of life, the onset of TPV is detected in 0.31 per 1000 women, but with age the detection frequency increases to 2.2 per 1000 patients i Bogachev V.Yu. Thrombophlebitis (thrombosis of superficial veins): modern standards of diagnosis and treatment / V.Yu. Bogachev [et al.] // Outpatient surgery. — 2021. — No. 3-4 (63-64). — P. 16-23. .

In 3-11% of patients, thrombophlebitis is localized on the lower extremities. The system of the great saphenous vein is affected in 60-80% of cases, the small saphenous vein - in 10-20%, and bilateral TPV occurs in 5-10% of cases i Bogachev V.Yu. Thrombophlebitis (thrombosis of superficial veins): modern standards of diagnosis and treatment / V.Yu. Bogachev [et al.] // Outpatient surgery. — 2021. — No. 3-4 (63-64). — P. 16-23. .

Against the background of varicose veins, thrombophlebitis occurs in 4-62% of patients i Bogachev V.Yu. Thrombophlebitis (thrombosis of superficial veins): modern standards of diagnosis and treatment / V.Yu. Bogachev [et al.] // Outpatient surgery. — 2021. — No. 3-4 (63-64). — P. 16-23. .

Folk remedies

Along with drug treatment, traditional methods can give good results. However, you should not blindly believe and thoughtlessly try everything on yourself. The doctor should control the treatment regimen, the admissibility and effectiveness of folk remedies.

• White cabbage. Cabbage leaves need to be softened, one side greased with oil and secured with a bandage on the painful area. Leave the compress on all night.
• Kalanchoe pinnate. Grind the leaves and fill the jar halfway with them. Fill the rest of the jar with vodka. Next, leave for 7 days in a dark place, shaking the contents periodically. Strain the finished tincture. Rub the sore leg from the foot to the groin in the direction of the vein. So for a month 2 rubles/day.
• Apple vinegar. Mix 2 teaspoons of vinegar and honey in a glass of water. Drink half a glass before meals 2 times a day.
• Mumiyo. You can make a tincture for internal use and ointment:
• for the tincture you need to mix 10g of mumiyo with 0.5l of water - drink 1 tablespoon/1 ruble per day, 10 days
• For the ointment, you need to mix mumiyo with Vaseline (or peach oil) in a ratio of 1 to 5 - smear 3 times a day, leave for 1 hour, 10 days.

Types (classification) of disease

Thrombophlebitis is divided into several types, taking into account the origin and origin of the disease, the localization of the lesion, and the extent of the lesion.

Venous thrombophlebitis is divided according to the affected area into:

• Migratory
  . A blood clot appears in one place. Over time, it disappears and appears in another area. The condition is dangerous and requires prompt medical attention.
• Local
  . A blood clot forms in a specific area. It doesn't have to be the shins. For example, thrombophlebitis of the hand is diagnosed.

Depending on the presence or absence of pathogens, subcutaneous thrombophlebitis occurs:

• Septic
  . The infection spreads quickly through the bloodstream, so there is a risk of developing sepsis. Diagnosed after childbirth, surgery and erysipelas. Treated with antibiotics.
• Aseptic
  . There is no infection, the disease occurs after injury. Most often, varicose thrombophlebitis is diagnosed due to improper or absent treatment.

Depending on the size of the blood clot, the disease can be:

• Occlusive
  . The lumen of the vein is completely blocked, so the outflow of blood is impaired. There is a risk of necrosis (tissue death), so immediate surgery is required.
• Non-occlusive
  . An attached blood clot partially blocks the venous lumen. Blood circulates.

Based on the extent of the pathological process, the following is revealed:

• Thrombophlebitis of the superficial veins
  . Symptoms appear immediately. The patient complains of pain along the vein. The surrounding skin turns red and thickens. Over time, swelling forms, which is difficult to eliminate. The temperature is kept within 39 °C. Treated with medication.
• Deep vein thrombosis
  . This form is detected less frequently and is more severe. The symptoms are the same, but their severity is stronger. The limbs become very swollen and turn blue. If there is a high risk of developing pulmonary embolism, surgery is performed.

First, thrombophlebitis of the superficial veins of the lower extremities develops. If left untreated, the disease develops into deep vein thrombosis, thrombophlebitis of the great saphenous vein.

Diet

People suffering from TF or at risk of developing this disease should eat as little as possible foods containing vitamin K, which stimulates blood clotting. These products include:

• Bananas;
• Cabbage;
• Pork liver;
• Black currant;
• Soy;
• Beans, etc.

You should also be careful about foods that are involved in the formation of blood clots:

• Confectionery and baked goods.
• Fat meat.
• Canned food.
• Sausages.
• Walnuts.

It is recommended to limit the consumption of salt, sugar, sour cream and butter, and include more plant foods in the diet, including herbs, fresh fruits and vegetables, and grains. Consumption of lean meat and seafood is allowed.

People suffering from TF should eat beef liver, which strengthens the walls of blood vessels, as well as buckwheat, melon, oatmeal, cinnamon, ginger, onions, citrus fruits, dairy products, etc. It is best to steam, or boil or stew foods. Fried, salted and smoked foods are excluded. The daily volume of fluid consumed should not be less than 2.5 liters, not counting strong tea, carbonated drinks and coffee.

Stages

The sequence of development of the disease is as follows:

1. Acute stage
   . Clinical signs of thrombophlebitis are bright and appear unexpectedly. The temperature rises, the skin around the affected area turns red, and the patient shudders. If treatment is started within two weeks, the development of the disease can be avoided. The blood clot will dissolve. The duration of exacerbation is up to one month.
2. Subacute stage
   . Lasts up to two months. Signs of the disease subside, but do not fade away. The skin remains red and the swollen veins turn blue. The swelling goes away, but the seals remain.
3. Chronic stage
   . Diagnosed two to three months after the disease is detected. Symptoms are either absent or worsened. During remission, the limbs remain swollen, quickly become tired and itchy, but there is no pain. Discomfort occurs in the lower extremities when walking for a long time.

Complications and prognosis

Complications of superficial thrombophlebitis occur extremely rarely. It is dangerous when a blood clot breaks off and leads to thromboembolism.

However, unlike deep vein thrombosis, which is rarely accompanied by inflammation, superficial thrombophlebitis is usually accompanied by an acute inflammatory reaction, causing the clot to adhere to the vessel wall. The likelihood of it breaking off and entering the bloodstream is very low. In addition, superficial veins, unlike deep veins, are not surrounded by muscles, the contractions of which contribute to compression and displacement of the blood clot, which can lead to its separation. For these reasons, superficial thrombophlebitis is rarely complicated by thromboembolism. However, the possible complications of superficial thrombophlebitis are as follows.

Be sure to tell your doctor that despite treatment for superficial thrombophlebitis, the symptoms do not decrease or increase. Also report any new symptoms such as fever, chills, paleness, or swelling of the extremity. A change in skin color at the site of thrombophlebitis may remain noticeable for a long time after treatment; this is not a pathological symptom.

How is thrombophlebitis different from varicose veins?

Varicose veins are increased pressure in thinned and inelastic veins, and thrombophlebitis is an inflammation of the venous walls with subsequent formation of blood clots. Most often, the diagnosis of thrombophlebitis is a consequence of varicose veins.

Thrombophlebitis differs from varicose veins in the following symptoms:

Both pathologies develop as a result of impaired hemostasis, but inflammation of the venous walls is more often associated with the entry of an infectious agent. The difference is the absence of local inflammation. With varicose veins, the veins do not become inflamed. In this case, only the blood circulation is disrupted.

Causes of thrombosis

The main cause of arterial thrombosis is atherosclerosis, in which clots of fats or calcium compounds form on the walls of the arteries. They narrow the artery and can completely block blood flow or break off and block smaller vessels.

The development of arterial thrombosis in the vessels of the brain results in strokes, and in the coronary arteries - myocardial infarction.

There are many more reasons for the formation of venous blood clots:

• varicose veins of the lower extremities;
• loss of mobility, both complete and partial;
• bone fractures;
• hypercoagulability and other autoimmune disorders;
• heredity.

Causes and risk factors for the development of thrombophlebitis

Thrombophlebitis of the lower extremities rarely begins spontaneously. Most often, the disease becomes a complication of leg diseases. The development mechanism is associated with improper outflow of lymph and blood through the veins and vessels. After injury to the inner layer of the vein, bleeding begins. In response to this, a blood clot forms. It prevents blood loss, but over time it grows and completely blocks the lumen of the vessel, preventing blood from circulating.

The following factors precede this process:

• Damage to the vascular wall. This group includes mechanical injury to veins due to trauma and compression of the limbs. Venous walls are damaged when injections are performed incorrectly, frequent and long IVs, or operations.
• Deterioration of blood supply to certain areas of the body. The blood flows poorly due to wearing a cast for a long time, bed rest and physical inactivity. Less commonly, slowing of blood flow occurs as a result of heart failure.
• Improper flow of blood in the veins due to venous insufficiency. The complication develops against the background of pregnancy and diseases of the pelvic organs.
• Increased blood clotting. The viscosity and homogeneity of blood and plasma change with long-term use of hormonal drugs, discrepancies in the levels of estrogen and progesterone, and infections.

Other causes of thrombophlebitis may be:

• obesity;
• allergic reactions and sensitization;
• a history of venous thromboembolic complications (VTEC);
• taking a number of medications (diazepam, amiodarone, vancomycin, chemotherapy drugs, heroin addiction).

Acute thrombophlebitis often develops against the background of some autoimmune diseases, such as systemic lupus erythematosus, vasculitis, Behcet's and Buerger's diseases. In particular, in Behçet’s disease, TPV is detected in 53.3%, and DVT in 29.8% of patients i Bogachev V.Yu. Thrombophlebitis (thrombosis of superficial veins): modern standards of diagnosis and treatment / V.Yu. Bogachev [et al.] // Outpatient surgery. — 2021. — No. 3-4 (63-64). — P. 16-23. .

The risk group includes:

• Patients with heart disease - chronic heart failure, ischemic stroke. Limbs swell, motor activity decreases, and after a stroke there may be paralysis, which impedes the flow of blood through the veins.
• Patients with concomitant phlebological diseases - varicose veins, venous thrombosis. The speed of blood movement in the veins decreases, the blood stagnates, forming a blood clot.
• Bedridden patients, people with complex fractures. Their mobility is impaired and the likelihood of blood clot formation increases.
• People with a hereditary predisposition. Hemostasis disorders are transmitted genetically. The likelihood of the disease is increased if blood flow pathologies are detected in first-degree relatives.

Who is at risk?

The risk group for developing the disease includes the following categories:

• Pregnant women, women after childbirth and on hormone replacement therapy.
• Patients with a malignant tumor.
• Women who have been using contraceptives for a long time.
• Patients with excessively limited physical activity.
• Patients with pathologies of the venous system.

The likelihood of developing the disease is also high for people:

• Over the age of 60.
• With a previous stroke and episodes of TF.
• Smoking abusers.
• Suffering from obesity.

It is worth remembering that regular physical activity and giving up bad habits stimulate normal blood circulation, which will avoid the formation of blood clots. People who are included in one of the above risk groups should contact a phlebologist for an examination and recommendations for preventive measures.

Symptoms

Signs of thrombophlebitis appear immediately. The disease can be suspected based on the following clinical picture:

• the limb swells;
• the skin over the inflamed vein turns red, and the vessel itself darkens and is clearly visible under the skin;
• a compaction is felt to the touch along the course of the vessel;
• there is a feeling of heaviness in the legs and bloating of the veins;
• in a supine position, the patient cannot lift his leg and rotate his foot;
• The leg is cold to the touch.

At the initial stage, the symptoms are local, that is, the general condition does not change. As the disease progresses, mobility becomes impaired. The patient notes weakness in the legs and cannot stand for a long time. When bending the foot, he feels tension in the lower leg and thigh. Temperatures range from 37°C to 39°C.

Distinctive signs of thrombophlebitis of the lower leg are that the calf muscle turns blue and the veins on it swell. The pain is so severe that the patient cannot step on his foot.

Thrombosis of the iliofemoral vein is manifested by pain in the lumbosacral spine, pain in the groin and the lower third of the abdomen on one side.

Femoral vein thrombosis is characterized by swelling of the veins in the upper thigh and discomfort in the groin area.

If the blood clot comes off

The thrombus is not always firmly attached to the wall of the vessel. When a clot is superficially attached, a simple surge in pressure, a blow, or a careless movement is enough for the clot to come off and travel through the circulatory system. Moving through the vessels, the detached thrombus sooner or later reaches the most important organs, and usually the pulmonary vein, if the thrombus was venous, or the left atrium, if arterial.

Pulmonary thrombus

In the most dangerous cases, blockage of the large vessels of the lung occurs, after which death occurs within a few minutes. A less severe option is infarction-pneumonia, when a blocked vessel bursts and the lungs begin to fill with venous blood, which is accompanied by acute pain and hemoptysis. In this case, the patient has every chance of survival.

The mildest case, when a blood clot enters the pulmonary veins, is accompanied by an increase in blood pressure in the lungs, pain, shortness of breath, and suffocation. If you call an ambulance right away, the patient is likely to survive.

Coronary thrombus

If a blood clot located in the left atrium or coronary arteries breaks off, the patient is at risk of: myocardial infarction, stroke if the blood clot enters the brain through the bloodstream, infarction of the intestines or kidneys if the arteries leading to them are blocked, as well as blood stagnation and gangrene with subsequent loss limbs if the blood clot gets into the large arteries of the arm or leg.

Diagnosis of thrombophlebitis

Diagnosis of the condition of the lower extremities includes:

• Vascular ultrasound in Doppler mode
  . The blood flow of the superficial and deep veins is analyzed. Areas of narrowing of the vascular lumen and slowing down of blood flow are identified.
• CT venography
  . The transition of the femoral vein to the iliac vein is poorly visualized on ultrasound, so computed tomography shows a splash of blood after slow passage through a certain area. It is carried out with contrast enhancement, that is, a dye is injected into the vein.
• D-dimer assay
  . When a blood clot forms, the amount of fibrin breakdown products in the blood increases. The analysis is performed after an ultrasound.
• Blood analysis
  . The diagnosis is confirmed by high coagulogram (clotting test) values. The presence of C-reactive protein indicates inflammation. Leukocytes also grow, ESR increases, and the number of rods in the blood increases.

Mechanism of thrombus formation

The formation of a blood clot always follows one scenario: first, damage occurs (trauma to the vessel wall), platelets rush to the site of damage, which stick together into a strong clot and adhere to the wound. Next, fibrin threads are formed, and the vessel receives a “patch.” Over time, the tissues are restored, the blood clot dissolves as unnecessary.

A useful mechanism that saves people from blood loss due to injury can become dangerous when there is an excess of platelets - thrombophilia. An excess of these blood cells results in blood clots that are too large for minor injuries. The second important factor in thrombus formation is the very presence of damage. Thrombosis becomes a pathology if it begins in the absence of injury to the vascular wall.

Treatment of thrombophlebitis

Therapeutic actions are aimed at suppressing inflammation, resolving blood clots and thinning the blood.

Drug treatment

venous thrombophlebitis involves taking:

• anticoagulants to thin and prevent blood clotting, in the acute phase are prescribed by injection;
• antibiotics for the infectious nature of the disease;
• angioprotectors to increase the tone of the veins, reduce venous stagnation;
• disaggregants for breaking down cells that form a blood clot;
• phlebotonics to strengthen and increase the elasticity of the walls of blood vessels;
• non-steroidal analgesics to relieve acute pain.

Compression therapy

using bandages, elastic stockings or class 2 sleeves accelerates blood flow in the superficial and deep veins, thereby preventing the growth of a blood clot. In addition, compression has an analgesic effect.

Physiotherapy

– an effective method of treating venous thrombophlebitis. After acute symptoms have been relieved, a course of magnetic therapy, infrared radiation, ultraviolet radiation, or darsonvalization of your choice is prescribed. The procedures reduce inflammation, increase blood circulation, and accelerate the regeneration of the internal walls of veins.

Surgical intervention

is prescribed if the blood clot grows and the threat of blocking the lumen of the vessel increases. There are several types of operations for thrombophlebitis:

• crossectomy – access to the saphenous vein through the groin and an incision in the thigh;
• thrombectomy – access to the thrombus through one incision;
• invagination stripping - with the help of a probe, the vein is everted, the blood clot is removed;
• stenting – the vein is expanded mechanically by installing a special balloon.

Why is it important to undergo treatment in a modern clinic?

Thrombophlebitis can be easily cured without surgery if the patient does not delay going to the doctor and does not self-medicate at home. This is why it is important to see a doctor at the first symptoms. The causes of the disease - inflammation of the vessel wall and blood clotting disorders - can only be eliminated through professional medical care provided by experienced doctors in a modern clinic. Not to mention acute forms of the disease, treatment of which is carried out only on an outpatient basis, since there is a risk of a threat to life.

Recommendations and contraindications for thrombophlebitis

The doctor advises you to follow a diet and wear low-heeled shoes with a comfortable last.

Forbidden:

• wear stilettos and heels higher than 3 cm;
• massage limbs;
• go to the gym and lift weights;
• remove leg hair with wax or epilator;
• go to the bathhouse and sunbathe;
• wear socks, stockings, and knee socks with a thick elastic band.

It is necessary to exclude the use of hormonal drugs and choose a different method of contraception.

General recommendations

You definitely need to change your usual lifestyle - the final result of treatment for thrombophlebitis will depend on how completely you can do this.

General recommendations from doctors are as follows:

1. You can't lift weights.
2. It is necessary to avoid prolonged standing or sitting - such statistical monotonous postures can lead to deterioration of health.
3. Regular physical education – at a minimum, morning exercises and walking, at a maximum – classes in the gym.
4. Patients with the disease in question are strictly prohibited from visiting baths and saunas. However, overheating is just as harmful as hypothermia.
5. During rest and night sleep, the legs should be in an elevated position - this will ensure the outflow of blood from the lower extremities and prevent congestion in the vessels of the lower extremities.

If the disease in question is diagnosed at an early stage, the effectiveness of treatment will be very high. But even if experts recommend surgical intervention, you should not refuse - such radical treatment usually leads to a complete restoration of the ability to live and work fully.

Sources

1. Bogachev V.Yu. Thrombophlebitis (thrombosis of superficial veins): modern standards of diagnosis and treatment / V.Yu. Bogachev [et al.] // Outpatient surgery. — 2021. — No. 3-4 (63-64). — P. 16-23.
2. Kuzmichev D.E. Pathomorphological findings. Thrombophlebitis / D.E. Kuzmichev [et al.] // Health care of Ugra: experience and innovations. - 2020. - No. 1. - P. 53-56.
3. Marushchak E.A. Modern methods of ultrasound diagnosis of venous thrombosis of the inferior vena cava system / E.A. Marushchak, A.R. Zubarev // Outpatient surgery. Stationary replacement technologies. - 2014. - No. 3-4 (55-56). — P. 38-47.

What is the danger of thrombophlebitis of the upper and lower extremities?

The first signs and symptoms of this disease should alert you. You should not trust traditional methods of treatment or hope that the disease will go away on its own. Its complications are extremely serious, and some are even incompatible with life. That is why it is extremely important to undergo a timely examination and begin treatment as early as possible. Thrombophlebitis is curable, and you can get rid of the unpleasant consequences. Qualified treatment will significantly improve your quality of life and relieve unbearable pain in your limbs.