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ACUTE SUPERFICIAL VENOUS THROMBOPHLEBITIS

the lower extremities Thrombophlebitis - inflammation of a vein with the formation of thrombi in their lumen. Etiology and pathogenesis Thrombophlebitis is divided into traumatic and non-traumatic. Traumatic thrombophlebitis occurs in cases where the injured vessel wall itself (intravenous injection, including long-term catheterization of veins, traumatic injury, surgery). Non-traumatic thrombosis - is often a transition of inflammation to the surrounding tissue to the venous wall with the subsequent formation of thrombus. Non-traumatic thrombophlebitis may occur also in violation of local hypercoagulation and blood. Thrombophlebitis Thrombophlebitis is divided into varicose veins and thrombophlebitis nonextended veins. Thrombosed veins under the influence of conservative tive therapy, usually within 2 ... 3 months rekanaliziruyutsya, but the inflammation ends with the formation of scar tissue, so the venous wall loses its elasticity, impaired function of its valvular apparatus. In some cases, scar obliteration of the vein occurs. The clinical picture In the event of thrombosis in patients complain of throbbing pain in the course of the venous trunk, sometimes very intense, worse when walking. Fever, malaise, and weakness. On examination, most often on the lower leg on the thigh are less inflammatory infiltrates along the saphenous vein, the skin over the infiltration hyperemic and edematous. Skin hot to touch, sharply painful. A number of patients indicated lymphangitis and / or enlarged inguinal lymph nodes (regional lymphadenitis). Appears leukocytosis, increased erythrocyte sedimentation rate. In rare cases, infiltration occurs in the course of softening, skin becomes bluish-purple color is determined by the fluctuation, which indicates that abscess formation (suppurative thrombophlebitis). Thrombophlebitis of superficial veins, if you do not extend to the deep veins, almost never causes pulmonary thromboembolism. Treatment In the acute stage of thrombosis can be treated conservatively: bed rest; antibiotic therapy; direct-acting anticoagulants (heparin, fraxiparine for 6 ... 8 days); anticoagulants of indirect action (fenilin, bishydroxycoumarin, pelentan, etc.) shall be appointed for 3 ... 4 day and received within 3 ... 4 weeks; anti-inflammatory (ibuprofen, Indus-tatsin, etc.); antihistamines. Non-variceal vein thrombophlebitis treated conservatively. Thrombophlebitis of varicose veins modified after eliminating acute phenomenon undergoes surgical treatment: resection is timecharged veins together with the surrounding infiltrate. Postoperative rehabilitation is required with the zinc-gelatin dressings as in varicose veins. Thrombosis and deep vein thrombophlebitis the lower extremities Primary (spontaneous) phlebemphraxis - is an aseptic condition, or more often a complication caused by Virchow's triad: hypercoagulability, injury (violation) of the vessel wall, upset regional blood flow. Secondary phlebemphraxis (thrombophlebitis), deep vein phenomenon is relatively rare, most often associated with septic process, which are located close to the corresponding vein. A significant difference between primary and secondary phlebemphraxis is a strong fixation of the thrombus to the vessel wall with secondary phlebothrombosis, which dramatically reduces or virtually eliminates the possibility of pulmonary thromboembolism (PTE). In the primary deep vein phlebothrombosis possible pulmonary embolism is often a natural outcome. The etiology and pathogenesis. Contributing factors in the development of deep vein phlebothrombosis are: hypercoagulation; reduction of fibrinolytic activity of blood; damage to the vessel wall; slowing or impairing blood flow; allergic condition of the body; violation of the rheological properties of blood; elderly age; cancer; Pregnancy obesity; presence of varicose veins. A very big danger is postoperative phlebothrombosis in which there are a number of predisposing factors. Spontaneous postoperative phlebothrombosis and other deep veins in the majority of cases occur in the lower limbs, due to specific morphological and functional features of legs veins located in the soleus and gastrocnemius muscles - suralnye vein.

Clinic phlebothrombosis deep vein A. A sense of fullness in the back of the gol-no. Two. Swelling of the distal limb - the rear area of the foot and ankle. Three. Spontaneous pain in the heels (symptom Ryabov GA) 4. Skin color is not changed or more bluish in the foot and n / s leg. Five. Palpation in the swelling is painless, there is pain in the calf muscles 6. Movement in the ankle joint is limited because of pain 7. Dorsal flexion sharply painful (symptom Homansa). Diagnosis A. Doppler Two. Rheography Three. Manometry 4. Phlebography (in the planning of surgery on the veins).

Acute phlebothrombosis This disease is caused by the development of primary thrombus in the lumen of one or another is not affected inflammation vein due to disturbances in coagulation and anticoagulation systems blood with a local slowing of venous flow. Subsequently, a thromboDhu join secondary inflammatory changes of the venous wall. When phlebothrombosis large veins (these include deep vein) is always there is a risk of pulmonary embolism and thrombophlebitis in this complication occurs much less frequently due to the strong fixation of the thrombus to the vevenous wall. Symptoms. Thrombophlebitis in contrast to phlebothrombosis from the beginning proceeds with oolee severe clinical picture of acute inflammation. Acute thrombosis is characterized by a combination of symptoms of illness regionarnogo venous blood with signs of acute inflammation fever, rapid deterioration of the patient's general condition, second, weak, weakness, leukocytosis with a shift of leukocyte left, a sharp pain along the thrombosed vein area, Regitionary lymphadenitis. Sometimes in the course of the affected veins are formed purulent ki, requiring autopsy. The clinical picture phlebothrombosis depends on the localization of a blood clot, and the degree of blockage of the lumen of their veins. Phlebemphraxis-characterized the edema and cyanosis of limbs with less of pain, almost total reaction of the organism, if it exists, it appears the subfebrile body temperature, slight malaise and weakness. Flebotromboz can proceed completely asymptomatic, especially in the floating (Floating) thrombus. These forms of thrombosis are dangerous, because these clots can easily rejected, and sometimes the first clinical sign of disease are no disturbances of blood circulation in the limb renoznogo and symptoms of emboLeah pulmonary artery. Phlebemphraxis calf deep vein often develops in patients are on bedrest (which is why all patients who findXia in bed, need to appoint a special preventive esk events). The first signs of deep vein phlebothrombosis golare often no feeling of heaviness in the legs and slight swelling (The latter may be absent). At the rear of the passive flexion of the foot there is pain on the back of the leg extending to the popliteal pitky, and in the popliteal fossa, as well as pressure on the sole. A large diagnostic value of a test, consisting in the lower leg compression

cuff of the device for measuring blood pressure in the deep flebotromooze at a pressure of 80-100 mm Hg. of Art. there is a sharp pain in the the affected leg, while the increase in pressure up to 150-170 mm Hg. of Art. in a healthy calf does not cause discomfort. Ilio-femoral phlebemphraxis (ileofemoralny). At full-Zach the lumen of the vein flogging ileofemoralny phlebemphraxis begins acutely with sharp What the pain in all limbs, accompanied by fever and chills with a decrease in skin temperature of the affected leg. Limb becomes pale and cyanotic. There is swelling throughout the leg, the decay rostranyayuschayasya on the abdomen and lumbar region. Ripple peripheral due to reflex spasm of the arteries is greatly weakened or even completely ceases to be determined, which often creates certain difficulties in the differential the differential diagnosis of arterial thrombosis ileofemoralnogo emboliher. Sometimes the only clinical manifestation of thrombotic ileofemoralnogo for it may be a pain when walking. Emergency care and hospitalization. All patients are subject to immediate statecapitalization in the surgical hospital. When phlebothrombosis chances on the effectiveness of fibrinolytic therapy restrictions HN. Treatment in hospital should be complex: the general anti-inflammatory Indeed, and anticoagulant therapy, topical treatment - complete rest toinfinity, physiotherapy, x-ray. Surgical treatment is applicable etsya when complications arise (ascending septic thrombosis, beneTurn embolism, the formation of ulcers, etc.). The operation is vein ligation and dissection of purulent foci. In some cases, thrombosing the bathroom is completely excised vein Phlebemphraxis deep veins - a potentially life-threatening disease. Thrombosis of the main veins of the pelvis and hips can be a primary location in the deep veins of the legs, or ilio-femoral veins. In the first 3-4 days of a blood clot poorly fixed to the vessel wall, possible separation of the thrombus and thromboembolism branches of the pulmonary artery (pulmonary embolism). After 5-6 days, joins an inflammation of the intima, contributing to fixing the clot, deep vein thrombophlebitis. In the U.S. each year the disease affects about 250,000 people. Etiology. Launchers consider the following factors: - Trauma or excessive physical stress; - A bacterial infection; - Prolonged bed rest in surgical, therapeutic, neurological diseases; - Post-natal period; - Use of oral contraceptives; - Cancer (especially lung, stomach, under-gastric cancer); - DIC. The localization process. Clinically distinguish deep vein thrombosis leg and iliac-femoral (iliofemoralny) phlebemphraxis. Emboli in the pulmonary artery originate from these vessels in approximately 80-90% of cases of pulmonary embolism. More than a rare localization. - Subclavian Vienna. - Vienna's upper extremities and neck (especially when catheterization). - The right atrium. - Renal vein (especially with renal disease). The clinical picture. Deep phlebemphraxis accompanied by persistent swelling of the legs or the whole foot, feeling of heaviness in the legs. The skin is glossy, clear picture appears saphenous veins (symptom Pratt). Characterized as a symptom of Payr (spread the pain on the inner surface of the foot, calf or thigh), Homansa symptom (pain in the leg with back flexion of the foot). Also, there is pain in the leg cuff compression device

for measuring blood pressure at a value of 80-100 mmHg (Symptom Lovenberga), while the compression of the healthy leg up to 150-180 mm Hg. of Art. does not cause discomfort.When the pelvic vein thrombosis observed light peritoneal symptoms, and sometimes dynamic ileus. Deep venous thrombosis is the classic clinical manifestations in only 50% of cases. In 50% of cases, confirmed by venography, deep vein thrombosis is not accompanied by visible changes. The first manifestation of the disease, many patients may be thromboembolism in the pulmonary artery vessels. The diagnosis of deep vein thrombosis confirmed by the following studies. - Phlebography (distal ascending) and the most accurate method of diagnosis of deep vein thrombosis. Radiopaque substance is injected into one of the saphenous veins of the foot below the turnstile, slightly compressing the ankle to direct the movement of contrast medium into the deep vein system. If the research does not wash out the vein with heparin in 3% of cases there is inflammation or thrombosis. - Doppler ultrasound confirmed deep vein thrombosis above the knee, up to 80-90%. - Impedance plethysmography. After loosening the cuff, compressing the shin with a force sufficient for the temporary occlusion of the venous blood supply to determine the change in volume of the tibia. The sample allows you to diagnose deep venous thrombosis above the knee, up to 90%. - Scan using labeled fibrinogen. To determine the incorporation of radioactive fibrinogen in the blood clot perform batch scanning of both lower extremities. The method is most effective for the diagnosis of leg vein thrombosis. Treatment. All patients with phlebemphraxis be treated in a surgical hospital. Prescribed strict bed rest for 7-10 days with a lofty position of the patient limb. Heparin is administered / v for 7-10 days. With the development of complications (eg pulmonary embolism), or the risk of recurrent embolism term anticoagulant therapy increased. Duration receiving anticoagulants of indirect action depends on the severity of the disease. Thrombolytic therapy (streptokinase or edyukinaza) is effective at the earliest, is rarely recognizable, stages of venous thrombosis. At later stages of thrombolysis may cause fragmentation of the thrombus and the occurrence of pulmonary embolism. In the diagnosis of thrombosis of the floating station is shown in the inferior vena cava cava filter below the renal veins or the holding of various surgical interventions, preventing the migration of a thrombus in the pulmonary artery system, followed by thrombolysis and anticoagulation therapy. Thrombolytic therapy without interruption cava filter thrombosis with ileomoralnom contraindicated because it promotes the migration of blood clots in the pulmonary artery to the development of TELA. Prevention. The simplest preventive measures include early motion after surgery, the use of elastic stockings (foot compressing the superficial veins and increases blood flow in the deep veins), as well as the exclusion of risk factors. Periodic leg compression with a pneumatic cuff increases the rate of blood flow in the lower extremities and helps prevent blood stasis. Venokonstriktory (eg, dihydroergotamine, detraleks) also increase the rate of blood flow in the deep veins. Heparin, administered at prophylactic doses before and after surgery can effectively prevent deep vein thrombosis. His repeated subcutaneous administration repeatedly every 4-6 hours