Thrombophlebitis and phlebothrombosis. Thrombophlebitis and phlebothrombosis - different diseases

An article on the topic: "thrombophlebitis and phlebothrombosis differences" as the most important information about the disease.

Until now, there is confusion in the formulation of the diagnosis: in what pathology should the terms thrombophlebitis and thrombosis be used. As a rule, in medical records one can find such formulations describing pathological processes in the venous system: “phlebitis” (inflammation of the wall without the formation of a blood clot in the lumen), “thrombophlebitis”, “phlebothrombosis” (or “thrombosis”). The last two terms are used interchangeably by many doctors, sometimes causing confusion. Nevertheless, there is a clear distinction between the use of these concepts, which denote diseases that are fundamentally different from each other.

What is the clinical difference between thrombosis and thrombophlebitis? Superficial thrombophlebitis can be suspected when soreness and swelling appear along the veins located directly under the skin. The pain can range from mild discomfort to sharp, like a cramp, increase gradually or come on suddenly. As a rule, such symptoms persist for one to two weeks, after which they fade, and “lumps” of compaction appear along the course of the veins.

Thrombophlebitis of superficial veins

Phlebothrombosis or deep vein thrombosis (DVT) can be asymptomatic and therefore difficult to diagnose. Most often, it is manifested by the appearance of pulling, “baking” pain in the calf muscles, so it can be confused with inflammatory diseases skin or muscles (myositis). And also quite often there is swelling, which is usually located on the foot and around the ankles, the skin in this area turns pale or becomes "crimson".

Deep vein thrombosis

The fundamental difference between thrombophlebitis and thrombosis is the localization of the inflammatory process in the venous system lower extremities. In the first case, this occurs in the subcutaneous vessels, and in the second, in the veins located deep in the fascial case. With these pathologies, macro- and microscopic changes in the veins are the same. Historically, disease names have been prioritized clinical manifestations: in defeat superficial vessels legs - symptoms of inflammation, and with deep ones - signs of their blockage.

Is there a serious threat to the health of the patient with phlebothrombosis and thrombophlebitis, what is the difference for the patient? The main danger of the formation of blood clots in the veins of the legs is the possibility of their separation from the vessel wall and moving along circulatory system into the lungs. A life-threatening condition occurs - pulmonary embolism (PE), which is often observed with DVT. Unfortunately, sometimes PE can be the first sign of phlebothrombosis of the lower extremities. In turn, with superficial thrombophlebitis, this situation is extremely rare.

Causes, risk factors for superficial thrombophlebitis and deep vein thrombosis

Disorders of the blood coagulation system (thrombophilia), which can be inherited from parents or appear as a reaction of any acquired pathology, are one of the causes of the formation of a blood clot. In addition, there are a number of risk factors that contribute to the formation of a blood clot in the venous bed of the lower extremities:

prolonged immobility (for example, in a hospital bed);
excesses of DVT and/or embolism in the past;
some types of cancer;
obesity;
Varicose veins.

The risk of deep vein thrombosis increases dramatically with postoperative period especially for hip and knee surgery. During pregnancy and 6 months after childbirth, due to hormonal changes in the body, increased blood clotting is observed. The same problem can occur in young women or older than 40 if they take hormonal drugs ( birth control pills or replacement therapy). Some experts believe that air travel can cause DVT, which is associated with prolonged periods of immobility coupled with dehydration, especially when aggravated by alcohol.

Superficial thrombophlebitis can appear after an insect bite, with trauma to the skin. A banal cut, if left untreated, sometimes causes inflammation of the vein. Also, thrombophlebitis is often found in drug addicts who use the vessels of the legs to administer drugs.

Diagnosis of pathologies

Specific tests help identify hereditary subtypes of thrombophilia. For certain types of bleeding disorders, the patient may be offered a permanent intake of drugs that prevent blood clots.

Diagnosis of superficial thrombophlebitis, as a rule, does not cause difficulties. If DVT is suspected, ultrasound of the venous system (duplex sonography) is usually done. Less commonly used magnetic resonance venography or computed tomography. Although these techniques are considered to be highly informative in diagnosing the pathology of the deep veins of the lower extremities, their high cost does not allow them to be widely used in clinical practice.

Magnetic resonance venography (MRI)

A blood test, known as a D-dimer test, is also sometimes used if a pulmonary embolism is suspected. When diagnosing this serious complication, CT (computed tomography) is usually performed.

thrombophlebitis of superficial veins

From it you will learn about the causes and localization of pathology, risk factors, complications, diagnosis and treatment options.

Differences in treatment

Superficial thrombophlebitis and deep vein phlebothrombosis have different therapeutic approaches. As a rule, at the first time, patients do not need hospitalization. Bed rest is recommended with a raised affected limb, local heat and compresses with antiseptics (dimexide, dioxidine). Anti-inflammatory drugs are given either orally or as a cream or gel (eg, Hirudoid®).

Treatment of deep vein thrombosis is carried out in a hospital, which usually includes injections low molecular weight heparin. The action of these drugs is aimed at preventing a further increase in blood clot, the appearance of new ones. Sometimes he resorts to surgical intervention: a blood clot is removed or a special filter is installed in the inferior vena cava. The main goal of treatment is to prevent pulmonary thrombosis.

Today, surgeons, as a rule, use the term “thrombophlebitis” to describe the inflammatory process in the saphenous veins, and “phlebothrombosis” to refer to deep lesions. Nevertheless, as microstudies show, in these pathologies, changes in the vascular wall are identical. It was also found that quite often the inflammatory process can move from superficial to deep vessels. Many therapists believe that superficial thrombophlebitis- a banal disease that does not pose a serious threat to the health of the patient. From this follows a practical conclusion for the patient: no matter what the diagnosis is - superficial thrombophlebitis or deep vein thrombosis - in any case, you should contact a specialist. It is best to see a phlebologist.

Diseases thrombophlebitis and phlebothrombosis are characterized by intravital formation of a thrombus in the lumen of a venous vessel, accompanied by characteristic signs and changes in blood flow.

Despite the consonance of these terms, they are completely different in content.

Thrombophlebitis

this is acute illness superficial veins, accompanied by inflammation of the vessel wall.

Phlebothrombosis strikes deep veins without inflammation of the vascular wall. Let us examine in more detail the differences between thrombophlebitis and phlebothrombosis.

Phlebothrombosis

A condition that develops when blood clots form in deep veins. The reasons are:

diseases that cause changes in blood clotting;
surgical interventions, including dental;
diseases of the lungs and heart, leading to stagnation of blood and increased formation of blood clots;
prolonged forced immobilization after strokes or injuries;
damage to the inner lining of blood vessels by microbial, pharmacological or chemical factors.

Circumstances that contribute to the development of thrombosis:

diabetes mellitus of any type;
oncological diseases;
obesity;
taking hormonal contraceptives;
taking steroids;
trauma;
pregnancy;
neoplasms in the pelvis.

The manifestations of the disease depend on the location of the thrombus and which vessel is damaged. Unlike acute thrombophlebitis, they are less pronounced and the diagnosis is more difficult to make. But there are symptoms, the appearance of which should immediately consult a doctor:

appearance severe pain in the calf muscles, which increase with movement;
swelling of the lower leg and ankle;
redness of the skin, accompanied by pain in the muscles;
pain, swelling, redness of large joints;
expansion of subcutaneous vessels.

These signs will be different in severity and located in different places. If a blood clot is in the deep veins of the lower leg, then swelling, expansion of the vascular pattern will be on the legs.

If thrombosis of the inferior vena cava develops, then the swelling will be in the lumbar region, and the superficial veins will expand on the abdomen. In any case, if such symptoms appear, you should immediately seek medical help.

Thrombophlebitis

The pathology of superficial vessels rarely begins on its own. More often this is a complication of the course varicose disease. Clinical course in acute subacute and chronic form˗ phlebothrombosis and thrombophlebitis what is the difference?

Anatomically, the cause of thrombophlebitis is a malfunction of the lymphatic and blood vessels, causing a violation of the blood flow and the formation of blood clots. Mostly small and large saphenous veins are affected. Conditions that “help” the onset of the disease:

surgical interventions and injury;
pregnancy and childbirth;
purulent-septic diseases;
allergic reactions.

Signs:

along the superficial vessels there are painful seals resembling a cord;
swelling of surrounding tissues;
skin redness;
excessive blood filling of superficial vessels;
deterioration in general well-being (chills, weakness, sweating).

The severity of symptoms gradually increases. "Bruises" form along the veins, dense nodules are felt when probing. The pain intensifies and spreads, swelling increases. All of the above is a reason to urgently contact a phlebologist.

Despite the differences in the mechanisms of development and symptoms of these two conditions, there are similarities.

Treatment of thrombosis

Effective treatment of both pathologies combines the appointment medicines, interfering with the formation of new blood clots and dissolving existing ones, and surgical removal of blood clots. Only with such combined approach recovery can be achieved.

Diseases of the facial vessels

The isolation of phlebitis, thrombophlebitis and phlebothrombosis of the veins of the face is due to the fact that narrow specialists in the field of maxillofacial surgery are engaged in the treatment of these diseases. A few words about the causes of these diseases.

The disease of superficial facial veins develops as a complication of inflammatory processes of facial tissues (boils, carbuncles, acne). It manifests itself in the same way as thrombophlebitis of the lower extremities, but with more pronounced signs of intoxication.

Deep facial veins are affected in the complication of trauma and dental interventions (tooth extraction). Complication is extremely rare. Modern dentistry phlebitis, thrombophlebitis and phlebothrombosis practically excluded the development of these pathologies. Diagnosing it is extremely difficult and often it ends with a person's disability or death.

What are the differences from phlebitis?

The view of these two pathological conditions as completely different has developed a very long time ago. But this position has not stood the test of time. Modern phlebology has proven that there are no significant differences in their development.

Inflammation of the vessel wall leads to the formation of a thrombus, and blockage by a thrombus leads to the development of inflammation. It is impossible to determine what is primary and what is secondary.

With regard to phlebitis and thrombosis, this is reminiscent of reasoning about the chicken and the egg. Paying tribute to traditions, doctors use the term "phlebothrombosis" to refer to damage to deep veins, and "thrombophlebitis" to superficial ones.

In practice, only one thing is important: a disease that began with superficial vessels can, at any moment, spread to deep ones. Lead to the development of life-threatening conditions. And the main task of the phlebologist is to prevent this.

A proven way to treat varicose veins at home in 14 days!

There are contraindications. Consult your doctor.

Thrombophlebitis and phlebothrombosis are often considered synonyms, the names of the same disease. Actually it is not. Despite the somewhat similar etiology, these are different pathologies. So what is the difference between thrombosis and thrombophlebitis? What factors influence their development? What are the symptoms of venous involvement in the first and second cases?

1 Specificity of diseases

The main difference between thrombosis and thrombophlebitis is the place of localization. Thrombophlebitis usually develops in superficial venous vessels, while thrombosis often affects deep veins. In addition, with thrombophlebitis, blood clots form in deformed vessels, while thrombosis can occur in unchanged, normal veins.

Cause pathological changes veins tend to become varicose, damaged inner walls blood vessel due to trauma, infection (local, general), etc. As a result of damage, the blood flow through the vein is disturbed, slowed down. As a result, this leads to inflammation of the vessel, the formation of dense blood clots in it, which further interferes with the passage of blood through the veins, inflammation of the soft tissues of the lower or upper extremities.

Thrombosis is considered a much more dangerous disease. For him, as well as for thrombophlebitis, the formation of blood clots in the veins is characteristic, preventing the normal passage of blood through the vessels. However, deep vein phlebothrombosis, in the first place, occurs due to a violation of the coagulation properties of the blood itself, and not damage to blood vessels.

Thrombosis and thrombophlebitis mainly differ in that the former can occur in a non-inflamed vein. This explains the frequent absence or low severity of symptoms of pathology.

As for thrombophlebitis, it is much easier to identify it. The disease occurs against the background of an inflammatory process in the vein, therefore, it is almost always accompanied by local and general inflammation-specific phenomena.

Reasons for the development of hypoplasia of the right vertebral artery, consequences and methods of treatment

2 Causes of pathologies

There are no significant differences in the etiology of the diseases. Multiple factors contribute to the formation of blood clots in both cases. Regardless of the location of the pathology, both thrombosis and thrombophlebitis occur against the background of:

Varicose disease.
Vascular diseases.
Damage to the venous walls.
Pathologically altered blood composition.
Increased blood clotting.
Slow blood flow.

In turn, the reasons for the development of such conditions are:

Endocrine diseases.
Oncological diseases.
chronic diseases of cardio-vascular system.
General and local infectious diseases.
Diseases of the blood.
neurotrophic disorders.
allergic processes.
Intravenous injections that damage a blood vessel.
Vein catheterization for a long time.
Operations performed in the area of the hip joint, pelvic floor, lower part abdominal cavity.
Local inflammatory, purulent processes.
Wrong nutrition.
Bad habits.
Violation of the processes of general metabolism.
Failures of hormonal regulation.
abortion.
Pregnancy, childbirth.

Most often, thrombophlebitis develops in deformed veins. Deformation of blood vessels occurs due to excessive loads on hip joints, legs (weight lifting, prolonged standing, etc.). Accordingly, active people who are exposed to excessive physical exertion are at risk.

But the lack of movement is also unhealthy. A sedentary lifestyle, sedentary work lead to the formation of phenomena of blood stagnation in the veins of the lower extremities. These conditions result in a violation normal blood flow, expansion, deformation of the veins, the formation of blood clots, blood clots in their lumens.

3 Main symptoms and signs

The main symptom of phlebothrombosis is a sudden flash of pain in the affected limb. Pain is not constant, but is aggravated by loads on the legs (walking, lifting weights, standing for a long time).

Next, tissue swelling occurs. There is a feeling of heaviness, fullness of the legs. The skin around the thrombosed area of the vein is cyanotic (cyanotic), strongly stretched, shiny. Expanded tense veins become noticeable a few days after the formation of a blood clot.

The temperature of the limb rises by 1.5-2 degrees. An increase in general body temperature is possible. The pulsation of the arteries of the diseased limb may not be disturbed, but most often it is felt weakly or completely absent.

With thrombosis of the gastrocnemius or only deep veins clinical picture diseases are erased. In such cases, the only symptom of the pathology that has arisen is a slight swelling in the ankle joint and pain in the calf muscle that occurs during physical exertion.

In acute thrombophlebitis of the superficial veins, the first symptoms are pain pulling character. The pain is localized in the area of the thrombosed area of the blood vessel. The affected vein is sealed, protrudes above the surface of the skin. Unlike thrombosis, arterial pulsation and limb temperature remain normal.

There is swelling of the sore leg, motor functions are difficult. In the course of a thrombosed vein, swelling, infiltration, and hyperemia of soft tissues are observed. The skin takes on a bluish tint. Varicose veins are tense, with palpation of the affected areas there is severe pain.

Specific signs of thrombophlebitis are often accompanied by inflammatory symptoms:

1. deterioration of health;
2. general weakness;
3. chills;
4. headache;
5. increase in body temperature (in severe cases up to 39 degrees).

Thrombophlebitis of deep veins is manifested by uniform swelling of the foot and lower leg. The pain is dull, increases sharply when you press on the calf muscle, when bending the foot. The patient can walk with difficulty. Sometimes the pain is so severe that the person cannot step on the foot.

If any of the above symptoms appear, it is necessary to consult a phlebologist. Undergo a medical examination and, if thrombophlebitis or thrombosis is detected, immediately begin adequate treatment under the guidance of a doctor.

Distinguish by characteristic symptoms phlebothrombosis and thrombophlebitis can only be done by a specialist, since they have a similar etiology and for staging accurate diagnosis it is necessary to know exactly the specifics of each disease.

The difference between the two diagnoses

Thrombophlebitis and thrombosis can be distinguished by the location of the affected area. The development of thrombophlebitis occurs on the veins that go directly under the skin, and thrombosis usually occurs on deep venous vessels.

With the development of thrombophlebitis, blood clots appear in deformed veins, and thrombosis can occur in any venous vessel that does not have any changes.

Thrombophlebitis and phlebothrombosis appear on the walls of deep veins. But the first can develop on superficial vein, and the second appears only on the walls of deep veins.

Thrombophlebitis appears with varicose veins, with damage to the venous wall, when there is a violation of the outflow of blood plasma from the limb, slowing down the circulation of blood flow. This forms a thrombus that closes the lumen in the vein.

Phlebothrombosis occurs on a non-inflamed, deep-lying venous canal, with the vein itself unchanged. A thrombus is formed on the wall of the vessel, which has a loose structure. It is easily torn off and can move with the blood flow, which leads to the development of thromboembolism. If the vein is varicose, then thrombophlebitis may appear along with phlebothrombosis. The first gives full symptoms of the lesion, and the second proceeds without any symptoms.

Usually, pathological changes in the venous channels begin to develop due to varicose veins themselves, lesions of the inner walls of blood vessels due to various injuries, development of an infection and many other reasons. All this slows down blood circulation in the venous channels, and stagnation leads to inflammatory processes. Blood clots appear, which quickly harden, forming blood clots. This leads to complete stagnation of blood, inflammation of the soft tissues of the legs or arms.

Unlike thrombophlebitis, thrombosis is considered more dangerous, since with it blood clots can develop due to the slightest damage to the vein. And phlebothrombosis with thrombophlebitis appear due to changes in the properties of the blood itself.

Thrombosis can develop in non-inflamed venous vessels, and the appearance of thrombophlebitis is almost always associated with varicose veins veins. With thrombosis, the symptoms of the disease are not as pronounced as it happens with the appearance of thrombophlebitis, which is much easier to identify, since it proceeds with noticeable inflammatory processes at the local and general levels.

Factors affecting the appearance of pathologies

The difference in the causes of the development of a particular disease in the veins of the limbs is small. With both types of ailments, blood clots form. Regardless of the location of any of the pathologies, the main causes of their appearance are:

the development of varicose ailments;
various vascular diseases;
injury to the walls of the vein;
pathology with a change in the composition of the blood, an increase in its coagulability;
slowdown and stagnation in the blood flow.

Usually, diseases of the endocrine system, various tumors, chronic diseases of the cardiovascular system, infections (both local and general) can lead to such human conditions. Lesions can appear due to blood diseases, allergies, and neurotrophic disorders. The vein can be damaged during an injection or during a long period of catheterization, pelvic and lower abdominal surgery. Often a large role in the appearance of ailments in the veins is played by local inflammation or purulent process. Thrombosis or thrombophlebitis can be caused by a metabolic disorder, poor diet, smoking and drinking, and malfunctions in the hormonal system. In women, pregnancy, abortion, childbirth can affect the appearance of venous diseases.

Thrombophlebitis can occur due to deformation of the veins that occurs with excessive loads on the hip joints, for example, with prolonged standing on the legs, large physical activity(weight lifting). But the same happens with the patient's low mobility, sedentary work, when there is stagnation of blood in the veins of the legs.

Symptoms of various lesions of the veins

Thrombosis differs from thrombophlebitis and phlebothrombosis and its signs. With the last two ailments, the patient develops pain at the site of the lesion on the limb. But it is not constant, although it can increase dramatically when walking, standing for a long time or lifting weights. After that, there may be swelling on the tissues, heaviness in the legs. The skin around the site affected by a thrombus turns blue, stretches strongly, gives off an unnatural luster. Tense and dilated veins can be seen 3-4 days after the formation of blood clots.

The temperature of the skin on the legs can increase by two degrees. In some patients, this causes a general rise in body temperature. The pulsation of the artery on the sore leg may be weakened or absent altogether.

If thrombosis of deep veins or gastrocnemius vessels begins, then the symptoms are usually erased, since in most cases a sign of the disease is a small swelling in the ankle joint area and slight soreness in the calves during physical exertion.

Acute thrombophlebitis on the superficial veins gives pain of a pulling nature, which is localized at the site of development of the thrombus itself. The diseased vein thickens and begins to protrude above the surface of the skin. At the same time, the pulsation in the arteries of the leg does not disappear, as happens with thrombosis. It is difficult for the patient to move the leg, swelling is fixed on the limb. Swelling appears along the affected vein. Noticeable hyperemia on the soft tissues, infiltration. The skin at the location of the thrombus turns blue. With varicose veins, it is very tense. During the palpation of the affected area, the patient feels severe pain.

Thrombophlebitis is accompanied by the following signs of inflammation: the patient begins to feel sharply worse, he complains of general weakness, pain in the head, he is tormented by chills. A significant increase in temperature is possible - up to 38-40ºС.

With the development of thrombophlebitis in deep veins, uniform edema is observed on the lower leg and foot. The pain is dull. It can sharply increase when you press on the calves or the fold of the foot. It is difficult for the patient to walk, and in some periods of time the pain intensifies so much that the person cannot step on the foot.

If at least one of the above symptoms occurs, you should seek help from a doctor of the appropriate specialty (phlebologist).

The patient will undergo a medical examination and, in the presence of any of the described vein diseases, will begin to treat the disease. It is better not to self-medicate because of possible complications.

Many patients have the opinion that thrombosis, thrombophlebitis and phlebothrombosis are no different from each other. But this various diseases, albeit with a similar etiology. Consider the difference between thrombosis and thrombophlebitis.

Characteristics of diseases (brief description)

Many patients, when corresponding on forums, confuse the names of pathologies, the symptoms and treatment of which differ markedly. To avoid confusion, you should know how thrombophlebitis differs from thrombosis of the lower extremities.

Thrombophlebitis

The inflammatory process of the vascular walls, which leads to the formation of blood clots inside, is called thrombophlebitis. Usually, pathology occurs as a result of untreated varicose veins. The disease is characterized by frequent relapses, which, without adequate treatment, can cause blockage of the pulmonary artery by a thrombus. Sometimes, against the background of thrombophlebitis, blood poisoning develops. The characteristics of the disease include:

The defeat of exclusively superficial vessels located under the epithelium;
The formation of blood clots occurs in the affected, previously deformed vessel;
It is easier to diagnose due to the bright symptoms.

Thrombosis

Thrombosis - more dangerous disease. Usually, pathology develops in patients who have lost the ability to move independently. Its consequences include embolism of the branches of the pulmonary artery. Thrombosis is characterized by:

The possibility of damage to a deep vessel;
Thrombus formation occurs on a healthy area, without touching the previously inflamed one;
The disease occurs as a result of violations of the coagulation properties of the blood. It doesn't matter what condition the veins have;
No inflammation is observed. At the beginning of development, there are no symptoms, which complicates the diagnosis of the disease.

Phlebothrombosis

Thrombophlebitis and phlebothrombosis are diagnosed against the background of untreated varicose veins. Inflammation slows down the speed of blood flow, which provokes the formation of a blood clot. Phlebothrombosis is characterized by the absence of symptoms at the beginning of development.

Usually, the pathology occurs after surgery on the deep veins of the pelvic region or lower extremities. In the first 4 days of formation, a thrombus is characterized by weak fixation to the walls of blood vessels. Therefore, there is a risk of developing pulmonary embolism. has some features:

The presence of previously damaged vessel walls without ruptures. As a result, there is a slowdown in blood flow, an increase in platelet volume. This process leads to the formation of blood clots;
Impaired blood clotting caused by hypercoagulability. This process is triggered due to failures of the body;
Violation of blood flow.

How are pathologies different?

Although pathologies have a similar etiology, there is a difference between thrombosis and thrombophlebitis in the symptoms and features of therapy.

Symptoms

Pathologies differ in their manifestation. This is due to which vessels are affected, deep or superficial, as well as the presence of an inflammatory process. Due to the fact that thrombosis affects deep veins, the following symptoms appear:

Sharp pains in the lower extremities;
Discomfort after active physical exertion;
As the disease progresses, edema is noted. In the evening, the patient suffers from a feeling of fullness and heaviness;
At the site of a thrombus lesion, the skin is characterized by a bluish tint, luster;
The temperature of the sore leg is 2-3 degrees higher than body temperature;
Sensation of pulsation in the affected vein.

As a result of the inflammatory process occurring in the vessels, thrombophlebitis has the following symptoms:

At the location of the thrombus, pulling pains are noted;
Seals in the area of the affected vein;
swelling;
Difficulty in movement;
Redness of the skin in the area of the vein;
The presence of swelling;
Penetration of inflammation into soft tissues.

On a note!
Thrombosis differs from thrombophlebitis by the pulsation of the affected vein.

Therapy

Treatment of thrombosis and thrombophlebitis has its own differences. Therapy of thrombophlebitis is characterized by:

No hospitalization. Treatment can be carried out on an outpatient basis;
Need to stay in bed for 2 days. The leg should be elevated to improve blood flow;
Allows you to alleviate the condition of a warm compress, the imposition of applications with Dimexide;
Taking non-steroidal anti-inflammatory drugs;
Use of anti-inflammatory ointments.

You can not delay the treatment of thrombophlebitis. The inflammatory process easily passes to deep veins from superficial ones.

The treatment of thrombosis needs to be approached more carefully. It has the following features:

Therapy is carried out in a hospital;
Heparin injections are required. This will allow not to cause a further increase in the formed blood clot, excludes the formation of new clots;
It is important to monitor blood counts;
It is possible to carry out surgical treatment, during which the elimination of blood clots that block the vessel occurs. If necessary, a filter is installed in the lower hollow vessel.

Thrombophlebitis and thrombosis are similar in pathogenesis. The main difference lies in which veins were affected, as well as the presence of an inflammatory process.

State budget educational institution

higher professional education

"Tver State Medical Academy"

Ministry of Health and Social Development

Russian Federation

Department of Surgical Diseases

Methodological development for the clinical practical lesson of the discipline

"SURGICAL DISEASES"

for students of pediatric faculty

TOPIC: Thrombophlebitis, phlebothrombosis. Post-thrombophlebitic syndrome.

Tver - 2012

Compiled by:

Under the editorship of the head of the Department of Surgical Diseases, MD. N.A. Sergeeva

Reviewer: Head of the Department of General Surgery, Professor E.M. Mokhov

"___" __________2012

I. Number learning topic: №18

II. Title of the educational topic: “Thrombophlebitis, phlebothrombosis. Post-thrombophlebitic syndrome"

III. The purpose of studying the educational topic : based on knowledge of the anatomy and physiology of the venous system of the lower extremities, etiology, pathogenesis and clinic of acute thrombophlebitis and post-thrombophlebitic syndrome (PTFS), the student must master the methodology for examining patients with this pathology, methods for diagnosing the disease, conducting a differential diagnosis and prescribing treatment at various stages of the course of the thrombotic process .

IV. Basic terms:

The structure of the venous wall.

The nature of intravascular thrombosis.

3. Thrombophlebitis.

4. Phlebothrombosis.

Post-thrombophlebitic syndrome of the lower extremities.

V. Plan for studying the topic:

The social significance of the topic.

The concept of thrombophlebitis.

The concept of phlebothrombosis.

Anatomical and features and patterns of blood circulation in the system of superficial, deep and communicating veins.

The nature of intravascular thrombosis: changes in the vascular wall.

Classification of acute thrombophlebitis.

Clinic of acute thrombophlebitis.

Research methods.

Diagnosis of acute thrombophlebitis.

Treatment of acute thrombophlebitis.

VI. Presentation of educational material

The social significance of the topic

Acute thrombophlebitis and post-thrombophlebitic syndrome of the lower extremities are very common diseases of the blood vessels. Most often, they are a complication of varicose veins (42-54%), closed and open injuries of the extremities, pregnancy and childbirth, gynecological diseases and related operations, and malignant neoplasms. In 50-76%, the thrombotic process occurs in the system of superficial veins. Thrombophlebitis occurs predominantly in women (74%) compared to men (26%). Thrombosis of the veins of the lower leg is the most common localization (90.7%) of the pathological process.

In their practical medical activities, many specialists often encounter these diseases. As a result of progressive growth, thrombus, and the development of a formidable complication in the form of pulmonary embolism, cases of death are not uncommon. Despite the use of anticoagulant and fibrinolytic therapy, 80-95% of patients with acute thrombosis of the iliac and deep veins of the leg develop post-thrombophlebitic syndrome in the future. Currently, acute thrombophlebitis and PTFS are considered as stages of the same process. About 40% of patients with PTFS become disabled of the second and third groups due to the development of leg ulcers, stable edema and induration of the skin and subcutaneous tissue, secondary varicose veins.

The success of the treatment of these sufferings depends on a clear knowledge of the etiological factors and the pathogenesis of the disease.

The study of the topic must begin with a repetition of the anatomy and physiology of the venous circulation of the lower extremities. The anatomical features and patterns of blood circulation in the system of superficial, deep and communicating veins (the structure of the venous wall, the origins and number of the main venous vessels, the direction of blood flow in each system of veins, the structure, function and location of the valve apparatus of the veins, the speed of blood flow in the veins, the amount of blood, flowing through superficial and deep veins, venous pressure figures in vertical, horizontal positions, when walking; which contributes to venous blood flow). Briefly, these data are presented in the guidelines "Varicose veins of the lower extremities", published at our department.

It is necessary to know the basic provisions about the nature of intravascular thrombosis: changes in the vascular wall (the role of the allergic factor), increased ability of the blood to form blood clots (causes, increased blood clotting and inhibition of fibrinolysis), local and general hemodynamic disorders (varicose veins, segmental narrowing of the veins, septum, extravasal compression; the role of venous stasis in the lower extremities, dehydration). It must be emphasized that infection itself is not the cause of venous thrombosis. In this regard, it is not advisable to use antibiotics in the treatment of thrombophlebitis.

With the development of thrombophlebitis, blood clots appear in deformed veins, and thrombosis can occur in any venous vessel that does not have any changes.

Thrombophlebitis and phlebothrombosis appear on the walls of deep veins. But the first can develop on the superficial vein, and the second appears only on the walls of the deep veins.

Usually, pathological changes in the venous channels begin to develop due to varicose veins themselves, damage to the inner walls of blood vessels due to various injuries, the development of infection, and many other reasons. All this slows down blood circulation in the venous channels, and stagnation leads to inflammatory processes. Blood clots appear, which quickly harden, forming blood clots. This leads to complete stagnation of blood, inflammation of the soft tissues of the legs or arms.

Unlike thrombophlebitis, thrombosis is considered more dangerous, since with it blood clots can develop due to the slightest damage to the vein. And phlebothrombosis with thrombophlebitis appear due to changes in the properties of the blood itself.

Thrombosis can develop in non-inflamed venous vessels, and the appearance of thrombophlebitis is almost always associated with varicose veins. With thrombosis, the symptoms of the disease are not as pronounced as it happens with the appearance of thrombophlebitis, which is much easier to identify, since it proceeds with noticeable inflammatory processes at the local and general levels.

Factors affecting the appearance of pathologies

the development of varicose ailments;
various vascular diseases;
injury to the walls of the vein;
pathology with a change in the composition of the blood, an increase in its coagulability;
slowdown and stagnation in the blood flow.

Usually, diseases of the endocrine system, various tumors, chronic diseases of the cardiovascular system, infections (both local and general) can lead to such human conditions. Lesions can appear due to blood diseases, allergies, and neurotrophic disorders. The vein can be damaged during an injection or during a long period of catheterization, pelvic and lower abdominal surgery. Often a large role in the appearance of ailments in the veins is played by local inflammation or a purulent process. Thrombosis or thrombophlebitis can be caused by a metabolic disorder, poor diet, smoking and drinking, and malfunctions in the hormonal system. In women, pregnancy, abortion, childbirth can affect the appearance of venous diseases.

Thrombophlebitis can occur due to deformation of the veins that occurs with excessive stress on the hip joints, for example, with prolonged standing on the legs, heavy physical exertion (weight lifting). But the same happens with the patient's low mobility, sedentary work, when there is stagnation of blood in the veins of the legs.

Symptoms of various lesions of the veins

If thrombosis of deep veins or gastrocnemius vessels begins, then the symptoms are usually erased, since in most cases a sign of the disease is a small swelling in the ankle joint area and slight soreness in the calves during physical exertion.

Thrombophlebitis is accompanied by the following signs of inflammation: the patient begins to feel sharply worse, he complains of general weakness, pain in the head, he is tormented by chills. Perhaps a significant increase in temperature - up to 38-40ºС.

If at least one of the above symptoms occurs, you should seek help from a doctor of the appropriate specialty (phlebologist).

Many patients think that there is no difference between phlebothrombosis and thrombophlebitis, considering them synonymous with one pathology. In fact, these are completely different diseases, although they have a similar etiology. The differences between these two pathologies are noticeable upon closer examination.

Description of diseases

The main distinguishing feature of phlebothrombosis and thrombophlebitis is the location of the pathology. Thrombophlebitis is localized in the superficial vein, and phlebothrombosis affects the deep venous vessels. Another difference is in the condition of the veins. With thrombophlebitis, blockage occurs only in damaged vessels, while phlebothrombosis affects healthy vessels.

Vein pathologies can develop due to varicose veins, mechanical damage, infection, and other factors. In any case, there is a slowdown in blood flow through the vessels, which causes their inflammation and the formation of clots (thrombi).

It is phlebothrombosis that is the most dangerous pathology blood vessels, since the formation of blood clots occurs due to a change in the coagulation properties of the blood, and not as a result of their damage, as occurs with thrombophlebitis.

The difference between phlebothrombosis and thrombophlebitis is that in the first pathology, the violation manifests itself in a healthy vein. And this means that the symptoms are weak or completely absent.

Reasons for development

The etiology of these two diseases is the same. The formation of a thrombus occurs as a result of many factors and in most cases develops against the background of disorders:

Phlebeurysm;
Pathology of blood flow through the veins;
Injury to the walls of blood vessels;
Deviation from the norm of blood composition;
Decreased blood flow.

Such changes in blood vessels can be caused by a number of reasons that affect the body. These include:

Violations of the endocrine system;
Active growth of malignant neoplasms;
Chronic form of vascular diseases;
Infectious processes in the body;
Violations of the composition of the blood;
Errors in the injection, suggesting injury to the vein;
Disorders of the nervous system;
Frequent location of the catheter in the same area;
Surgical intervention affecting the pelvis and abdominal cavity;
Pregnancy and childbirth;
artificial termination of pregnancy;
Violation of the hormonal background;
Improper nutrition or strict diets;
Bad habits;
Metabolism disorder.

Thrombophlebitis affects those vessels that have the greatest load. Therefore, most often this disease affects the lower limbs, which account for the entire load of the body, especially if a person is constantly in motion or lifts weights.

Not only an overabundance, but also a lack of movement causes the development of thrombosis. Moderate exercise is the best solution.

Signs and symptoms

The main symptom of phlebothrombosis is sharp pain in the limb where the pathological process began. At the same time, it is not permanent, but manifests itself, first of all, while walking, carrying heavy loads and other situations when the legs have the greatest load.

Also for given state characterized by swelling of the soft tissues, which is accompanied by a feeling of heaviness and fullness in the legs. The skin around the affected area stretches and becomes bluish. Expansion and blockage of the vein becomes noticeable only a few days after the formation of a blood clot.

The temperature of the affected leg is usually 2 0 higher than the general body temperature. The pulsation of the artery in the injured leg may remain unchanged, but most often it is reduced or completely invisible.

If a person suffers from thrombophlebitis, the clinical picture of deep vein damage will be practically erased. In this case, the only manifestation may be a large swelling at the location of the ankle joint, as well as minor pain in the calf muscle.

The acute form of thrombophlebitis manifests itself as a pulling pain that occurs in the area of the affected vein. The vessel itself has a seal and can protrude above the skin. Unlike phlebothrombosis, with this pathology, the pulsation in the vein will be palpable and be normal.

Signs of thrombophlebitis may be accompanied by symptoms of an inflammatory process in the affected limb. Which include:

General disturbance of well-being;
Chills;
Headache;
Increased body temperature;
Weakness.

With the development of thrombophlebitis, there is a uniform development of swelling of the lower leg and foot. Pain sensations are dull in nature, which are aggravated by bending the leg or pressing on the affected area.

There are a lot of differences between these two diseases, however, if there is the slightest suspicion or a similar symptom, you should consult a doctor for a diagnosis.

Treatment

When diagnosing phlebothrombosis, complex treatment is prescribed. Conservative methods include medication and special procedures. Namely:

Taking anticoagulants normalize blood viscosity.
Disaggregants minimize the creation of clots and the formation of blood clots.
Phlebotonics improve blood flow and normalize vascular tone.
Immobilization helps to keep the affected limb in one position.
Compression with elastic bandages is necessary during the recovery phase.
A diet containing a minimum amount of cholesterol.

Depending on the severity of the disease, it may be prescribed surgery. It consists in excising a vein and removing its damaged area.

In the case of diagnosing thrombophlebitis, complex therapy is also prescribed, which consists in the following procedures and preparations:

Fixation of the injured limb with a Beller splint.
Compression clothing, as well as fixation of the foot with elastic bandages.
Anticoagulant drugs.
Anti-inflammatory drugs.
A small amount of glucocorticoids.

Thrombophlebitis and phlebothrombosis are treatable. Its favorable outcome is most likely with the timely detection of pathology. And attention to your health plays an important role in this case.

What is the difference between phlebothrombosis and thrombophlebitis?

There is no single view among physicians as to whether thrombophlebitis and phlebothrombosis should be considered as different pathologies or whether they should be considered one disease. Concerning clinical practice, then three names are used here to denote the defeat of the venous system by blood clots: "venous thrombosis" (with indication of localization), "phlebothrombosis" and "thrombophlebitis".

With regard to venous thrombosis, there is no disagreement among physicians - this term is used as a designation for the entire group of diseases associated with blood clots. But there is confusion about the other two names: some experts consider the names synonymous, others - different pathologies that have fundamental differences.

Differences between diseases

More recently, it was believed that with thrombophlebitis, pathology first covers the venous wall and only then does a thrombus form. Moreover, the thrombus is tightly fixed on the wall, and therefore the probability of its separation with subsequent embolization is practically reduced to zero. Such a view of the problem was axiomatic - based on this, therapeutic tactics were built.

Phlebothrombosis was considered as a process in which a thrombus occurs without prior changes in the venous wall. It was this fact that explained the almost unsystematic course of phlebothrombosis in most cases. Unlike thrombophlebitis, in the case of phlebothrombosis, there is a high probability of a thrombus breaking off, since the blood clot is less reliably fixed to the venous wall.

The above ideas about thrombophlebitis and phlebothrombosis have dominated for many years - they have developed back in those days when operations on thrombosed veins were quite rare. However, as surgeons gained experience, the old views turned out to be untenable from an evidence point of view: it turned out that there are no fundamental differences between the pathogenesis of both pathologies considered in this article.

The inflammatory process in the venous wall (most often aseptic) leads to the formation of blood clots, and the occurrence of a thrombus is associated with an endothelial reaction and phlebitis.

Thus, both processes (phlebitis and thrombosis) are interrelated, and arguments about which of these pathologies is primary resemble a dispute about the primacy of an egg or a chicken.

With sufficiently limited symptoms of phlebothrombosis during surgery, pronounced phlebitis and inflammatory changes in paravasal tissues are found at the site of primary thrombus formation. With typical thrombophlebitis, when the inflammatory process is obvious, the proximal part of the thrombus can be located completely freely in the vascular lumen, and the manifestations of phlebitis will become apparent only after a few days.

Thus, based on classical concepts, one and the same patient can have at the same time different areas venous system, both thrombophlebitis and phlebothrombosis are noted.

Most phlebologists are currently aware of the conventionality of separation, in which phlebothrombosis and thrombophlebitis are considered different diseases. Therefore, experts use the term "thrombophlebitis" when they talk about damage to the saphenous veins, and by "phlebothrombosis" they mean pathology in the deep veins. In the case of phlebothrombosis, the symptoms are almost imperceptible, since the vein is located at a depth - in the fascial case, and the manifestations of the disease can only be judged by violations of the outflow from the veins (swelling, pain syndrome). At the same time, it should be noted that macroscopic and microscopic transformations in the vein wall caused by inflammatory process, are present both in the case of deep vein thrombosis and in the case of thrombophlebitis. The only exception is the currently very rare purulent fusion of blood clots, which can occur both in superficial veins and in deep ones.

From the point of view of the clinical approach, acute thrombophlebitis is especially dangerous, since if a thrombus is localized in the saphenous veins, it can go into the deep veins of the legs with highly likely serious complications. Among the consequences of this development of events is chronic venous insufficiency, trophic ulcers myocardial infarction and even death.

At the present stage, many doctors associate thrombophlebitis with varicose veins. This opinion is especially common if the patient has symptoms corresponding to varicose veins - venous nodes with pronounced varicose changes.

Among doctors general practice there is such a view on phlebothrombosis and thrombophlebitis: the latter, unlike deep vein damage, is not a serious pathology. This approach is due to what was said above - the perception of the two names as different pathological processes, although in practice it has been proven that this is not the case.

The formation of blood clots in the saphenous veins may well be combined with a similar pathology in the deep veins. This possibility exists due to the spread of the process through fistulas, perforating veins, and also due to the simultaneous formation of a thrombus. According to statistics, % of patients with thrombophlebitis have blood clots in deep veins.

In most cases, the spread of thrombosis to deep veins can be avoided. However, if time is lost, pathology transforms into a completely different format. Even if no pulmonary embolism occurs, phlebothrombosis will require complex, lengthy treatment (often lifelong).

Features of the development and treatment of phlebothrombosis

Phlebothrombosis (deep vein thrombosis) is a pathological process in which blood clots form in the bloodstream, which are fixed on the veins.

Most often, the disease is associated with an increase in blood density and impaired blood flow, which leads to thrombosis. The thrombus is fixed on the venous wall. Moreover, in the first 5-7 days, the blood clot is held very unreliably, which creates an increased risk of its separation with the possibility pulmonary embolism.

Causes of the disease

The causes of phlebothrombosis can be divided into three groups (the so-called Virchow triad):

Damage to the venous wall (without rupture). In this case, the body connects a mechanism that inhibits bleeding. As a result, the volume of platelets increases sharply, and prostacyclin (does not allow platelets to connect to each other), on the contrary, becomes smaller. Thrombi are easily formed in the altered blood composition.

Blood clotting disorder (thrombophilia). It is also possible to reduce the activity of factors that counteract coagulation (hypercoagulation). The pathological process can be started both under the influence external factors, and as a result of failures in the body itself (for example, in the case of an excess of adrenaline).
Violation of the nature of the blood flow. Too slow blood flow, as well as turbulent, provokes the formation of blood clots.

For the development of thrombosis, any of the above reasons is sufficient. All other causes are secondary, but may have additional predisposing significance. Among the secondary causes of thrombosis are the following:

genetic predisposition;
autoimmune diseases;
oncological diseases;
a long period of immobilization (bed rest, sedentary work, constant flights in an uncomfortable position);
injuries (surgical interventions, bruises, fractures);
bad habits (drugs, alcohol, tobacco).

Symptoms

Symptoms of phlebothrombosis are most often mild. This is due to the fact that the vessels located deep in the lower extremities are affected.

To detect the disease, a system of tests is used:

Homans symptom. With this test, you can assess the patency of deep veins in the lower leg. For examination, the patient lies on his back, bends his knees and then bends the ankle to the back. If there is pain in the area calf muscle, the symptom test is positive.

Payr's sign. For the test, palpation of the back of the ankle is performed. Pain on palpation indicates a positive test result.
Lowenberg's sign. A cuff of a special device, a sphygmomanometer, is applied to the lower leg. The cuff is then inflated to millimeters of mercury. If pain occurs, the symptom test is positive.
Symptom Pratt. Positive result according to the symptom, it is noted in the case of a pronounced venous network on the lower limb.
Symptom of Sperling. The test is positive if skin pale with a bluish tint.

There are a number of additional secondary signs of phlebothrombosis:

increased fatigue;
heart rhythm disturbances, tachycardia;
increase in body temperature up to degrees;

increased local temperature in certain areas of the lower extremities;
pulling, arching pain sensations (usually become more intense in the vertical position of the body).

Classification

Deep vein thrombosis is classified according to a number of criteria (localization, degree of development, types of thrombus). In turn, such a parameter as localization is also heterogeneous and has its own classification:

phlebothrombosis in the vessels associated with the inferior vena cava (ileofemoral, muscular veins of the leg, kavaileofemoral, trunk of the inferior vena cava);
phlebothrombosis in vessels associated with the superior vena cava (vein trunk, innominate veins, orifices of unpaired veins, complete thrombosis of the upper limb).

With all this, most often, according to localization, phlebothrombosis is divided into 4 groups:

According to the degree of development, the disease is divided into three types:

acute thrombosis (development period - up to 2 weeks);
subacute (from 2 weeks to 2 months);
chronic (over 2 months).

According to the type of thrombus, there is the following classification:

occlusive thrombi (stretched along the vein);
non-occlusive thrombi (parietal);
floating (attached to the vein only by a small area, and therefore can always come off);
embologenic (mobile).

Deep vein thrombosis can lead to dangerous complications, including:

post-thrombotic syndrome and chronic venous insufficiency;
trophic ulcers;

pulmonary embolism (can lead to a heart attack or even death).

Diagnostics

Diagnostic measures begin with an examination of the patient and the collection of anamnesis. Next, the doctor prescribes a set of laboratory and instrumental studies:

TEG - determination of the level of blood clotting using graphics;
APTT (activated partial thromboplastin time) - study of the internal and general pathway of blood coagulation;
thrombin production test;
general blood analysis;
ultrasonic techniques (coloring elements can be used);
venography (to assess the condition of the venous network and find a blood clot);

magnetic resonance imaging (allows you to examine deep veins);
radioisotope scintigraphy.

Timely and accurate diagnosis allows effective treatment and avoids dangerous complications diseases.

Treatment

To help the patient, both conservative methods and surgery. The specific treatment tactics is determined by the doctor, based on the stage of development of the pathological process and general condition patient.

In acute deep vein thrombosis, the patient may need hospitalization. This condition is accompanied by severe swelling, pain syndrome bursting nature, cyanosis of the skin and high body temperature.

In conservative therapy are used:

anticoagulants (needed to reduce blood density);
phlebotonic drugs (improve vascular tone, which allows you to optimize blood flow);
deaggregating agents (prevent platelets from sticking together);
anti-inflammatory drugs (usually non-steroidal drugs are used);
slimming (compression) jersey or elastic bandages(especially important at the recovery stage after thrombosis treatment);
the location of the lower extremities in an elevated position (above the level of the heart);
diet low in cholesterol.

If conservative methods do not give the desired result, phlebothrombosis can be treated with surgical methods. Indications for surgical intervention include a high probability of pulmonary embolism, gangrene, purulent course of the disease.

The following surgical techniques are used:

Excision of the affected vein. In the case of large veins, prosthetics can be performed. However, preference is given to shortening the vein (if possible).
Partial occlusion. This technique consists in reducing venous patency through the use of a special clamp. Occlusion is used to prevent pulmonary embolism.
Endovascular surgery. In this case, a coil is inserted into the vein through the catheter, which blocks the passage for large blood clots.

Prevention

Preventive measures are reduced to creating conditions under which the likelihood of congestion or high blood viscosity will be minimized.

organizing a healthy diet;
wearing tight underwear;
reasonable motor activity (walking, swimming, therapeutic exercises);
regular examinations by a phlebologist.

Venous pathologies pose a danger to the patient and require serious complex treatment. If you have even the most minor symptoms, you should consult a doctor.

All information on the site is provided for informational purposes only. Before using any recommendations, be sure to consult your doctor. Full or partial copying of information from the site without an active link to it is prohibited. oblivki

Deep vein thrombosis of the lower extremities (phlebothrombosis)

The pathological condition, manifested by the formation of blood clots with partial inflammation of the venous wall and impaired patency of the lumen of the vein, is called phlebothrombosis. In medical literature, everyday life and among specialists it is found under a different name - deep vein thrombosis of the lower extremities. No one will doubt the relevance of the topic due to the severity of the manifestations and the danger of complications of this disease. Women get sick more often reproductive age. The young age group also predominates among men. It is important to consider the correct terminology regarding this pathological condition. This is due to the fact that in most cases thrombosis is called thrombophlebitis, which is not entirely correct.

Phlebothrombosis and thrombophlebitis, what is the difference

It would seem that here to understand. But in fact, these are two completely different diseases. Common to them is only the pathogenetic basis, which is the formation of blood clots against the background of an inflamed venous wall. The difference lies in the fact that with thrombophlebitis, the process is localized in the superficial veins, and with phlebothrombosis, deep veins are affected. The clinical manifestations, complications and treatment of these conditions depend on this. Patient management is fundamentally different.

With thrombophlebitis, inflammatory changes prevail over the formation of blood clots. Deep vein thrombosis of the lower extremities is manifested by massive thrombus formation with minimal inflammatory changes in the venous wall.

Anatomical background

The venous system of the body is represented by superficial and deep venous plexuses. The main volume of venous outflow is carried out along deep highways. Superficial trunks carry away only 20-25% of the blood from the lower extremities.

Of greatest interest are the deep veins of the lower leg. It is in them that the formation of blood clots most often occurs. This is due to the presence of many venous cisterns and sinuses that form with the veins of the muscle pump of the leg. They act as natural blood depots. The lower leg, being the distal segment of the body, is constantly immobilized, which contributes to stagnation of blood. This is the trigger mechanism for thrombosis, determining the prognosis for deep vein thrombosis of the lower extremities.

Causal mechanisms of development

At risk for development this disease include:

Varicose transformation of veins with decompensated insufficiency of perforating veins;
sedentary work with in a sedentary manner life;
Taking oral combined oral contraceptives;
Operations on limbs, organs of the pelvis and abdomen;
Fractures of large bones of the lower limb;
Tumors of the abdominal cavity, pelvis and retroperitoneal space;
Dyshormonal conditions from the endocrine and reproductive systems;
Positional compression syndrome.

The central link in the pathogenesis that determines the symptoms of deep vein thrombosis of the lower extremities is blood stasis, in which accelerated blood clotting occurs. Thrombi form, obliterating the lumen of the vein. Venous outflow difficult, with the occurrence of venous hypertension in the deep system below the obstruction.

Features of clinical manifestations

Symptoms of deep vein thrombosis of the lower extremities consist of anamnestic data, patient complaints, objective examination data and additional research methods.

The presence of risk factors for the development of this disease in patients is always alarming, suggesting the possibility of developing phlebothrombosis. Modern phlebologists use special scales that determine the risk of developing the disease as a percentage.

All patients with phlebothrombosis complain of severe swelling of the lower extremities, accompanied by pain. Movements and attempts to walk cause them to increase, which is why patients spend most of their time in a supine position. The biggest pains are localized in the calf muscles.

The data of examination and palpation help to identify such signs that depend on the level of thrombosis and determine the tactics in the treatment of deep vein thrombosis of the lower extremities:

Ileofemoral - localization in the iliac-femoral segment;
Femoral - thrombosis of the femoral segment;
Femoral popliteal phlebothrombosis;
Phlebothrombosis of the leg.

This forms the clinical picture. The higher the localization of vein stenosis, the higher the level of pathological changes determined during examination. They are reduced to a woody edema of the affected segment of the lower leg and thigh compared with a healthy limb, discoloration of the skin in the form of cyanosis and hyperemic spots. Pain is determined by palpation during anterior-posterior compression of the lower leg ( positive symptom Homans), and its strengthening by flexion-extension of the foot (positive Moses sign). These data are specific for phlebothrombosis of the lower extremities when combined with severe edema.

For laboratory diagnostics conduct a study of blood coagulability: platelets, prothrombin index, clotting time and duration of bleeding, coagulogram, fibrinogen, prothrombin and active partial thromboplastin time. Instrumental diagnostics lies in ultrasound examination with Doppler amplification of the lower extremities with the determination of their patency and blood flow intensity.

Treatment

Choosing the treatment of deep vein thrombosis of the lower extremities, take into account the pathogenesis. Therefore, in the composition complex therapy include:

Immobilization of the affected limb with a Beller tire with an elevated position of the foot;
Elastic bandage and compression stockings;
Anticoagulant drugs and antiplatelet agents: heparin, fraxiparin, clexane, ticlopidine, clopidogrel;
Rheological and vascular preparations: rheosobilact, pentoxifylline, tivortin, trental. They are included as basic in the treatment of thrombosis of the lower extremities;
Prostaglandin preparations: alprostan, vazaprostan, ilomedin;
Non-steroidal anti-inflammatory drugs: dicloberl, olfen, melbek;
Glucocorticoids in small doses: dexamethasone, methylprednisolone.

Treatment of thrombosis of the lower extremities is carried out under the control of blood coagulation parameters. If there is a risk of thrombus migration into the vessels of the lungs with the development of thromboembolism pulmonary vessels catheterization is performed femoral vein with the installation of a cava filter, which will become an obstacle to the spread of blood clots.

The prognosis for deep vein thrombosis of the lower extremities is a post-thrombophlebitic disease, gradually decreasing with recanalization of the affected vein.

Differences between diseases

The inflammatory process in the venous wall (most often aseptic) leads to the formation of blood clots, and the occurrence of a thrombus is associated with an endothelial reaction and phlebitis.

Thus, both processes (phlebitis and thrombosis) are interrelated, and arguments about which of these pathologies is primary resemble a dispute about the primacy of an egg or a chicken.

Thus, based on classical concepts, in the same patient, both thrombophlebitis and phlebothrombosis can be noted at the same time in different parts of the venous system.

Most phlebologists are currently aware of the conventionality of separation, in which phlebothrombosis and thrombophlebitis are considered different diseases. Therefore, experts use the term "thrombophlebitis" when they talk about damage to the saphenous veins, and by "phlebothrombosis" they mean pathology in the deep veins. In the case of phlebothrombosis, the symptoms are almost imperceptible, since the vein is located at a depth - in the fascial case, and the manifestations of the disease can only be judged by violations of the outflow from the veins (swelling, pain syndrome). It should be noted that macroscopic and microscopic transformations in the vein wall caused by the inflammatory process are present both in the case of deep vein thrombosis and in the case of thrombophlebitis. The only exception is the currently very rare purulent fusion of blood clots, which can occur both in superficial veins and in deep ones.

From the point of view of the clinical approach, acute thrombophlebitis is especially dangerous, since if a thrombus is localized in the saphenous veins, it can go into the deep veins of the legs with a high probability of serious complications. Among the consequences of such a development of events are chronic venous insufficiency, trophic ulcers, myocardial infarction and even death.

Among general practitioners, there is such a view on phlebothrombosis and thrombophlebitis: the latter, unlike deep vein damage, is not a serious pathology. This approach is due to what was said above - the perception of the two names as different pathological processes, although in practice it has been proven that this is not the case.

The formation of blood clots in the saphenous veins may well be combined with a similar pathology in the deep veins. This possibility exists due to the spread of the process through fistulas, perforating veins, and also due to the simultaneous formation of a thrombus. According to statistics, 10-15% of patients with thrombophlebitis have blood clots in deep veins.

Features of the development and treatment of phlebothrombosis

Phlebothrombosis (deep vein thrombosis) is a pathological process in which blood clots form in the bloodstream, which are fixed on the veins.

Causes of the disease

The causes of phlebothrombosis can be divided into three groups (the so-called Virchow triad):

Damage to the venous wall (without rupture). In this case, the body connects a mechanism that inhibits bleeding. As a result, the volume of platelets increases sharply, and prostacyclin (does not allow platelets to connect to each other), on the contrary, becomes smaller. Thrombi are easily formed in the altered blood composition.

Blood clotting disorder (thrombophilia). It is also possible to reduce the activity of factors that counteract coagulation (hypercoagulation). The pathological process can be triggered both under the influence of external factors and as a result of failures in the body itself (for example, in the case of an excess of adrenaline).
Violation of the nature of the blood flow. Too slow blood flow, as well as turbulent, provokes the formation of blood clots.

For the development of thrombosis, any of the above reasons is sufficient. All other causes are secondary, but may have additional predisposing significance. Among the secondary causes of thrombosis are the following:

genetic predisposition;
autoimmune diseases;
oncological diseases;
a long period of immobilization (bed rest, sedentary work, constant flights in an uncomfortable position);
injuries (surgical interventions, bruises, fractures);
bad habits (drugs, alcohol, tobacco).

Symptoms

Symptoms of phlebothrombosis are most often mild. This is due to the fact that the vessels located deep in the lower extremities are affected.

To detect the disease, a system of tests is used:

Homans symptom. With this test, you can assess the patency of deep veins in the lower leg. For examination, the patient lies on his back, bends his knees and then bends the ankle to the back. If there is pain in the calf muscle, the symptom test is positive.

Payr's sign. For the test, palpation of the back of the ankle is performed. Pain on palpation indicates a positive test result.
Lowenberg's sign. A cuff of a special device, a sphygmomanometer, is applied to the lower leg. Next, air is injected into the cuff to a level of 60-150 millimeters of mercury. If pain occurs, the symptom test is positive.
Symptom Pratt. A positive result on the symptom is noted in the case of a pronounced venous network on the lower limb.
Symptom of Sperling. The test is positive if the skin is pale with a bluish tint.

There are a number of additional secondary signs of phlebothrombosis:

increased fatigue;
heart rhythm disturbances, tachycardia;
increase in body temperature up to 39-40 degrees;

increased local temperature in certain areas of the lower extremities;
pulling, arching pain sensations (usually become more intense in the vertical position of the body).

Classification

phlebothrombosis in the vessels associated with the inferior vena cava (ileofemoral, muscular veins of the leg, kavaileofemoral, trunk of the inferior vena cava);
phlebothrombosis in vessels associated with the superior vena cava (vein trunk, innominate veins, orifices of unpaired veins, complete thrombosis of the upper limb).

With all this, most often, according to localization, phlebothrombosis is divided into 4 groups:

deep veins of the leg;
popliteal vein;
femoral;
iliac-femoral.

According to the degree of development, the disease is divided into three types:

acute thrombosis (development period - up to 2 weeks);
subacute (from 2 weeks to 2 months);
chronic (over 2 months).

According to the type of thrombus, there is the following classification:

occlusive thrombi (stretched along the vein);
non-occlusive thrombi (parietal);
floating (attached to the vein only by a small area, and therefore can always come off);
embologenic (mobile).

Deep vein thrombosis can lead to dangerous complications, including:

post-thrombotic syndrome and chronic venous insufficiency;
trophic ulcers;

pulmonary embolism (can lead to a heart attack or even death).

Diagnostics

Diagnostic measures begin with an examination of the patient and the collection of anamnesis. Next, the doctor prescribes a set of laboratory and instrumental studies:

TEG - determination of the level of blood clotting using graphics;
APTT (activated partial thromboplastin time) - study of the internal and general pathway of blood coagulation;
thrombin production test;
general blood analysis;
ultrasonic techniques (coloring elements can be used);
venography (to assess the condition of the venous network and find a blood clot);

magnetic resonance imaging (allows you to examine deep veins);
radioisotope scintigraphy.

Timely and accurate diagnosis allows you to effectively treat and avoid dangerous complications of the disease.

Treatment

Both conservative methods and surgery can be used to help the patient. The specific treatment tactics is determined by the doctor, based on the stage of development of the pathological process and the general condition of the patient.

In acute deep vein thrombosis, the patient may need hospitalization. This condition is accompanied by severe swelling, bursting pain syndrome, cyanosis of the skin and high body temperature.

In conservative therapy are used:

anticoagulants (needed to reduce blood density);
phlebotonic drugs (improve vascular tone, which allows you to optimize blood flow);
deaggregating agents (prevent platelets from sticking together);
anti-inflammatory drugs (usually non-steroidal drugs are used);
slimming (compression) knitwear or elastic bandages (especially important at the recovery stage after thrombosis treatment);
the location of the lower extremities in an elevated position (above the level of the heart);
diet low in cholesterol.

The following surgical techniques are used:

Excision of the affected vein. In the case of large veins, prosthetics can be performed. However, preference is given to shortening the vein (if possible).
Partial occlusion. This technique consists in reducing venous patency through the use of a special clamp. Occlusion is used to prevent pulmonary embolism.
Endovascular surgery. In this case, a coil is inserted into the vein through the catheter, which blocks the passage for large blood clots.

Prevention

Preventive measures are reduced to creating conditions under which the likelihood of congestion or high blood viscosity will be minimized.

Prevention includes:

organizing a healthy diet;
wearing tight underwear;
reasonable motor activity (walking, swimming, therapeutic exercises);
regular examinations by a phlebologist.

Venous pathologies pose a danger to the patient and require serious complex treatment. If you have even the most minor symptoms, you should consult a doctor.

Thrombophlebitis and phlebothrombosis. Thrombophlebitis and phlebothrombosis - different diseases

Causes, risk factors for superficial thrombophlebitis and deep vein thrombosis

Diagnosis of pathologies

Differences in treatment

Phlebothrombosis

Thrombophlebitis

Treatment of thrombosis

Diseases of the facial vessels

What are the differences from phlebitis?

1 Specificity of diseases

2 Causes of pathologies

3 Main symptoms and signs

The difference between the two diagnoses

Factors affecting the appearance of pathologies

Symptoms of various lesions of the veins

Characteristics of diseases (brief description)

Thrombophlebitis

Thrombosis

Phlebothrombosis

How are pathologies different?

Symptoms

Therapy

"Tver State Medical Academy"

The social significance of the topic

Factors affecting the appearance of pathologies

Symptoms of various lesions of the veins

Description of diseases

Reasons for development

Signs and symptoms

Treatment

What is the difference between phlebothrombosis and thrombophlebitis?

Differences between diseases

Features of the development and treatment of phlebothrombosis

Causes of the disease

Symptoms

Classification

Diagnostics

Treatment

Prevention

Deep vein thrombosis of the lower extremities (phlebothrombosis)

Phlebothrombosis and thrombophlebitis, what is the difference

Anatomical background

Causal mechanisms of development

Features of clinical manifestations

Treatment

Related videos

Differences between diseases

Features of the development and treatment of phlebothrombosis

Causes of the disease

Symptoms

Classification

Diagnostics

Treatment

Prevention