Acute thrombophlebitis of lower limb veins

Thrombophlebitis is characterized by the presence of inflammatory changes in the vein walls. As a result, a thrombus forms on the damaged surface. Vessels of any localization are subject to this process. Most often, the lower extremities are affected. Thus, acute thrombophlebitis of the veins of the lower extremities is a serious inflammatory process. Sometimes the resulting thrombus leads to a disruption of blood flow. In some cases, it migrates along the vascular bed.

ICD-10 code

According to the international classification of diseases, thrombophlebitis is marked by the code I80. Phlebitis and thrombophlebitis (I80). This category includes: endophlebitis inflammation of the veins periphlebitis purulent phlebitis. Phlebitis and thrombophlebitis of a complicating course, abortion, ectopic or molar pregnancy (O00-O07, O08.7) are completely excluded. Pregnancy, childbirth and the postpartum period have their own code according to ICD 10 (O22, O87). Intracranial and spinal septic or NCD (G08). Intracranial nonpyogenic (I67.6), spinal nonpyogenic (G95.1), portal vein (K75.1) postphlebitic syndrome (I87.0) migratory thrombophlebitis (I82.1). In order to identify the drug, the use of which led to such consequences, an additional coding is used (class XX).

I80.0 Phlebitis and thrombophlebitis of superficial vessels of lower limbs. I80.1 Phlebitis and thrombophlebitis of femoral vein. I80.2 Phlebitis and thrombophlebitis of other deep vessels of lower limbs. This includes: deep vein thrombosis NEC. I80.3 Phlebitis and thrombophlebitis of lower limbs, unspecified. Includes: embolism or thrombosis of lower limbs NEC. I80.8 Phlebitis and thrombophlebitis of other sites. I80.9 Phlebitis and thrombophlebitis, unspecified.

Causes of acute thrombophlebitis of the veins of the lower extremities

Three specific factors are sufficient for a thrombus to form. The main cause of thrombophlebitis of the veins of the lower extremities is damage to the venous wall. Superficial veins, due to their location, are often subject to mechanical action. Sometimes damage can be caused during surgical operations, as well as during the introduction of concentrated solutions.

The second reason is slow blood flow. For this risk factor to occur, it is enough to stay in bed for a long time. The person does not move, which results in compression of the veins and their trauma. A similar condition is typical for people with heart failure. When staying in bed, stagnation begins to form. Ultimately, the blood flow rate decreases significantly.

The next reason is increased blood clotting. This condition may appear from birth, or arise due to certain factors. Some people have a defect in the normal functionality of the blood system from birth. As for the acquired condition, it is associated with past infectious diseases, as well as hormonal imbalance.

The inflammatory process in the vein is aseptic, it develops against the background of damage to the wall or the formation of the thrombus itself. If there are microbes in the bloodstream, the process becomes purulent. When all the above factors are present, thrombophlebitis begins to develop. During treatment or simply spontaneously, the thrombus stops growing and the inflammation gradually subsides. The risk of detachment in this case becomes minimal.

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Pathogenesis

The main pathogenetic factors of the disease formation are: slowing of the general blood flow, changes in the structure of the vascular wall, and also increased coagulation properties of the blood. All this is combined into Virchow's triad. These factors represent the main pathogenesis of the disease.

The inflammatory process starts in the vein from its inner lining. This is how endophlebitis manifests itself. Then the thrombus formation begins, the process can also be observed from the outer lining, this is the so-called periphlebitis.

Thrombophlebitis can be both simple and purulent. The purulent process develops against the background of the penetration of microbes into the body. Depending on the location of the veins, the disease can be superficial and deep. Naturally, it also differs in its course. There are 3 types of thrombophlebitis: acute, subacute and chronic. All inflammatory processes begin in the same way, but differ in the severity of the symptoms.

Symptoms of acute thrombophlebitis of the veins of the lower extremities

Depending on the nature of the process itself, there are two main types: acute and chronic thrombophlebitis. Thus, the symptoms of acute thrombophlebitis, originating from the veins of the lower extremities, are characterized by a sudden onset. Moreover, there are no visible reasons for this condition. Sometimes this is preceded by the presence of an injury to the lower extremities. Often the patient suffers from an inflammatory infection, takes oral contraceptives. All this can lead to a violation of the blood clotting function. Most often, the disease develops due to complications of varicose veins.

Local manifestations can prevail. In this case, the person's condition is normal, practically nothing bothers him. Minor pain may appear during walking, with time, limitation of limb movement develops. The affected area turns red, the disease gradually progresses, and the symptoms manifest themselves more acutely. An increase in body temperature is possible, as well as minor redness. A painful and dense cord is detected in the affected area. If dilated veins are involved in the general process, then pain in varicose nodes is observed, as well as a change in their size. Swelling of the lower limbs is often noted. The main manifestation of the disease is an increase in body temperature. The person is bothered by general malaise and chills.

First signs

The first thing that begins to manifest itself is minor swelling of the legs. Over time, everything is supplemented by painful sensations in the calves, a burning sensation and heaviness in the legs are possible. These are the first signs of thrombophlebitis, ignoring them is highly undesirable. Redness of the skin may be observed at the site of the lesion.

In most cases, patients do not focus on such symptoms. They seek help from a doctor during the progression of the disease, when the signs are obvious. At the same time, the legs begin to swell greatly. In the place where the thrombus formed, the skin may take on a bluish tint. If the condition is extremely severe, the limb may turn black. The main localization of the thrombus is the thigh, shin or ankle.

Ignoring the manifestation of the disease is not worth it, it can lead to really disastrous complications. Timely detection of thrombophlebitis and its quality treatment will return a person to his former life.

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Acute thrombophlebitis of superficial veins

The most common form of the disease is the varicose type. It is characterized by intense pain, as well as redness at the site of inflammation. Acute thrombophlebitis of superficial veins is characterized by the presence of pronounced edema, and the vein itself becomes tense. As the thrombus begins to develop, the edema gradually moves to deeper veins. This symptom carries an increased danger. The pain is accompanied by an increase in body temperature, as well as weakness.

Varicose veins and thrombophlebitis have always been considered interrelated diseases. Varicose veins themselves are often the trigger for thrombus development. After all, this condition is characterized by slow blood flow. As for thrombophlebitis, it is simply a serious complication of this process.

It is important to notice the localization of inflammation in time and begin treatment. For this, anti-inflammatory therapy is widely used, which not only helps to cope with pain, but also significantly reduces swelling.

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Acute deep vein thrombophlebitis

This condition is characterized by a sudden onset. It is characterized by severe pain in the affected limbs, as well as elevated temperature. If you start palpating the vein, there is excessive pain. By the end of the first day, the limb may begin to swell, while the skin turns pale and becomes elastic. The pulse weakens, the affected area is colder and shiny. In acute deep vein thrombophlebitis, the lymph nodes in the groin area become enlarged and painful. The swelling of the limb lasts for 3 months. When the acute symptoms subside, the so-called postphlebitic syndrome develops.

It is important not to let the condition worsen. When the first symptoms appear, immediate treatment should be started. After all, such "attacks" can be repeated constantly. There is nothing good about this, because thrombophlebitis can lead to serious complications.

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Acute ascending thrombophlebitis of the subcutaneous veins

Ascending thrombophlebitis is an inflammatory process that originates from the walls of the veins. This disease has a varicose nature, as a result of which a thrombus may form. Most often, acute ascending thrombophlebitis is a complication after varicose veins of the subcutaneous veins. A similar condition occurs when the inflammatory process moves from low veins to the groin area. If thrombophlebitis has moved from a superficial vein to a deep vein, the risk of a thrombus breaking off and migrating increases. This can cause pulmonary embolism.

Ascending thrombophlebitis manifests itself as pain in the lower extremities, a feeling of distension in the shin, and reddening of the skin along the varicose vein. Over time, swelling of the legs appears, the body temperature rises significantly, and the person feels generally unwell. Often there are: hyperemia, lymphadenitis, and lymphangitis. The presence of such a disease is especially dangerous to life. If treatment is not started in a timely manner, a fatal outcome is possible.

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Consequences

Serious complications after superficial thrombophlebitis do not occur. The only serious consequence is the risk of a thrombus breaking off with a subsequent change in its location. Thrombosis is characterized by the presence of a serious inflammatory process, as a result of which the thrombus sticks to the vessel wall. The probability of its breaking off and getting into the bloodstream is negligible, but still exists.

Superficial veins are not surrounded by muscles, so the probability of contraction and movement of the thrombus is simply impossible. But if a person has deep vein thrombophlebitis, then the probability of this process developing is not excluded. In this case, the risk to life remains. Ascending thrombophlebitis is especially dangerous, it can lead to death.

Any changes in the skin may indicate the presence of a serious inflammatory process. It should not be ignored, because serious consequences may develop.

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Complications

Deep vein thrombophlebitis is asymptomatic in most cases. It can only be suspected by the development of complications. This is typical for cases where the thrombus has already attached to the wall of the vein with its head, and its tail can freely move under the influence of the blood flow. The most serious complication can be the development of pulmonary embolism. This condition is characterized by shortness of breath, lack of air, and the development of cyanosis of the face and extremities. In this case, the thrombus must be removed surgically or dissolved with special drugs. If this measure is not taken, pneumonia may develop.

Another serious complication is blue phlegmasia. This condition is characterized by thrombosis of all veins in the extremities at once. Therefore, the symptoms are more pronounced. A person is tormented by intense pain, swelling begins to gradually increase. The extremities can increase in volume several times. The vessels are dilated, the skin can become purple. Very quickly, an infection joins this condition. If this complication is not eliminated, gangrene may develop, which entails amputation of the limb.

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Diagnosis of acute thrombophlebitis of the veins of the lower extremities

The first step is to collect anamnesis data. Acute thrombophlebitis of the veins of the lower extremities is characterized by a rapid and sudden onset, which greatly facilitates diagnosis. The diagnosis can be made thanks to modern examination methods. Inflammation of the subcutaneous veins in some cases can be accompanied by the development of lymphadenitis. The fact is that the lymph nodes pass next to the veins. Therefore, the inflammatory process most often affects them. The presence of the disease can be determined by external signs. Thus, the lymph nodes become painful.

If the inflammation is erysipelas, then red formations are visible on the skin. The inflamed area has clear boundaries. With phlegmon, the condition of the victim is severe. He suffers from chills, high temperature, swelling of the affected area, edema and a significant increase in lymph nodes.

Additional studies include ultrasound Dopplerography and computed tomography. In addition, a general blood test is taken to determine the level of leukocytes.

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Tests

Before making a diagnosis, a person needs to undergo all the necessary diagnostic procedures. The first step is to take tests. Laboratory tests allow you to study a person's blood and identify changes in some indicators. An increase in the number of leukocytes most often indicates the presence of an inflammatory process in the body. That is why a preliminary analysis can be done based on a general blood test.

In addition, a blood clotting test is performed. If increased clotting activity is observed, this is also a symptom of an inflammatory process in the body. No additional laboratory tests are performed. It is impossible to make a diagnosis based on tests alone; information from other studies is needed for this, in particular differential diagnostics. All the data obtained are combined, and based on them, a preliminary diagnosis is confirmed.

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Instrumental diagnostics

In addition to collecting anamnesis and taking tests, additional research methods must be used. Thus, to obtain certain information, it is necessary to conduct instrumental diagnostics. Its methods include: ultrasound Dopplerography and computed tomography - angiography.

Ultrasound Dopplerography of the vessels of the lower extremities. This procedure allows for an assessment of the blood flow and patency of the veins. In addition, the degree of thrombus flotation and the level of its damage are determined. This allows for a real assessment of what is happening.

Computer tomography - angiography. This method is performed using a contrast agent. Thanks to it, it is possible to obtain a clear picture. After all, the contrast agent darkens the affected areas and thus facilitates the process of diagnosis. This method allows you to assess the condition of the vessels. These procedures are performed both separately and together.

Differential diagnostics

The main signs of thrombophlebitis are visual. Thus, the skin becomes rough and inflamed. A red spot with clear boundaries begins to form on it. Over time, it can increase in size and in different directions. A diagnosis can be made based on differential diagnostics and examination. In some cases, the skin has purulent inflammation. This process is accompanied by an increase in lymph nodes and a sharp rise in temperature. This condition is characterized by an extremely serious situation.

It is impossible to make a diagnosis based on anamnesis. Additional studies should be performed. A person needs to have a blood test. This will reveal the level of leukocytes and check the coagulation activity. If these indicators are elevated, it means that there is an inflammatory process in the body. The data obtained are compared with the results of instrumental diagnostics, and a diagnosis is made based on them.

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Treatment of acute thrombophlebitis of the veins of the lower extremities

Treatment consists of preventing the spread of the process to deep veins, reducing the inflammatory process and relapse of the disease. For these purposes, a whole range of effective measures has been developed. Thus, treatment of acute thrombophlebitis of the veins of the lower extremities can be carried out at home, but it is better to go to the hospital. This will avoid the development of possible complications. Regardless of the treatment regimen, it is necessary to resort to the drug method, local treatment and elastic compression.

The medicinal method involves the use of special drugs. Thus, to strengthen the walls of blood vessels, they resort to the help of Troxevasin, Detralex and Ginkor-fort. They use drugs that prevent the formation of blood clots, such as Aspirin. Ketoprofen and Diclofenac are used as anti-inflammatory drugs. Ointments that lead to the dissolution of the blood clot are used, this can be Lyoton-gel and Heparin ointment.

They also resort to hirudinotherapy, or, in simpler terms, the use of leeches. They are used only in acute cases of the disease. This is possible if the patient cannot use anticoagulants. Hirudin, produced from the glands of leeches, penetrates the blood. It is able to reduce its viscosity and coagulability. At the same time, the risk of developing spasms of arterial vessels is significantly reduced. Leeches can be "applied" to the affected area, in the amount of 10 pieces. The procedure should be carried out for 6 days. If there is no effect from conservative treatment, the affected vein is removed surgically.

Particular preference is given to physiotherapeutic methods. These include infrared rays, ultraviolet radiation and sollux. They are used in chronic disease, during the period of thrombus formation. It is important to undergo treatment at resorts. Pyatigorsk and Sochi are suitable for people suffering from venous diseases.

Medicines

To treat thrombophlebitis, medications are used. They not only relieve swelling, but also dissolve the formed thrombus. Many of them prevent the development of a new thrombus. As frequently used medications, preference is given to: Troxevasin, Detralex and Ginkor-fort. Later, Aspirin and anti-inflammatory drugs Ketoprofen and Diclofenac are used. Ointments such as Lioton-gel and Heparin ointment are used locally.

• Troxevasin. The product is applied to the affected area in a thin layer. The gel is not greasy, so it does not leave marks on clothing. In severe cases of the disease, the gel is combined with capsules of this drug. The dosage is prescribed by a doctor. The product cannot be used in case of hypersensitivity, as well as severe lesions of the skin. Local allergic reactions may develop.
• Detralex. The drug is used during meals, 2 tablets 2 times a day. The dose can be adjusted by the attending physician. The duration of administration does not exceed one week. The drug cannot be used in case of hypersensitivity. May lead to the development of nausea, vomiting, diarrhea and skin rash.
• Ginkor-fort. The drug is used one capsule 2 times a day. The duration of treatment is 2 weeks. The drug is not used for hyperthyroidism. No side effects were identified.
• Aspirin. The product is used 2-3 times a day, one capsule at a time. The dosage is prescribed by a doctor, depending on the severity of the pain syndrome. The drug cannot be used in case of hypersensitivity, as well as impaired liver and kidney function. May cause nausea, vomiting and allergic reactions.
• Ketoprofen. The dosage is prescribed individually, depending on the severity of the disease. On average, the daily dose is 300 mg. The drug cannot be used in case of impaired liver and kidney function, during pregnancy. Local use prohibits this action in the presence of open wounds. May lead to the development of allergic reactions and gastrointestinal disorders.
• Diclofenac. The drug is used in the form of tablets. It is enough to use one piece per day, 2-3 times a day. The dosage depends on the severity of the person's condition. People with increased sensitivity to diclofenac should not use the drug. People with impaired liver and kidney function are at particular risk. The drug can lead to the development of gastrointestinal disorders.
• Lioton-gel. The gel should be applied to the affected area 2-3 times a day, in a thin layer. If necessary, the number of applications is increased, such a decision can only be made by a doctor, based on the person's condition. The product cannot be used in case of severe skin lesions, with open wounds. The gel can cause local allergic reactions.
• Heparin ointment. The ointment is applied several times a day, depending on the location of the lesion and the desired therapeutic effect. It cannot be used on open wounds or with sensitive skin. May cause allergic reactions.

Folk remedies

Traditional methods have many effective ways to eliminate thrombophlebitis in their arsenal. But before using them, you should consult a doctor. So, traditional treatment is not always appropriate. Eliminating the problem in this way can lead to a worsening of the situation.

• Honey compress. To prepare it, you need to take honey and spread it on a linen cloth and apply it to the affected area. The first three days, the compress is left for 2-4 hours. Then it can be applied all night. In this case, the affected leg needs to be wrapped in something, over the honey cloth.
• Cabbage compress. This remedy is the most effective for thrombosis. You need to take a cabbage leaf, beat it slightly and cut it with a sharp knife. Then, on one side, it is smeared with honey or vegetable oil. This remedy is applied to the affected area and fixed with a natural cloth. It is necessary to keep such a compress as long as possible, up to a day. Even if the main symptoms have disappeared, it is still used for a whole month.

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Herbal treatment

Many medicinal herbs are effective against thrombophlebitis. Bitter and silver wormwood, fern grass, Kalanchoe and calamus rhizomes have positive properties. For treatment with these herbs, it is worth consulting a doctor to avoid the risk of complications.

• Recipe #1. Take a tablespoon of medicinal verbena and pour a glass of boiling water over it. The remedy needs time to settle. The resulting infusion should be consumed within 24 hours.
• Recipe #2. You can apply a lilac leaf to the affected area at night. This will help relieve swelling and inflammation. It is advisable to use a fresh leaf.
• Recipe #3. The grass should be dipped in a bucket of boiling water. 200 grams of the main ingredient is enough. After that, the remedy should be wrapped up and left to infuse. As soon as it is ready, you can dip the affected limbs in it for about 30 minutes. It is advisable to do the procedure before bedtime.
• Recipe #4. A tablespoon of nettle is poured with a glass of boiling water. After that, the remedy should be left for 40 minutes to infuse. Then it is filtered and used three times a day, 2 tablespoons at a time. It is advisable to do this before meals.
• Recipe #5. Wormwood, ground together with sour milk, can be used as raw material for compresses. The compress is done at night.

Homeopathy

Homeopathic medicines are particularly popular today. They are also widely used to treat thrombophlebitis. Before using homeopathic medicines, it is worth trying traditional treatment methods. Homeopathic medicines do not undergo clinical trials and can be dangerous for the human body.

Hamamelis. This remedy is available in the form of granules, suppositories and ointments. It is used mainly to eliminate thrombophlebitis, varicose veins and neuralgia. The composition of the drug includes natural components. It is used in 1, 2, 3 and 6 divisions. For thrombophlebitis, the drug is used externally. It is necessary to make a lotion from the tincture mixed with water. The drug actively affects the membranes of the veins. Thus, it promotes their relaxation and prevents the development of stagnation. It is used even for open wounds, it perfectly stops bleeding. The purified extract of the drug is used exclusively locally.

There are other medications, you can learn about them at a homeopathic doctor's appointment. It is not recommended to start treatment on your own, and even more so to prescribe dosages.

Surgical treatment

Surgical intervention is possible only in case of thrombophlebitis of the lower extremities. In other cases, everything is eliminated with medication. Conservative treatment methods cope well with these inflammatory processes. In turn, surgical treatment can prevent deep vein thrombosis, as well as a possible relapse.

True, not all patients will be able to undergo surgical intervention. This is due to the peculiarities of the inflammatory process. Sometimes it is simply impossible to perform the operation. There are only two types of surgical intervention: radical and palliative.

• Radical surgery. This procedure involves the removal of all varicose veins, as well as dissection of significant insufficient perforators. This type of intervention is justified and appropriate only in the case of varicose disease. In the period of post-thrombophlebitic disease, this can, on the contrary, aggravate the situation. Radical surgery allows you to quickly get rid of thrombophlebitis, because in this way the main cause of its occurrence is eliminated.
• Palliative surgery. This procedure does not speed up the recovery process, it prevents the development of a thrombus. To speed up the patient's recovery, percutaneous puncture thrombectomy may be used. An absolute indication for this procedure is the presence of complications.

Prevention

The main task of preventive measures is to prevent the thrombus from breaking off and migrating to the lungs. Today, a special device called a cava filter is widely used. It allows you to catch a broken thrombus and prevent it from migrating throughout the body. Prevention does not end there; surgical skills are widely used.

Thrombectomy allows to remove formed blood clots from veins, thus preventing serious consequences. This intervention is surgical, it gives excellent results, even in the treatment of deep vein thrombosis.

All this applies if venous diseases already exist. But it is possible to prevent their development. To do this, it is enough to move a lot, not to overload the limbs and treat diseases in time. If pain in the legs and veins appears, you should consult a doctor. Timely elimination of the disease will help to avoid consequences.

Forecast

It is important to understand that acute thrombophlebitis can become chronic. To do this, it is enough to simply not eliminate the main symptoms and wait 15 days. In this case, the prognosis will be unfavorable, because the risk of developing serious complications is high.

If a person notices strange symptoms and seeks help from a doctor, everything is eliminated quite quickly. Moreover, there is a possibility of preventing the development of a blood clot and eliminating the disease at the very root. If conservative treatment is prescribed correctly, the inflammatory process recedes. Many medications allow not only to eliminate a blood clot, but also prevent the disease from reappearing. Everything depends on how quickly a person began treatment. The favorable prognosis is compared with the period of detection of thrombophlebitis and its elimination. It is impossible to say for sure how the recovery process will go. This is an individual process, conclusions on it are made regarding each case.

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