Inferior vena cava syndrome

Sometimes, during pregnancy and not only, inferior vena cava syndrome is diagnosed. It is not quite correct to call this syndrome a disease: rather, it is a violation of the body's adaptation to an enlarged uterus or other changes in venous circulation.

In most cases, the syndrome is detected in women with multiple pregnancies, polyhydramnios, large fetuses, pregnancy combined with vascular hypotension, as well as tumors and blood clotting disorders.

Causes inferior vena cava syndrome

The underlying cause of the syndrome has not yet been fully established. However, it has been proven that the following may be provoking factors:

• high blood clotting;
• altered biochemical composition of blood;
• infectious venous diseases;
• hereditary factor.

In addition to the period of bearing a child, inferior vena cava syndrome can develop much less frequently with echinococcosis, tumor processes in the abdominal cavity. Patients with such pathologies need to be especially vigilant about their health.

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Pathogenesis

The pathogenesis of the syndrome is specific, but depends on the characteristics of a particular organism. Most often, there is a violation of the patency of the base of the inferior vena cava, which can often be combined with the formation of a thrombus in the affected area of the vessel.

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Symptoms inferior vena cava syndrome

The symptoms of this syndrome depend on the degree of compression or blockage of the lumen of the inferior vena cava. The most pronounced signs are observed with maximum blockage of the vessel in combination with deterioration of the patency of the veins of the liver and kidneys.

The first signs of the syndrome that you should pay attention to are the sensation of “crawling ants” in the legs, followed by numbness.

Further, the disease develops depending on the location of the blockage of the inferior vena cava.

• If the inferior vena cava is blocked above the site of divergence of the renal arteries, the following manifestations may be observed:
  • nephrotic syndrome;
  • swelling of the lower extremities;
  • protein in urine;
  • renal failure.
• If the blockage occurs below the site of divergence of the renal veins, the following symptoms may appear:
  • hemorrhages under the skin (bruises);
  • swelling of the lower extremities and genitals;
  • varicose veins;
  • pain and weakness in the legs.

In addition, blood pressure may increase, weakness and anxiety may appear, and the heartbeat may increase.

Superior and inferior vena cava syndrome

The superior and inferior vena cava syndrome appears due to a circulatory disorder in the superior vena cava.

Physiologically, venous blood from the upper body flows through the superior vena cava. Normal blood flow can be disrupted by tumor processes, aneurysm, enlarged lymph nodes, and blood clots.

Typically, this syndrome develops gradually. The patient may experience periodic headaches, sleep disturbances, nosebleeds or throat bleeding, vision impairment, difficulty falling asleep in a lying position. Over time, the patient develops swelling, cyanosis, and varicose veins in the upper body. At the same time, symptoms of the underlying pathology that initially caused the obstruction are revealed.

Treatment of superior and inferior vena cava syndrome is prescribed depending on the degree of blockage and its localization. Conservative therapy involves taking fibrinolytic, anticoagulant and antiplatelet drugs.

Complications and consequences

Inferior vena cava syndrome in pregnant women does not always lead to any negative consequences. The fact is that in most patients, the outflow of venous blood from the lower part of the body occurs through the azygos and vertebral veins, so inferior vena cava syndrome may not be accompanied by circulatory disorders.

The situation in which a collaptoid state develops is dangerous. This usually occurs during a cesarean section and is taken into account by doctors.

When the uterus significantly presses on the inferior vena cava, blood circulation directly in the uterus and kidneys deteriorates. As a result, the condition of the unborn child suffers, and the woman's glomerular filtration is also disrupted. The listed processes can cause premature placental abruption, thrombus formation, and varicose veins.

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Diagnostics inferior vena cava syndrome

Laboratory methods: general blood and urine tests, blood biochemistry, blood clotting assessment.

Instrumental diagnostics:

• phlebography (a type of X-ray examination that is performed after intravenous administration of a contrast agent, which allows one to determine the location of the narrowing of the vessel);
• Doppler ultrasound examination;
• duplex scanning;
• magnetic resonance or computed phlebography method.

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Differential diagnosis

Differential diagnostics is aimed at excluding extravasal compression of the inferior vena cava by a tumor or inflammatory process. It is important to determine the presence or absence of a tumor based on the results of ultrasound, CT or phlebography.

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Treatment inferior vena cava syndrome

At present, there is no clear treatment regimen for inferior vena cava syndrome. In most situations, conservative therapy is used with mandatory prescription of drugs that affect blood clotting, both direct and indirect.

When prescribing a drug, the duration of the disease should be taken into account, which is practically impossible to determine with this syndrome. It is known that antithrombotic agents have the greatest effect only at the initial stages of the formation of blockage.

Maintaining normal kidney and liver function is also of no small importance.

	Directions for use	Side effects	Special instructions
Fraxiparin	It is used before and after surgery, most often 0.3 ml by subcutaneous injection.	Bleeding, subcutaneous hematomas, hemorrhages.	The drug is not used intramuscularly.
Warfarin	Most often taken orally, from 2 to 10 mg per day.	Bleeding, hemorrhage, anemia, dermatitis, headache.	During the course of therapy, the degree of blood clotting should be monitored.
Streptokinase	A product for infusion therapy. The dose of the drug is selected only individually.	Bleeding gums, hematomas, redness of the skin, internal bleeding.	It is prescribed with caution in cases of liver and kidney diseases, as well as in old age.
Refortan	Administered intravenously by drip, from 10 to 1000 ml per day.	Vomiting, itchy skin, pain in the lower back.	During treatment, renal function must be monitored.
Curantil	Take 75 mg three times a day.	Increased heart rate, dyspepsia, thrombocytopenia, tinnitus, feeling of weakness.	It is not recommended to take it simultaneously with caffeine-containing drinks.

The main vitamins that help strengthen the venous walls are tocopherol and ascorbic acid. Foods rich in these vitamins reduce the likelihood of blood clots and blockage of the inferior vena cava.

Tocopherol (in E) is present in beans, cereals, liver, broccoli, and also in vegetable oils.

Ascorbic acid is found in sufficient quantities in berries, grapes, kiwi and citrus fruits.

In addition, it is advisable to eat food rich in carotene, rutin, and microelements such as copper, iron, and zinc. To do this, you need to cook more often dishes from cabbage, nuts, red fruits and vegetables, meat.

Of the pharmaceutical preparations, Aevit and Ascorutin are especially recommended, which are prescribed 1 tablet or capsule twice a day for 3-4 weeks. During pregnancy, it is necessary to select a vitamin preparation only under the supervision of a doctor.

Physiotherapeutic treatment for inferior vena cava syndrome is used extremely rarely. It is possible to prescribe therapeutic exercise, manual therapy (according to indications).

Homeopathy has been treating diseases such as inferior vena cava syndrome for many years. In this case, homeopathic doctors recommend using remedies that strengthen the vascular walls, regulate blood circulation and improve the properties of the blood. Treatment tactics are usually determined depending on the disease or condition that could have caused the vein blockage.

The following homeopathic preparations have recently become of interest:

• Crotalus (striped rattlesnake) - Heel brand products are used, such as Crotalus-Heel and Crotalus-Heel forte, in dilutions of 12, 30, 200;
• Aesculus (horse chestnut extract) – prescribed in the form of injections (Aesculus Ingeel and Aesculus Ingeel Forte), or in the form of solutions Aesculus Heel, Arnica Heel or Arteria Heel, 10-15 drops three times a day;
• Vipera berus (a preparation made from viper venom) – is used in the form of injections of the preparation Vipera berus Ingeel. Dosage D–15, 30, 200.

In addition, drugs prepared on the basis of coagulating factors can be prescribed: thrombin, fibrinogen, fibrin, etc. In the future, it is recommended to use Aorta suis Ingeel, Arteria suis Injeel, Vena suis Ingeel, which are made from thrombotic material.

Surgical treatment is prescribed for thrombosis of the inferior vena cava:

• in the presence of thromboembolism of the lumen of the inferior vena cava;
• in case of blockage of the venous vessels of the liver or kidneys with impairment of organ function;
• in case of coarctation of the inferior vena cava;
• in case of “delayed thrombosis” (more than 14-20 days).

Operations are not recommended if the patient has decompensated cardiac activity or a recent stroke of the cerebral vessels.

The operation is performed under intubation anesthesia using muscle relaxant drugs. The surgeon performs a midline laparotomy, thoracophrenolumbotomy, or various types of extraperitoneal access. The trunk of the inferior vena cava is isolated, clamps are applied, and a radical removal of the thrombus or other cause that prevents normal blood circulation in the vessel is performed. If a narrowed area is detected, balloon dilation with subsequent stenting is performed.

Folk remedies

In consultation with your doctor, you can use the following folk recipes:

• Take 15 g of verbena leaf, brew in a glass of boiling water. Take 1 tbsp. every hour until the condition improves.
• Drink a third of a glass of infusion of St. John's wort, plantain, immortelle, coriander, licorice rhizome and succession. To prepare the infusion, you will need 2 tbsp. of an equal mixture of the listed plants and 220 ml of boiling water. The medicine is taken half an hour before meals.
• Take ground nutmeg with plain warm water or tea.
• Take 0.3 g of mumiyo orally twice a day, possibly in combination with honey and milk. Duration of administration is up to 25 days in a row.

Herbal treatment often includes complex multi-component recipes:

• Prepare a mixture of 25 g of yarrow herb, 100 g of immortelle flowers, 50 g of lingonberry leaves, 50 g of buckthorn bark and the same amount of birch leaves. Brew 1 tbsp of the mixture with 250 ml of boiling water and leave in a thermos for at least 4 hours. Drink 100 ml three times a day before meals.
• Prepare an equal mixture of sage leaf, chamomile flowers, marshmallow root and flaxseed. Two tablespoons of the mixture are poured with boiling water (250 ml) and drunk throughout the day.
• Prepare a mixture of equal parts of horsetail, hop cones, and sweet clover. Brew 2 tbsp of the mixture in 250 ml of boiling water and leave for 2 hours. Drink 100 ml three times a day before meals.

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Prevention

Prevention can be based on the probable causes of the inferior vena cava syndrome. It is important to prevent the onset of the problem, as well as to prevent exacerbations.

• It is necessary to monitor the degree of blood clotting. If there are any violations, you should consult a doctor regarding further treatment or preventive measures.
• It is advisable to treat any diseases of the cardiovascular system and hematopoietic organs in a timely manner.
• At the first signs of inferior vena cava syndrome, you should see a doctor. Self-medication in such a case is unacceptable.

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Forecast

Doctors in most cases give a relatively good prognosis for the disease. The only condition is that the inferior vena cava syndrome must be detected in a timely manner.

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