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Thrombophlebitis of the upper limbs

 
, medical expert
Last reviewed: 17.10.2021
 
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Inflammation of the venous wall, which is characterized by the formation of a thrombus is called thrombophlebitis. He can develop on both the upper and lower limbs. The disease affects the superficial or deep veins at any site. To develop thrombophlebitis of the upper limbs can at any site.

ICD-10 code

Thrombophlebitis is a disease of the circulatory system. It is classified according to the code μb 10 as I00-I99. I00-I02 Acute rheumatic fever. I05-I09 Chronic rheumatic heart diseases. I10-I15 Diseases characterized by high blood pressure. I20-I25 Ischemic heart disease. I26-I28 Pulmonary heart and pulmonary circulation disorders. I30-I52 Other heart diseases. I60-I69 Cerebrovascular diseases. I70-I79 Diseases of arteries, arterioles and capillaries. I80-I89 Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified. I95-I99 Other and unspecified diseases of the circulatory system.

I80-I89 Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified. I80 Phlebitis and thrombophlebitis. This category includes thrombosis of deep veins of the lower extremities, as well as thrombophlebitis of the surface. I81 portal vein thrombosis. This includes a portal vein thrombosis. I82 Embolism and thrombosis of other veins. I83 Varicose veins of lower extremities. This includes varicose veins. I84 Hemorrhoids. I85 Varicose veins of the esophagus. I86 Varicose veins of other sites. I87 Other disorders of veins. I88 Nonspecific lymphadenitis. I89 Other non-infectious diseases of lymphatic vessels and lymph nodes.

I82 Embolism and thrombosis of other veins. I82.0 Badd-Chiari Syndrome.

I82.1 Migrating thrombophlebitis. I82.2 Embolism and thrombosis of the vena cava.

I82.3 Embolism and thrombosis of the renal vein. I82.8 Embolism and thrombosis of other specified veins. I82.9 Embolism and thrombosis of unspecified vein.

Causes of thrombophlebitis of the upper extremities

In order to form a thrombus, it is necessary to have several factors at once. Classical medicine knows three main reasons for which there is thrombophlebitis of the upper extremities. The first factor is a sharp increase in the clotting activity of the blood. This condition can be called: pregnancy, childbirth, the presence of diabetes and genetic predisposition.

The second factor is trauma on the inner walls of the vessels. So, it can be susceptible to traumatization due to injections incompetent in this matter by people. Chemotherapy and radiation treatment can cause trauma.

The third and last factor is slow blood circulation. It arises against the backdrop of the development of pathological processes, such as varicose veins, limb immobility, as well as excess body weight.

Thrombophlebitis can develop against the background of one or all of the factors at once. For example, with fracture of bones, not only extensive hemorrhage occurs, but also the level of coagulation increases. As a result, the development of the inflammatory process in the veins can occur.

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Pathogenesis

Most often thrombophlebitis develops on the background of mechanical damage. It can cause injuries, childbirth, surgical and gynecological operations. The basis of pathogenesis is the so-called Virchova triad. It includes the endothelium of the vein wall, a slow process of blood flow and an increase in the clotting activity of the blood.

An important role is played by the endothelium of the vessels. This process is accompanied by the defeat of the limbs, as well as the isolation of interleukins. They, in turn, activate platelets and a coagulation cascade. The surface of the endothelium begins to acquire thrombogenicity. These factors lead to the development of a blood clot. To lead to the formation of a clot can also tissue thromboplastins. In excess, they enter the bloodstream from damaged tissues.

Simultaneously with these processes, compensatory mechanisms can also occur. These include: spontaneous, partial or complete thrombolysis and the development of collateral circulation.

Symptoms of thrombophlebitis of the upper extremities

Often the inflammatory process is formed against the background of varicose veins. Inflammatory process of nearby tissues can lead to blockage of blood vessels. In this regard, the symptoms of thrombophlebitis, which seizes the upper limbs, begin to manifest themselves.

As a rule, everything begins with pain, it can be both moderate and acute. There is redness, in the place of redness the vein is well probed. It becomes rough and heavy. Simultaneously with these processes, the temperature of the body can also manifest itself. If this is a superficial thrombophlebitis, it is not worth worrying about, there is no danger for a person. Closure of thrombus is impossible, so there is no threat to life. It is important to properly organize therapy and not to delay the process of deep veins.

The disease is characterized by the presence of enlarged lymph nodes, red bands, painful palpation and the appearance of body temperature up to 38 degrees. Often there are sharp pains in the direction of the affected vein. It is recommended to begin treatment on time, this will prevent the development of complications.

First signs

Thrombophlebitis of the upper limbs can develop on the background of an unsuccessful injection and even after an insect bite. The affected vein is strongly translucent and has a crimson hue. This indicates its inflammation. To the touch it is painful and dense, because there is formed the so-called weight. So, the first signs begin to manifest themselves immediately. Sometimes the process has a fast and unexpected flow. Acute pain manifests itself at lightning speed.

Body temperature starts to increase gradually, but in some cases this symptom is absent. To notice an inflamed vein is quite simple, it immediately starts to bother a person. Over time, the limb may swell due to impaired blood circulation. If you do not pay attention to this, there is limited movement. If the vein becomes painful, its redness should be addressed to the hospital. If deep veins are affected, there is a risk of serious complications.

trusted-source[7], [8], [9], [10], [11]

Thrombophlebitis of superficial veins of the upper extremities

The most typical signs of this disease are general inflammatory reactions, the presence of pain and swelling. Often thrombophlebitis of superficial veins promotes the development of lymphadenitis on the upper limbs. All is accompanied by severe hyperemia and the presence of infiltrates along the thrombosed veins. The patient is pestered by fever, in some cases the figure is 39 degrees.

The limb does not change in size, but it swells a little. The movements in the joints are loose, but can be painful. The thing is that there are zones of inflammation. In the place of formation of a thrombus, you can feel a painful infiltrate, which has clear boundaries. The lymphatic system does not participate in the inflammatory process, but only at the initial stage. When the thrombosed vein begins to catch up, lymphadenitis is observed.

Sometimes the symptomatology can manifest itself abruptly. This indicates the presence of an acute form of the disease. The person feels a strong pain. Within a few days there is relief, but the pain is still retained when feeling.

If symptoms appear, you need to seek help from a doctor. Qualitative differential diagnosis will make it possible to correctly diagnose. This, in turn, will affect the effectiveness of the prescribed treatment.

Deep vein thrombophlebitis of upper extremities

Defeat of deep veins usually occurs after intravenous administration of drugs that can lead to the development of irritation. Often, the cause of deep vein thrombophlebitis affecting the upper limbs becomes an insect bite or a local injury. In the course of the vein, infiltration and flushing are observed. This process is visually similar to the crimson band, which is located at the site of the inflammatory process. Here there is painful palpation and the presence of dense nodules. There is a so-called chest, represented by a seal on the affected area.

If the lesion has engulfed the cubital veins or vessels on the wrist, the mobility of the joints is disrupted due to the presence of severe pain. In addition, the process is accompanied by an increase in temperature. If adequate therapy is prescribed, thrombophlebitis will begin to recede after 12 days. During treatment, the inflammatory phenomena gradually subside and the vein recovers.

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Effects

If the treatment was selected correctly, then a positive result can be observed in a few days. Moreover, the inflammatory process gradually ceases and the vein begins to recover. All this is possible with timely treatment in the hospital and the appointment of quality therapy. In this case, the consequences can not develop, because everything is seized. But not everything is so easy. Sometimes people do not pay attention to serious symptoms and do not start treatment. This is fraught with not only the formation of a thrombus, but also its tearing off.

To exclude possible complications, it is necessary to observe a phlebologist within a year after successful treatment. It is necessary to monitor the state of the venous system and the most affected limb. If a surgical operation was performed, a surgeon will have to visit.

Correctly selected treatment will make it possible to achieve maximum penetration of the vein, which will lead to an improvement in venous outflow. Despite this, the risk of post-thrombotic disease still persists. She can show herself after two or three years. In this case, a comprehensive study of veins. If there is an urgent need, perform a surgical operation.

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Complications

The danger of the disease lies in the location of the inflammatory process and the thrombus itself. Superficial veins suffer much more often, because thrombophlebitis is a complication of varicose veins. This process does not represent a serious danger to human health. All is eliminated by medication and with the help of compression therapy.

Thrombophlebitis is more dangerous, as a result of which a fatal outcome can occur. This probability persists in the defeat of deep veins. There are a number of other serious complications. There is a risk of developing venous gangrene, it is formed due to the cessation of blood flow to the limb. Such a state threatens complete amputation. Thrombophlebitis can lead to pulmonary embolism. This condition is characterized by the separation of the thrombus from the vessel wall and its movement into the pulmonary artery. Immediate surgical intervention is necessary here. Timely detection of venous diseases will avoid all possible complications, including thrombophlebitis.

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Diagnosis of thrombophlebitis of the upper limbs

Diagnostic measures are simple, thanks to them to determine the presence of the disease can be without much difficulty. Instrumental methods of diagnosis of thrombophlebitis of the upper extremities are widely used. These include rheovasography or ultrasound dopplerography. Get accurate information can be due to ultrasonic duplex angioscanning. For this, the process is characterized by the color coding of the blood flow.

Due to angioscanization, the condition of the walls and lumen of the veins can be assessed. Determine the presence of thrombotic masses in them, as well as the nature of the formed thrombus. In some cases, it is possible to roughly judge the "age" of the thrombus and the degree of its organization. Ultrasonic scanning of the subcutaneous veins allows to reveal the extent of the thrombus.

Laboratory diagnostics does not play a special role. After all, it allows to detect the presence of an inflammatory process, but does not fix in which organ or system it originated.

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Analyzes

Laboratory diagnosis is not as important as instrumental research. Previously, there were suggestions that changes in homeostasis could indicate the presence of a thrombogenesis process, its stifling or activity. But, coagulation tests have not proved their worth. These analyzes do not provide complete information on the likelihood of thrombosis and its active development.

Earlier it was thought that an increase in the thrombosed index indicates the formation of a blood clot in a vein. This approach can not provide accurate information, and therefore had to stay in the past. To date, there are sensitive markers of thrombosis. But even their use does not allow to determine the level of thrombophlebitis, and also to assess the likelihood of pulmonary embolism.

Clinical analyzes show only superficial signs of the inflammatory process. An increase in the level of leukocytes, an increase in the rate of ESR, as well as a positive reaction to C-reactive protein. But they do not indicate where the inflammatory process is developing. Therefore, to diagnose thrombophlebitis, they do not play a special role.

trusted-source[37], [38], [39], [40], [41], [42]

Instrumental diagnostics

To diagnose the inflammatory process, many methods are used. One of these is ultrasonic angiography of the extremities. This method of instrumental diagnosis is based on the ability of tissues to absorb and reflect ultrasonic waves. For the survey, thus, it is necessary to make a color mapping of blood flow. The main drawback of the technique is the strong dependence on the technical characteristics of the instruments, as well as the qualifications of the person conducting the study.

  • Ultrasonic dopplerography. This method will determine the direction and speed of blood flow in different parts of the vessel. This method is perfectly suited for obtaining the general state of functioning of the circulatory system. But, he does not provide data on the structure and anatomy of the veins.
  • Phleboscintigraphy. To conduct the study in a vein, you must enter a special drug, which contains a radioactive isotope with a short half-life. Then the contrast agent is distributed through the system, using a special device.
  • Phlebography. This method assesses the condition of veins with the help of a special contrast agent, which is based on iodine. Finally, magnetic resonance imaging. It is one of the modern methods of research, but also the most expensive. Thanks to this technique, you can get the most accurate results. A procedure is prescribed in the event that all previous methods did not provide complete information about the condition of a person.

Differential diagnostics

In addition to instrumental research, laboratory analyzes are also carried out. True, they do not bear special significance. So, differential diagnosis is the delivery of blood tests. This concept is characteristic only of thrombophlebitis. In general, this method of research includes a lot of other analyzes.

In the blood, an increased number of leukocytes can be detected, which indicates the presence of an inflammatory process. Indicate this may change the index of ESR, as well as increased activity of blood coagulability. An important role is played by sensitive markers of fermentation. These include: thrombin-antithrombin complex, fibrinopeptide A, soluble fibrin-monomer complexes, D-dimer level in plasma. True, their use will not allow to determine the level of thrombosis, as well as the likelihood of pulmonary embolism. Therefore, it would be most expedient to carry out not only differential methods of research, but also instrumental ones. Based on the obtained data, they are compared and the diagnosis is made.

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Treatment of thrombophlebitis of the upper extremities

Conservative treatment with thrombophlebitis is possible, but only if the area is small. With the defeat of deep veins resort to surgical intervention. The drug treatment of thrombophlebitis of the upper extremities is aimed at preventing possible complications, as well as preventing the development of a thrombus.

To eliminate the inflammatory processes resort to the help of drugs such as Ibuprofen, Diclofenac and Aspirin. They are able to eliminate not only the inflammatory process, but also reduce puffiness and reduce pain. Widely used and direct anticoagulants, which can improve blood flow to the blood, including Heparin, Enoxaparin and Fraksiparin. Assign them if there is a risk of thrombophlebitis spreading to deep veins. Thrombolytic agents such as Streptokinase and Alteplase can also resort to help. Locally used Heparin ointment, gel Ketoprofen and Troxevasin.

A man must be kept bed rest. Affected limbs should be on the elevation, this will allow normalizing the outflow of blood and reduce the risk of thromboembolism. The entire course of treatment should be under the guidance of a specialist.

Medications

Drug therapy is effective in cases where the superficial veins are affected. It is aimed at reducing edema, pain and restoring blood flow. To eliminate the inflammatory process and reduce pain, anti-inflammatory medications such as Ibuprofen, Diclofenac and Aspirin are taken. To improve blood flow appoint Heparin, Enoxaparin and Fraksiparin. Widely used and thrombolytics, such as Enoxaparin and Fraksiparin. Place using ointments and gels: Heparin ointment, Ketoprofen gel and Troxevasin.

  • Ibuprofen. The drug is used one tablet 2-3 times a day. Depending on the patient's condition, the dose can be adjusted. Take the drug is not suitable for patients with increased sensitivity, as well as a pronounced impairment of the functionality of the liver and kidneys. During the bearing of the child and during the period of breastfeeding, the reception is prohibited, but it can be agreed with the attending physician. It can cause nausea, vomiting, diarrhea and allergic reactions.
  • Diclofenac. The drug is applied on a single tablet up to 4 times a day. Its active ingredient is diclofenac, so it can not be used by people with increased sensitivity to it. The risk group includes pregnant girls, children and people with impaired functionality of the liver and kidneys. The agent can cause the development of allergic reactions from the body.
  • Aspirin. The drug is used for one capsule, no more than 3 times a day. The exact dose is prescribed by the attending physician. Use the product not for children, pregnant girls, people with hypersensitivity, as well as those with severe hepatic and renal insufficiency. May lead to the development of allergic reactions from the body.
  • Heparin. The dose and the way of application is assigned by the doctor individually. The drug should not be used with increased bleeding, bleeding of any site, acute heart aneurysm, liver and kidney failure. May cause allergic reactions from the body.
  • Enoxaparin. The drug is administered solely in the prone position, only subcutaneously in the anterolateral or posterolateral region. The average dosage is 20 mg per day, it can be adjusted by the attending physician. Take the drug is not suitable for people with severe hepatic and renal insufficiency, as well as in the presence of hypersensitivity. Is able to cause hemorrhagic manifestations.
  • Frakssiparin. The dose is prescribed exclusively on an individual basis. Use the product is not possible for peptic ulcer of the stomach and duodenum, as well as acute infective endocarditis. It can lead to the appearance of small hematomas and an increase in the level of liver enzymes.
  • Heparin ointment. Apply the product a thin layer on the affected area. You can use it up to 4 times a day, depending on the complexity of the situation. Applying the ointment is not necessary for open wounds and when the integrity of the skin is compromised. Can lead to local allergic reactions, such as itching, burning, redness and swelling.
  • Ketoprofen. The gel is applied in a thin layer to the lesion site, 3-4 times a day. Use it is not possible for people with increased sensitivity of the skin. May lead to the development of allergic reactions.
  • Troxevasin. The gel is applied in a thin layer, with light, massaging movements 3 times a day. It can not be used if the integrity of the skin is disturbed. May lead to the development of an allergic reaction, causing itching, burning and redness.

Alternative treatment

Alternative medicine is rich in its effective recipes. In some cases, resort to alternative treatment is not necessary. After all, if you want to eliminate thrombophlebitis, without special knowledge, you can cause serious harm to the body.

  • Recipe number 1. It should take 15 grams of verbena leaf medicinal and pour them a glass of boiling water. After that give a little infusion and take a tablespoon. Effectively helps with blockage of veins.
  • Recipe number 2. In order to remove inflammation and eliminate puffiness, limbs can be applied fresh lilac leaves.
  • Recipe number 3. It is necessary to take 20 grams of St. John's wort, stripes and licorice root. For efficiency, add 15 grams of plantain and coriander leaf, dilute all with 10 grams of cucumber. All ingredients are mixed together. Take only 2 tablespoons and pour them with boiling water. The product is heated in a water bath for 15 minutes. After that, it is cooled, filtered and brought to a volume of 200 ml. Take it 30 minutes before meals.

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Herbal Treatment

In alternative medicine, there are a lot of effective recipes, with the use of herbs. They help not only cope with the main symptoms of the disease, but also significantly improve the patient's condition. In general, herbal therapy has a positive effect, but only if all prescriptions are approved by a doctor.

Fine wormwood has silvery properties. It is necessary to take fresh leaves of wormwood and carefully grind them in a mortar. Then take a tablespoon of the powder obtained and combine it with sour milk. After that, everything is thoroughly mixed and applied to gauze. The resulting compress should be applied to the affected veins. Duration of treatment is 3-4 days.

Not bad helps to cope with symptoms of thrombophlebitis common hops. It is necessary to take one tablespoon of hop cones and finely chop them. Then pour a glass of boiling water and heat in a water bath for 15 minutes. The received product is taken by a glass 3 times a day before meals.

Pay attention to the horse chestnut. You need to take 50 grams of the main ingredient and pour it with 500 ml of vodka. Then it should be sent to a warm place for 2 weeks. After the expiration of the preset period, the agent is applied for 30-40 drops throughout the month.

Homeopathy

Homeopathic remedies have always been very popular. This is due to its natural composition, in which there are no substances harmful to the body. But, due to the fact that the drugs have not been clinically tested, their use can harm a person. Therefore, homeopathy is used in case the doctor himself appointed such a method of treatment.

To eliminate the varicose process and thrombophlebitis, the drug Job-Venum is widely used. The product must be taken for several months. Primary action can be seen at the 3 week of admission. In some cases, the drug may cause increased symptoms or worsening of the patient's condition. They are afraid of this, it is not necessary, this process indicates that the healing processes in the body are beginning to actively proceed. If there is a negative symptomatology, it is necessary to give up the drug for a week, then continue taking it. It is enough 8-10 drops 2 times a day, for 5-6 days. The dose and schedule of application is prescribed by the doctor. With other drugs can be found at a reception with an experienced homeopathic doctor.

Operative treatment

Patients who are experiencing ascending thrombophlebitis or a disease with deep veins need surgical intervention. The supervising physician should make the decision about operative treatment. Endure such verdict after carrying out ultrasonic scanning.

Depending on the severity of the disease, as well as its features, the doctor must decide whether to surgically or minimally invasively remove the thrombus. Surgical methods allow to sclerize or completely remove the affected veins during the progression of the disease. A minimally invasive method can be combined with conservative treatment. It helps to eliminate the formed thrombus. This technique is less traumatic and practically does not cause any complications. Therefore, resort to this method of removal of the affected vein is completely safe. This procedure is used even during pregnancy.

Prevention

Preventive measures are determined in a timely manner by the treatment started. Patients with varicose veins should immediately undergo surgical treatment. The main task of prevention during the prevention of separation of the thrombus and its migration is the setting up of a special trap. It must be installed in a vein. There, it seems to open up and only flows through the blood, and large blood clots remain in it. The method is effective, but has a lot of drawbacks.

Remove thrombus without consequences will allow thrombectomy. True, this method requires high surgical skills. The procedure allows you to remove a thrombus directly from the vein. In addition, it improves the long-term results of treatment of deep venous thrombosis. The effectiveness of the technique lies in the fact that after its application the development of postthrombotic disease is not observed. Timely treatment will really help to cope with the problem. Moreover, the timely elimination of varicose veins is the main preventive measure, which will not allow the development of thrombophlebitis.

Forecast

Thrombophlebitis is a most dangerous disease. However, despite this, it is perfectly amenable to therapy. If the treatment was started on time, then the prognosis will be positive.

After performing a surgical intervention or conservative therapy, the blood flow is normalized. But, despite this, patients still need to use compression knitwear and take medications, which will appoint a supervising doctor. This will avoid possible complications.

Treatment, which was not started on time, can lead to the development of ulcers, gangrene, and thrombosis of large veins. In this case, the forecast becomes unfavorable. After eliminating complications, a person may well return to work, naturally, if he has not removed the limb due to the development of gangrene. The quality of life of patients is significantly reduced. The prognosis depends entirely on the form of the disease, as well as on the affected veins.

trusted-source[59], [60], [61], [62], [63]

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