Thrombophlebitis is an inflammation of the inner lining of the walls of the veins, with the deposition of thrombotic masses on them, which can completely block the vessel or be placed near the wall. In our country, it is common to call thrombophlebitis the defeat of the superficial saphenous veins.
There is another concept – phlebothrombosis . This term is used when it comes to the lesion of the deep veins of the lower extremities. It is worth noting that in the international classification of diseases there is no second term.
There are 3 groups of factors that can influence the development of thrombophlebitis:
- Changes in blood properties (increased clotting).
- Damage to the vascular wall.
- Slowing blood flow.
The first group includes staging of venous catheters, various intravenous manipulations, operations, injuries and fractures, immobilization of the limbs or the whole body.
Increased clotting can be observed in a number of diseases such as thrombophilia , cancer, myocardial infarction, stroke, obesity, heart failure. As well as taking certain medications: oral contraceptives, hormone replacement therapy, chemotherapy.
Of great importance is also age (older than 40 years), smoking, dehydration of the body and, of course, the presence of transferred thrombosis.
As a rule, thrombophlebitis is a complication of varicose veins and develops in the varicose superficial veins of the legs.
Thrombophlebitis of the superficial veins begins with pain in the legs, which is not very strong. Sore skin along the saphenous veins. The skin over the thrombosed veins reddens, inflamed, becomes warmer than normal skin to the touch.
There is a slight increase in body temperature – up to 37.5 C, less often – up to 38 C. After some time (usually after 5-6 days), the temperature returns to normal or remains at the level of a small increase. Sometimes thrombophlebitis of the lower extremities occur without any increase in body temperature.
A concomitant sign of thrombophlebitis is a small swelling of the leg where a thrombus has formed. The skin along the veins is inflamed with stripes. Then begin to appear compacted skin of various sizes. Their size depends on the diameter of the thrombosed veins. These compacted areas are palpable and are in fact blood clots. However, not always compacted areas can show the boundary of the pathological process. Only instrumental diagnostic methods can reveal its true prevalence.
In addition to visual symptoms, the function of the lower limb also suffers. Walking is accompanied by pain.
Diagnosis of thrombophlebitis in most cases does not cause significant difficulties. Used instrumental research methods.
The most accurate diagnostic information provides ultrasound duplex angioscanning with color coding of blood flow. This study allows us to assess the condition of the walls and lumen of the veins, the presence of thrombotic masses in them, the nature of a blood clot, and even tentatively judge its “age”, i.e. degree of organization.
Ultrasound scanning of the saphenous veins makes it possible with absolute accuracy to reveal the true extent of thrombosis.
The role of laboratory diagnosis is small. Complete blood count reveals moderate signs of inflammation. Sometimes a blood test for d- dimer is prescribed in a medical institution . But it serves only to confirm the process of thrombosis in the body and does not show the localization of the process or its prevalence.
Most patients with thrombophlebitis can be treated conservatively on an outpatient basis.
Emergency hospitalization in surgical hospitals (preferably in specialized vascular or phlebological departments) is necessary for ascending forms of thrombophlebitis of the trunks of the great and small saphenous veins, when there is a threat of transition of thrombosis to deep veins. Such patients should be operated on an emergency basis after an ultrasound scan.
Surgical treatment includes saphenous vein ligation or removal of all varicose ( thrombosed and non- thrombosed) veins.
Conservative treatment of thrombophlebitis should be aimed at eliminating inflammatory and local thrombotic processes. The regimen that is prescribed to patients must be active.
A mistake should be the appointment of bed rest, since the activity of the muscular-venous pump of the lower leg provides intensive blood flow in the deep veins, preventing the development of thrombosis in them.
In the first days of thrombophlebitis, when inflammation is most pronounced and active local treatment is required, it is advisable to form a bandage in the first 7-10 days with the help of elastic bands of an average degree of elasticity. As inflammation subsides, medical knitwear can be successfully used for compression treatment – socks, stockings or tights 2-3 of compression class.
A simple but effective measure is local cooling, which gives a good anesthetic effect.
With thrombophlebitis, the use of various forms of several classes of pharmaceutical preparations is justified:
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- rutin derivatives;
- antiplatelet agents ;
- phlebotonics of plant origin
Nonsteroidal anti-inflammatory drugs in the treatment of thrombophlebitis
From the group of NSAIDs, diclofenac and ketoprofen are most effective for this disease. These drugs have not only powerful anti-inflammatory, but also a good analgesic effect.
Ketoprofen gel is applied 2-3 times a day in an amount of 3-5 g (1 cm of ointment squeezed out of a tube) directly onto the affected area of the extremity and lightly circular movements of the fingers are rubbed into the skin.
Rapid effect is given by intramuscular injections of NSAIDs, as well as their use in rectal suppositories. These methods of using these agents reduce the frequency and severity of complications.
Effective in treating thrombosis are derivatives of rutin ( Rutoside , troksevazin , troxerutin ) representing universal protectors venous wall and has a pronounced anti-inflammatory effect. The daily dose of various troxerutins is usually 1200 mg.
Heparin, as an anticoagulant, has a powerful anti-thrombotic and anti-inflammatory effect. It is mandatory in the treatment of thrombophlebitis. The dose of the drug is calculated in accordance with the mass and blood clotting analyzes.
Local therapeutic action is provided by the use of heparin-containing and NSAID gels. The dosage and frequency of their use are similar to each other. At the same time, the alternation of these drugs has proven itself well, i.e. gel applications are carried out 4 times a day according to the scheme: heparin – NSAIDs – heparin – NSAIDs.
When conducting conservative measures, it is necessary to remember about the possibility of progression of thrombophlebitis, despite the ongoing treatment. Therefore, in the course of therapy, dynamic control (clinical and ultrasonographic ) over the course of the disease should be carried out .
The basic principle of the prevention of thrombophlebitis is the timely and adequate treatment of chronic venous diseases. This includes primarily the surgical treatment of early (uncomplicated) stages of varicose veins.
If the patient has already suffered thrombophlebitis, then the doctor’s task is to prevent his relapse.
If the patient refuses to perform the operation or if it is impossible to perform it, he will undergo dispensary observation and systematically conduct courses of conservative treatment of venous insufficiency.
Patients should constantly use compression hosiery or bandages and 2-3 times a year to undergo treatment with phlebotonics , NSAIDs.
Diet has a certain importance: you should limit the consumption of animal fats, use vegetable oils more widely in your diet, eat more vegetables and berries rich in ascorbic acid and rutin .
Of great importance is the correct choice of profession, the organization of work and leisure. If the work involves a long sitting or standing, then periodically it is necessary to carry out a unloading pause: charging for the legs, taking a lying position with the legs slightly elevated. Lifestyle changes should include regular exercise: daily walking, swimming, water aerobics.