Swelling of the thrombus
What is this disease and why does it occur?
Thrombosis of veins - a disease in which in the lumenvein formed clot (clot of blood), clogging the vessel and interfering with normal blood flow. Over time, the length of the thrombus increases, and it completely covers a certain area of the venous vessel.
What is the cause of deep vein thrombosis?
In the human body for "fluid" bloodTwo systems correspond: coagulating and anticoagulant. Thanks to the coagulation system, bleeding stops when the vessel is injured, and the anticoagulant system provides the opposite effect - maintenance of the liquid state of blood in the lumen of the vessel. A thrombus (blood clot in a vessel) appears when the balance between these systems is violated towards the predominance of clotting processes. Thrombosis can be caused by such causes as thickening of blood, damage to the vessel wall, slowing of blood flow. Allocate the following risk factors that trigger the onset of deep vein thrombosis:
- Elderly age;
- Injuries, surgeries;
- Varicose disease or previous thrombosis;
- Long period of motor activity restriction;
- Uncontrolled intake of hormonal drugs;
- The presence of blood diseases leading to its thickening;
- Postponed viral infections;
- External compression of vessels.
Influenced by one or moreThe above causes a parietal clot, which consists of stuck together formed blood elements. As a result, a mechanism is triggered, resulting in a complete overlap of the lumen of the vessel and an increase in the length of the thrombus.
How does vein thrombosis manifest and how dangerous is it?
In a healthy body, blood moves from the lowerlimbs to the heart, then flows into the lungs, saturating them with oxygen, and then again comes to the peripheral organs. If the lumen of the main vein is blocked, this will greatly complicate the process of blood flow from the legs. Therefore, the main symptom of venous thrombosis is leg edema. Depending on the location of the thrombus, there may be swelling of the ankle, lower leg or thigh, it is possible swelling of the entire leg (completely). In the acute period, the symptoms of the disease are also painful sensations (mainly in the calf muscles), a feeling of bursting and heaviness in the lower extremity. The feeling of bursting and pain intensifies when the foot is lowered and decreases when it is raised. In some cases, the subcutaneous venous pattern is clearly visible against the background of the edema.
Severe forms of venous thrombosis, in whichblood clots in veins block both superficial and deep venous lines, as well as the largest collateral branches, cause a condition called phlegmasia. A sign of it is swelling of the entire leg, accompanied by a violation of microcirculation of tissues. In the absence of proper treatment, a violation of blood supply to the tissues of the leg can lead to gangrene. Venous gangrene, the most serious complication of vein thrombosis, requires urgent amputation of the leg.
Sometimes, deep vein thrombosis of the lower limbsit is asymptomatic, without pain and swelling. This occurs if the thrombus blocks the vein only partially and does not cause a sudden obstruction of the outflow. But such thrombi on the legs are quite dangerous - they can come off and get into the lungs. This threatens a serious complication called pulmonary embolism (PE).
This condition arises from the separation andmigration of the thrombus or its parts from the thrombosed veins of the legs into the pulmonary artery, resulting in its occlusion. Circulation of blood through the pulmonary artery is disrupted, a person develops acute cardiac and respiratory failure.
Degree of severity of pulmonary embolismdepends on the number and size of the moved pieces of thrombus - emboli. Small parts of the thrombus overlap small branches of the pulmonary artery, which causes a violation of blood circulation in the lung tissue and leads to a lung infarction. The main signs of this condition: attacks of dyspnea, cough, general weakness, in some cases, chest pain and hemoptysis. Embolism of a large fragment of a blood clot can result in death.
Pain and swelling of the leg, which are the main symptomsvenous thrombosis, may be signs and a host of other diseases (lymphostasis, renal and heart failure, arthritis, myositis, arthrosis, etc.), therefore, a vascular surgeon's consultation is mandatory. It should be understood that during the examination the specialist can only assume that the patient has vein thrombosis. But confirmation (or refutation) of the diagnosis, as well as the determination of the probability of separation of thrombus, can only be obtained after duplex scanning (vascular ultrasound studies).
How common is this disease?
Every year, a diagnosis of "deep vein thrombosis of the lowerlimbs, "put on average 160 out of 100 000 people. It is equally common in both women and men. In 2008, 50 000 cases of pulmonary embolism were recorded in Ukraine, 10 000 of them were fatal. After 8-15 years after the disease, 50-80% of patients develop disability as a result of the progression of severe forms of venous insufficiency.
Diagnosis of deep vein thrombosis
The main method used for diagnosisvenous thrombosis, is ultrasound duplex scanning of veins. This procedure is highly informative, it is completely safe and painless, so it can be repeated many times without harm to the patient.
Duplex scanning enablesto determine the presence and nature of thrombus, the localization of thrombosis, the presence of a floating thrombus tip, to determine the extent of the vessel's damage, and also helps the surgeon obtain other important information for determining the tactics of treatment.
Without duplex scanning, treatmentvenous thrombosis will be carried out "blindly", therefore can be ineffective and fraught with complications. Duplex scanning is also necessary to monitor the treatment and follow up of the patient during the post-illness period.
Deep vein thrombosis treatment
When the diagnosis of "deep vein thrombosis" is appliedconservative or surgical treatment. Given the nature of the course of this disease, the risk of serious complications and the severe consequences of thrombosis, the choice of a treatment technique should always be performed by a vascular surgeon.
Conservative method implies appointmentpatient blood thinners. These drugs can not destroy the already existing thrombi in the veins, but can prevent them from increasing. Also, anti-inflammatory drugs and drugs that improve the fluid properties of blood are used. In each case, the doctor individually selects a dose of medication and determines the duration of the medication.
The procedure for dissolving thrombus is calledthrombolysis. It consists in the introduction of a special agent into the lumen of the vein, which dissolves the thrombus-thrombolytic. For this procedure, there are contraindications, so it should only be carried out in a hospital, under the supervision of an experienced vascular surgeon, who closely follows the indicators of blood coagulation of the patient. The degree of effectiveness of this procedure depends on how timely the treatment was prescribed.
If there is evidence,surgical intervention - thrombi is removed from the lumen of the vein. Taking into account the peculiarities of the structure of deep veins, the removal of thrombi is possible only in individual cases.
If a patient has a floating thrombus, urgent intervention by an experienced vascular surgeon is necessary to prevent pulmonary embolism.
With venous thrombosis, for prophylaxisthromboembolism of the pulmonary artery, strictly according to indications, put a special metal filter inside the inferior vena cava. The lower hollow vein is the main vessel through which blood flows in the direction from the legs, pelvic organs, the abdominal cavity to the lungs and the heart. The purpose of the filter is to protect the pulmonary artery from ingress of emboli into it in case of a thrombus rupture.
Treatment of veins on the legs also includeselastic compression, the purpose of which is to reduce the swelling of the legs and improve the outflow of blood. This procedure is carried out by elastic bandaging of the foot or with the help of compression knitwear. The choice of compression therapy in each case is determined by a vascular surgeon.
Variants of the outcome of venous thrombosis can besuch as: resorption of the thrombus completely, fragmentary opening of the vein lumen and obliteration of the vein - in this case, the lumen overgrown with a connective tissue and disappears completely. The period of resorption of the thrombus in the veins of each patient, and depends on the extent of thrombosis, the diameter of the vessel and the individual characteristics of the body.
To facilitate the movement of blood from the lowerlimbs to the heart, in the veins on the legs there are valves that, like the door leaves, flow the blood upwards, after which they close, preventing it from coming back down. In most cases, in the process of resolution, the blood clot damages or completely destroys the valves located in the deep vein, which causes the person to develop blood stasis in the legs or venous insufficiency.
Signs of chronic venous insufficiencyare: sensations of gravity, pulling pains, swelling of the legs, which intensify towards evening or after physical activity. Over time, swelling becomes permanent, and heaviness in the lower limbs remains even after a night's sleep. Often, inflammation, dermatitis and eczema appear on the skin. Then, in places of altered skin (below or in the middle of the shin) a trophic ulcer occurs. It appears as a result of a long irregular outflow of blood from the skin and soft tissues of the limb, which causes the nutrition of these tissues to be disturbed, the skin becomes thinner and very easily injured. As a result ulcers are formed, which then heal, then open again, they cease to heal completely and form large ulcers in the area. Through these ulcers, an infection enters the human body, causing general intoxication and undermining immunity.
In addition, as a result of occlusion of the lumendeep vein thrombus increases the load on the superficial veins, which take on the function of the outflow of blood from the legs. This excessive load can lead to secondary varicose veins, which will accelerate the development of chronic venous insufficiency.
All of the above signs of chronicVenous insufficiency, which occur after a long time after a venous thrombosis, is called one common term - postthrombophlebitic syndrome (PTFS).
To prevent disability due tothe occurrence of trophic ulcers, patients with PTFs should be observed in the vascular surgeon and regularly undergo examination of deep and superficial veins with the aid of duplex scanning. The vascular surgeon will schedule your visits to a specialist, during which you will be introduced with information about the duration and dose of medication, regimens of compression therapy and motor loads, which are individual for each patient. With regular monitoring of the patient, the doctor will be able to notice the harbingers of trophic ulceration in time and help prevent its formation.
To prevent the occurrence of thisdisease, should not allow a prolonged immobile position of the legs: it is not recommended to sit in the same position for a long time during long trips and flights (the leg-to-foot pose is especially dangerous); Avoid also squeezing the legs with tight clothing, the edge of the seat, etc.
In hot weather (in the summer, in a sauna or a bath), be sure to drink plenty of fluids - this will prevent blood clotting.
People at risk - bedridden patients, patients after surgery and trauma, cancer patients - need special procedures for prevention of venous thrombosis.
The risk group also includes patients with varicose veinsthe expansion of superficial veins on the legs. Timely surgery to remove varicose veins significantly reduces the possibility of developing deep vein thrombosis.
When the first symptoms of the disease manifest themselves (sharppain in the leg muscles, swelling) urgently seek help from a vascular surgeon, since with this disease, the success of treatment is directly related to the time factor. The earlier the course of treatment is started, the more likely the patient will be to recover.