Edema in thrombosis
Pain syndrome with iliac-femoral thrombosisis inextricably linked with the increasing edema of the lower limb. In the beginning, the edema of the lower limb is very tight, so that when pressing the finger on the skin surface there is no depressions, this swelling softens as the subcutaneous tissue stretches with the transudate. The skin surface becomes tense and smooth at this time, and when you press your finger over the bone formations a long, non-divergent depression appears. Accordingly, edema increases the perimeter of the affected limb in comparison with the healthy one (when measured with a centimeter band at symmetrical sites).
The proximal is the venous occlusionwith ileo-femoral thrombosis, the more uniform the edema of the entire limb looks. If the thrombus formation begins in the distal sections of the venous trunk and gradually continues in the proximal direction, the edema differs asymmetrically and spreads from the foot and shin to the thigh.
With high venous occlusion, edema does not captureonly the entire lower limb, but sometimes the anterior abdominal wall, the external genital organs and the gluteal region, causing changes in the configuration of these parts of the body and the smoothness of the inguinal fold.
The rate of edema of the lower limb and itsthe severity depends on the rate of onset of thrombotic occlusion and the state of venous collaterals. The course of the pathological process is easier the more the venous outflow is compensated for the developed collateral, and the more severe the proximal the localization of phlebothrombosis and the more total the occlusion of the venous trunk with the involvement of the collateral vascular network.
Minor edema of the lower limb with easy flow the disease accumulates gradually, for 2 - 3days; a feeling of tension in the foot therefore does not arise, and an increase in the perimeter of the affected limb, relative to the intact limb, can remain within the measurement error or not exceed 3-4 cm.
At current medium gravity edema of the lower limb grows rapidly and at the endthe first day from the onset of the disease reaches the greatest value, extending not only to the entire limb, but also the gluteal region and the external genital organs and somewhat falling off with the elevated position of the foot. The difference in the perimeter of the affected and healthy limb at the level of the thigh and lower leg reaches 5-8 cm. A certain reduction in edema occurs no earlier than 3 days (as the venous collaterals form).
When heavy current phlebothrombosis edema of the lower limb becomesmaximum for several hours and does not subside with the elevated position of the limb. The difference in the perimeter between the intact and affected limb, where up to 2-3 liters of blood can accumulate with total blockage of venous outflow, sometimes exceeds 10 cm. The period of further edema can last up to 5-7 days, accompanied by severe hypo-volition and ending only after formation of a strengthened and expanded network of subcutaneous veins, respectively, the localization of thrombotic occlusion (in the inguinal or iliac region or in the upper third of the thigh).
Unlike gradually progressing andflowing without a pain syndrome of bilateral edema with congestive heart failure or mild, watery, mobile edema with kidney disease, edema of the extremity caused by acute orofemoral venous thrombosis is always one-sided and is accompanied by both painful phenomena and corresponding changes in the color of the skin.
Density, prevalence and dynamics of edema(along with the characteristic pain syndrome and cyanotic skin tone) also allows us to distinguish the venous occlusion from the painless lymphostasis caused by the inflammatory or oncological process, with prolonged preservation of which lymphatic dermatitis occurs with peeling, hyperpigmentation and skin lichenification.
Evdokimov A.G. Topoliansky V.D.