Thrombophlebitis of the superficial veins: causes, clinical picture, methods of diagnosis and treatment, complications. Why is thrombosis of the superficial veins of the lower extremities dangerous?

Thrombophlebitis of the superficial veins of the lower extremities is a disease characterized by the development of an inflammatory process in the superficial venous trunks of the legs and the formation of blood clots in this place. Inflammation and thrombus formation are closely related and form a vicious circle of disease. Professions related to long stay on your feet, prolonged bed rest, illness hematopoietic organs and blood, varicose dilatation of the superficial veins of the legs, pregnancy are risk factors for the development of thrombophlebitis lesions venous vessels lower extremities.

Thrombophlebitis of the superficial vessels of the legs significantly reduces the patient’s quality of life and causes a lot of problems and inconveniences. In addition to the expressed cosmetic defect, there is pain in the legs, a feeling of heaviness and a symptom of fullness. All this requires immediate initiation of treatment for the disease. On initial stages For the development of lesions in the superficial veins of the legs, drug treatment is predominantly prescribed. A long-term disease rarely resolves without surgical intervention.

Clinically, thrombophlebitic damage to the superficial vessels of the lower extremities is a disease of the great saphenous vein. The small saphenous vein is included in the process much less frequently. Usually the disease develops against the background of varicose dilated venous trunks.

You can understand whether thrombophlebitis has begun or whether it is varicose dilatation by the following signs: with varicose veins, the skin is not red, the temperature of the body and skin over the nodes is normal, there is no pain. In a lying position, the blood filling the varicose nodules will go into deeper veins and the nodules themselves will become smaller.

Acute superficial thrombophlebitis is characterized by pain in the lower extremities, swelling, redness and the appearance of dense and painful venous trunks under the skin. During the chronic course, periods of remission and health alternate with periods of an acute process, which is characterized by all of the above symptoms. Due to long-term superficial thrombophlebitis, trophic skin ulcers often develop, and the color of the skin over the affected veins changes. During the period of remission, external signs of the disease may not be detected.

Thrombophlebitis of the superficial veins is rarely accompanied by any complications. The inflammatory reaction is more pronounced in superficial vessels than in deep ones, which ensures the adhesion of the thrombotic mass to the venous wall. This process is why the likelihood of a blood clot breaking off in a superficial vein is lower, although it still exists. Inflammation from superficial vessels is often accompanied by the spread of the process to nearby subcutaneous fat or arteries.

Conservative therapy of thrombophlebitis

Considering all the clinical manifestations of thrombophlebitis of the superficial veins of the legs, the risk possible complications and development accompanying pathologies it becomes clear that treatment must begin with the earliest signs of the disease. Treatment is usually prescribed by a phlebologist or therapist. Therapeutic measures are aimed at reducing blood viscosity, stopping the ascending spread of thrombophlebitic lesions, as well as the transition of inflammation and thrombosis from superficial venous vessels to deep veins or in the artery, relieving the inflammatory reaction, preventing repeated episodes of the disease and its complications.

Treatment of thrombophlebitis can be general and local. If superficial venous vessels are affected, treatment can be carried out at home. The exception is a condition threatening pulmonary embolism.

The acute course of superficial thrombophlebitis requires strict bed rest to reduce the risk of blockage of the pulmonary artery. Optimal to improve outflow venous blood, there will be a pose with an elevated position of the lower limbs. Plenty of fluid intake is indicated, up to three liters per day, but only if there are no contraindications (kidney disease, heart disease). In case of chronic thrombophlebitic process, heat compresses can be used. They improve peripheral blood circulation. At acute defeat veins, heat compresses are contraindicated. To reduce pain during an acute process, a blockade with novocaine according to Vishnevsky and cold compresses are used (only if there is pulsation of the arteries of the foot).

Therapeutic treatment has been successfully used for superficial thrombophlebitis with occlusive thrombi. Therapy consists of the following activities:

• Elastic compression.
• Drug treatment.
• Physiotherapy.
• Hirudotherapy.

Elastic compression for thrombophlebitis involves the use of special compression garments and bandaging with elastic bandages. This technique reduces the symptoms of edema and pain by eliminating their cause - weak venous function.

Drug therapy can be general and local. The following are used:

• strengthening the venous wall;
• antiplatelet agents and anticoagulants;
• improving microcirculation;
• dissolving thrombotic masses;
• non-steroidal anti-inflammatory drugs;
• antibiotics.

Antibacterial therapy is used for septic thrombophlebitis (caused by any viral or bacterial pathogen). Damage to the superficial veins is usually infectious. Also antibacterial treatment requires such a complication as trophic leg ulcers. Antibiotics are not prescribed for prophylactic purposes, as some of them can provoke increased blood clotting and the formation of blood clots.

The following groups of antibacterial drugs are used:

• penicillins;
• tetracyclines;
• doxycycline;
• amoxicillin.

Antibacterial agents are administered either intravenously or into the subcutaneous fat, which is located next to the source of inflammation. Antibiotic therapy requires avoiding alcohol consumption, maintaining an adequate level of physical activity, and using compression garments.

Anticoagulant therapy helps reduce blood viscosity, thins it, reduces the deposition of thrombotic masses and prevents thrombosis. It is mandatory to prescribe anticoagulants for ascending lesions of the superficial veins of the lower extremities and postthrombophlebitic syndrome. The most common anticoagulants are low molecular weight heparins. The reasons for this: dosages are easy to select, there is no need for coagulation tests, and it is approved for use in pregnant women. At mild damage For superficial veins of the lower extremities, local anticoagulation therapy is sufficient. To dissolve thrombotic masses and relieve symptoms of vascular blockage in such cases, heparin ointment is used. In addition to reducing blood clotting, the ointment reduces inflammation and reduces the amount of swelling.

Nonsteroidal anti-inflammatory drugs relieve swelling and pain. Nonsteroidal drugs V short time remove inflammatory phenomena. If the process is acute, then they are prescribed in the form intramuscular injections, and then transfer the patient to tablet forms. The most commonly used drugs from this group are diclofenac, ibuprofen, meloxicam (it can be used for ulcerative lesions intestines, stomach and asthmatic disease). To enhance the effect of general non-steroidal anti-inflammatory therapy, drugs are used local action(ointments, gels).

Angioprotectors, together with non-steroidal anti-inflammatory drugs, quickly eliminate the symptoms of an acute inflammatory process by reducing the permeability of the vascular walls. The most common angioprotector is troxerutin. The duration of therapy with troxerutin is 20 days. It protects the vascular wall. Angioprotectors are available in various dosage forms: tablets, ointments, gels.

They improve the flow properties of blood and effectively thin it with antiplatelet agents. Most often, acetylsalicylic acid preparations (aspirin) are used for these purposes. Aspirin, as a non-steroidal anti-inflammatory drug, not only reduces blood viscosity, but also relieves symptoms of inflammation. Anticoagulants and aspirin should not be used at the same time, as this may cause bleeding.

Polyenzyme preparations dissolve thrombotic masses. These include Wobenzym and Phlogenzym.

Thrombolytics for superficial thrombophlebitis are used in the case of an ascending process or if there is a risk of developing pulmonary embolism. These drugs include the following: streptokinase, urokinase and alteplase. Thrombolytic agents dilute the formed thrombus and restore blood flow through the vessels. Thrombolytics can cause bleeding, so they are used only for life-threatening conditions.

Advanced thrombophlebitis of the superficial veins of the legs is often complicated by trophic ulcerations of the skin. To treat trophic ulcers, systemic antibacterial drugs are prescribed. Damaged tissue is removed, the surface of the ulcer is treated with antiseptics. Ointments are applied to the dried surface of the ulceration to accelerate healing. The most common and effective means Vishnevsky ointment is considered.

As additional method Treatments include physiotherapy. Physiotherapeutic effects are aimed directly at the inflamed area with a formed blood clot, as well as areas of the skin affected by trophic ulcers.

Apply:

1. UHF therapy. Relieves swelling, inflammatory symptoms, improves lymphatic drainage.
2. Electrophoresis with drugs. Under the influence of an electric current, medications are delivered to the affected veins.
3. Magnetotherapy. Has a beneficial effect on rheological properties blood, thins it, has an analgesic and anti-inflammatory effect.

Drug therapy should be based on individual characteristics patients. Dosages medicines and the necessary combinations should only be selected by a doctor. Attempts at self-therapy can result in the development of severe complications: from bleeding from arteries and veins to blockage of the pulmonary trunk.

Acute thrombophlebitis of the superficial vessels of the legs can be treated with hirudotherapy. Treatment medical leeches This is especially important if there are contraindications for the use of anticoagulants. Leeches produce a substance that reduces blood viscosity and clotting, and reduces spasm of arteries and veins. Typically, 5 to 10 leeches are placed along the affected vein. Hirudotherapy is used once a week under the supervision of a physician.

Surgical interventions for thrombophlebitis

Surgical treatment is resorted to if there is no effect from conservative therapy, when Great chance development of thrombus melting with purulent exudate.

The following types of surgical intervention are used:

• thrombectomy;
• ligation of a venous vessel or suturing of a vessel;
• the imposition of intervascular anastomosis (connection of arteries and veins);
• installing a filter in large venous vessels (inferior vena cava).

An operation aimed at removing thrombotic masses from a vessel is called thrombectomy. This technique restoration of blood flow is considered one of the most gentle and does not pose any significant difficulty when performing.

A modern method of removing blockages from blood vessels is thrombolysis (used for damage to both veins and arteries), carried out using a special catheter. A tube is inserted into the vascular trunk, through which the thrombolytic drug is delivered directly to the location of the thrombus. In this way, large deposits of thrombotic masses can be removed, eliminating the symptoms of complete blockage of veins or arteries.

Prevention of thrombophlebitis

For patients in the postoperative period or forced for a long time If you are on bed rest, preventive measures against blockages of superficial veins are required:

• long-term use of anticoagulants;
• compression products (elastic bandaging, medical underwear);
• early rise of patients after surgery, physical therapy.

The attitude towards thrombophlebitis as a disease of the venous system is twofold:

• some scientists consider it a common complication of varicose veins with the most common localization on the legs;
• others claim that damage to veins occurs even without varicose veins; a significant role is assigned to the allergic mood of the vascular endothelium (inner lining).

Summarizing both opinions, we will assume that thrombophlebitis of the superficial veins of the lower extremities is a manifestation of different causes, but the result is the same - a section of inflamed loose wall with thrombotic masses blocking the blood flow. The degree of circulatory disturbance depends on the size of the blood clot. Timely treatment allows you to minimize the consequences and prevent complications.

Connections between superficial and deep veins

Superficial veins are located externally at a depth of 2–3 cm. They practically lie in the thickness of the fatty tissue. The network is extensive. The largest is the great saphenous vein. It is in its bed that up to 95% of cases of thrombophlebitis are found. In the area of ​​the small saphenous vein, blood clots and inflammation occur much less frequently.

Communication with deep venous trunks is carried out through perforating branches

The superficial part of the venous system of the lower extremities provides the outflow of blood from the skin of the fingers, feet, small joints, legs and thighs. The valve apparatus of the venous vessels is much weaker than that of the deep veins. In addition, there is no auxiliary “pump” from the calf muscles to pump blood upward. The subcutaneous vessels are very vulnerable and are easily compressed.

In 5–10% of cases, superficial thrombophlebitis simultaneously affects deep vessels.

What factors are involved in the development of thrombophlebitis

The appearance of inflammation (phlebitis), and then on the legs, is facilitated by a combination of several factors:

1. Wall injury - superficial localization puts the saphenous veins at significant risk. Any mechanical injury (bruise, cut) affects the structure of the vessel wall, destroys and makes weak connections thin muscle fibers. Even “bruises” or, more correctly, small hematomas from contusions, can continue in the form of loss of tone with the expansion of part of the vein. Traumatic factors include various intravenous medical procedures related to the installation of catheters for long-term use, intravenous infusion of solutions, ligation of veins during operations on bones and joints of the lower extremities.
2. Slowing blood flow- the speed of blood flow decreases in congestive heart failure, in cases of prolonged bed rest in patients with heart disease, brain disease, and in a fixed position of the leg in a plaster cast after a fracture.
3. Changes in the physical and chemical properties of blood- coagulability increases during fluid loss (vomiting, diarrhea, bleeding, taking a large dose of diuretics), from an increase in the proportion of coarse proteins, increased agglutination (sticking together) of platelets. Blood viscosity increases as its glucose level increases. diabetes mellitus. In the postoperative period, the fact that the enzyme thrombokinase enters the bloodstream from destroyed tissues and its stimulating role in thrombus formation has been proven.

These processes occur during long-term infectious diseases, hormonal disorders, malignant neoplasms, treatment with certain medications.

Phlebitis of the vein wall can serve as a manifestation of the body’s allergic mood and occur without infection. This process is called aseptic. More dangerous is the addition of a “dormant” infection from existing untreated lesions in the mouth, nasopharynx, and genitals. Depending on the microorganisms, phlebitis can turn into a purulent form.

The infection reaches the venous wall through arteries, lymphatic ducts, and from neighboring tissues. Of great importance are teeth affected by caries, flu on the legs, erysipelas, tuberculosis, pneumonia, septicopyemia (multiple pustules on the skin).

Causes of thrombophlebitis

The causes of thrombophlebitis of the superficial and deep veins differ little. The most common include:

• severe injuries, including surgery;
• infectious diseases;
• the presence of hypersensitivity and allergic reactions;
• malignant tumors;
• hormonal changes due to obesity, taking contraceptive medications;
• frequent intravenous procedures in the hospital and insertion into a vein narcotic drugs drug addicts.

For women, a significant risk factor is the period of pregnancy and the condition after a medical abortion.

Thrombophlebitis in the small veins of the dorsum of the foot often occurs due to wearing uncomfortable shoes or minor injuries

Classification of thrombophlebitis

All infectious thrombophlebitis, depending on the specific causes, are divided into:

• postoperative;
• postpartum (including after abortion);
• associated with purulent processes;
• complication of typhus.

Non-infectious forms (aseptic) are divided according to the most frequent violations on the:

• complication of varicose veins of the lower extremities;
• post-traumatic;
• concomitant heart pathology;
• migrating.

Depending on the course of the disease, thrombophlebitis can be acute, subacute and chronic.

Features of the clinical course

Acute thrombophlebitis of the superficial veins begins suddenly with an increase in body temperature, pain in the legs along the veins. Pain syndrome worsens with movement and bending of the joints. Local swelling is possible.

An examination by a doctor can determine redness of the skin, the lump above the site of inflammation is hot to the touch

Finding out your medical history helps establish a connection with trauma, recent surgery, abortion, or respiratory infection. Duration acute form- up to a month.

The subacute form does not manifest itself as acute pain; it is aching for a long time. The temperature does not rise. Seals along the veins are not painful. The color of the skin over the source of inflammation changes, it becomes bluish-brown. The duration of the disease is 1-4 months.

Chronic superficial thrombophlebitis most often accompanies varicose veins of the legs. Against the background of symptoms of varicose veins (weakness, swelling, cramps in the calves, pain when walking), a dense cord appears along the venous node. At the same time, the clinic is expanding venous insufficiency due to trophic ulcers on the foot. Characterized by a wave-like course with periods of exacerbation and subsidence.

Clinical importance is attached to repeated thrombophlebitis in previously undamaged areas of the venous bed. This form is called migratory. It may indicate development malignant neoplasm, systemic lupus erythematosus, thrombocytosis, erythremia.

Diagnostics

Diagnosis of thrombophlebitis in the superficial veins of the legs does not cause difficulties. All symptoms are clearly manifested and identified in the patient.

To clarify the degree of influence on the deep veins of the thigh, the following examination methods may be useful:

• rheovasography - determines the degree of vascular filling;
• Doppler ultrasound - records the reflected signal, establishes the speed of blood flow in the vessel;
• duplex scanning - allows you to visualize the contours of the vascular network, the diameter is different levels, thrombus sizes.

How is treatment done without surgery?

Objectives of the treatment of superficial thrombophlebitis:

• prevent the transition of the inflammatory process and thrombosis to the deep veins;
• reduce the risk of thromboembolic complications;
• remove inflammation and factors contributing to increased thrombosis.

The disease can be treated on an outpatient basis if diagnostics have established that there is no transition to the deep veins. Otherwise, hospitalization is necessary.

To methods conservative treatment relate:

• round-the-clock tight bandaging or wearing compression stockings in the first 10 days, then wearing compressive underwear is allowed only during the day;
• local and internal drug therapy.

Topically used:

• to relieve pain and limit inflammation - apply cold to the hardened and painful area of ​​the vein for 2–3 days;
• Heparin ointment, Lyoton-gel, which affects small blood clots, Ketonal-gel to relieve inflammation.

Heparin ointment works much more effectively in the form of a compress

Internally prescribed:

• drugs with venotonic action - Detralex, Troxevasin;
• anti-inflammatory drugs - Reopirin, Butadione, Ibuprofen, antibiotics wide range intramuscularly;
• antiplatelet agents - Acetylsalicylic acid, Curantil, Trental;
• according to indications, it is possible to use drugs that relieve hypersensitivity of venous vessels - Tavegil, Suprastin, Loratadine.

Anticoagulants are prescribed if there is a risk of embolus rupture. Heparin is suitable for this in the acute stage with a transition to indirect-acting drugs (Warfarin). The duration of treatment is several months. Blood clotting control is necessary.

To dissolve an acute thrombus in the first 6 hours of the disease, it is possible to use fibrinolytic agents - Streptokinase, Fibrinolysin, Trypsin, Chymotrypsin, Urokinase.

During periods of remission in chronic thrombophlebitis, physiotherapy is used:

• irradiation with ultraviolet rays;
• infrared procedures;
• Sollux.

Balneological medicinal baths indicated in remission. The resorts of Pyatigorsk and Sochi (Matsesta) have proven themselves well, where natural mud baths and hydrogen sulfide springs are used.

Natural sources of hydrogen sulfide in the Matsesta River valley have been healing thousands of patients for many years

Surgical methods

The use of surgery is possible if there are no results from conservative treatment. The selection methods are:

• ligation of the large superficial vein of the thigh;
• crossectomy - additional isolation and intersection of tributaries to prevent the spread of infection;
• radical phlebectomy - ligation and removal of all affected veins.

How does a blood clot change in a vessel?

Against the background of the development of superficial thrombophlebitis, the further course of the disease depends on the “behavior” of the blood clot. There are options here.

Under the influence of treatment or spontaneously, inflammation decreases. The clot also becomes smaller in size. It partially or completely closes the lumen of the vein. When completely blocked, the vein becomes empty and collapses. In this case, the risk of a piece of blood clot breaking off and turning it into an embolus is minimized.

If there is no effect of therapy, then phlebitis continues to develop and spread to other areas. The thrombus turns into a “floating” one. Its head is attached to the wall of the vein, and the other end moves freely in the cavity of the vessel. Loose walls cause a part of the blood clot to break off. The embolus most often moves towards the vena cava, towards the right atrium and enters the pulmonary arteries. This results in a dangerous complication - thrombosis of the pulmonary artery or its smaller branches.

The growth of a blood clot along a vessel can wedge into deep veins through venous shunts and contribute to the destruction of the valve apparatus with the development.

Complications of superficial thrombophlebitis

Thrombophlebitis of the superficial veins does not often lead to complications. This is more typical of deep vein lesions. However, lack of or inadequate treatment can cause:

• phlegmon and abscess on the leg;
• dermatitis such as eczema;
• embolism in internal organs;
• inflammation of regional lymph nodes (lymphadenitis most often in the groin area);
• development of general sepsis;
• ischemic neuritis.

Prevention

The basis for the prevention of thrombophlebitis in healthy person- maintaining mobility, fighting overweight. If it is necessary to adhere to bed rest, it is recommended to make active movements in the legs; even while lying down, you can pull your socks towards you and back, forcing the calf muscles to work.

In the period after surgery, thrombophlebitis occurs in 13-21% of cases. The fight against postoperative thrombophlebitis is dealt with in the hospital at the stage of preparation for elective surgery. The feet are bandaged, the teeth are sanitation controlled, palatine tonsils and other possible chronic foci.

Treatment prescribed by a doctor must be carried out in courses in strict accordance with the recommended dosages of the drug. Do not switch to traditional methods and outside advice.

The meaning of the term Acute Thrombophlebitis of the Saphenous Veins of the Lower Extremities in the Encyclopedia of the Scientific Library

Acute Thrombophlebitis of the Saphenous Veins of the Lower Extremities— Most often it occurs as a result of mechanical and chemical damage to the venous wall, after intravenous administration of drugs, often as a reactive process during influenza infection, sore throat, pneumonia, tuberculosis, typhoid, etc. It is very often observed in people suffering from varicose veins of the saphenous veins of the lower extremities, in particular in 31.5% of pregnant women with varicose veins of the saphenous veins.

The inflammatory process is mainly localized in the wall of the great saphenous vein of the leg, thigh and in their tributaries, mainly affects the saphenous veins of the upper third of the leg, lower and middle thirds of the thigh and can be focal, segmental or widespread.

Clinic and diagnosis. Acute thrombophlebitis of the saphenous veins of the lower extremities manifested by moderate or severe pain and thickening (infiltrate) along the saphenous vein, hyperemia of the skin above it. When surrounding tissues are involved in the inflammatory process, periphlebitis occurs, general health with limited, segmental thrombophlebitis of the saphenous veins does not suffer. With a common thrombophlebitic process general state patients worsens, body temperature rises (up to 38° or more). There is a slight leukocytosis with a moderate shift of the formula to the left and an increased ESR. An important pathognomonic sign acute thrombophlebitis of the saphenous veins is the absence of swelling of the affected limb. After a few days, the acute process becomes subacute, and after 2 - 3 weeks the inflammatory phenomena stop, but only after 2 - 4 months the lumen of the affected vein is restored. Acute thrombophlebitis of the saphenous veins can cause severe complications that arise as a result of the spread of the thrombotic process from the saphenous to the main veins: a) through the mouth of the great saphenous vein of the thigh; b) through the mouth of the small saphenous vein of the leg; c) through the communicating veins.

The thrombotic process from the saphenous veins to the main vein most often spreads when there is insufficient fixation of the thrombus to the vein wall. In this case, a “floating thrombus” is formed, which can reach a length of 15–20 cm and penetrate into the femoral vein. When thrombosis spreads proximally, pain is noted along the anteromedial surface of the thigh. Therefore, when clinical signs Acute thrombophlebitis of the great saphenous vein of the thigh at the border of the middle and upper thirds should raise the question of emergency surgery - phlebectomy of the great saphenous vein at its mouth - as a preventive measure for the spread of thrombosis to the femoral vein. It must be remembered that “floating blood clots” are a potential source of pulmonary embolism.

Treatment. For acute and subacute thrombophlebitis of the superficial veins, surgical intervention is usually indicated, which in 90% of cases provides a permanent cure. Only thrombophlebitis that occurs in unchanged veins and is limited in nature is subject to conservative treatment. Surgical treatment of acute thrombophlebitis is also contraindicated in case of: obstruction of the main veins, decompensated heart disease, myocardial infarction, inflammatory process in the lungs and abdominal cavity. In case of severe symptoms of acute thrombophlebitis, it is advisable to perform the operation after the acute inflammatory process has subsided. Surgical technique for acute thrombophlebitis of the saphenous veins differs little from that during phlebectomy in the case of varicose veins of the saphenous veins. However, in case of thrombophlebitis of the proximal portion of the great saphenous vein of the thigh with thrombosis spreading to the femoral vein, resection of the great saphenous vein in combination with thrombectomy is indicated. In case of severe periphlebitic phenomena, covering a large area of ​​surrounding tissue, an incision is made bordering the inflammatory infiltrate, and the thrombosed vein is removed along with the skin and subcutaneous tissue. It should be remembered that too wide an incision can cause excessive tension of the skin with the development of its marginal necrosis. Thrombosed veins, without pronounced non-riflebitic phenomena, are usually removed by a linear or bordering incision and ligation of all branches of the main trunk of the saphenous vein. Unchanged veins are removed using the Babcock method. At the end of the operation, a pressure bandage is applied to the limb and the operated limb is placed in an elevated position. On the 2nd - 3rd day after surgery, when the patient begins to walk, a elastic bandage.

In the postoperative period, antibiotics and anticoagulants are indicated. Of the latter, the most commonly used is finilin 0.03 g 1 - 2 times a day under the control of the prothrombin index and blood clotting time. In this case, blood prothrombin should remain at the same level - 0.60 - 0.70. It is necessary to discontinue finilin by gradually reducing the daily dose to 1/4 tablet/day within 10 days from the moment of stabilization normal level blood prothrombin. After discontinuation of finilin, patients should receive acetylsalicylic acid (ASA) 0.25 g 4 times a day, which inhibits platelet aggregation and adhesion, in addition, does not require special monitoring of the state of the blood coagulation system.

Thrombophlebitis of the saphenous veins

Introduction

Thrombophlebitis of the saphenous veins(thrombophlebitis of the superficial veins or superficial thrombophlebitis) is inflammatory disease superficial veins. Most often damaged with thrombophlebitis superficial veins lower extremities and groin area. Thrombophlebitis develops in people suffering from varicose veins.

Unlike deep veins, with thrombophlebitis of the saphenous veins, a pronounced inflammatory reaction develops, which is accompanied by severe pain. In turn, inflammation damages the vein wall, which contributes to the development and progression of thrombosis. In addition, the superficial veins are not surrounded by muscles, so when muscle contraction the risk of blood clot destruction and migration of its pieces with the bloodstream (embolism) does not increase, so superficial thrombophlebitis is potentially not dangerous.

Sometimes thrombophlebitis can occur again, this especially often occurs when oncological diseases or other serious illnesses internal organs. When thrombophlebitis occurs as a concomitant disease with an oncological process in the body, this condition is also called Trousseau syndrome.

Symptoms of superficial thrombophlebitis

The first symptoms of thrombophlebitis are local pain and swelling; the skin in the area of ​​the vein in which thrombophlebitis has developed becomes brown or red and hard. Since a blood clot has formed in the vein, it becomes denser along its length.

Diagnosis of superficial thrombophlebitis

The diagnosis is usually made after collecting anamnestic data and examination. To confirm the diagnosis, color duplex ultrasound scanning is performed.

Treatment of superficial thrombophlebitis

In most cases, thrombophlebitis of the superficial veins goes away on its own. Treatment usually includes pain relievers such as aspirin or other non-steroidal anti-inflammatory drugs, which help reduce pain and inflammation. Antiplatelet agents and anticoagulants (blood thinning medications) are also used to reduce blood clotting. In case of severe thrombophlebitis, local anesthesia is applied, the blood clot is removed and then a compression bandage is put on, which must be worn.

If thrombophlebitis develops in the superficial veins in the pelvic area, then there is a high probability of migration of blood clots and the development of deep vein thrombophlebitis and pulmonary embolism. To prevent the development of these complications in thrombophlebitis of the deep and superficial veins in the pelvic area, emergency treatment is recommended. surgery in a hospital setting.

Thrombosis and thrombophlebitis of the saphenous veins

It is known that ascending thrombophlebitis in the system of the great or small saphenous vein accounts for up to 3% of all causes of deep vein thrombosis. At the same time, in emergency angiosurgical practice, the issues of diagnosis and treatment of this pathology remain controversial and not fully resolved; a good phlebologist must navigate this issue.

Every year, up to 80 patients diagnosed with thrombophlebitis of the saphenous veins of the lower extremities are delivered to the emergency department of City Hospital No. 1 by ambulance from clinics and various medical institutions in the city of Irkutsk. After examination by an angiosurgeon and ultrasound examination, from 35 to 45 patients are hospitalized in the vascular surgery department. The most common diagnostic error is erysipelas of the lower extremities.

The predominant cause leading to thrombosis and thrombophlebitis of the saphenous veins was varicose veins with severe disturbances of venous hemodynamics and gross morphological changes in the walls of the veins. In isolated cases, the trigger for the development of venous thrombosis was cancer, injuries to the lower extremities, long-term surgical interventions using muscle relaxants, various skin dermatitis or thrombophilic conditions. In most cases, the system of the great saphenous vein was involved in the inflammatory process, and cases of thrombosis of the small saphenous vein were isolated. The age of the patients ranged from 34 to 75 years, of which 55% of all patients were still over 55 years of age. Among total number 12% of those admitted were women of childbearing age.

In the first day after the onset of the disease, as a rule, patients are admitted very rarely. 45% were admitted within 2 to 5 days (the most favorable time for surgery). From 5 to 10 days - up to 35%, and more late dates- the remaining 25%. The disease manifested itself with both local and general symptoms: compaction along the saphenous veins, pain at the site of compaction with or without palpation, hyperemia along the thrombosed veins, compaction of soft tissues around the veins, hyperthermia, both local and general. In the case of severe varicose veins and in the absence of adequate drug treatment, it took only a few days for thrombosis to spread to the mouth of the great or small saphenous vein with the subsequent formation of a loose floating thrombus.

From 2000 to 2004 In the Department of Vascular Surgery, 166 patients were operated on as an emergency. Most of the operations were performed under local anesthesia. In 25 patients, thrombectomy was performed from the mouth of the great saphenous vein and a loose thrombus extending to the femoral vein was removed. It was repeatedly confirmed intraoperatively that the level of thrombosis of the trunk of the saphenous veins was always significantly higher (by 10-15 cm) determined preoperatively visually and by palpation.

Clinically reliably established cases of small focal pulmonary embolism after such operations were isolated. There were no cases of massive pulmonary embolism after these operations. Most patients in the postoperative period received complex drug treatment, including heparinization, and were prescribed an active motor regimen.

1. Error in diagnosing thrombosis and thrombophlebitis of the saphenous veins of the lower extremities in prehospital stage up to 50%, which causes further tactical and treatment errors.
2. The most informative type of examination in the diagnostic process should be considered a duplex or three-dimensional examination of the patient’s venous bed.
3. Only drug treatment, without risk, should be limited in cases of thrombosis of the saphenous veins of the leg or thrombosis of varicose veins of the lower third of the thigh.
4. In case of reliable diagnosis of thrombosis of the trunk of the great or small saphenous vein, reaching the confluence with the deep venous system, surgical treatment it is necessary to consider only effective way prevention of deep vein thrombosis.
5. In the case of diagnosing a floating thrombus of the common femoral or external iliac vein, it is necessary to perform a standard access to the main veins and isolate them over a sufficient length.
6. Complete thrombectomy from the mouth of the great saphenous vein more than a week after the onset of thrombosis most often fails due to the tight fixation of thrombotic masses to the walls of the vein.
7. In the case of the presence of massive thrombosed venous conglomerates on the leg and thigh without a pronounced perivasal process, it is advisable to either remove these conglomerates immediately or evacuate thrombotic masses through small venotomy holes.
8. In the case of diagnosis of thrombosis at the level of the mouth of the great saphenous vein in pregnant women and within a period not exceeding 2 - 5 days, surgical treatment should be carried out urgently.
9. The surgical stage is not the final stage of treatment of this disease. After surgery, it is imperative to carry out complex drug treatment, since sometimes undiagnosed thrombosis of perforating veins is overlooked, which can also be a route for the spread of thrombus formation to the deep veins.

Acute thrombophlebitis is inflammation of a vein with the formation of blood clots inside it.

Symptoms of acute thrombophlebitis of the superficial veins and its diagnosis. Most typical signs Acute thrombophlebitis of the superficial veins of the upper and lower extremities are symptoms of a general inflammatory reaction, hyperemia of the skin, infiltrates along the thrombosed veins, lymphadenitis and lymphangitis. Patients are concerned about an increase in body temperature to 39 ° C, chills, weakness, and malaise. Along the course of the affected vein, hyperemia and swelling of the skin are noted. However, the swelling is minor. The diameter of the limb remains virtually unchanged. Movement in the joints remains free, but somewhat painful due to the presence of zones of inflammation in the subcutaneous tissue. In the area of ​​the thrombosed vein, a painful infiltrate with clear boundaries is palpated, fused with the surrounding tissues. In the initial period of the disease lymphatic system is not involved in the inflammatory process. Subsequently, especially with suppuration of thrombosed veins, lymphangitis and lymphadenitis are observed.

With localized thrombophlebitis, signs of the inflammatory process are detected only in a small area of ​​the saphenous veins. Migrating thrombophlebitis is characterized by the presence of many small foci of thrombosis in different segments of the limb. Ascending thrombophlebitis is accompanied by a gradual spread of the process from the distal parts of the saphenous veins to the proximal ones.

Acute thrombophlebitis after a few days turns into subacute, followed by either complete cure, or the formation of chronic inflammation. Subacute thrombophlebitis is characterized by the absence of symptoms of a general inflammatory reaction, the disappearance of pain and hyperemia of the skin over the affected vein. However, pain does not occur during palpation of thrombosed veins, but periodically and independently. In persons with chronic thrombophlebitis, a solid or clear-shaped cord forms at the site of the thrombosed vein. Its palpation or physical activity is accompanied by the appearance of slight pain. The prolonged existence of chronic thrombophlebitis of the superficial veins contributes to the development of trophic tissue disorders.

When the phenomena of inflammation are relieved, the thrombosed superficial vein is recanalized in most cases, but loses its anatomical and physiological properties: it expands unevenly and its valve apparatus is destroyed. The skin over it becomes hyperpigmented and indurated. With migrating thrombophlebitis, there are practically no skin trophic disorders.

The course of thrombophlebitis of the saphenous veins is often complicated by suppuration of thrombosed superficial veins with the formation of subcutaneous abscesses and phlegmon, the spread of thrombus formation to the deep veins through the sapheno-popliteal anastomosis, as well as through the communicating veins. Having penetrated the main veins, the thrombus either completely blocks their lumen or is in a floating state (oscillates under the influence of blood flow). The detachment of blood clots leads to pulmonary embolism. If infected blood clots migrate, metastatic lung abscesses occur.

Differential diagnosis of acute thrombophlebitis of the superficial veins. Thrombophlebitis of the superficial veins must be differentiated from diseases that occur with a similar clinical picture: acute thrombophlebitis of the deep veins, lymphangitis, erythematous form of erysipelas, soft tissue phlegmon, etc.

Treatment of acute thrombophlebitis of superficial veins. Tactics for acute thrombophlebitis of the superficial veins are determined by the localization of thrombosis, the condition of the venous vessels involved in the inflammatory process, and the nature of the disease.

Conservative treatment is carried out when acute thrombosis saphenous veins of the forearm and shoulder, as well as local thrombophlebitis of unchanged varicose veins of the leg and lower third of the thigh without a tendency to spread and in the absence of symptoms of pulmonary embolism; for subacute and chronic thrombophlebitis of varicose veins that are not changed, amenable to conservative measures; in severe condition of patients due to concomitant pathology.

Patients with acute thrombophlebitis of the superficial veins of the forearm and leg, subacute and chronic thrombophlebitis can be treated on an outpatient basis. In all other situations they are hospitalized. General and local treatment. In the acute phase of the disease, conditional bed rest with an elevated position of the diseased limb is indicated. Compresses with heparin, heparoid, butadione ointments, Vishnevsky ointment, 30% dimexide solution, semi alcohol compresses etc., cold. Elastic bandaging of the legs is performed on top of the compresses to accelerate the outflow of blood and thereby prevent the spread of the process. Drugs are prescribed that improve microcirculation and rheological properties of blood (trental, teonicop, flexital, etc.); inhibitory effects on the adhesive-aggregation function of platelets (aspirin, chimes, indomethacin, etc.); corrective disorders of venous blood flow (detralex, venoruton, troxevasin, aescusan, etc.); having anti-inflammatory, antipyretic, analgesic effects (butadione, reopirin, analgin, etc.); desensitizing agents (diphenhydramine, suprastin, etc.). are used in the presence of severe inflammatory process.

Anticoagulant therapy for thrombophlebitis of the superficial veins, as a rule, is not carried out. Only with significant hyperprothrombinemia is it possible to use both indirect (phenilin, pelentan, neodicoumarin, etc.) and direct (heparin, fraxiparin, etc.) anticoagulants.

In the subsiding phase of acute inflammation, physiotherapeutic procedures are prescribed to accelerate the resorption of blood clots and infiltrates. Iontophoresis of potassium iodide, proteolytic enzymes (trypsin, chymotrypsin, etc.), heparin are effective; UHF; prolonged diathermy; Sollux lamp. After relief of acute thrombophlebitis, patients with varicose veins of the lower extremities are recommended to use elastic bandaging of the extremities and wearing elastic stockings for 2 months. During the same period, it is advisable to take drugs that have a phlebodynamic effect.

Surgical intervention is a radical method of treating thrombophlebitis of the superficial veins, preventing the development of its complications and relapses. for thrombophlebitis of the superficial veins, they are performed on an emergency and planned basis.

Indications for emergency surgical intervention are: 1) acute ascending thrombophlebitis of the great saphenous vein when the objectively determined upper border of the thrombus is localized at or above the border of the upper and middle thirds of the thigh; 2) acute ascending thrombophlebitis of the small saphenous vein with the upper limit of thrombosis located at or above the border of the middle and upper thirds of the posterior surface of the leg; 3) the presence of symptoms and the threat of recurrent pulmonary embolism; 4) purulent melting of the thrombus. If necessary, preoperative preparation and special methods examination, surgery in patients with a risk of recurrent pulmonary embolism may be delayed.

Planned operations are indicated for thrombophlebitis of varicose veins; if conservative treatment of acute thrombophlebitis of varicose veins, subacute and chronic thrombophlebitis is unsuccessful.

Contraindications to radical surgery: occlusion or hypoplasia of the main veins; heart disease with symptoms of decompensation, myocardial infarction, hypertension I - Stage III, suppurative processes in the lungs, inflammatory diseases of the abdominal organs; skin diseases (eczema, pyoderma). A relative contraindication is the advanced age of patients.

Most often, the main trunk of the great or small saphenous vein involved in the inflammatory process is removed and its lateral branches are treated.

The operation for acute thrombophlebitis of the superficial veins is performed in a certain sequence. First, the saphenofemoral anastomosis is isolated from an oblique or vertical incision. The oblique incision extends 3 cm below inguinal fold and parallel to it, and obliquely vertical - on the border between the inner and middle thirds of the Poupart ligament through the oval fossa or slightly medially determined pulsation of the femoral artery. The anastomosis area is examined. If there are no blood clots in the area where the great saphenous vein flows into the common femoral vein, the v.saphena magna and its tributaries are ligated and intersected (Troyanov-Trendelenburg operation). If there is a thrombus in the common femoral or external iliac vein, the external iliac, superficial and common femoral veins are initially isolated and clamped outside the zones of thrombosis. The tributaries of the great saphenous vein are ligated and divided. Thrombectomy from its mouth is performed by transverse intersection of the great saphenous vein, and from the deep veins by longitudinal dissection of the remaining valve and the wall of the common femoral vein. The effectiveness of thrombectomy is monitored visually and by the presence of retrograde blood flow from the iliac veins at the height of the Valsalva maneuver.

Phlebectomy of thrombosed veins on the thigh and lower leg is carried out from separate incisions 4 - 6 cm long (Narata operation tunnel method(operation by F.K. Sidorina) or by making a continuous skin incision from the inguinal fold to the medial malleolus (Madelung’s operation). Babcock's operation (removal of veins using probes) is acceptable for phlebectomy of non-thrombosed vessels. In case of severe phlebitis and panniculitis, the thrombosed trunk is removed from the bordering incisions along with the tissue and skin flap (operation by R.L. Askerkhanov). Communicators are bandaged subfascially (according to Linton) or suprafascially (according to Cockett) only after preliminary removal of blood clots from their lumen.

The sapheno-subcutaneous anastomosis is exposed from a transverse, vertical or B-shaped approach similar to the exposure of the sapheno-femoral anastomosis. The trunk of the small saphenous vein is removed using one of the methods described above. Small tributaries of the great and small saphenous veins are sutured according to Shede (percutaneous suturing of veins with tying the ends of the threads on the skin) or according to Sokolov-Klapp (intradermal suturing of veins).

In severe patients with ascending thrombophlebitis of the saphenous veins of the lower extremities, only the intersection and ligation of the great saphenous vein and tributaries at the saphenofemoral (Troyanov-Trendelenburg operation) and the small saphenous vein - at the sapheno-popliteal anastomosis are performed.

Phlebectomy of thrombosed veins of the upper extremities is performed according to Marat or Askerkhanov. In the postoperative period, to improve regional blood circulation in the limb and prevent relapse of thrombophlebitis, continued disaggregant therapy (10 - 15 days), bandaging the limb or wearing an elastic stocking for 3 months, exercise.

Thrombophlebitis- inflammation of the vein wall, which leads to the formation of a thrombus - a dense blood clot with an uneven surface. This is an inflammatory vascular disease associated with infection, changes in blood properties, or compression of a vein. With thrombophlebitis, a painful, knotty cord appears under the skin, and the tissue above it turns red and swells.

Thrombophlebitis is the most common vascular disease, which is often accompanied by atherosclerosis and varicose veins. Every fourth woman and every fifth man over forty suffers from this pathology.

Interestingly, thrombophlebitis occurs 3 times more often in Europeans than in Asian countries. This is due to the fact that in Asian culture it is common to sit on mats. At the same time, blood circulation in the legs is better than when you sit on a chair.
In people who are obese and have more than 30 kg of excess weight, the risk of developing thrombophlebitis is 30% higher.
Thrombophlebitis occurs in young people as young as 17 years of age, but this danger is greatest in people over 75 years of age. Average age patients are 40-50 years old.

Thrombophlebitis happens

• Spicy – develops in 2-3 days. Accompanied by increased temperature, redness and swelling at the site of blood clot formation. The area becomes hot and painful to the touch.
• Chronic – is often a complication of varicose veins. The inflammation is sluggish. The blood clot enlarges, and if you press on the area around it, you feel pain. The limb swells.
• Purulent – occurs if there is a source of infection nearby on the skin. Occurs with severe intoxication and high temperature. May cause blood poisoning (sepsis).
• Non-purulent – the inflammatory process is caused by a change in the properties of the blood (thickening) or disruption of its movement. Red, painful stripes appear on the skin, but the general condition is normal. Non-purulent thrombophlebitis can result in the resorption of the blood clot, or it can occur in a chronic form.

Thrombophlebitis is treated by a phlebologist or vascular surgeon.

Anatomy of veins

Veins have one peculiarity: they do not look like tree branches, but rather like a mesh. Therefore, if violations appear in some area, then blood is flowing to the heart in roundabout ways.

The vein wall consists of several layers.

1. Inner layer (intima) – endothelial cells, which are located in one layer;
2. Soft connecting layer;
3. Thin muscle layer;
4. Dense outer layer of connective tissue.

Blood moves to the heart through veins at low pressure and often against gravity. But there are factors that ensure blood flow in the right direction:

1. Vein valves are outgrowths of the inner layer of the vein that allow blood to flow in only one direction;
2. Venous pulse - contraction of the walls of the veins;
3. Promotion of blood due to surrounding muscles;
4. Suction action of the heart and diaphragm.

Causes of thrombophlebitis

1. Infection. The disease provokes a focus of purulent infection near the vein. This could be a boil, cracked toes, or sepsis. Through the wound, microorganisms enter the bloodstream, causing inflammation in a small area of ​​the vessel wall. At the same time, substances begin to be released that lead to platelets sticking together and forming a blood clot.
2. Respiratory disease. Bacteria or viruses disperse throughout the body and enter the bloodstream. If there is a defect on the vein wall, microorganisms attach to it and begin to multiply, causing inflammation.
3. Intravenous administration medications or a catheter that remains in the vein for a long time. The body's response to foreign bodies is the formation of blood clots around them. If there are microorganisms on the needle or catheter, they cause inflammation of the vessel walls.
4. Injury: blows during sports or at home, bruises, burns, fractures. When injured, the internal endothelium peels off and the soft connective layer is exposed. Platelets, and then other blood cells, easily attach to it, forming a blood clot. After this, inflammation begins in the damaged wall.
5. Complications of operations, childbirth. The operation leads to injury to tissues and blood vessels. The body responds by releasing substances designed to clot the blood to stop bleeding. In addition, after such procedures, activity decreases - the person is forced to lie in bed. This leads to blood stagnation.
6. Tumors(malignant and benign neoplasms). Tumors can compress nearby vessels and grow into them, disrupting the functioning of the veins. And with cancer it changes biochemical composition blood and the person moves very little. This leads to the fact that thromboembolism is considered the second most common cause of death in cancer patients.
7. Taking hormonal medications or hormonal disorders. Hormonal imbalances lead to changes in blood composition and a tendency to inflammatory processes.
8. Dehydration. The volume of the liquid part of the blood decreases, but the amount blood cells remains the same. The blood becomes thicker and less diluted. This can happen if diuretics are not taken correctly, persistent vomiting or diarrhea.
9. Hereditary predisposition to blood thickening(coagulopathy, thrombophilia). With these hereditary diseases, there is an excess of platelets in the human blood. Their function is to ensure that blood stops during bleeding. But when there are too many of them, the platelets stick together and form a clot. The wall of the vessel at the site of its attachment grows and becomes inflamed.
10. Slowing blood flow. This happens when sedentary life. It is believed that if you spend 3 days in a row without moving (after a stroke, surgery), the risk of blood stagnation in the vessels of the legs and the appearance of blood clots in the superficial veins significantly increases.
11. Obesity and overweight. In overweight people, immunity decreases and blood circulation is impaired, blood vessels are compressed by fatty tissue and atherosclerotic plaques appear in them. As a result, inflammation often occurs both on the skin and in the walls of blood vessels.
12. Improper blood flow. Vortexes are formed that look like small whirlpools. This occurs where blood under pressure passes through a narrowed section of the vein, to the wall of which atherosclerotic plaques are attached. Often in such places, blood cells accumulate and stick together.
13. Phlebeurysm. Causes the vein to become dilated and tortuous. In some areas, blood circulates poorly and stagnates, and a blood clot forms in this area. It sticks to the wall of the vessel. From it, blood components penetrate into the intima, which leads to inflammation.

Thrombophlebitis of the superficial veins of the lower extremities

Symptoms and signs of thrombophlebitis of the superficial veins of the lower extremities

Diagnosis of thrombophlebitis

Physical examination, examination

The doctor carefully examines each leg on both sides from the foot to the groin. At the same time, he pays attention to the following signs of illness:

• presence of dilated veins;
• areas of redness and other changes in skin color;
• swelling;
• swelling of the legs;
• hot areas of skin.

• when signs of illness appeared;
• how quickly they developed and grew;
• what medications did you take during this period?

A study that combines Doppler ultrasound scanning and traditional ultrasound. Vascular Doppler is based on the fact that an ultrasonic wave is reflected from moving blood cells, and the sensor picks up this reflection. Based on the data obtained, the computer calculates the characteristics of blood movement through the vessels. In order to obtain more accurate results, the vein is examined with different sides(projections). A two-dimensional image appears on the monitor screen, which allows you to determine whether there is a blood clot or inflammation.

With thrombophlebitis of the superficial veins, the following signs appear:

• the diameter of the veins increases if thrombophlebitis is caused by varicose veins;
• the screen shows narrowed areas at the site of attachment of the blood clot;
• foci of inflammation on the venous wall;
• the appearance of reverse blood flow;
• slow or reverse blood flow.

Ultrasound/vascular Doppler has no side effects or complications. You do not need to prepare specially for this procedure; it is absolutely painless. You will lie down on the couch, and the doctor will apply a special gel to the skin, which conducts ultrasound well and facilitates the sliding of the sensor. The procedure lasts 15-25 minutes. Equipment for duplex ultrasound scanning is quite expensive. Therefore, this procedure is mainly performed in private clinics. Cost from 1000 to 3500 rubles.

Functional tests

These studies allow the doctor to identify varicose veins and determine the condition of the veins and their valves without equipment.

• Schwartz test(percussion). The doctor applies left hand to the artery on the thigh, and with the right one taps the inflamed area. If there is insufficiency of the valves of the great saphenous vein, then in the intervals between taps the doctor feels a reverse wave of blood directed from top to bottom.
• Troyanov–Trendelenburg test. You lie down on the couch and put your foot on a raised platform. Using light massage movements from the foot to the groin, the doctor expels blood from the superficial veins and applies a tourniquet to the top part hips. If the veins and varicose nodes quickly fill with blood, this indicates that the vessels are in poor condition and the valves of the veins are not working enough.
• Burrow–Shaneys three-strand test. You will be placed on a couch and the superficial veins will be drained using massage. After this, the doctor applies 3 tourniquets: in the groin, on the lower third of the thigh and below the knee. You will be asked to stand up and the doctor will evaluate the test results. If the veins fill with blood within 30 seconds, this indicates poor valve function.
• Pratt test. A tourniquet is applied to the thigh. An elastic bandage is applied from the foot to the thigh. They begin to unwind it and at the same time apply another bandage from top to bottom. In the gap between the bandages, swollen varicose nodes appear, which are marked with brilliant green.

Treatment

Ointments for the treatment of thrombophlebitis

Heparin ointment
Application. Apply a thin layer to the skin 2-3 times a day. Rub in with careful movements.
Mechanism of action. The ointment has anti-inflammatory and anti-edematous effects. It penetrates the blood plasma and prevents the formation of blood clots.

Essaven-gel
Application. Apply a thin layer to the skin around the inflamed vein 2-3 times a day. There is no need to rub in the ointment so as not to further injure the affected area.

Mechanism of action. Heparin improves blood circulation and promotes the resorption of blood clots, has an anti-inflammatory effect and prevents blood clotting. Escin improves blood properties and increases the tone of the vein wall, prevents fluid from escaping through the capillary walls and the appearance of edema. The cooling effect helps relieve pain.

Ketonal cream 5%
Application. Apply a 2-3 cm strip of cream to the affected area. Gently rub in using stroking movements. Use 2-3 times a day for 2 weeks.

Mechanism of action. The drug belongs to non-steroidal anti-inflammatory drugs. It relieves pain, swelling and inflammation in the vein and soft tissues around her.

Lyoton-gel
Application. 3-10 cm of gel is applied along the diseased vein in a thin layer. The procedure is repeated 1-3 times a day. The duration of use depends on the severity of the disease.

Doctors consider this regimen to be the most effective: Lyoton-gel 2 times a day and Ketonal cream 2 times a day. Let us remind you that these products can only be applied to intact skin.

Mechanism of action. The components of the drug prevent the release of fluid into the tissue and the appearance of edema, reduce blood clotting and relieve inflammation in the walls of the veins.

Sometimes people use ointments intended for treating wounds: Vishnevsky ointment, Levasin, Levomekol. We warn you that they are suitable for the treatment of trophic ulcers, but under no circumstances should they be applied as a compress to intact skin over the blood clot. This leads to increased inflammation in the vein.

Physiotherapy

Depending on the power of the equipment, the UV lamp can be installed 2 cm or 80 cm from the skin. The first procedure lasts 30-60 seconds. Each time the irradiation time is increased by 30 seconds and brought to 3-5 minutes. The course of treatment is 15-28 procedures.

UVR has a resolving and anti-inflammatory effect, activating biochemical processes in cells. Also, UV rays destroy microorganisms that can cause blood clots to suppurate and accelerate the healing of ulcers and other skin lesions.

Infrared radiation

To treat thrombophlebitis of the superficial veins, red emitters with a power of 60 mW and a wavelength of 670 nm are used. The lamp will be installed at a distance of 30-100 cm from the skin. You will feel pleasant warmth, the procedure lasts 20-30 minutes. The course of treatment is 10 sessions.

The radiation penetrates to a depth of 2-3 cm and helps relieve inflammation and activates immune cells that fight infection. They improve metabolism in cells, warm them up, relieve pain and reduce swelling.

Electrophoresis of hypocoagulants and disaggregants

Using low voltage direct current (up to 80 V) and low force, the medicine is injected into the tissue. The most commonly used is a 5% solution of acetylsalicylic acid, heparin, trental, fibrinolysin, a 5% solution of theonicol, a 1% solution nicotinic acid. The drugs go directly into the affected vein. During the procedure, you will lie on a couch and a nurse will apply moist, medicated cloth pads to your leg and attach electrodes. you will feel slight tingling and a slight burning sensation, this is normal. The procedure lasts 15-20 minutes. The course of treatment is 10-15 sessions.

As a result of exposure to alternating current, enzymes are activated, which improve metabolism in cells, heat production increases and blood flow to the diseased area increases. This action is complemented by the effect of using medications that quickly begin to act, relieving inflammation and thinning the blood.

Magnetotherapy

During the procedure, you will lie on a couch. Magnetic inductors will be placed near the sore leg, which create a healing magnetic field and. Treatment lasts 8-20 minutes. During this time, you may experience pleasant warmth. The course consists of 10-15 procedures.

Vortex electric currents and a magnetic field stimulate the muscle wall of the vessel. The vein contracts and pushes out the stagnant blood. This helps prevent swelling from spreading and reduce pain and inflammation.

Laser therapy

The light guide is moved slowly across the skin or at a distance of 20 cm above it (depending on the chosen technique), for 5 minutes for each area. In some cases, reflex points are affected, for 60 seconds each. The laser beam penetrates tissue to a depth of 6 cm, and you do not experience any unpleasant sensations. influence. The total procedure time does not exceed half an hour. The course consists of 10-30 sessions.

Laser therapy improves cell nutrition, they renew faster, the vein wall is restored, and swelling disappears. Blood viscosity decreases, local immunity is strengthened. As a result, recovery occurs faster.

D'Arsonval

There are contact and non-contact methods. In the first case, a vacuum electrode is passed over dry skin (sometimes it is sprinkled with talcum powder). In the non-contact method, the electrode is moved above the skin at a distance of 0.5-2 cm. In this case, sparks jump between the surfaces and a faint pink reduction occurs. At the same time, you experience a slight tingling sensation and the skin turns red. The procedure lasts about 10 minutes. To achieve the effect, 10-12 procedures are required.

Increases the tone of the veins, at the first stage causing them to vasoconstrict, and then dilate. Blood stagnation in the vessels is reduced, blood circulation in the capillaries and lymph circulation improves. Foci of inflammation resolve, pain and itching decrease, and skin sensitivity decreases.

Barotherapy

For pressure treatment, special pressure chambers are used. You place your leg there, after which a special cuff is inflated and the chamber becomes airtight. With the help of air injection it is created high pressure, after which the air is pumped out and the pressure becomes significantly lower than atmospheric. Periods of high and low pressure alternate and last for 3-5 minutes. The duration of the procedure is 5-30 minutes. To achieve the desired effect you need 20-30 sessions. During treatment you will experience either pressure or a feeling of fullness.

As a result of treatment with compressed and rarefied air, blood pressure in the vessels changes and blood flow improves. nutrients into a cage. High blood pressure displaces fluid from tissues into blood vessels, eliminating swelling. This treatment method also helps get rid of trophic ulcers.

Drug treatment of thrombophlebitis

Angioprotectors: Rutin
Improves the condition of the venous wall. Has an anti-inflammatory effect. Relieves pain in the legs and prevents the appearance of ulcers. Take 1 capsule 3-4 times a day for 1 month.

Enzymes: Wobenzym, Phlogenzyme
Relieves swelling, inflammation and promotes the dissolution of blood clots. Take 3 times a day, 2-4 tablets, with plenty of water.

Antiplatelet drugs: Dipyridamole, Acetylsalicylic acid
Prevents platelets from sticking together and forming a blood clot in the veins. The drugs are taken for a long time from two weeks to several months. Dipyridamole is taken before meals, 25 mg 3 times a day. Aspirin is prescribed 1 tablet per day, it must be taken immediately after meals.

Antibiotics: Amoxicillin, Flucloxacillin
Antibiotics are used for acute purulent thrombophlebitis. They are prescribed in tablets or the doctor gives an injection into the inflamed tissue around the vein.

When treating thrombophlebitis, an elastic bandage or special compression stockings must be used. This helps to avoid stagnation of blood in dilated veins and prevent the formation of blood clots.

Do not try to treat thrombophlebitis on your own. All medications have contraindications and can worsen your condition. For example, antibiotics thicken the blood, and aspirin should not be taken by people suffering from gastritis or peptic ulcers.

Operations

There are more gentle methods, when the vein is cleared of a blood clot, and radical ones, when a section of the vein is removed. After this, the blood flows to the heart through neighboring vessels.

Indications for surgery for superficial thrombophlebitis

• threat of pulmonary embolism;
• movement of a blood clot up the veins;
• the thrombus is located in the trunk of the great or small saphenous vein;
• the danger of a blood clot spreading into the deep veins;
• varicose veins of the lower extremities if there were attacks of acute thrombophlebitis;
• reflux of blood from deep veins to superficial ones.

• age over 75 years;
• heavy accompanying illnesses heart, lungs, liver, kidneys;
• allergies to medications used for anesthesia.

Types of operations for thrombophlebitis

Invagination (inversion) stripping

Removal of the entire trunk of the saphenous vein (great or small) using a special probe that turns the vein inside out, tearing it away from the surrounding tissue. The method is considered less traumatic than the previous one.

The advantage is that after surgery the leg looks more aesthetically pleasing. But there is a danger that during “evering” the vein may rupture and an incision will be required to remove its remnants.

Indications

• varicose veins, if their diameter is less than 1 cm;
• must be removed small area veins;
• It is important to get a good cosmetic result.

A thin tube with numerous holes in the walls is inserted into the vein. Through these holes, a substance is introduced into the lumen of the vessel, which destroys its inner lining and causes the walls to stick together. After this, the vein is clamped along its entire length. Advantages: surrounding tissues and nerves that pass next to the vein are not damaged, and hemorrhages do not occur. Disadvantage: in 20-50% of people, the vein is restored and blood flows through it again, which can cause repeated inflammation.

Indications

• inflammation and expansion (varicose) veins, but not more than 8mm in diameter.

Traditional methods of treatment

Diet for thrombophlebitis

Onions, garlic and tomatoes reduce blood viscosity. And red wine in this regard is quite comparable to aspirin.
Very useful: cherries, cranberries, blueberries, strawberries, black currants, sea buckthorn, grapes and citrus fruits, as well as dried fruits.

The best spices to use include cinnamon, curry, thyme, turmeric, mint, cayenne pepper and ginger.
It is advisable to steam, boil or stew food. But fried and smoked foods are not suitable for those who have problems with veins.

Large amounts of carbohydrates increase blood glucose levels. And this contributes to the appearance of foci of inflammation. Therefore it is advisable to limit confectionery and flour dishes.

Eat more raw vegetables and fruits, which normalize digestion and metabolism.

Prevention of thrombophlebitis

• wear shoes with medium heels;
• lead an active lifestyle, walk more;
• watch your weight;
• avoid dehydration and blood thickening;
• eat right, take a vitamin complex, especially in the spring;
• treat in a timely manner respiratory diseases and foci of purulent inflammation.