The circulatory system of the upper extremities is a complex “structure” that deals with the transfer of blood from other vessels. Therefore, subclavian vein thrombosis dramatically changes the movement of blood along the entire arm.
The essence and causes
The causes of subclavian vein thrombosis are the following factors:
- random movement of blood or its significant slowdown;
- impaired blood coagulability (under the influence of any factors due to diseases of a genetic and hereditary nature);
- the subclavian vein can be pinched by a large and abnormally formed bone growth that can occur as a result of a clavicular fracture or the appearance of an uncharacteristic cervical rib.
Thrombosis of the subclavian vein only in rare cases can be the result of a thrombus formed in other parts of the body. This phenomenon is associated with the organization of the human circulatory system. Thrombosis of the upper extremities occurs as a result of the detachment of a thrombus in the heart muscle. In most cases, subclavian vein thrombosis does not manifest itself in any way if the process is slow.
Symptomatology
Thrombosis of the subclavian vein occurs as a result of excessive physical activities and loads. This factor plays a major role in the formation of a blood clot. In some cases, a blood clot can come off regardless of the degree of physical activity, but this happens in very rare cases. Clogging of the subclavian vein has either increasing or disappearing symptoms, manifested by influxes. There are no serious consequences from thrombosis, because blood circulation is replaced by other vessels. However, this blood is not enough to fully support the tissues of the upper extremities. In ICD-10, subclavian vein thrombosis has the code I82.8.
The main clinical picture
The main symptoms of subclavian vein thrombosis are as follows:
- pain in the arm;
- a rather bright vein pattern is visible through the skin;
- severe swelling of the hand on which a glossy gloss appears;
- signs of a neurological disorder: numbness of the limb, twitching, etc.
Other symptoms of pathology
The appearance of a venous pattern on the arm is difficult not to notice, especially for white-skinned people. The diameter of the veins will depend on the size of the thrombus and the increase in hypertension of the thrombus.
The pain process is usually observed during physical exertion. The pain may be present constantly, throbbing, "bursting", but in all cases it is quite intense. Basically, pain is felt throughout the arm, in the shoulder and collarbone, and in some cases also from above the chest and back.
Puffiness occurs on the entire arm completely. If you press on the edematous region, the fossa in this place does not remain. The hand acquires an unusual weight and hardness. If the edema process has been going on for quite some time, blood circulation is disturbed and becomes reactive, as a result of which subclavian vein thrombosis only intensifies.
Neurological disorder manifests itself in different ways. In many, the fingers of the limbs twitch, they feel a tingling sensation, a burning sensation. The affected limb may be limited in movement.
If acute subclavian vein thrombosis becomes chronic, the clinical picture of the disease becomes blurred and less pronounced. Swelling and vein pattern almost disappear. Most often, there remains a low reaction of the damaged limb to external stimuli, restrictions on physical activity, muscle atrophy and soreness with serious physical exertion. In some cases, disability is prescribed for thrombosis of the subclavian vein.
Diagnostic measures
Diagnostic actions begin with a medical history - that is, the doctor should question the patient in detail about the symptoms that disturb him and about when and what types of physical activity could lead to such consequences. This is necessary in order to find out how long the process of thrombosis has been taking place.
To diagnose chronic or acute subclavian vein thrombosis, they resort to the following diagnostic methods:
- X-ray and magnetic resonance imaging to determine the cause of the pathology and identify the location of the thrombus;
- duplex scan of the subclavian vein;
- assessment of blood circulation in an injured vein - dopplerography;
- contrast x-ray;
- ultrasound examination (ultrasound) of deep veins;
- venography;
- computed tomography (CT) of the shoulder girdle.
Treatment
If the disease is the result of a catheter, then it must be removed. If the vessels are slightly clogged, then resort to local therapy. The limb should be in the so-called functional rest, moreover, no elastic bandages and full bed rest are needed here. In horizontal position, the hand must be raised slightly above the heart, and in vertical position it should be suspended by bending at the elbow, using a bandage or scarf. With local treatment, such drugs are used:
- alcohol-based compresses (about 50%);
- "Hepatrombin", "Liotongel" - ointments, which contain heparin;
- gel ointments with troxevasin and rutoside in the composition;
- non-steroidal anti-inflammatory drugs, for example, Indomethacin Ointment, Indovazin, Diclofenac.
A little more about drug treatment
If the pathology becomes acute and is accompanied by extremely painful symptoms, then the patient is placed in a hospital. There, treatment consists of the following medicines:
- fibrinolytic drugs - “Fibrinolysin”, “Streptokinase”, “Urokinase”, etc .;
- antiplatelet agents;
- angioprotectors;
- medicines against blood coagulation (the first few days it can be “Heparin” and “Fibrinolysin”, and then “Fenilin”, “Sinkumar”, “Fraksiparin” are used);
- non-steroidal anti-inflammatory drugs.
The main task of treating subclavian vein thrombosis with medication is to restore impaired circulation in the subclavian vein,
To summarize, drug treatment boils down to two types of drugs:
- antithrombotic drugs that help to destroy a blood clot and prevent the appearance of new ones (these include “Heparin”);
- drugs that improve the metabolism of the walls of the veins, painkillers and anti-inflammatory drugs.
When is surgery scheduled?
Usually, drug therapy lasts from one to several months. If during this period the blood clot did not resolve, then you have to resort to surgical intervention. If subclavian vein thrombosis (left or right) lasts too long, tissue necrosis of the upper limb may occur. In this situation, an operation is also prescribed during which it is necessary to remove tissues that have died out.
To remove a blood clot, a special device called a laparoscope is used. He passes into a vein, grabs a blood clot and pulls it out. For this purpose, a small incision is made in the armpit area, which allows you to get to the subclavian vein, a puncture is also made in it - a laparoscope passes into it. With minor injury to the vascular walls, a special catheter is inserted there. In some cases, a special shunt is inserted into the affected area of the vein.
It is also important to note that if the patient has a sensation of warmth, sharp pain, a tumor is present, and the process of redness or bluishness of the shoulder, it is urgent to connect a new course of treatment. All of these symptoms may indicate pulmonary embolism. If a patient is diagnosed with a stomach ulcer or gastritis, he is prescribed suppositories. Also, the familiar Aspirin is excluded from the course of treatment; instead, it is necessary to choose drugs of the same property, but soluble in the intestine. To avoid relapses and repeated exacerbations, antihistamines are used as a prophylactic.
The severity of the venous outflow and the intensity of the characteristic symptoms and signs of the disease are affected by the severity of the pathology of the main veins, the formation of blood clots and the formation of bypass circulatory pathways. If the patient has idiopathic thrombosis, then in most cases he will need a special course of treatment for life.
Surgical intervention
If blood circulation through the veins is seriously impaired, and subclavian vein thrombosis has become chronic, then the following two types of surgical intervention are resorted to.
To restore the outflow of venous blood. This operation involves several steps:
- removal of the thrombus itself, i.e. thromboectomy or recanalization;
- venous plastic: transplantation of a section of a vein or bypass surgery;
- phlebolysis, that is, the allocation of a vessel from the nearest scar tissue, and scalenotomy, that is, the absolute intersection of the muscles that surround the bundle of vessels and nerves, or even the removal of sections of individual ligaments and muscles.
To improve the outflow of venous blood. This also includes several steps:
- removal of mechanical obstruction, in particular bone growths;
- effects on the sympathetic nervous system, for example, perivenous sympathectomy.
If the clinical picture is pronounced and the patient feels extremely painful symptoms, then surgery can be prescribed about 3-4 days after the pain and swelling decrease slightly, but before blood clots occur and attach to the vein wall. Typically, blood circulation is restored after a trobectomy. But the result of this procedure is far from always predictable. Quite often, thrombosis occurs repeatedly, and the vein in the area where the surgery occurred, becomes already laid. Once the thrombus has been removed, it is necessary to eliminate those factors that can cause injury to the subclavian vein. For this purpose, the central section of the subclavian muscle, clavicle or process of the first rib is removed, the costal-coracoid ligament and the anterior scalene muscle are excised.
Arm bypass and amputation
If it is impossible to make a thrombectomy, and in the case of the disease becoming chronic, after the deformed section of the main vein is removed, it is plastic or resorted to bypass surgery. A shunt, that is, a workaround, can be a section of the jugular vein or large saphenous. If the disease is completely untreatable, then the arm has to be amputated.
Preventive measures against thrombosis
Subclavian vein thrombosis is a problem that no one is safe from, it can occur in the life of every person. However, factors that may affect the development of this disease can be excluded. There is a risk of subclavian vein thrombosis due to an abscess, which must be addressed in a timely manner. In many other cases, it is almost impossible to avoid the disease. But there are some recommendations that can significantly reduce the risk of blood clots. Such measures include daily exercise and physical activity, regular walks in the fresh air, a balanced diet and the treatment of all diseases in a timely manner.
Prevention of folk remedies
To strengthen the vascular walls and maintain the normal functioning of blood circulation, it is advised to regularly drink tinctures from St. John's wort, cranberries or rose hips. And most importantly, as a prophylaxis, it is worth visiting a doctor at the first painful manifestations in the upper extremities, since thrombosis in the initial stages is treated much faster and easier than in the advanced stage. It is better to prevent the development of the disease in time than to deal with its consequences later. If you want to know about subclavian vein thrombosis in the ICD, then this disease has the code I82.8.