👩‍👩‍👧‍👦 😦 😞 Surgical treatment of thrombophlebitis of the lower extremities 🚎 👩🏻‍🔧 🧑🏽

Thrombophlebitis refers to a blood vessel disease. As a result of the pathology, inflammation of the venous walls occurs with the formation of blood clots in them. As a result, blood flow slows down or completely stops. Most often, inflammation of the superficial veins occurs, but damage to deep vessels is also possible. This disease is considered a complication of varicose veins and chronic venous insufficiency, when part of the affected vessel is closed by a blood clot. A serious pathology can go into a chronic form, progress and in the absence of therapy, which should be carried out in accordance with the standard for the treatment of thrombophlebitis of the lower extremities, provoke various complications.

Causes of the disease

Thrombophlebitis appears only in the case of the simultaneous action of the following three factors, and one of them is always expressed more strongly than others:

Damage to the walls of the vein. This occurs in connection with the careless actions of medical personnel during surgical operations, the introduction of concentrated drugs, when installing catheters.
Slow blood flow in a vein. This is facilitated by prolonged bed rest, squeezing the limbs (gypsum, tight dressing, trauma, heart failure).
Increased blood coagulation. It is congenital during normal functioning of the circulatory system. Acquired causes include infectious diseases with fever, metabolic disturbances, unsystematic use of hormonal contraceptives, liver diseases, and various malignant tumors.

How to recognize a disease?

There are two forms of the course of thrombophlebitis of the lower extremities:

Sharp. It develops quickly, unexpectedly for a person and for no apparent reason. In some cases, the disease appears after an injury, long-term contraceptive protection, but more often as a complication of varicose veins. With a satisfactory general condition, the following characteristic symptoms appear: pain that occurs along the vein, poor mobility of the limb, increasing redness of the skin, increased temperature in the area of the damaged dermis, compaction and pain on palpation of the vein.
Chronic This insidious disease for a long time may not manifest itself. However, at some point, the symptoms become like an acute form. After their relief, the disease goes into remission to a new exacerbation. The formed thrombus clogs the vessel, resulting in a violation of venous circulation, which provokes the appearance of ulcers. In addition, superficial veins expand to increase blood flow, which cannot pass through a damaged inner vessel. Hospitalization with this form of the disease is carried out only during the period of exacerbation. The rest of the time, the patient is observed by a phlebologist.

Veins affected by the disease differ from the dilated ones in that there is completely no redness, soreness, or fever. In addition, in a horizontal position, they decrease in volume, as blood begins to flow through deeper vessels.

Establishing diagnosis

The following examinations are performed to diagnose thrombophlebitis of the lower extremities :

Visual examination of the limbs - external symptoms of the disease are determined.
Phlebography is an X-ray examination of veins.
Blood tests - general (elevated ESR, fibrinogen and C-reactive peptide concentrations), coagulogram (increased blood coagulation), D-dimer (elevated rates in the acute form of the disease).
Ultrasound examination - determine the affected areas of tissue.
Phleboscintigraphy - blood flow is examined using a contrast medium.
Doppler ultrasound - determines the direction and speed of blood flow.
MRI and computed tomography are additional studies if there are doubts about the diagnosis.

With proper diagnosis and early detection of symptoms and causes of thrombophlebitis of the lower extremities, treatment will have a positive effect.

Therapy of superficial vein thrombosis

In this case, treatment of individual symptoms of the disease is indicated. Compresses with a warming effect are used. The patient is recommended to constantly wear compression stockings or bandaging the limbs with an elastic bandage. For oral administration, NSAIDs are prescribed. Ointments and gels are used to reduce inflammation and reduce pain. It is mandatory that aspirin is prescribed to thin the blood and prevent blood clots. Treatment of thrombophlebitis of the veins of the lower extremities with folk remedies is also possible. With localization of thrombophlebitis in the inguinal region, there is a possibility of its movement into the deep vein, since in this zone there is a union of those and other vessels. In this case, deep veins will have to be treated.

Drug treatment of deep vein thrombosis

With this therapy, drugs are used that reduce blood coagulability and prevent blood clots, called anticoagulants. Uncomplicated thrombosis is treated for about three months.

In case of complications, the course of treatment of thrombophlebitis of the lower extremities of the internal deep veins is set individually and it lasts longer. After surgery and various injuries to the patient, anticoagulants are contraindicated due to the high risk of bleeding. In such cases, another therapy is prescribed.

Drugs used to treat deep veins of the lower extremities

For therapy, the following drugs are prescribed:

Heparin ointment. It has an analgesic and anti-inflammatory effect, and also interferes with the formation of blood clots and does not complicate the process of blood coagulation. The ointment is rubbed into the damaged area or applied to a bandage and fixed. The course lasts two weeks.
Non-steroidal anti-inflammatory ointments "Indovazin", "Diclofenac", "Nurofen" anesthetize and inhibit inflammation.
The anticoagulants Streptokinase and Heparin inhibit blood coagulation, promote the dissolution of blood clots and cleanse blood vessels. Injection is done intravenously in a hospital under the supervision of a doctor.
Non-steroidal anti-inflammatory tablets for the treatment of thrombophlebitis of the lower extremities are Ortofen, Indomethacin, Butadion. They relieve inflammation and pain in deep tissues. Contraindicated in patients with gastric ulcer. The course of treatment is up to two weeks.
Angioprotectors "Doxy-Hem" and "Troxerutin" strengthen the walls of the veins, increase their tone and reduce the permeability of capillaries. With therapy, edema and inflammation are reduced. The course lasts for a week.

Treatment of acute thrombophlebitis of the deep veins of the lower extremities is carried out in the hospital due to the high probability of a thrombus detachment.

Physiotherapeutic procedures

For the treatment of thrombophlebitis, in addition to the main therapy, physiotherapeutic procedures are included to help accelerate recovery. To do this, apply:

Magnetotherapy. The impact of an alternating magnetic field on the affected surface of the limb for a third of an hour every day is manifested by a slight sense of warmth. The course of treatment is about 15 days. Penetrating deep into the tissue, the magnetic field relieves inflammation and severe pain. Treatment of thrombophlebitis of the lower extremities with this method can improve blood properties, reduce swelling.
Electrophoresis Medicines through the dermis (under the influence of electric current) are introduced into the body. As a result, blood clots begin to dissolve, inflammation is on the decline. The procedure lasts a quarter of an hour. Manipulation is carried out daily for two weeks.
Ultra High Frequency Therapy (UHF). Acting on the damaged area of the lower extremities, it reduces swelling, improves the resorption of the blood clot and the outflow of lymphatic fluid, and stops inflammation. The duration of treatment of thrombophlebitis of the lower extremities with a UHF device is ten minutes.
Paraffin baths. This procedure is especially often prescribed to patients who may develop trophic ulcers. It helps strengthen blood vessels, improves blood circulation in the limbs and metabolic processes in the dermis. In the acute course of the disease, paraffin is not used. The duration of the procedure is 30 minutes, the number of sessions is up to 20.
Hirudotherapy or leech treatment of thrombophlebitis of the lower extremities. During the bite, special substances are released into the patient’s blood, which reduce blood coagulation, eliminate vasospasms and increase blood flow.
In addition, the inflammation is removed, the pain goes away and metabolic processes are established. The procedure is recommended for the acute stage of the disease. Leeches are used only once, it is impossible to get infected through them from another patient. Such treatment with leeches of thrombophlebitis of the lower extremities is recommended for patients with poor tolerance of drugs that thin the blood.

Surgery

Surgery is performed through a small incision, the length of which is about a centimeter. The operation is considered to be less traumatic and is carried out using X-ray television. Surgical treatment is indicated in the following cases:

progressive thrombophlebitis;
acute thrombosis;
threat of pulmonary embolism;
separation of a blood clot and its movement to the zone of connection of superficial and deep veins.

The operation is performed when the patient cannot undergo medication due to allergic reactions or has contraindications to the use of necessary drugs. In such cases, the prognosis and treatment of symptoms of thrombophlebitis of the lower extremities by the surgical method is the most favorable. In addition, there are a number of contraindications to such treatment, these include:

advanced stage of the disease;
complex heart ailments;
inflammatory diseases of the legs (eczema, erysipelas);
pregnancy;
old age.

The operation is performed under spinal anesthesia, its duration is about three hours. In the postoperative period, the patient is in the hospital for up to five days.

Types of Surgery

In practice, different types of surgical treatment are used, these include:

Stitching of the inferior vena cava. Such surgical treatment of thrombophlebitis of the lower extremities is indicated for several blood clots in the deep veins, the repeated formation of clots that cannot be removed by a catheter. The vein is stitched and a special clamp is applied so that there are narrow gaps through which blood can pass without passing clots. As a result of this operation, blood flow in a vein worsens.
Installing a metal cava filter. The operation is carried out as a preventive measure to prevent thromboembolism, when the patient has a large blood clot, and he does not tolerate anticoagulant therapy. A filter is inserted into the inferior vena cava, which passes blood, but does not allow blood clots to pass.
Endovascular catheter thrombectomy. Such treatment of thrombophlebitis of the lower extremities is used after ineffective drug therapy, with oncology and an increased risk of thromboembolism. For this, a catheter is inserted into a vein, with the help of which a clot is removed or crushed. After the operation, normal blood flow is restored, but relapses are possible.

Sometimes it is necessary to combine the types of operations or remove part of the damaged vein. The surgeon's actions depend on the results of the examination, the location of the thrombus and the state of the veins. In the postoperative period, it is recommended to wear compression stockings to avoid relapse.

Treatment of thrombophlebitis of the lower extremities and trophic ulcer

The appearance of trophic ulcers indicates a prolonged violation of the blood flow. This spoils not only the aesthetic appearance of the legs (which is why women especially suffer), but also the general condition of a person worsens. Ulcers are difficult to treat, they often get an infection. They cause discomfort and a lot of complexes, require careful care, and sometimes surgical treatment. A trophic ulcer is not an independent disease. It occurs due to chronic venous insufficiency at the site of thrombophlebitis. Before the formation of the ulcer, edema appears, the skin turns red and itches severely. The patient combs the skin, a liquid appears. Most often, wounds occur on the foot or lower leg. They can be single and multiple, of different shapes and sizes. An ulcer is a purulent wound with tight edges, from which an unpleasant odor appears and oozing fluid. Treatment of ulcers with thrombophlebitis of the lower extremities is carried out in a hospital. After the diagnosis, the doctor prescribes a comprehensive treatment of both the underlying disease that provoked the ulcer and its consequences. To do this, use:

Elastic compression. This is a simple and effective method. Bandage the affected limb with an elastic bandage and put on compression underwear.
Drug treatment. Prescribed medications that prevent blood clots and can thin the blood. Treatment is with fibrinolytics, which help dissolve blood clots, which are the main cause of ulcers. Local antibiotics are used to disinfect wounds, and vitamins of groups B and A are used to heal them.
Ozone therapy. This procedure in the treatment of thrombophlebitis of the lower extremities cleanses the wounds from purulent discharge, destroys bacteria and promotes healing. Ozone is used both for external use, and injected with saline into a vein.
Massage and physiotherapy. For this, lymphatic drainage massage is performed. It enhances blood circulation, speeds up metabolism, reduces swelling, trains venous valves, accelerates the absorption of blood clots. In physiotherapy, the properties of electric current and magnetic radiation are used to treat. Such procedures are often prescribed for the chronic course of the disease and during the recovery period.
Local treatment. Ointments with anti-inflammatory, antibacterial and healing effects are applied to the surface of trophic ulcers. Wounds are washed with a solution of furatsilina, decoctions of herbs, treated with hydrogen peroxide. Use "Vishnevsky Ointment" to cleanse the wound, "Iruksol" - for healing, "Troxevasin" and "Troxerutin" - to restore blood circulation, "Levomikol" - to disinfect ulcers.
Diet and treatment of thrombophlebitis of the lower extremities. It is recommended to eat more plant foods, limit the intake of fatty foods, often eat garlic, onions, olive oil, pumpkin, melon, dill, citrus fruits, vegetables and red fruits. They thin the blood.
Surgical intervention. After using all of the above treatment methods, but without achieving the desired result, an operation is prescribed. As a result, the blood clot is removed and rehabilitation therapy is performed.

Treatment of thrombophlebitis of the lower extremities during pregnancy

During the bearing of a child, the risk of developing the disease increases due to changes in the venous system due to:

increase in circulating blood volume ;
hormonal changes;
weight gain;
decrease in physical activity;
uterine growth.

In addition, the risk of thrombosis increases if the following factors are present:

age over 35 years;
venous insufficiency before pregnancy;
not the first pregnancy;
lung, heart disease, or arthritis;
prolonged toxicosis;
multiple pregnancy;
infectious diseases.

Thrombophlebitis does not affect the development of the fetus and the birth of a child, but can have a negative effect on the health of the mother. The day before birth, you must stop taking all medications that thin the blood. And during labor and in the postpartum period, use elastic bandages, do special exercises to prevent thrombophlebitis. The manifestation of symptoms and diagnosis of the disease in pregnant women are no different from those described above. For the treatment of women, drugs approved for use in pregnant women are used. Other drugs are prescribed, assessing all the risks for the unborn baby and the benefits for the mother. With the right selection of medicines and the necessary procedures, the prognosis and treatment of symptoms of thrombophlebitis of the lower extremities will be favorable. A woman will safely give birth to a baby and preserve the health of the child and herself.

Thrombophlebitis prophylaxis

Its purpose is to prevent the disease and to avoid its consequences. Particular attention should be paid to people at risk, that is, pregnant women with varicose veins, overweight and those who lead a sedentary lifestyle. To prevent the disease should:

Temper the body. For this it is possible to use a contrast shower, rubbing with cold water, swimming, walking barefoot. All this will help strengthen the walls of blood vessels, increase immunity.
Create yourself moderate physical activity.With an inactive lifestyle, it is necessary to perform physical exercises daily, giving them at least half an hour of time. The treatment of thrombophlebitis of the lower extremities will be helped by stroking, starting from the feet, exercises “bicycle” and “scissors”, rotation of the feet, lifting on toes.
Wear compression hosiery. These are special tights, stockings or tights for women and men, used to improve blood flow in the veins. Put them on immediately after sleep, lying in bed. Lingerie must be selected strictly in size.
Timely treat diseases preceding thrombophlebitis: varicose veins, trophic ulcers, acute respiratory infections, influenza, caries. Pay attention to dehydration, blood coagulation.
Balance nutrition. Treatment of thrombophlebitis of the lower extremities and diet are interconnected. You should drink fluids up to two liters per day, eat fruits, vegetables, meat, fish. Additionally, use vitamin complexes, including trace elements. All this will help strengthen the venous system of the legs and reduce blood clots.
Constantly monitor body weight.
To refuse from bad habits.

Whenever possible, avoid situations where you need to be in a standing or sitting position for a long time. With the appearance of dilated veins on the legs, do not visit the sauna and for a long time do not be in the sun. After a working day, a bath with the addition of sea salt will help relieve fatigue and heaviness in the legs. The main thing is not to forget that the person himself is responsible for the state of his health.

Surgical treatment of thrombophlebitis of the lower extremities