Deep vein thrombosis of the lower extremities
Thrombosis is the formation of a dense blood clot in the lumen of the venous circulatory system. The formed thrombus disrupts the blood supply to various parts of the human body, changes the size and structure of the vessel. Most often, the disease is asymptomatic, only in 20% of cases pain and limitation of the range of motion can be noted.
A disorder of the cardiovascular system or problems with blood clotting can lead to the disease. Due to the thrombosis of the vessels, their patency deteriorates, blood flow is impeded, which leads to malaise in the patient and discomfort in the arms or legs (depending on the location of the lesion). If thrombosis is left untreated, the vessel can be completely blocked, which will cause serious consequences.
ICD code: according to the international classification of diseases 10 revision (ICD-10), this disease has a code of 180. It belongs to the interval 110-199 (Diseases of the circulatory system), which includes the interval 180-189 (Diseases of the veins, lymphatic vessels and lymphatic knots, not elsewhere classified).
Content:
- The first signs of venous thrombosis of the lower extremities
- Other symptoms of lower limb thrombosis
- Thrombosis reasons
- What is the danger of thrombosis?
- Thrombosis diagnostics
- Treatment of thrombosis of the lower extremities
- 5 foods prohibited for thrombosis
The first signs of venous thrombosis of the lower extremities
The formation of blood clots is characterized by the Virchow triad, the most common theory describing the mechanism of the development of pathology.
The structure of the process of blood clots:
- Alteration, or damage, of the venous wall. With stretching, compression, traumatic rupture of the vein endothelium, the prerequisites for thrombus formation are created.
- Increased blood clotting. The production of thrombin, tissue thromboplastin, which increase blood clotting, into the bloodstream of the blood vessel, leads to adhesion of platelets.
- Violation of the dynamics of blood flow. A sedentary lifestyle, prolonged bed rest, the presence of atherosclerotic plaques in the vessels disrupts the optimal conditions for the movement of blood through the blood vessels. No less than immobility, a "vortex" flow of blood is dangerous.
Other symptoms of lower limb thrombosis
Thrombosis, as a rule, manifests itself unexpectedly for the patient with sharp pain in the affected limb. Sometimes this process is accompanied by a feeling of heaviness and swelling. It seems to a person that something is bursting with a leg from the inside.
The external manifestations of thrombosis depend on how deep the vein is located and how much it is thrombosed. If the blood clot is in the iliac or femoral vein, then the swelling spreads to the entire leg, the skin turns blue and seems cold. Due to the fact that the outflow of blood through the main veins worsens, it is redistributed into the subcutaneous vessels, as a result of which their mesh becomes clearly visible, sometimes the veins on the abdomen expand. In this case, the person's condition deteriorates sharply, the temperature rises, chills appear, and weakness is felt.
In the case when small veins are thrombosed, it is quite difficult to detect the disease, since in this case the symptoms are almost not manifested. The only thing that can be guided in such a situation is the patient's subjective sensations of pain while walking.
The main manifestations of the disease:
- Heaviness in the legs, felt most strongly in the evening;
- Swelling, an increase in the volume of the lower leg;
- Pressing, bursting pains, intensely expressed in the evening;
- Numbness, "goose bumps" in the lower leg;
- Local or general hyperthermia with inflammation of the vessel;
- The skin is pale, bluish, thinned.
Visually, the doctor detects a decrease in the sensitivity of the lower leg, overflow of superficial veins, and an increase in the vascular pattern. With thrombosis, the affected limb has a lower temperature than the healthy leg.
Video about risk factors for thrombosis, reasons for the separation of thrombi, measures to prevent thrombosis:
Many are afraid of getting into a car accident, but few are afraid of becoming a victim of thromboembolism - the separation of a blood clot and clogging up important arteries of the human body. This comes from ignorance, since people know little about the causes of blood clots and their migration through the body, the visual symptoms of a blood clot in a vein.
Thrombosis reasons
It's no secret that with age, structural changes occur in the human body in general and in the circulatory system in particular - the tone of the vessel wall decreases, it becomes less elastic. Age-related changes also affect the characteristics of the blood, increasing its coagulability. In addition, in old age, people move little, which also has a negative effect on the patient's condition.
Movement is very important for all body systems. Studies show that even in healthy people, blood flow in the deep veins at rest is very weak. If a person is in a sitting position all the time, he risks greatly aggravating his condition. This happens because the outflow of blood is disturbed in a sitting position, and the constant holding of the legs in a bent state can lead to bending of the popliteal vein.
This problem is relevant both for retirees who sit for hours at the TV, and for healthy young people who have to sit for a long time due to the nature of their work. This category includes office workers, truck drivers, and people who often have to endure long flights.
Immobilization of patients in the postoperative period can also contribute to the appearance of thrombosis. The operation itself is a factor that increases the risk of thrombus formation, since during it general anesthesia is applied with the use of muscle relaxants. In addition, in this case, most likely, the patient has some kind of severe pathology, since he needed an operation.
The risk of thrombosis as a complication after surgery is greatly increased in people who are overweight and in pregnant women. The factors leading to thrombosis of the veins in the latter also include complicated labor, the presence of injuries to the extremities and pelvis, and prolonged bed rest.
In addition to all of the above reasons, the causes of thrombosis can be cancer, kidney disease and vascular compression.
The following diseases and conditions become the main risk factors for the formation of thrombosis:
- Hormonal imbalance. It can be caused by pregnancy, the effects of hormone therapy, disruption of the functioning of the endocrine system. Women who have high levels of estrogen and progesterone are at highest risk.
- Heredity, congenital vascular pathologies. This is the weakness of the venous walls, impaired functionality of the venous valves, varicose veins, fistulas between the veins and arteries, through which blood from the arteries is thrown into the veins.
- Tumors. Thickening of blood and an increase in its coagulability may be a consequence of tumor processes.
- Surgery, trauma and fractures with bleeding. Thrombotic alertness is caused by increased formation of thromboplastin after operations and injuries, leading to thickening of the blood.
- Paresis and paralysis. Violation of the innervation of the extremities, muscle atrophy due to immobility slows down and disrupts functional blood flow, which provokes thrombus formation.
- Excess of normal body weight. Leptin, which is abundant in obesity, increases platelet adhesion (adhesion) and lowers the blood clotting threshold.
- Severe infections transferred in severe form. Extensive burns, pneumonia, sepsis, purulent processes with the formation of a large number of platelets are accompanied by the formation of a large amount of toxins. These waste products of pathogenic microbes stimulate the formation of a large number of thrombotic masses.
These processes are facilitated by a sedentary lifestyle, excessive physical overload, alcohol consumption, smoking, old age.
What is the danger of thrombosis?
According to medical statistics, about 25% of the adult population has a history of thrombosis. This pathology is unevenly distributed according to gender - in men, thrombosis is diagnosed several times less often than in women. The development of thrombosis is facilitated by excess of normal weight, side effects of uncontrolled medication, and disturbed ecology.
Thrombosis can be fatal!
Very often the venous network of the lower extremities suffers from this disease. It consists of superficial and deep veins. Anything that happens to deep veins is not easy to notice without special examinations, unlike superficial vein pathologies. This is one of the dangers of thrombosis.
It takes 3-5 days for a blood clot to form in a deep vein. Since it is loosely attached to the venous wall, the blood clot is able to break off and, moving along the circulatory system, cause blockage of any part of it.
Thrombosis diagnostics
The most informative method for diagnosing deep vein thrombosis of the lower extremities is phlebography, or X-ray examination of blood vessels with contrast.
What can be seen on the phlebogram:
- Blood clots in the form of uncolored formations soldered to the walls of the vein;
- A significant decrease in the lumen of the vessel;
- A fragmentary image of a contrast agent at the site of the lesion (the vein seems to be "chopped off");
- A significant amount of cholesterol plaques in the form of roughness inside the vein.
An extremely reliable diagnostic method is ultrasound with dopplerography. This study is based on the effect of the reflection of ultrasonic waves from blood cells. Assessing the movement of blood, ultrasound with Doppler ultrasound measures the volume of blood flow, the speed of blood movement, the difference in these parameters on both limbs.
The doctor can perform functional tests with high informational significance to clarify the diagnosis.
Functional test method:
- Homans symptom. The patient lies on his back, his legs are bent at the knees. The doctor flexes his foot. If pain and discomfort develops in the calf muscle, there may be a blood clot in the limb.
- Moses' test. At the first stage, the lower leg is squeezed from front to back, at the second stage it is squeezed laterally. In the presence of thrombosis, pain will be felt at the first stage of diagnosis.
- Lowenberg test. A sphygmomanometer cuff is applied to the middle part of the lower leg. If you increase the pressure in it to 150 mm Hg. Art., with thrombosis, pain may appear in the lower leg.
- Lisker's sign. If you tap the surface of the tibial crest, thrombosis may cause pain in the front of the tibia.
- Louvel's sign. When coughing, sneezing, bone pain appears or increases.
- Marching test. The patient is asked to walk for a short time, having previously applied an elastic bandage to the entire leg. If, after removing the bandage, pain occurs and the expansion of the saphenous veins is noticeable, thrombosis should be diagnosed.
- Pratt test - 1. In the supine position, the patient's leg circumference is measured, then the leg is raised, with the help of manual massage the superficial veins are emptied and an elastic bandage is applied. Then the patient walks for several minutes, the bandage is removed, the circumference of the lower leg is measured. If it is increased, pain and discomfort appear, the presence of thrombosis is confirmed.
- Mayo-Pratt test. The patient lies on a flat surface, a roller is placed under his legs. After manually massaging the leg to drain the veins, a tourniquet is applied to the upper thigh. The patient walks for half an hour. If there is a pronounced pain and a feeling of fullness in the lower leg, the diagnosis is "thrombosis".
Additional diagnostic methods - sphygmography, measuring the temperature of the extremities, methods of radioisotope exposure.
Treatment of thrombosis of the lower extremities
Thrombosis treatment depends on the degree of its neglect. With a mild stage of the disease, treatment is carried out medically with the use of drugs that thin the blood. This improves its flow through the veins and helps to avoid blood clots.
The problem is that these drugs cannot cope with chronic blood clots, so in case of a severe form of the disease, surgery is necessary. The problem cannot be ignored, since over time, the disease can lead to serious undesirable consequences.
In any case, regardless of the stage of the disease, the decision on the need for surgery or drug treatment should be made by a vascular surgeon. He also determines the duration of treatment and the required dosage of drugs.
For the treatment of the disease, conservative and surgical methods of treatment are used.
Groups of drugs used for drug treatment:
- Direct-acting anticoagulants (Heparin, Clexan, Fraxiparin) - reduce blood density by increasing the production of antithrombin.
- Indirect anticoagulants (Warfarin, Coumadin) - suppress the formation of prothrombin, preventing the production of thrombin. May cause massive bleeding.
- Drugs to improve blood microcirculation (Reosorbilact, Reopolyglucin) - reduce blood viscosity, the risk of blood clots. Are introduced drip.
- Anti-inflammatory drugs (Aspirin, Indomethacin, Voltaren) - reduce pain, relieve inflammation and swelling, thin the blood. They are administered orally and drip.
- Enzymatic substances for thrombolytic therapy - promote the dissolution of blood clots, reduce blood clotting.
Thrombolytic therapy
Thrombolytic drugs are used to dissolve blood clots, which solve serious problems in patients with thrombosis. The choice of drugs, the calculation of the dosage and the frequency of drug administration is carried out by the doctor. Thrombolysis is performed in a hospital by drip injection of the following drugs:
- Streptokinase,
- Urokinase,
- Alteplaza,
- Anistreplaza,
- plasminogen activators.
Thrombolytics have a lot of contraindications and complications, the main of which is the high probability of bleeding. Such treatment is contraindicated in high blood pressure, gastrointestinal diseases, diabetes mellitus, tuberculosis, falls, injuries, bruises.
Preparations for thrombolytic therapy are not always combined with aspirin, anticoagulants, cephalosporins, and anticonvulsants.
Surgery
Indications for surgery:
- The risk of a thrombus rupture and a high risk of pulmonary embolism (PE);
- Thrombophlebitis;
- Pronounced thrombotic process;
- Flotation of a thrombus that is not attached to the venous wall.
The operation is not performed in the acute phase of the disease, in the presence of pathologies of the heart and respiratory system, during an acute infectious process.
The main methods of treating venous thrombosis of the lower extremities:
- Thrombectomy. Collateral removal of a thrombus formed at least 7 days ago, restoration of optimal blood flow.
- Troyanov-Trendelenburg operation. Isolation of the great saphenous vein through the inguinal incision, suturing it to fix the floating thrombus.
- Installation of filters. Sewing an umbrella-shaped filter into the cavity of the inferior vena cava to prevent a thrombus from entering important blood vessels and preventing their spread through the bloodstream.
5 foods prohibited for thrombosis
To reduce excess weight, the patient will have to adjust his diet, introduce fortified foods into it. The menu should be rich in fruits and vegetables. To strengthen the walls of blood vessels, the diet includes cabbage, rose hips, sorrel, watermelon, dill. Seafood containing copper increases the elasticity of the veins.
Prohibited foods with a high risk of blood clots:
- Alcohol, which negatively affects the production of proteins by the liver;
- Chocolate, coffee, extractives of which activate the sympathetic-adrenal system;
- Apples, cabbage, black bread, leading to increased gas formation and difficulty in the outflow of blood from the lower extremities;
- Lettuce, spinach, beef liver, which contains a large amount of vitamin K, with the participation of which blood clots form;
- Mayonnaise, fatty foods, smoked meats, animal fats that are difficult to digest and for the liver.
Deep Vein Thrombosis Nutrition Video:
The video contains a description of the products that are prohibited with an increased risk of blood clots. The purpose of nutritional therapy: preventing the risk of a new blood clot formation, accelerating the resorption of the formed blood clot. Avoiding prohibited foods will increase the likelihood of improving your well-being.
To prevent blood clots, you should walk more, optimize your motor regime, and practice long walks. Dousing with cool water will reduce the risk of developing vascular pathologies. It is very important to completely stop smoking and drinking alcohol.
When the first signs of varicose veins appear, you need to consult a doctor, carefully follow his recommendations. Such a tactic will slow down the progression of the disease and reduce the risk of complications.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
