Ileofemoral thrombosis
Ileofemoral thrombosis is a blockage of the deep femoral and iliac veins by a blood clot. The disease has been identified as a separate nosological form, since it has a severe course and poses a direct threat to human life. Ileofemoral thrombosis is often complicated by pulmonary embolism. Therefore, if signs of pathology are detected, the patient should be provided with emergency medical care.
3-4 times more often the left limb suffers from ileofemoral thrombosis than the right one.
Content:
- Causes of ileofemoral thrombosis
- Ileofemoral thrombosis symptoms
- Diagnostics
- Treatment of ileofemoral thrombosis
- Prevention of ileofemoral thrombosis
Causes of ileofemoral thrombosis
The causes of ileofemoral thrombosis can be varied, among them are:
- Injuries to the veins and soft tissues of the lower extremities.
- The introduction of a bacterial infection into the body.
- Prolonged bed rest, for example, after an operation or against the background of a serious illness.
- The period after the birth of the child.
- DIC syndrome.
- The presence of a malignant tumor in the body. A particular danger in terms of the development of thrombosis are neoplasms located in the pelvic area: cancer of the sigmoid colon, kidneys, adrenal glands, cervix, as well as retroperitoneal sarcoma.
- Aneurysm of the abdominal aorta, femoral or iliac arteries.
- The presence of a popliteal cystic neoplasm.
- Pregnancy.
- Any purulent processes that are localized in the pelvic region, in its cellular spaces and organs.
- Iatrogenic lesion of the veins.
- Retroperitoneal fibrosis.
Most often, ileofemoral thrombosis is an ascending pathology that originates in the popliteal or femoral segment.
Ileofemoral thrombosis symptoms
The course of the disease is divided into two phases: prodromal and acute (stage of severe symptoms).
The prodromal stage is characterized by the following symptoms:
- An increase in body temperature to subfebrile levels.
- Pain in the sacrum and lower back, in the lower abdomen, in the legs. Particularly severe pain will be from the affected vessel.
- The pains arise unexpectedly for a person, they are dull and aching in nature.
- Sometimes pain occurs only while walking.
The acute stage of the disease is expressed by the following symptoms:
- Increase in body temperature to febrile values.
- Increased pain that becomes very intense, covering the groin area, thigh and calf muscle.
- The appearance of a feeling of heaviness in the limbs. Patients indicate that their leg is bursting from the inside.
- The onset of edema that spreads throughout the leg, from the foot to the groin fold. Swelling of the buttocks is possible.
- The edematous tissues exert strong pressure on the vessels, resulting in their spasm. This is expressed in an acute malnutrition of the lower limb, in sharp pains, deterioration in sensitivity.
-
The skin changes its color. Sometimes there is a pronounced pallor of the lower extremities (white pain phlegmas), and sometimes cyanosis (blue pain phlegmas) occurs. White phlegmas is a consequence of arterial spasm, and blue phlegmas develops when blood flow in the femoral and iliac veins is completely blocked.
- In the groin, the veins begin to show through the skin strongly, and the vascular pattern increases.
- The general condition of the patient deteriorates significantly when serious complications develop: thrombosis of the inferior vena cava, pulmonary embolism, venous gangrene, phlegmas.
- The posterior muscles of the limbs are painful when palpated. Painful infiltrates can be found in the immediate vicinity of the great vessels.
- The lymph nodes in the groin become enlarged and painful.
- A person cannot make active movements of the lower limb. Passive movements cause pain.
Separately, it should be noted that pallidum phlegmas is an extremely serious complication of ileofemoral thrombosis. It often ends in the death of the patient. Against the background of persistent arterial spasm, collapse develops with partial or complete loss of consciousness, a sharp drop in pressure, and an increase in body temperature up to 40 ° C. The size of the leg increases by 2 times, the skin is cold to the touch, the pulse on the legs is not palpable.
If it is possible to save the patient's life, then the consequences of white phlegmasia will bother him for a long time. This is expressed in dystrophy of the muscle fibers of the lower extremities, which develops against the background of prolonged edema. The joints lose their former mobility, active leg movements will be sharply limited.
Blue phlegmas is characterized by complete blockage of all main and auxiliary venous lines of the thigh and lower leg. The leg increases in size by 2 times, the skin acquires a bluish tint, becomes covered with subcutaneous hemorrhages, the muscles are tense. At the same time, the body temperature rises to 40 ° C, it is possible to develop shock with shortness of breath, tachycardia and loss of consciousness.
If the patient is saved, then after 2-3 days the tissues of the legs begin to undergo necrosis, bubbles with liquid appear on it, and there is no sensitivity at all. In the future, symptoms of hemolytic jaundice join. On days 4-7, the tissues of the fingers are exposed to necrosis, and then the patient develops gangrene of the foot. During this period, about 45% of all case histories are fatal.
Diagnostics
Diagnosis of the disease begins with the examination of the patient. According to the characteristic set of symptoms, the doctor will be able to suspect ileofemoral thrombosis.
The following instrumental techniques are used to confirm the diagnosis:
- Duplex or triplex scanning.
- X-ray contrast phlebography.
- Radionuclide phlebography.
- Scanning with labeled fibrinogen.
It is imperative to distinguish between ileofemoral thrombosis with erysipelas, renal and heart failure, radiculitis, arthritis, bursitis.
Treatment of ileofemoral thrombosis
Without exception, all patients with an established diagnosis of ileofemoral thrombosis are hospitalized without fail in an angiosurgical hospital. It is necessary to transport the patient in a supine position. Until medical assistance is provided, he must adhere to the strictest bed rest. If it is not possible to perform a qualitative examination of the victim, then he is prescribed anticoagulants, fibrinolytics and thrombolytics for up to 10 days.
General recommendations for the management of patients with acute ileofemoral thrombosis:
- Anticoagulant drugs: low molecular weight Heparin, Logiparin, Fraxiparin.
- Elimination of pain, removal of the patient from shock.
- Removal of spasm from blood vessels, normalization of hemodynamics.
- Thrombolysis drugs: Streptokinase or Urokinase. However, it should be remembered that the use of thrombolytic drugs is always associated with the risk of bleeding and death of the patient. Therefore, thrombolysis drugs are prescribed only to patients under the age of 50, who have acute thrombosis no later than 7 days before going to the doctor. At the same time, cava filters should be installed in patients, otherwise there is a high probability of the spread of small particles of the thrombus through the bloodstream and the development of pulmonary embolism.
- Fibrinolysis activators: Complamin, Theonikol, Nicotinic acid (intravenous), Pyrogenal (intramuscular).
- Normalization of rheological parameters of blood is carried out using the drugs Trental, Euphyllin, Actovegin, etc.
- If inflammation develops, then antibiotics are indicated.
Operation for ileofemoral thrombosis is prescribed only for vital indications: if the patient is diagnosed with floating thrombi, which pose a threat of pulmonary embolism, or with the development of complications of thrombosis. These include: embologenous thrombosis, high risk of gangrene on the background of blue phlegmasia, ascending thrombosis.
There are also relative indications for surgery, including:
- Lack of effect from drug treatment for 2-3 days.
- The duration of thrombosis is more than 8 days.
- Senile age.
Thrombectomy is the main method of surgical intervention for ileofemoral thrombosis. It should be remembered that with blue phlegmasia, conservative therapy is useless in 100% of cases. The prognosis for blue phlegmasia is largely determined by how timely the surgical intervention was performed (before the development of gangrene). In this case, patients are shown a radical trobectomy. The risk of PE is increased with right iliac vein thrombectomy.
Prevention of ileofemoral thrombosis
The consequences of ileofemoral thrombosis are the more severe, the later treatment was started. Therefore, doctors strongly recommend that patients with risk groups regularly undergo examinations and preventive examinations. This will prevent the development of the disease, or prevent serious complications for health and life. It should always be remembered that thrombosis of a given localization at the initial stages of its formation behaves rather hidden.
Thrombosis prevention measures:
- Balanced diet. The menu must include fruits, vegetables, herbs, beans, seafood.
- Rejection of bad habits.
- Moderate physical activity.
- Get enough sleep.
If a person has already suffered ileofemoral thrombosis once, then he must comply with all medical recommendations, take the prescribed medications for blood thinning, wear elastic stockings, etc.
You should not refuse to install kava filters. These devices are shaped like an umbrella, which has holes for blood to pass through them. The filter is inserted into the inferior vena cava, into its infrarenal segment. It only unfolds when it reaches its destination. In the future, in case of recurrent thrombosis, this filter will avoid the development of PE and save the patient's life.
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.
