Internal jugular vein thrombosis
Internal jugular vein thrombosis is an acute disease of the main venous vessel, which is caused by the formation of a thrombus in its lumen. As a result of impaired blood flow, intravenous pressure increases, and transcapillary exchange is impaired.
The internal jugular vein is located in the neck. Therefore, her thrombosis is always accompanied by the onset of pain in this area, the formation of edema, and blue discoloration of the skin. Jugular vein thrombosis is a pathological condition that requires emergency medical attention.
In total, there are three pairs of jugular veins in the human body (internal, external and anterior). It is the internal pair of jugular veins that is the largest of all. She is responsible for supplying blood to the skull.
Thrombosis of this vein is not so common, however, this does not diminish the significance of the pathology. In the general system of thrombosis, the internal jugular vein suffers in 5% of cases. By itself, thrombosis of the jugular vein rarely leads to the death of the patient, but with the development of its complications in the form of thrombus embolism, this scenario is quite possible. Therefore, it is important to know the signs of the disease and seek medical help in a timely manner.
Content:
- Causes of jugular vein thrombosis
- Jugular vein thrombosis symptoms
- Diagnosis of jugular vein thrombosis
- Jugular vein thrombosis treatment
Causes of jugular vein thrombosis
The most common cause of jugular vein thrombosis is exogenous interventions, namely, placement of a catheter during infusion therapy. Thrombosis develops while the patient is in a hospital, but sometimes the symptoms of this pathology are hidden. Indeed, during the course of therapy, most patients receive antiplatelet agents and anticoagulants. Therefore, acute jugular vein thrombosis is observed after discharge from the hospital.
Other causes of jugular vein thrombosis include:
- Mechanical compression of the vein.
- Features of the anatomical structure of the human skeleton.
- Heavy physical activity.
- Installing a pacemaker.
- Patient undergoing radiation therapy.
- Virchow's triad as the cause of the formation of internal jugular vein thrombosis. It includes:
- Damage to the inner layer of the vein, for example, when a catheter is in it for a long time. Sometimes such disorders are common among people who inject drugs.
- Slowing blood flow in a vein, which may be due to the presence of a tumor that squeezes the vein.
- Blood clotting disorders, for example, against the background of chronic or acute diseases.
In addition to the main causes of jugular vein thrombosis, additional risk factors are distinguished that increase the likelihood of its occurrence.
These include:
- Senile age.
- Overweight.
- Infectious diseases with the ability to damage the venous wall.
- Bad habits: drug addiction, tobacco smoking, alcohol abuse.
- Postponed surgical interventions on the neck.
- Diseases of the cardiovascular system.
- Kidney damage.
- Menopause in women.
- Uncontrolled use of oral contraceptives.
- Physical inactivity.
- Systemic diseases of the body.
Jugular vein thrombosis symptoms
The symptoms of internal jugular vein thrombosis depend on how pronounced the pathological process is.
If it develops sharply, then the manifestations will be as follows:
- Increased body temperature. Fever is an unfavorable prognostic sign, as it indicates an infection. In this case, the likelihood of developing fulminant sepsis increases.
- A painful swelling in the neck.
- Head movements will be painful. The pain increases during neck extension and when the head is rotated to a healthy side.
- The saphenous veins increase in size, can respond with pain during palpation.
- The person tends to take a gentle position for the head to reduce pain.
- Swelling of the neck, which can spread to the chest, shoulder, shoulder blade. Often, thrombosis of the jugular vein is combined with thrombosis of the subclavian vein.
- Violation of venous outflow from the cranial cavity is accompanied by the following symptoms: severe headache, tinnitus, blue nasolabial triangle, swelling of the veins and face, numbness of the limbs, discomfort in the eyes, temporary loss of consciousness.
- With the spread of thrombosis to the veins located in the immediate vicinity (subclavian, brachial, axillary), an increase in the intensity of symptoms occurs, an increase in edema. This carries the risk of developing gangrene.
Sometimes acute manifestations of the disease are able to resolve on their own. In this case, the reverse development of the clinical picture is observed. Nevertheless, a full-fledged regression does not occur in most patients, and the disease becomes chronic. At the same time, the reporting falls off completely, or becomes much less, the pain decreases. With head rotation and tilting, neurological symptoms will increase. The person will begin to notice discomfort that was previously absent. These manifestations are due to stagnant processes, tissue hypoxia, the presence of perivascular edema and an increase in the level of CO2 in the venous blood. Another sign that can lead to the idea of chronic jugular vein thrombosis is the presence of a dense, slightly painful mass in the neck.
In the chronic course of thrombosis, the symptoms of venous outflow from the cranial cavity do not completely disappear, but become less pronounced. The patient will periodically experience headaches, suffer from bouts of dizziness. The swelling of the face often worsens in the morning hours, and can pass in the evening.
Diagnosis of jugular vein thrombosis
Diagnosis of thrombosis of the internal jugular vein most often does not cause difficulties for the doctor. It is based on the listed symptoms, but must be complemented by instrumental methods. Preference should be given to computed tomography or MRI, as the most informative diagnostic methods. Although most often the patient undergoes ultrasound (duplex scanning, Doppler ultrasound). In principle, the jugular vein is well accessible for ultrasound, therefore, most often, the diagnosis is correct. In this case, it is imperative to distinguish between thrombosis with an abscess, a necrosed tumor and inflamed lymph nodes.
To assess the prevalence of thrombosis and to clarify the location of the thrombus, you can use phlebography using a contrast agent. However, phlebography should be prescribed only to those patients who will receive thrombolytic therapy. After the procedure, a fibrinolytic agent is immediately introduced into the vein.
Jugular vein thrombosis treatment
Since with thrombosis of the jugular vein, there is always a threat of pulmonary embolism, the patient must be hospitalized on an emergency basis.
Treatment is most often conservative. If there is no therapy, then after 2-3 weeks from the beginning of the formation of a thrombus, it begins to dissolve. However, this does not mean that the patient can wait for the self-resolution of the pathological process, since all this time there is a threat to his life.
The main objectives of the treatment of jugular vein thrombosis:
- Stop the process of further clot formation.
- Fix the blood clot on the vein wall.
- Eliminate vasospasm.
- Eliminate the inflammatory process.
During treatment, the patient must adhere to bed rest. He is injected with antibacterial drugs with a wide spectrum of action. This is necessary in order to prevent the development of the inflammatory process, or get rid of it.
The basis of the therapeutic effect in jugular vein thrombosis is the conduct of anticoagulant therapy. For this, the patient is injected with Heparin for 3-10 days. The combination of Heparin with Fibrinolysin enhances the effect. The drugs are administered intravenously, drip. Streptokinase is not used in the treatment of great vein thrombosis, as this drug increases the risk of severe complications.
Preference should be given precisely to low molecular weight heparins, since they have a number of undoubted advantages:
- High bioavailability;
- Long period of existence;
- The minimum likelihood of developing side effects;
- The ability to use drugs at home.
After 10 days from the start of treatment with Heparin, the patient is transferred to indirect anticoagulants.
Immediately after the patient is admitted to the hospital, he is prescribed flavonoids. These can be drugs such as: Troxevasin, Detralex, Venoruton, etc. They have a beneficial effect on metabolic processes in the venous wall and surrounding tissues. Flavonoids also reduce inflammation and reduce the intensity of pain.
To relieve vasospasm and normalize blood flow to the brain, the patient is prescribed drugs such as: Trental and Xanthinol nicotinate. They can be mixed and given intravenously. Nevertheless, the usual antispasmodics do not lose their relevance. Therefore, it is also possible to appoint Papaverin and No-shpa.
If the subclavian artery is involved in the process, then various disorders from the upper limb are possible. In such a situation, her immobilization is required, as well as the application of medical compresses with heparin ointments, with flavonoids, for example, Troxevasin. Practice shows that leech therapy (hirudotherapy) gives a good effect.
Surgical intervention in the form of resection or vein ligation is rarely necessary. The operation is prescribed in the case when there is a risk of developing gangrene, with severe hemodynamic disturbances. During phlebography, it is possible to use balloon angioplasty of a vein in parallel, or to perform its endoprosthetics.
If a person did not seek therapy and thrombosis acquired a chronic course, then it will be more effective to eliminate it with the help of surgical methods of treatment. Therapy with medications in this case gives a minimal effect. Therefore, the vast majority of patients are prescribed reconstructive vascular surgery. Their goal will be to create bypass routes of venous outflow and unload the jugular vein.
As a rule, the prognosis for jugular vein thrombosis is favorable. However, a full recovery, even with timely therapy, is not always achieved.
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.
