Inferior Vena Cava Thrombosis - Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Inferior vena cava thrombosis

The inferior vena cava is one of the largest vessels of the human circulatory system. It delivers blood to the right atrium from the abdominal organs, small pelvis, from the lower extremities. Despite the fact that the inferior vena cava has an impressive diameter, blood clots can form in its lumen, just like in any other vessel. Since the cessation of blood circulation in the great vessel has dire consequences, thrombosis of the inferior vena cava is often fatal. It is this pathology in 90% of cases that causes pulmonary embolism.

Content:

• Development reasons
• The clinical picture of thrombosis of the inferior vena cava
• Diagnostics
• Treatment of thrombosis of the inferior vena cava

Development reasons

Most often, blood clots form in the vessels of the lower extremities and small pelvis. The reason for this is that a person is mainly in an upright position. When walking, the load on the legs increases, because the blood has to develop an increased speed to circulate in the vertical direction.

The reasons for the formation of blood clots:

• Mechanical, allergic, infectious damage to the vascular wall. Disruption of the smoothness of the inner wall of the vein creates the prerequisites for the accumulation of blood cells in this place. With an increased concentration of blood cells, a blood clot forms.
• Increased blood clotting. Heredity, bad habits, the impact of the external environment, the consequences of the transferred diseases can become the reasons for the change in the coagulation index.
• Slow blood circulation. Physical inactivity, heart and vascular diseases negatively affect the blood flow rate. In this case, blood cannot pass through the venous valves at an optimal speed, it moves in the opposite direction, stagnates.

The combination of these reasons is called the Virchow triad. It is considered an important indicator for the diagnosis of thrombosis. Since the blood flow velocity and the diameter of the inferior vena cava do not create the prerequisites for thrombus formation, this pathology develops as a result of the migration of a thrombus into it from the lower extremities, vessels of the abdominal cavity, and small pelvis.

Factors predisposing to thrombus formation:

• Injuries to the limbs and abdominal cavity;
• The presence of a malignant tumor;
• Surgery in the abdominal cavity, on the organs of the genitourinary system, on the lower extremities;
• Taking hormonal contraceptives;
• Infections transmitted through the circulatory system;
• History of varicose veins;
• Difficult course of pregnancy and childbirth;
• Allergy, autoimmune pathology;
• Hormonal imbalance;
• Endocrine system diseases;
• Prolonged bed rest.

At risk are the elderly, patients with chronic diseases, as well as those who are overweight, susceptible to bad habits, a profession that involves a static posture.

The clinical picture of thrombosis of the inferior vena cava

The classic signs of a blood clot directly in a vein are protruding veins on the surface of the abdomen and chest, edema of both lower extremities, genitals and abdomen, pain in the lower body. Such a picture is rare, because a thrombus is rarely formed in the vein itself; it migrates into the vessel from its other branches.

Segments of the inferior vena cava affected by thrombosis:

• Infrarenal,
• Renal and suprarenal,
• Hepatic.

The clinical picture of the lesion occurs in the case of complete occlusion of the vessel. If a floating thrombus enters the inferior vena cava and its segments, or a parietal blood clot is formed, the manifestations of pathology are insignificant.

Thrombus in the infernal segment - symptoms:

• Severe back pain
• Swelling of the extremities, cyanosis;
• Distinct veins in the lower abdomen.

The symptoms of venous thrombosis in the renal region are similar to those of a kidney tumor. In this case, the blood flow is rarely completely disturbed, since in this area it is quite powerful.

Thrombus in the renal and suprarenal segment - symptoms of blockage of renal venous outflow:

• Severe back pain;
• Microhematuria;
• Macrohematuria;
• A sharp decrease in the concentration and volume of urine;
• Increased blood urea and creatinine levels;
• Replacing oliguria with anuria (complete cessation of urine excretion);
• Nausea and vomiting;
• Intoxication symptoms.

With the restoration of blood flow, the symptoms change for the better, the patient's well-being improves.

If the hepatic segment of the inferior vena cava is affected, the symptom complex manifests itself immediately. The liver accumulates up to 1.5 liters of blood, its fibrous membrane is stretched.

Thrombus in the hepatic segment - symptoms:

• Bursting pains in the right hypochondrium, radiating under the scapula;
• On palpation, the liver is smooth, its edges are round;
• Ascites;
• Discoloration of the skin, jaundice;
• Enlarged spleen
• Expansion of superficial veins in the upper abdomen, in the lower chest;
• Cyanosis of the anterior wall of the peritoneum.

Thrombosis of the inferior vena cava should be distinguished from circulatory failure, heart failure, lymphostasis of the extremities, anaerobic phlegmon, traumatic edema, soft tissue hematoma, arthrosis and arthritis, dropsy of pregnant women, crushed tissue syndrome.

Diagnostics

Since in a certain part of patients the pathology is asymptomatic, or its manifestations are masked by the symptoms of another serious disease, instrumental diagnostics comes first in diagnosis.

The purpose of the survey:

• Confirmation of the presence or absence of thrombosis;
• Determination of its location;
• Identifying the risk of pulmonary thromboembolism;
• Identification of an asymptomatic blood clot in other vessels;
• Determining the cause of a blood clot.

Choosing a diagnostic method, the doctor focuses on its safety, information content, economic feasibility. The priority is non-invasive diagnostic methods.

Emergency diagnostic methods:

• Rapid test for determining the level of D-dimer in blood plasma - an excessive amount of fibrin breakdown products is assessed as a marker of intravascular thrombus formation;
• Radionuclide study with labeled fibrinogen - determines the hidden source of thrombus formation, is not used in pregnant and lactating women, is not able to assess the likelihood of embolism;
• Duplex ultrasound angioscanning - allows you to observe the dynamics of thrombus formation in dynamics, adjust the treatment;
• Radiopaque retrograde iliokavography - determines the proximal border of the thrombus and its nature, is limitedly used in pregnant women, is prohibited in the 1st trimester.

During angiography, medical manipulations can be performed - implanting a cava filter, performing catheter thrombectomy.

Treatment of thrombosis of the inferior vena cava

In the treatment of thrombosis of the inferior vena cava and its segment, conservative and surgical methods are used. The goal of the doctor is to prevent pulmonary embolism, prevent edema, restore vein patency, remove a blood clot and prevent recurrence of thrombosis. Treatment of any form of thrombosis begins in a hospital setting to eliminate the risk of pulmonary embolism.

Conservative therapy

Until the risk of pulmonary embolism is excluded, the patient must comply with bed rest. Prolonged stay in bed for more than 7-10 days lowers the rate of blood circulation, therefore, after removing the edema, eliminating the risk of floating thrombosis, dosed walking is recommended, performing therapeutic exercises to improve venous outflow.

An effective measure for the prevention of varicose veins is the use of elastic compression. The patient applies the imposition of a compression bandage.

Drug therapy - drug groups:

• Anticoagulant therapy for the prevention of recurrent thrombosis for 3-6 months, is not used in pregnant women, patients with cirrhosis and alcoholism;
• Hemorheologically active agents - improve blood microcirculation, reduce its density;
• Non-specific anti-inflammatory drugs (diclofenac, ketoprofen) - relieve pain and inflammation;
• Antibacterial drugs, as an adjunct for the addition of inflammation, pneumonia, with a high risk of sepsis (HIV, diabetes mellitus), are useless for the treatment of thrombosis;
• Ointments for local treatment with Heparin, Diclofenac (Lioton-gel, Fastum-gel) to relieve inflammation.

It is forbidden to use warming ointments and compresses that increase blood flow.

Operative treatment

The purpose of surgical intervention for thrombosis of the inferior vena cava is to restore the lumen of the vessel, to prevent pulmonary embolism. Thrombectomy is used to solve these problems. In cases where there are contraindications to radical surgery, palliative interventions are used to prevent PE:

• Endovascular surgery;
• Deep vein ligation;
• Plication of the inferior vena cava;
• Implantation of cava filters.

These methods can be combined or used in isolation, independently of each other. In a serious condition of the patient, burdened by somatic diseases and age-related changes in the body, preference is given to minimally invasive interventions.

Thrombosis of the inferior vena cava is a complex pathology with an unpredictable prognosis. At the first signs of illness, you should seek qualified medical help.

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.