Sural Vein Thrombosis - Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Sural vein thrombosis

Sural vein thrombosis is a blockage of its lumen by a blood clot, which disrupts the normal flow of blood. The sural veins are a separate group of deep veins that are located in the thickness of the soleus and calf muscles. The diameter of the veins is quite impressive and can reach 10 mm. The venous walls are thin. Sural veins have a close relationship not only with the rest of the intramuscular veins of the lower limb, but also with superficial veins. Sural vein thrombosis is important in the pathogenesis of chronic venous insufficiency of the lower extremities. In the sural veins, embologenous thrombi can be located, which often do not give symptoms, but pose a threat not only to the health, but also to the patient's life.

In the practice of modern clinicians, thrombosis of the sural veins occurs very often, especially in comparison with thrombosis of the upper half of the trunk. The pathological condition is expressed by severe pain, blue skin, an increase in superficial calf veins in size. If such signs occur, it is necessary to seek immediate medical help in order to receive adequate therapy for the disease.

Content:

• Causes of sural vein thrombosis
• Sural vein thrombosis symptoms
• Why is sural vein thrombosis dangerous?
• Diagnostics
• Sural vein thrombosis treatment

Causes of sural vein thrombosis

In order for a person to form sural vein thrombosis, a combination of several pathogenetic factors is necessary:

• Damage to the inner layer of the vein. High blood pressure, penetration of bacterial endotoxins into the bloodstream, exposure to radiation, metabolic disorders, toxic effects of cigarette smoke, etc. can lead to such injuries.
• Violation of blood flow. Blood stasis is one of the most significant causes that lead to the formation of blood clots in the veins. Blood turbulence, previous myocardial infarction, rheumatic mitral stenosis, polycythemia vera, sickle cell anemia negatively affect the veins.
• Hypercoagulation of blood (thrombophilia). Causes of blood hypercoagulability: high levels of fibrinogen in the body, prothrombin mutations, fibrinolysis disorders, etc.

There is a high probability of developing thrombosis in people who are forced to adhere to bed rest for a long time period. This is especially true for hospital patients. Nevertheless, even a long flight in an airplane can affect. It is not without reason that doctors call deep vein thrombosis "a disease of the economic class." Therefore, any long pastime in a sitting position with legs down, can result in thrombosis of the sural veins.

Other factors that lead to a high risk of sural vein thrombosis:

• Postponed myocardial infarction;
• Atrial fibrillation;
• Damage to the tissues of the lower extremities, including deep burns, leg fractures, surgical interventions on the veins and soft tissues;
• The presence of a malignant tumor in the body;
• Having a prosthetic heart valve;
• Cardiomyopathy;
• Nephrotic syndrome;
• Elevated levels of estrogen in the blood during pregnancy and in the early period after childbirth;
• Burger's disease;
• Obesity and diabetes mellitus;
• Frequent infectious diseases;
• Excessive physical activity and physical inactivity;
• Taking hormonal drugs to prevent unwanted pregnancy;
• Smoking;
• Elderly age.

Sural vein thrombosis symptoms

Sural vein thrombosis is expressed by the following symptoms:

• Pain localized in the limb, the veins of which are affected by a thrombus. The pain is bursting, occurs in the calf area.
• If you try to put pressure on the leg along the vein, the pain will intensify.
• The pain increases with movement.
• The calf muscle may feel hot to the touch. Sometimes a person suffers not only from local hyperthermia, but also from a general increase in body temperature.
• Swelling in the calf muscle. Moreover, the leg can begin to increase in size literally before our eyes, if we are talking about acute thrombosis of the sural veins.
• An increase in superficial veins in size.

It should be borne in mind that thrombosis of the sural veins is not always accompanied by all of the above symptoms. Moreover, in 50% of patients, the blood finds an additional outlet into the saphenous veins through the system of communicating veins. This allows partially normalizing blood flow bypassing the affected vein and minimizing the symptoms of pathology. Therefore, he can learn that a person has thrombosis of the sural veins only by the developed vascular branches of blood vessels that are visible through the skin. They will be located in the lower leg and calf muscles.

Why is sural vein thrombosis dangerous?

Chronic venous insufficiency of the lower extremities is the most common complication of sural venous thrombosis. This condition leads to pronounced edema, malnutrition of the tissues of the lower extremities. As a result, the patient's legs may develop eczema, long-term non-healing trophic ulcers. In addition, the person will constantly experience heaviness in the legs, and cramps will begin to disturb him at night. The skin will lose its elasticity, become dry, covered with pigmented rashes. This will lead to the fact that the patient will find it difficult to endure both physical and mental stress.

An even more formidable complication of sural vein thrombosis is pulmonary embolism. In this case, pieces of a thrombus are detached, which rise higher through the bloodstream, reach the pulmonary artery and block its lumen. As a result, the patient develops pulmonary and heart failure, which leads to death. If a particle of a blood clot clogs a small branch of the pulmonary artery, then the person develops a serious condition such as a pulmonary infarction.

Diagnostics

To diagnose thrombosis of the sural veins, the doctor examines the patient.

Specific methods that can be carried out directly during the reception are the following:

• Homans symptom is positive. It is characterized by pain that occurs in the calf muscle during flexion of the foot. The patient is in the supine position.
• Positive Moses test, when, when squeezing the leg from front to back, the patient experiences pain. If you press on the lower leg in the lateral direction, there will be no pain.
• Other research methods: Lowenberg's test, Lisker's sign, Louvel's sign, march test, Pratt's test - 1, Mayo-Pratt's test.

These examination methods allow the specialist to suspect deep vein thrombosis of the lower extremities.

To clarify the localization of the thrombus, instrumental diagnostics will be required:

• Phlebography.
• Duplex scanning.
• Ultrasonography of the veins of the lower extremities.
• Radionuclide scanning.
• Rheovasography of the lower extremities.

As a rule, doctors give preference to phlebography, which makes it possible to clarify the extent of the lesion and the location of the thrombus.

Sural vein thrombosis treatment

If thrombosis of the sural veins has an uncomplicated course, then only conservative treatment is possible. But at the same time, the patient must observe strict bed rest for two weeks, but not less.

The following drugs are used for therapy:

• Direct anticoagulants. Low molecular weight Heparin remains the drug of choice. It helps to reduce blood viscosity, as well as increased release of antithrombin in the body. As a result, the blood clot dissolves. Heparin is administered intravenously. The doctor determines the dosage on an individual basis.
• Indirect anticoagulants. These are drugs such as Warfarin and Coumadin. They prevent thrombin from being produced. It should be borne in mind that taking Warfarin is associated with a risk of bleeding, therefore, the patient should be under strict medical supervision.
• Enzyme preparations that have thrombolytic properties. These include Streptokinase and Urokinase. They allow the clot to dissolve and prevent blood from clotting. Medicines are administered only in the form of injections.
• Preparations that are designed to improve the quality of blood, enhance its microcirculation, and reduce blood viscosity. These are such medicines as: Reosorbilact, Reopolyglucin, etc.
• NSAIDs are drugs that are designed to reduce inflammation, thin the blood, and relieve pain. For this purpose, drugs such as Voltaren, Indomethacin, Aspirin, etc. can be used.

Thrombolytic drugs can be prescribed only in the early stages of thrombus formation. If time is lost, then taking them is fraught with the risk of blood clot separation. An elastic bandage is applied to the affected limb and lifted. Compression stockings can serve as a replacement for bandages.

Sometimes, with thrombosis of the sural veins, it is not possible to avoid surgery. The surgeon's help is required in the following cases:

• The patient develops thrombophlebitis.
• There is a high likelihood of developing pulmonary thromboembolism.
• The presence of a floating blood clot. This means that it is not fixed on the vascular wall, so it can come off at any time.
• Limb circulation is severely impaired.

An operation to remove a blood clot is called a thrombectomy. It is contraindicated in the case when the patient has decompensated diseases of the cardiovascular system or the respiratory system, or an acute infection is observed.

After discharge from the hospital, the patient must strictly follow all medical recommendations, as well as eat right, enriching his diet with fortified foods. The diet must necessarily contain seafood, since they contain copper, which is necessary for vessels to maintain their elasticity. Be sure to quit smoking and drinking alcohol.

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.