Iliac vein thrombosis
Iliac vein thrombosis is the formation of a blood clot in the vena cava system that obstructs normal blood flow. In the practice of clinicians, vena cava thrombosis occurs more often than thrombosis localized in other parts of the body. Pathology is characterized by pain that has a bursting character, blue skin, clear skin, swelling of the veins of the lower extremities.
The common iliac vein is a large vessel that lacks valves. It originates in the sacroiliac joint, where the external and internal iliac veins merge. First, the common right iliac vein passes behind, and then on the side of the iliac artery. The left iliac vein runs medially. The internal iliac vein also does not contain valves and is located on the side wall of the small pelvis.
Iliac vein thrombosis occurs in 10-15% of all thrombosis cases. This is a serious condition that requires urgent medical attention, as it poses a direct threat to human life. Thrombosis should not be confused with thrombophlebitis.
Content:
- Iliac vein thrombosis symptoms
- Causes of iliac vein thrombosis
- Complications of iliac vein thrombosis
- Diagnostics of the thrombosis of the iliac vein
- Treatment of iliac vein thrombosis
- Prevention of recurrence of iliac vein thrombosis
Iliac vein thrombosis symptoms
Symptoms suggestive of iliac vein thrombosis have a number of features:
- The pain is localized most often in the groin area, in the area of the inner thigh.
- The pain can be given to the gastrocnemius muscle.
- The nature of the pain: bursting, pulling, dull. With iliac vein thrombosis, acute pain never occurs.
- Pain at first bothers a person only during physical activity, and then begins to appear at rest.
- Pain is associated with a number of factors:
- Development of periphlebitis in the iliac region (inflammation of the tissue surrounding the iliac vein);
- Stretching of the walls of the affected vein by formed blood clots;
- Stretching of the walls of the vein tributaries due to increased blood circulation;
- Increased venous pressure;
- Strengthening blood circulation in the arteries that are associated with the iliac vein, which has undergone thrombosis;
- Overstrain of the limbs.
- Swelling of the leg from the side of the lesion. A characteristic feature of iliac vein thrombosis is that tissue edema extends not only to the thigh and leg, but also to the genitals and the buttock. Of course, it is the thigh that swells the most. When you press on the affected tissue, no pits are left. The reason for its absence comes down to the fact that the veins are overflowing with blood during thrombosis, so water is contained not only in the subcutaneous fat layer, but also in soft tissues. Edema always occurs, but the degree of its severity differs in all patients.
There are the following degrees of edema in vena cava thrombosis:
- If the femoral part of the limb increases in size by less than 3 cm, then the edema is considered small.
- If the femoral part of the leg increases in size by 3-5 cm, then the edema is considered average.
- If the femoral part of the leg increases in size by 5 cm or more, then the edema is considered sharp.
- Blue skin of the limb from which thrombosis is observed. The upper thigh and pelvic cavity can also acquire a purple-red hue, or a milky white hue (white phlegmas). With a bluish color, the limbs of the pain will be bursting, "tearing" the vein from the inside. If the vein is overfilled with blood, then blisters containing hemorrhagic fluid may appear on the skin, and it itself will acquire a black color. If there is a complete blockage of the vein, venous gangrene develops. With white phlegmas, the leg becomes cold, its sensitivity is lost, and mobility decreases.
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Small brown spots are often formed on the surface of the skin of the thigh.
- There is an increase in the size of the saphenous veins of the thigh. This is most noticeable above the pubis and on the anterior wall of the peritoneum.
- Less commonly, ulcerative lesions of the lower extremities form in patients. Ulcerative defects most often develop with multiple venous thrombosis of the lower extremities.
- Ulcers on the legs with isolated thrombosis of the iliac vein are not formed.
- With inflammation of the vein and surrounding tissues, an increase in body temperature is possible.
- A common symptom of thrombosis of the iliac vein is enlarged inguinal lymph nodes.
The disease never develops lightning fast. The process of blood clot formation occurs gradually, with a gradual increase in the intensity of symptoms.
Doctors distinguish several stages of the development of the disease:
- Prodromal stage, which is always painful. They arise in the area of the upper third of the thigh, give to the groin, lower back, abdomen, lower limb from the side of the vein. The pain is dull, aching. At this stage, an increase in body temperature is possible. Often, it is an unexplained fever that is the only sign of incipient iliac vein thrombosis. This symptom is especially relevant when it occurs in a certain category of patients: in the postpartum or postoperative period, in people immobilized after an injury, etc.
- The stage of pronounced manifestations of the disease. The pain intensifies, spreads, capturing more and more areas, edema of the hip and limb is formed. Numbness of the leg from the side of the lesion is possible.
The combination of symptoms can be varied. Sometimes the disease proceeds without any external manifestations at all.
Causes of iliac vein thrombosis
Iliac vein thrombosis develops when a combination of several factors occurs:
- The vein wall was damaged. The cause can be chemical, allergic, infectious or mechanical injury.
- Disorders in the process of blood clotting.
- Slow blood flow.
Blood viscosity can increase for a variety of reasons. If there are injuries on the walls of the vein, this will lead to the fact that blood clots begin to form on them. A small blood clot provokes an inflammatory reaction that further damages the vessel wall. This becomes a predisposing factor for the formation of new blood clots.
Stagnation of blood and lymph in the veins of the lower extremities is another reason that leads to the formation of blood clots. Stagnation occurs in those people who spend a long time in an immobile state, or lead a sedentary lifestyle.
The mechanisms that can trigger the formation of blood clots in the iliac vein are:
- Transferred operations. If a person is motionless, congestion of blood in the veins will lead to the formation of blood clots.
- Past infections.
- Being in an immobilized position after surgery or due to illness.
- Postpartum period.
- Taking hormonal drugs to prevent the development of unwanted pregnancy. Blood clots form due to thickening of the blood.
- The presence of a malignant tumor in the body. In terms of the formation of thrombosis, cancer of the lungs, stomach and pancreas is especially dangerous. Blood clots form against the background of the fact that these diseases lead to thickening of the blood.
- Thrombohemorrhagic syndrome.
Complications of iliac vein thrombosis
The most formidable complication of the disease is the separation of a blood clot with pulmonary embolism. This can happen with any physical activity, which is always accompanied by increased blood circulation. Parts of the thrombus move through the veins along with the blood flow into the lungs, enter the pulmonary artery and clog it. This causes acute heart and respiratory failure, which are often fatal. If a blood clot enters a small pulmonary artery, it causes a pulmonary infarction.
Another complication of the disease is chronic venous insufficiency. It is dangerous by malnutrition of the lower extremities, the formation of eczema, trophic ulcers, the development of lipodermatosclerosis. Therefore, treatment of the disease must be urgent.
Diagnostics of the thrombosis of the iliac vein
The phlebologist is engaged in the diagnosis of the disease.
The doctor in service has many methods that allow you to identify the existing problem, including:
- Conducting a radionuclide study with labeled fibrinogen.
- Duplex vein scanning, which is aimed at assessing hemodynamics.
- X-ray of blood vessels using a contrast agent. This allows you to qualitatively assess the condition of the iliac vein and visualize a thrombus.
Of the laboratory diagnostic methods, the most informative is the determination of the level of D-dimer in blood plasma. Also, modern rapid tests can be used to determine the level of fibrin monomer in the blood, fibrinogen in plasma.
As a rule, these studies are sufficient to confirm or refute the diagnosis.
Treatment of iliac vein thrombosis
All patients diagnosed with thrombosis of the iliac vein should be hospitalized. This is due to the fact that such patients remain at high risk of developing serious complications that pose a direct threat to life.
The tasks of the conducted terraria should be as follows:
- Prevent further spread of thrombosis.
- Prevent the development of pulmonary embolism.
- Stop the spread of edema, which will avoid the formation of gangrene and save the affected limb.
- Conduct therapeutic measures aimed at restoring the patency of the iliac vein.
- Prevent recurrence of the disease.
The patient must take heparin for a week. Then it is transferred to soft coagulants, such as Warfarin. The patient must take it for six months. If the patient abuses alcohol, he has cirrhosis of the liver, or is over 75 years old, he is prescribed antiplatelet drugs. Also, oral coagulants are not prescribed for women in position, as this can lead to a wide variety of complications of pregnancy.
Relapses of thrombosis occur in the first 3-6 months, but sometimes this period stretches for a year or more. Therefore, some patients can be prescribed anticoagulant therapy for life.
Local treatment is reduced to local hemotremia. In the future, ointments with heparin and a non-steroidal anti-inflammatory component, for example, Fastum-gel or Lioton-gel, are applied to the affected area. They are applied in a thin layer to the medial surface of the thigh.
The patient must observe strict bed rest for 7-10 days. Immobilization for a longer period is meaningless (unless the thrombus poses a risk of embolism). In the future, patients are shown dosed walking, the implementation of special gymnastic exercises.
While a person is in an immobilized position, a Beler splint is applied to his limb and the part of the bed where the legs are located is lifted.
If there is a risk of a thrombus rupture, surgery is indicated - thrombectomy.
Prevention of recurrence of iliac vein thrombosis
In order to prevent the re-formation of iliac vein thrombosis, the following preventive measures must be taken:
- Eliminate all risk factors, including: a sedentary lifestyle, insufficient use of clean drinking water, long sitting time, etc.
- Wearing elastic stockings.
- According to the testimony of a doctor, patients take Heparin and Aspirin for a long time, which prevent excessive blood clotting.
- After the operation, the patient must be set in motion early.
- The patient should be regularly observed by a doctor about his pathology.
- Leading a healthy lifestyle is a prerequisite for patients with thrombosis.
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.
