Thrombophlebitis - this is an acute inflammation of the veins, accompanied by the formation of blood clots (thrombi) in their lumen, and, often, inflammation of the soft tissues surrounding the vein.

Etiology.

For the occurrence of thrombophlebitis, three factors play a role - slowing down of venous blood flow, inflammation of the vein wall and changes in the physicochemical composition of the blood (that is, the content of fibrinogen in the blood is disrupted, the activity of fibrinolysis decreases, the content of platelets increases).

Thrombophlebitis is the most common complication of venous varicose veins. The development of thrombophlebitis is facilitated by a long stay in bed caused by a particular disease or injury.

Pathogenesis

When blood flow slows down, leukocytes are fixed to the inner lining of the vein against the background of inflammation of its endothelium.

Observations indicate that thrombophlebitis is one of the early symptoms of cancer of internal organs. Inflammatory diseases such as typhoid also contribute to the formation of thrombophlebitis.

Mayo classification:

1. Local thrombophlebitis - develops against the background of varicose veins.

2. Thrombophlebitis that occurs after injection of sclerosing or chemicals.

3. Thrombophlebitis due to injury.

4. Thrombophlebitis arising in connection with a suppurative process in soft tissues.

5. Thrombophlebitis resulting from ischemia caused by blockage of blood vessels, more often arteries.

Distinguish: acute, subacute, chronic and recurrent thrombophlebitis.

Clinic

Pain- a constant symptom of thrombophlebitis, occurs suddenly. The intensity is the greater, the larger the area of ​​the vein is affected. In the horizontal position of the limb, the pain decreases. The pain is combined with a feeling of heaviness, bloating, fatigue in the limb, which intensifies in the evening.

Edema and tissue induration- are observed in all patients. The amount of edema depends on the level of thrombosis and its length. Induction or, otherwise, fibrosis develops around the altered vein and depends on the size of the edema, the severity of the subcutaneous fat. Gradually, the tissue coarsens, turning into scar tissue, which leads to joint stiffness (ankle, knee, etc.).

Dermatitis and eczema usually occur with prolonged recurrent course and are accompanied by itching. As a result, skin scratching occurs, through which infection penetrates with the subsequent development of pyoderma. Eczema is combined with skin pigmentation, which is focal or diffuse. Hyperpigmentation is usually localized in the lower and middle third of the lower leg.

Other symptoms include intoxication, an increase in both local and general temperature.

Diagnostics.

Based on local symptoms - pain, skin redness, fever... An objective examination determines the pain when feeling the limb.

Of the additional examination methods, phlebography is used, which allows you to determine the length of the thrombotic process, the degree of development of collaterals.

Differential diagnosis.

First of all, it is carried out between thrombophlebitis and phlebothrombosis. With thrombophlebitis, a thrombus forms at the site of inflammation of the vascular wall, it is firmly connected to the vein wall and is characterized by signs of inflammation: fever, leukocytosis, local signs of inflammation. With phlebothrombosis, a thrombus forms at the site of a healthy vein wall and can easily break off, giving embolism. Clinically asymptomatic. Phlebitis symptoms:

1. Mahler's symptom- a progressive increase in heart rate until the temperature rises.

2. Homans symptom- a quick and abrupt movement of the foot causes pain throughout the limb.

3. Levenberg's symptom- when applying the cuff of the Riva-Rocchi apparatus at 35-40 mm Hg. Art. - pain in the limb at the site of localization of phlebothrombosis.

Treatment.

1. On the first 3-4 days from the onset of the disease, patients are prescribed strict bed rest (especially with phlebothrombosis), then the patients are allowed to move in the ankle and knee joints while lying down, which prevents the further development of thrombus formation.

The diet is subcaloric, protein-free, with a lot of vitamins (cabbage, spinach). Limit the dose of alkalis (soda), fats.

2. Appointment of thermal procedures in the form of light half-baths with a temperature of 36 0 С, for 10-15 minutes, dressings with Vishnevsky's ointment.

3. Prescribing antibiotics for thrombophlebitis. However, one should take into account the fact that they increase blood clotting, so it is preferable to prescribe them locally in the tissue surrounding the altered vein.

4. Hirudotherapy. One leech (hirudin) sucks 20-25 ml of blood. Usually 5-8 leeches are prescribed, 2-3 days in a row. There is a decrease in edema, pain, inflammation. Danger - violation of the blood coagulation system. The danger of infection with Botkin's disease.

5. Anticoagulant therapy. These are direct-acting anticoagulants - heparin. It is prescribed 5.000 IU 4-6 times a day in the umbilical region. Indirect anticoagulants - pelentan, neodikumarin. Assign a course, their action begins in 24-32 hours. Other drugs include escuzan (30 drops 3 times a day before meals), phenylin (1 ton 3 times a day).

Operative methods of treatment.

1. In case of septic thrombophlebitis, when the vein is thrombosed throughout, an operation is performed according to Troyanov-Trendelenburg (ligation of the great saphenous vein at the place where it flows into the femoral vein with excision of the thrombosed vein along the entire length).

2. In case of thrombosis of the iliac vein, an operation of autovenous shunting is performed (to the site of thrombosis, a large saphenous vein on the affected limb is sutured to the large saphenous vein of a healthy limb, thereby bypassing the thrombosed area).

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Among vascular diseases, there is one that doctors consider the most insidious, with difficult to predict consequences. This is thrombophlebitis of the lower extremities. This is the name of the inflammatory process of the venous walls, which leads to the formation in the venous lumen. A disease developing in the vessels of the legs is the most common form. But sometimes ( although much less often) there are other forms of it - thrombophlebitis of the upper extremities, as well as the cervical and thoracic regions.

Each person has a network of veins located on the surface ( under the skin) and hidden in deeper layers. Depending on this, two types of the disease are distinguished:

1. Deep vein thrombophlebitis of the lower extremities(its medical designation is);
2. Thrombophlebitis of the subcutaneous, superficial veins.

Sometimes the walls of the venous vessels become inflamed, and a thrombus does not form. In this case, the disease is called.

Causes of the disease

There are many reasons causing thrombophlebitis. But the following are considered the main ones:

• Genetic (hereditary) predisposition to coagulopathy (blood clots) and thrombophilia.
• Often the cause of inflammation is trauma to the venous wall.
• A common cause is varicose veins, which causes a decrease in the rate of blood flow through the veins, resulting in.

In addition, thrombophlebitis can manifest itself after the infection is brought in from the outside. An example of such a case is described in the video below:

The severity of the condition

A characteristic feature of the disease is that the symptoms of thrombophlebitis most often appear when the disease has already spread over large areas. And in the initial stage, most patients do not even suspect that their body is in danger, which consists in raising a blood clot too high. This significantly increases the likelihood of its separation, after which it goes into "free swimming" along the vascular system. It is impossible to predict its movement. The most dangerous is considered to be the ingress of a detached blood clot into the blood vessels of the lungs, leading to. This can cause instant ( sudden) death.

Growing up, the thrombus affects ( and further can lead to blockage) the main veins. What is the cause of the onset of a chronic nature. In this case, the treatment of thrombophlebitis is significantly complicated.

Thrombophlebitis symptoms

The onset of inflammation in the venous vessels is indicated by the following symptoms, which most people do not always pay attention to:

1. Minor;
2. Painful sensations in the calves
3. A burning sensation and heaviness in the legs,
4. Redness of the skin.

In most cases, patients seek medical attention when the disease progresses. At the same time, the swelling of the legs increases, in the area of ​​thrombus formation, the skin acquires a bluish tint. In a neglected state, the limb may turn black. The blood clot is usually localized in the veins of the thigh, lower leg, or ankle.

Thrombophlebitis of superficial veins (left) and deep veins (right)

At-risk groups

• People who spend a lot of time in a seated (stationary) position, traveling by plane or driving a car.
• Anyone who has undergone surgery and is forced to observe motionless bed rest for a long time.
• Suffering from varicose veins.
• Patients with antiphospholipid syndrome, hyperhomocystinemia (accelerated blood clotting).
• Pregnant women. The risk of thrombophlebitis increases during childbirth.
• Thrombophlebitis is a frequent companion of obese people who are obese.
• Elderly people with a sedentary lifestyle.

Video: superficial and deep thrombophlebitis

There are several subspecies of thrombophlebitis:

Acute thrombophlebitis

The signs of thrombophlebitis are most clearly manifested in the acute course of the disease, which begins with the appearance of sharp pain along the direction of the blood flow of the affected vein. At the same time, a change in the color of the skin is noticeable. It becomes cyanotic with an expanded network of blood vessels on the surface. Against the background of increased body temperature, the sore leg remains cold. , as if bursting her. Instinctively, the patient tries to keep her in an elevated state, trying to reduce the pain syndrome.

At the first symptoms of acute thrombophlebitis, you should immediately call a doctor and put the patient to bed. At the same time, before the arrival of doctors, it is strictly forbidden to carry out any treatment ( rubbing in ointments, performing massage procedures, applying compresses, etc.). This can provoke the detachment of a part of the blood clot and its introduction into the lungs or other internal organs.

Detachment of a thrombus during exacerbation of thrombophlebitis

In addition, the acute form of thrombophlebitis very quickly turns into complications - gangrenous or ischemic thrombophlebitis, white or blue phlegmas. They are accompanied by increased pain and increasing, literally every minute, swelling. The skin first turns pale, then takes on a purple hue. Therefore, the sooner medical assistance is provided, the more likely it is to avoid serious consequences.

Treatment

Treatment of the acute form of the disease is selected based on the state of the vessels, the nature of the course of the disease, the location of the thrombus. Conservative therapy is usually used for this, which includes local and general treatment. Patients diagnosed with acute thrombophlebitis of the forearm and lower leg can be treated on an outpatient basis. For all other types, patients are sent to the hospital. They are assigned to bed rest, the sore leg is in an elevated state.

Local therapy includes the following procedures:

1. The imposition of one of: Vishnevsky, butadione, or heparin.
2. Semi-alcohol compresses or cold treatment, with obligatory elastic bandage.
3. For oral administration, drugs are recommended that improve blood microcirculation, such as flexital, teonicon, trental, etc.
4. Indomethacin, courantil, aspirin, etc. are prescribed as inhibitors.
5. To correct impaired blood flow in the veins, escusan, troxevasin, venaruton, and detralex can be used.
6. Preparations for anesthesia, reducing the inflammatory process and lowering the temperature - analgin, reopirin, butadion, etc.
7. For desensitization - suprastin, diphenhydramine, etc.

After the acute inflammatory process is removed, physiotherapeutic treatment with a solux lamp, diametrical currents, UHF is recommended to increase the efficiency of clot resorption. Good results are obtained by iontophoresis with heparin, proteolytic enzymes ( chymotrypsin, trypsin, etc..), as well as with potassium iodide. Elastic compression should be continued for another two months after the completion of the main treatment, while taking phlebodynamic drugs.

Operative surgical intervention is performed in emergency cases, with the following indications:

• Ascending thrombophlebitis of a large or small saphenous, superficial vein in an acute form, located on the upper or middle of the thigh.
• Threat of pulmonary embolism.
• Fusion of a thrombus with purulent exudate.

In the treatment of ascending thrombophlebitis, laser obliteration is also used, the essence of which is the heating of the vein wall just above the thrombus. This allows you to remove pathological venous nodes from the great vessels, stopping the proliferation of a thrombus with an inflammatory process. Eliminating the likelihood of a thrombus pushing into the blood vessels is facilitated by an alternative technique of conducting a laser beam directed opposite to the movement of blood flow. It is unique at this point in time.

With ascending thrombophlebitis, an effective method that prevents a thrombus from developing and penetrating deeply located vessels is an operation associated with ligation of the place where the superficial vein goes into a deep one. It is called . The manipulation is performed using local anesthesia, on an outpatient basis.

Post-injection thrombophlebitis

In the treatment of thrombophlebitis caused by varicose veins, anti-inflammatory therapy is used to help relieve pain and reduce inflammation. It includes hormonal ointments, compresses with 50% alcohol, and suppositories with diclofenac or butydione.

An obstacle to the transition of thrombophlebitis to veins located in deeper layers is elastic compression ( stockings, tights) or bandages. To reduce edema and inflammation, drugs are prescribed to improve blood circulation - Anistax, Detralex, etc.

Thrombophlebitis during pregnancy

Pregnancy is the period in which a woman is most often exposed to diseases such as varicose veins of the lower extremities and thrombophlebitis. This is due to an increase in their intrauterine pressure and physiological changes in the composition of the blood. The greatest danger of thrombophlebitis is in the first days of the postpartum period. Since most of the complications in the form of thromboembolism occur precisely after childbirth. Childbirth is a huge overload in the work of the vascular system.

• First, the pressure inside the abdominal cavity increases two to three times.
• Secondly, the child, passing through the birth canal, squeezes the veins of the pelvis with his head for a few moments.
• In this case, the tone of the walls of the veins located on the legs is sharply reduced and their expansion occurs.

All this leads to disruption of natural blood flow in the lower extremities and the formation of blood clots.

The first signs of varicose veins are usually noted in the second trimester of pregnancy, when the expectant mother begins to noticeably gain weight. First, it is the appearance of the shins, thighs or ankles on the skin, then veins enlarge and pain occurs. Legs in the evening begin to swell more and more often, sometimes cramps occur.

As soon as these symptoms arise, it is necessary to immediately consult a phlebologist. He will conduct a duplex color scan in order to examine the state of the circulatory system and give recommendations on how to prevent the development of a more severe form of the disease and avoid complicated treatment.

During this period, the prevention of thrombophlebitis is very important, which includes the following:

1. From the moment the first symptoms appear until the very birth, it is necessary to wear elastic compression underwear ( tights, stockings). A phlebologist should pick it up. Since the wrong pressure ( compression) can adversely affect the patient's condition, cause discomfort when wearing, etc.
2. It is useful to do therapeutic exercises for pregnant women, including exercises to improve blood flow in the veins of the lower extremities. Physical activity not only protects against stagnation of blood in the legs, but also contributes to the additional supply of oxygen to the fetus.
3. Every day, in any weather, before going to bed you need to go for a short walk (about 30 minutes).
4. It is necessary to ensure that the diet contains more plant foods. You need to eat them raw. Watermelons, melons, pineapples are especially useful. They contribute to blood dilution, and are biostimulants of active hemodilution.
5. Limit fluid intake, since during the period of bearing a child, there is a delay in the body. And this is the risk of persistent edema that is difficult to remove.

Thrombophlebitis of superficial veins during pregnancy is often accompanied by severe pain. It must be remembered that taking medications is not recommended during this period. Quickly relieve the patient of discomfort, and prevent a blood clot from invading the veins located in deeper layers will help venocentesis... This is a puncture of the affected node in order to remove a blood clot. This method is safe for the fetus, since the manipulation is performed under local tumenoscent anesthesia ( an anesthetic drug is injected under the skin, forming a protective cushion around the operated vessel).

Detralex with thrombophlebitis: does it help?

In some cases, for the treatment of varicose veins, the phlebologist may decide to prescribe the drug Detralex. But there is a limitation: by expectant mothers, it can only be used in the second half of pregnancy. This is an effective drug for the treatment of varicose veins of any stage and other diseases of the circulatory system, which is considered quite safe. It contains components of plant origin. It does not change the composition of the blood, but only increases the tone of the walls of blood vessels. It has no side effects, but there is a possibility of an allergic reaction.

But in the treatment of thrombophlebitis, it gives positive results in combination with and. It is rarely used as an independent remedy for thrombosis., mainly for the relief of attacks of chronic venous insufficiency. But it is often prescribed after surgical treatment of thrombophlebitis, as a maintenance, long-term therapy.

Traditional medicine in the treatment of thrombosis

Treatment of thrombophlebitis with folk remedies will help ease the course of the disease, reduce pain and swelling in the legs, and relieve other symptoms. These are methods that have been proven for more than one generation. Some of them are much more effective than synthetic drugs. Beekeeping products are considered the most effective in this disease: honey, propolis and bee dead. We offer several recipes from these products.

Beekeeping products

• Tincture from beesworm. The life of bees is short. And by the spring, the old individuals that have worked for the summer die off. Young bees carry them out to the landing board. This is called podmor. They must be collected and poured with vodka (a handful of podmore for 0.5 liters of vodka). Insist for two weeks, strain. Use as a compress, which is applied to a sore spot for 1.5-2 hours.
• Honey compress. To do this, pure honey is applied to a linen napkin and applied to the area with the affected vein. For a compress, honey can be mixed with crushed Kalanchoe leaf, or applied to a cabbage leaf. These two plants only increase the strength of honey.

**The body of a bee contains substances that are part of various medicines. These are poison, nectar and pollen of plants, propolis and microparticles of wax. In essence, it is a ready-made medicine, only in microscopic doses.

• From propolis, you can prepare a healing ointment for thrombophlebitis. To do this, grind it, mix with warmed butter in a ratio of 3:10 and warm it up a little (no more than 15 minutes). Apply as a compress or simply rub into the affected area.

Apple vinegar

• Homemade apple cider vinegar is an effective remedy for this severe vein disease. It is used in the form of rubbing, previously diluted with water (a tablespoon of vinegar in a glass of water).

Goose fat

• Most urban people do not know that in the village many diseases of the legs and arms (burns, frostbite), as well as ulcers of various origins and thrombophlebitis, were treated with goose fat. Even today, it is considered one of the most effective means, which is used both in pure form and in the preparation of ointments with the addition of various herbs, such as calendula or St. John's wort. Full recovery can be achieved using a 30% ointment with the addition of comfrey (larkspur) roots crushed into gruel. To do this, add 30 g of comfrey roots to one hundred grams of goose fat. Heat for 15 minutes, filter. The ointment is ready to use.

Herbal infusions for oral administration

Some external remedies are sometimes not enough to get rid of the disease. Traditional medicine also recommends taking inside decoctions of medicinal herbs that improve blood circulation, increase the elasticity of the walls of venous vessels.

1. The most effective is nettle infusion. It not only has a beneficial effect on the circulatory system, but also heals and strengthens the entire body as a whole. It is especially useful in the spring when there is a lack of vitamins.
   ** Kvass can be prepared from young nettle, which has medicinal properties and energizes. To prepare it, pick fresh nettles. Rinse well, you can scald with boiling water. Put it in a three-liter jar, add three tablespoons of sugar and pour boiling water over it. Tie the neck with gauze and leave in a warm place for three to four days to ferment. After the kvass ferments, strain and you can start treatment, consuming half a glass three times a day 20 minutes before meals.
2. It is also useful to take escuzan - horse chestnut inflorescences infused with alcohol.
3. Tea from dried clover heads (1 tablespoon per cup) helps to treat thrombophlebitis well.

All the proposed methods of treatment with folk remedies, before use, must be agreed with the attending physician ... It is better to use them in combination with drug therapy.

Gymnastics for thrombophlebitis

For many years, medical luminaries have been arguing about the need for exercise for diseases of the veins of the lower extremities. Some argue that complete rest is necessary, others are ardent supporters of physical activity. Both are right.

During the period of exacerbation, when the risk of a blood clot rupture and the occurrence of serious complications is high enough, it is necessary to observe bed rest, not subjecting the sore legs to stress. During this period, thermal baths and all types of massage are strictly prohibited.

But, upon completion of treatment, during the period of rehabilitation, as well as as a prophylaxis of the disease, which help to increase the elasticity of the venous walls and improve blood circulation are very useful. The only condition is not to overdo it. The complex of remedial gymnastics includes the following exercises:

In the prone position:

• Exercise "fish". Having relaxed the body, vibrate it, imitating the movement of a fish in water. Continue for one to two minutes.
• Slowly raise your legs up and lower to their original position. Repeat no more than 8-10 times.
• "Scissors". Raise your legs up to the sides, and then move them. The number of repetitions is 10 times.

In a standing or sitting position:

• Circular movements of the feet to the right or left (from five to ten times).

In the standing position:

• 1. Raise to the toes and soft lowering to the heels (up to 15 times).
• 2. Bend your right leg and raise. Then straighten and lower to the floor. Perform this movement with the left foot. You can do this exercise alternately, changing your leg each time. The second option involves performing first with one leg (12 times), then the same amount with the other leg.

All of these exercises effectively massage the veins and prevent the stagnation of blood in the veins. Observing all the prescriptions of the doctor and performing preventive measures, you can get rid of the unpleasant symptoms accompanying the disease and avoid complications that require long-term treatment.

Video: a set of exercises for the legs with varicose veins and non-acute thrombophlebitis

How to eat with thrombophlebitis?

One of the causes of the described disease is obesity. Therefore, everyone who is susceptible to any disease of the venous system needs to limit themselves in the use of certain foods.

So, for example, a diet for thrombophlebitis ( for the period of treatment) recommends giving up fried, spicy, too salty and spicy foods. It is advisable to refrain from fatty varieties of fish and meat, to include dietary varieties in your diet: chicken breasts, rabbit meat, turkey meat. There should always be fresh vegetables and fruits on the table, except for bananas, peas and beans.

In winter, take a multivitamin. Make it a rule to eat a clove of garlic every day, be sure to eat onions.

People who are at risk for thrombophlebitis need to be very attentive to the condition of their hands and feet. Adhere to the recommendations given by the phlebologist. You should lead an active lifestyle. Try to walk more, master special exercises that prevent the development of the disease. Nice to go swimming, ride a bike. At home, you can maintain the tone of blood vessels with vitamin teas, often drink cranberry juice, St. John's wort tincture.

At the same time, avoid static stress that occurs when a person is sitting for a long time or standing on their feet (for example, working at a machine tool). Steam bath, dehydration is contraindicated in thrombophlebitis. Shoes should be as comfortable as possible, with an optimal heel height and orthopedic insoles. It is recommended to rest while lying down, slightly raising your legs and placing a small pillow under them. You should also put on compression garments while lying on your legs raised up.

Video: lecture by Ph.D. Belkina Z.P. about thrombophlebitis and related diseases

THROMBOFLEBIT - acute inflammation of the vein walls with the formation of a blood clot in its lumen.

A number of factors play a role in the development of the disease: a slowdown in blood flow, a change in its composition, disorders in the blood coagulation system, damage or disease of the vascular wall, neurotrophic and endocrine disorders, infection, allergic reactions. Thrombophlebitis often develops in patients with varicose veins, purulent infectious diseases, hemorrhoids, tumors, blood and heart diseases, as well as after surgical interventions (especially on the pelvic organs), childbirth, with prolonged vein catheterization, wounds and injuries, intravenous antibiotics , concentrated solutions of medicines.

Clinical picture depends on the localization of thrombosis. Distinguish between superficial thrombophlebitis (mainly varicose veins) and deep vein thrombophlebitis of the lower extremities.

Acute thrombophlebitis of the superficial veins of the lower extremities has a characteristic clinical picture and develops, as a rule, in a varicose vein. The greater saphenous vein is more often affected. In the course of the thrombosed vein, acute pulling pains occur, possibly an increase in body temperature up to 37.5 - 38 ° C. In the course of the affected vein, local hyperemia, skin hyperemia and a dense, painful cord on palpation are determined. In some cases, ascending thrombophlebitis of the great saphenous vein develops with the threat of pulmonary embolism.

Clinical picture acute thrombophlebitis of the deep veins of the leg depends on the length and location of the thrombus, the number of veins involved in the process. The disease usually begins acutely, with pain in the calf muscles, the appearance of a feeling of bursting in the lower leg, especially when lowering it down, an increase in body temperature. In the distal parts of the leg, edema appears, the skin acquires a slightly cyanotic hue, and after 2 - 3 days a network of dilated superficial veins appears on the legs, thighs, and abdomen. With dorsiflexion of the foot, sharp pains appear in the calf muscles. Perhaps the appearance of pain with deep palpation of the gastrocnemius muscle. Early diagnostic signs of deep thrombophlebitis are: Moses symptom -. soreness when squeezing the lower leg in the anteroposterior direction in the absence of pain after compression from the sides; symptom of Opitsa - Raminesa - sharp pain along the veins of the lower leg after increasing pressure to 40 - 45 mm Hg. Art. in the sphygmomanometer cuff placed above the knee joint; after lowering the pressure, the pain disappears; Lowenberg's symptom is a sharp pain in the calf muscles at a pressure of 60-150 mm Hg. Art. in a cuff overlaid on the middle third of the lower leg.

The development of thrombophlebitis in the femoral vein before the deep vein flows into it is characterized by less pronounced signs of impaired venous outflow due to well-developed collateral circulation. Pains are noted in the area of ​​the adductor muscles of the thigh. On examination, slight edema and dilatation of the saphenous veins are found. Thrombophlebitis of the common femoral vein is accompanied by sharp pain in the limb, pronounced edema and cyanosis. An increase in body temperature is accompanied by chills. In the upper third of the thigh, groin and pubic regions, dilated superficial veins appear.

The most severe is thrombophlebitis of the ilio-femoral segment of the main vein. With the initial occlusion of the common or external iliac veins with parietal localization of a thrombus or a thrombus that does not completely cover the lumen of the vein, minor pains appear in the lumbar and sacral regions, in the lower abdomen on the side of the lesion. Patients note malaise, a slight increase in body temperature. With floating blood clots, the pulmonary arteries may be the only sign of the disease. With complete occlusion of the iliac vein, sharp pains occur in the groin region, widespread edema of the entire limb develops with the transition to the gluteal and groin regions, genitals, and the anterior abdominal wall on the affected side. The edema is mild at first, then becomes dense. The skin becomes milky white or purple in color. The venous pattern is enhanced. The body temperature rises to 38 -39 ° C, chills, lethargy, weakness, and intoxication appear.

The most formidable complication of deep vein thrombosis of the lower extremities is the pulmonary arteries.

Treatment. The only radical method of treating thrombophlebitis of varicose veins is surgical, since only the operation reliably prevents the further spread of thrombosis, complications and relapses. Thrombophlebitis arising in previously unchanged veins are often subject to conservative treatment. Emergency surgery is indicated for progressive ascending thrombophlebitis of the great and small saphenous veins in order to prevent the spread of thrombosis to deep veins and to prevent thromboembolism.

Conservative treatment on an outpatient basis is acceptable with limited superficial thrombophlebitis of the foot and lower leg. At the same time, patients remain active. It is periodically recommended to give the affected limb an elevated position. Apply locally cold, dressings with heparin ointment, troxevasin jelly; anti-inflammatory and reducing congestion in the veins are prescribed (indomethacin, escuzan, venoruton, anavenol, troxevasin). With a pronounced inflammatory process in the tissues surrounding the vein, antibiotics and sulfa drugs are prescribed. In the acute period, UHF therapy is used. An important role is played by elastic bandaging of the limb.

Treatment patients with deep vein thrombophlebitis should be carried out in a hospital. In the first days, bed rest is shown with a limb raised by 15 - 20 °, bandaged with an elastic bandage. After confirming the diagnosis, therapy is carried out aimed at lysis of a thrombus (administration of streptase, streptokinase, urokinase) and suspension of thrombus formation - intravenous infusions of heparin (30-40 thousand units per day) under the control of blood clotting, rheopolyglucin (0.7 - 1.0 g / kg per day), pentoxifylline (3 - 5 mg / kg per day).

The activation of patients with deep thrombophlebitis begins from the 5th to the 10th day. Patients begin to do motor exercises (slow flexion and extension of the foot) lying down, then sitting in bed with their legs down; gradually switch to dosed walking. Elastic bandaging of the limb is mandatory.

After suffering acute thrombophlebitis, after 3 - 4 months, resort treatment with the use of radon or hydrogen sulfide baths in cardiovascular sanatoriums is indicated.

Forecast in acute superficial thrombophlebitis, as a rule, favorable. After 1-2 months, the patients resume their previous labor activity. After suffering acute deep vein thrombophlebitis, 75 - 90% of patients develop chronic venous insufficiency, the course of which is often complicated by the development of an edematous-painful form of post-thrombophlebitic syndrome, trophic ulcers, erysipelas, which is the cause of persistent disability and disability.

Prevention. Patients with varicose veins should be promptly referred for surgical treatment. Elastic compression of a limb with a stocking or bandage is indicated for pregnant women in the 2nd half of pregnancy. In the postoperative period, physiotherapy exercises, early activation of patients, elastic compression of the lower extremities, massage are recommended. With intravenous infusions, strict adherence to the rules of asepsis and antiseptics is necessary. The use of veins of the lower extremities for infusion should be avoided. For intravenous vein catheterization, small doses of heparin are injected into the catheter. With the threat of the development of troflebitis (varicose veins of the lower extremities, a history of thrombophlebitis, age over 60 years, etc.) in the postoperative period, the appointment of heparin, intravenous administration of dextrans that improve the rheological properties of blood (rheopolyglucin) are indicated.

Etiology and pathogenesis. A number of factors play a role in the development of thrombophlebitis: changes in the reactivity of the body, neurotrophic and endocrine disorders, damage to the vascular wall, infection, changes in the biochemical composition of the blood, slowing blood flow (for example, in heart failure) and venous stasis. Thrombophlebitis often develops against the background of varicose veins (see the complete body of knowledge). Often, the onset of thrombophlebitis is preceded by various surgical interventions, mainly on the pelvic organs and in the inguinal-iliac regions, abortions with a complicated course and childbirth (the so-called postpartum thrombophlebitis, which develops as a result of metroendometritis or adnexitis complicating labor), malignant tumors, trauma and wounds, prolonged vein catheterization.

The role of infection in the development of thrombophlebitis is complex. Some researchers believe that the causative agent of the infection acts directly on the vein wall, entering it either with the blood stream or from a nearby inflammatory focus. Others consider the action of the infection as general toxic, affecting the entire vascular system, disrupting the function of the blood coagulation and anticoagulation systems. If the vessels feeding the venous wall (vasa vasorum) are involved in the purulent process, the vein may melt (purulent thrombophlebitis).

Primary inflammation occurs, apparently, as a result of the reaction of the venous wall to irritants of an infectious, allergic

(autoimmune) or tumor in nature, entering the lymphatic vessels, capillaries of the vascular wall and perivascular spaces. A damaging agent causes not only damage to the endothelium of the venous system and activation of the blood coagulation process (see the complete body of knowledge: Blood coagulation system), it acts on the complement system (see the complete body of knowledge) and the kinin system (see the complete body of knowledge: Kinins), which have common activators and inhibitors; leads to a change in the protein-forming function of the liver with a predominance of the synthesis of procoagulants, inhibitors of fibrinolysis, a decrease in the production of heparin and activators of the fibrinolytic link of the hemostasis system (see the complete body of knowledge). These disorders ultimately lead to the emergence of a thrombotic state, characterized by significant hypercoagulation, pronounced inhibition of fibrinolysis and an increase in platelet and erythrocyte aggregation. This condition is predisposing for the formation of a blood clot and its active growth in the affected vessels.

Pathological anatomy. Features of morphogenesis Thrombophlebitis depend on the relationship between the processes of inflammation and thrombosis (see the complete body of knowledge). The inflammatory process in the vein wall can precede thrombosis, developing in the inner lining of the vessel (endophlebitis) or spreading from the tissues surrounding the vein (periphlebitis), and gradually capture the entire thickness of the vein wall (panphlebitis). The onset of thrombosis is usually associated with damage to the endothelium. However, another way is also possible: with a violation of hemodynamics in a vein, as well as with pathology of the blood coagulation system, phlebothrombosis occurs, to which inflammatory changes in the wall, usually its inner membrane, join. Endophlebitis in combination with thrombosis is called endothrombophlebitis. Thrombophlebitis, which develops on the basis of periphlebitis, is called perithrombophlebitis; more often it occurs during suppurative processes - boils, abscesses, phlegmon (color picture 11).

With endothrombophlebitis, the vein wall is hyperemic, edematous, its inner layer is moderately infiltrated with polymorphonuclear leukocytes. The endothelial layer of the wall is absent, thrombotic masses are adjacent to it. Collagen and elastic fibers are not changed, the outer wall membrane and perivascular connective tissue are intact.

In some cases, the intensity of infiltration of the vein wall by polymorphonuclear leukocytes over some extent can be significant. In this case, the inner layers of the wall are melted; its structural elements in these areas are not traced, a thrombus is adjacent to the necrotic area, which contains a significant number of leukocytes. Leukocyte infiltrate, gradually decreasing, spreads to the outer wall membrane; in accordance with a decrease in infiltration, destructive changes decrease. Vasa vasorum thrombosis occurs only when inflammatory infiltration captures all layers of the vein wall, including the outer ones.

With perithrombophlebitis, the outer sheath of the vein wall and the vasa vasorum are primarily affected. The vein wall is thickened, gray-yellow in color, with areas of hemorrhage. Leukocyte infiltration extends from the perivascular connective tissue to the outer, then the middle and inner lining of the vessel. The walls of the vasa vasorum, around which the most intense infiltration is noted, undergo necrosis, and their lumen is thrombosed. Violation of blood circulation in the vasa vasorum system leads to the development of degenerative and necrotic changes in the vein wall. Against this background, inflammatory infiltration intensifies, the spread of which to all layers of the wall ends with the formation of first a parietal, and then an obstructing thrombus.

Thrombophlebitis in sepsis (see complete body of knowledge) is characterized by purulent inflammation of the inner lining of the vessel; in thrombotic masses infiltrated by leukocytes, microbial colonies are found. Often they are located not only in thrombotic masses, but also in the middle and outer veins, which leads to the formation of micro-abscesses. Subsequently, thrombotic masses undergo purulent fusion together with the adjacent sections of the vein wall. Septic thrombophlebitis becomes a source of generalization of infection, the development of thrombobacterial embolism (see the complete body of knowledge: Embolism) and purulent-destructive changes in various organs and tissues.

With a favorable course of acute thrombophlebitis, resorption of necrotic masses occurs, polymorphonuclear leukocytes disappear, macrophages, lymphocytes, plasma cells, and fibroblasts appear instead. A loose young granulation tissue develops (see the complete body of knowledge), and then the organization or drainage of a thrombus occurs, the maturation of granulation tissue (color picture 12) and its transformation into coarse fibrous connective tissue. If the lumen remains in the vessel and the wall remains mobile, it is possible to restore elastic fibers and form membrane-like structures from them, which have an irregular shape and uneven folding. When obliterating the lumen of the vessel, elastic fibers are formed a little; they do not fold into membrane-like structures. The newly formed collagen fibers both in the vein wall and in the thrombus are not oriented. Smooth muscle cells are not restored, and the remaining ones are located in groups among the fibrous structures. After the completion of the organization process, it is not possible to microscopically determine the boundary between the altered venous wall and the fibrous tissue that has developed at the site of the thrombus. Often in the fibrous-altered tissues of the vein wall, areas of hyalinosis (see the complete body of knowledge), calcification (see the complete body of knowledge) are revealed.

The outcome of thrombophlebitis is sclerosis (see the complete body of knowledge) of the venous wall and thrombus. The vein takes the form of a dense whitish tube or cord. The degree of restoration of the lumen of the vein in thrombophlebitis depends on the size of the thrombus. A small parietal thrombus in the process of scarring merges with the wall, making it thicker, bricking up the venous valves, but not interfering with blood flow, that is, almost complete restoration of the lumen occurs. The thrombus, which closes most of the lumen of the vein, as the connective tissue matures, turns into a thick connective tissue cushion; the lumen of the vessel narrows unevenly, in places acquiring a slit-like shape. A thrombus that obstructs the lumen of a vein, after completion of the organization, leads to obliteration of its lumen. In the connective tissue replacing a thrombus, you can find gaps and channels lined with endothelium and containing blood. The degree of restoration of blood flow depends to a certain extent on their volume.

Periphlebitis, which develops in thrombophlebitis, can be the cause of sclerosis of the connective tissue surrounding the neurovascular bundle, and therefore the latter is in a dense fibrous sheath. It is possible that this case, especially when it is petrified, is important in the development of neurotrophic disorders in post-thrombophlebitic syndrome (see the complete body of knowledge: below).

Changes in organs and tissues with thrombophlebitis depend on the localization and severity of the process. Venous congestion leads to the development of dystrophic, atrophic, sclerotic changes in the surrounding tissues; development of venous (stagnant) heart attacks of internal organs, the occurrence of trophic ulcers is possible (see the complete body of knowledge). With purulent thrombophlebitis, especially with sepsis, metastatic abscesses are found in internal organs - lungs, kidneys, liver, brain, heart.

The clinical picture. Thrombophlebitis usually develops in the vessels of the lower extremities and pelvis; Thrombophlebitis of hemorrhoidal (rectal) veins is quite common (see the complete body of knowledge: Hemorrhoids). Much less often the main veins of the upper extremities are affected; a typical manifestation of the disease is Thrombophlebitis from exertion, or Paget-Schrötter syndrome (see the complete body of knowledge: Paget-Schrötter syndrome). Thrombophlebitis of the veins of the pelvic organs, portal vein and its branches and the venous system of the brain occurs, as a rule, as a result of acute or chronic inflammatory diseases of the corresponding organs, as well as as a complication after surgery (see the complete body of knowledge: Metrothrombophlebitis, Pylephlebitis, Thrombosis of cerebral vessels brain).

With thrombophlebitis of the vessels of the lower extremities, the duration of the acute period is up to 20 days, the subacute period is from 21 to 30 days from the moment the clinical signs of the disease appear. By this time, the processes of inflammation and thrombus formation usually end and the disease passes into the stage of consequences Thrombophlebitis, characterized by the presence of chronic venous insufficiency, and in the case of localization of the process on the lower extremities, the development of post-thrombophlebitic (post-phlebitic) syndrome, against which patients often have relapses of thrombophlebitis (recurrent Thrombophlebitis). The term chronic thrombophlebitis, previously used to denote this condition, is currently not used.

Acute thrombophlebitis of the superficial (saphenous) veins usually develops on the lower extremity, more often affecting the varicose vein of the great saphenous vein of the leg (color picture 9). The process can be localized on the foot, lower leg, thigh, or spread to the entire limb. Suddenly there are acute pains along the thrombosed vein, possibly an increase in body temperature up to 38 °. On examination, skin hyperemia and infiltration are determined along the thrombosed vein, which is palpated in the form of a dense painful cord. The thrombotic process, ahead of the inflammation of the vein, often spreads significantly above the clinically determined proximal border Thrombophlebitis.If this causes occlusion of the main vein, then the clinical picture of the disease consists of symptoms of acute superficial thrombophlebitis and signs of its occlusion.

Rice. 9. Inflammatory infiltrates in the area of ​​varicose-dilated great saphenous vein of the right thigh in acute thrombophlebitis of superficial veins. Rice. 10. External manifestations of deep vein thrombophlebitis of the left leg, complicated by gangrene of the left foot: the left leg is increased in volume (the perimeter of the thigh in the middle third is 53 centimeters at the lower leg in the middle third - 35.5 centimeters on the right - respectively 37.5 centimeters and 25 centimeters) , the distal part and the inner surface of the left foot are dark in color. Rice. 11. Microscopic specimen of the vein wall and surrounding tissues with thrombophlebitis caused by phlegmon: red thrombus in the lumen of the vein (indicated by the arrow), inflammatory infiltration of the vein wall and surrounding tissues; staining with hematoxylin-eosin; × 80. Rice. 12. Microscopic specimen of the subclavian vein wall with endophlebitis associated with its catheterization: 1 - thrombotic masses; 2 - maturing granulation tissue in place of the destroyed inner membrane of the vein wall; staining with hematoxylin-eosin; × 200.

Acute deep vein thrombophlebitis of the lower leg. Clinical, the picture of deep vein thrombophlebitis of the leg depends on the localization and length of the process, as well as on the number of vessels involved in the pathological process. The disease usually begins with pain in the calf muscles. With the spread of the process, the pain increases sharply, there is a feeling of bursting in the lower legs, the body temperature rises, sometimes with chills, the general condition worsens. In the distal part of the leg, moderate edema appears, which can increase and spread to its lower third. The skin is normal or cyanotic; on the 2-3rd day, a network of dilated superficial veins appears; calf skin temperature is usually elevated. With the defeat of all deep veins of the leg and popliteal vein, a sharp violation of venous outflow develops; along with the described signs, diffuse cyanosis of the skin appears in the lower third of the lower leg and on the foot. With deep vein thrombophlebitis of the lower leg, one of the signs is a symptom of Gomans - the appearance or intensification of pain in the gastrocnemius muscle during dorsiflexion of groans. Palpation reveals soreness of the leg muscles. A positive Moses symptom is determined: pain when squeezing the lower leg in the anteroposterior direction and its absence when squeezing from the sides. This symptom is important in the differential diagnosis of thrombophlebitis and myositis. A positive Lowenberg test is determined with a sphygmomanometer cuff applied to the middle third of the lower leg: a sharp pain in the calf muscles appears at a pressure of 60-150 millimeters of mercury; normally, minor pain occurs only at a pressure of 180 millimeters of mercury

Despite the large number of diagnostic techniques, the recognition of acute deep vein thrombophlebitis of the lower leg is often difficult, since these techniques are not specific tests. The final diagnosis can be made using radioisotope and radiopaque research methods.

Acute thrombophlebitis of the femoral vein. If thrombophlebitis develops in the femoral vein before the deep vein of the thigh flows into it, the venous outflow from the limb suffers less than in the case of the lesion of its overlying section. Therefore, in clinical practice, at the suggestion of B.N.Kholtsov (1892), most surgeons usually divide the femoral vein into the superficial vein of the thigh, extending to the confluence of the deep vein of the thigh, and the common femoral vein, located proximal.

Primary thrombophlebitis of the superficial vein of the thigh, like thrombophlebitis that spreads from distal veins, often occurs latently due to well-developed collateral circulation. Patients note aching pains along the medial surface of the thigh; the most important clinical signs are the expansion of the saphenous veins on the thigh in the basin of the great saphenous vein of the leg, slight edema and soreness along the vascular bundle on the thigh. Acute thrombophlebitis of the common femoral vein is manifested by vivid clinical symptoms, since most of the main collaterals of the thigh and lower leg are turned off from the blood circulation. The spread of the process from the superficial femoral vein to the general one is characterized by a sudden significant edema of the entire lower limb, often with cyanosis of the skin. The general condition deteriorates sharply, the body temperature rises, and chills occur at the same time. The pronounced edema lasts for 2-3 days, after which it slowly decreases due to the inclusion of collateral vessels in the circulation. During this period, the expansion of the saphenous veins is found in the upper third of the thigh, in the pubic and groin areas. In primary acute Thrombophlebitis of the common femoral vein, the disease begins acutely with pain in the upper third of the thigh and groin. This is followed by edema and diffuse cyanosis of the skin of the entire limb, sharp soreness in the upper third of the thigh, infiltration along the vascular bundle and a significant increase in the inguinal lymph nodes. The rest is clinical, the picture of the disease is similar to the clinical picture of the ascending thrombophlebitis of the common femoral vein.

Acute thrombophlebitis of the main pelvic veins is the most severe form of Thrombophlebitis of the lower extremities. Its typical manifestation is the so-called ilio-femoral (iliofemoral) venous thrombosis, in the development of which there are two stages: the stage of compensation (prodromal) and the stage of decompensation (pronounced clinical manifestations).

The stage of compensation corresponds to the initial occlusion of the common or external iliac veins with parietal localization of a thrombus or with a thrombus of a small diameter, compensated by collateral circulation, in the absence of hemodynamic disturbances in the limb. The pathological process is sometimes limited to the first stage, and its only manifestation may be sudden pulmonary embolism. With ascending thrombophlebitis, the prodromal stage is absent, since the moment of occlusion of the iliac veins is preceded by a clinical picture of ascending thrombophlebitis of the main veins of the limb.

In the clinical stage of compensation, the picture is poor. As a rule, there is a characteristic pain syndrome - dull aching pains in the lumbosacral region, lower abdomen and lower extremities on the side of the lesion, which are caused by stretching of the walls of thrombosed veins, hypertension in distal venous segments and periphlebitis. Patients complain of malaise, lethargy; subfebrile temperature is possible. The duration of this stage is from 1 to 28 days, depending on the localization of the primary thrombophlebitis, the rate of propagation of the process and the compensatory possibilities of collateral circulation.

The stage of decompensation occurs with complete occlusion of the iliac veins, which leads to severe hemodynamic disturbances in the limb. The pain intensifies sharply, usually localized in the groin area, along the medial surface of the thigh and in the calf muscles. The edema extends to the entire limb up to the groin fold, buttock, external genitals and the anterior abdominal wall on the affected side. The color of the skin of the affected limb changes dramatically: it becomes either violet-cyanotic due to pronounced venous stasis, or milky white with sharply impaired lymph outflow. After a decrease in edema, an enhanced pattern of the saphenous veins on the thigh and in the groin area, as well as signs of psoitis (soreness in the iliac region with maximum flexion of the hip, flexion contracture in the hip joint), caused by periphlebitis of the common iliac vein, which is located in the immediate vicinity of the greater lumbar muscles.

Complications. The course of acute Thrombophlebitis of the main veins of the lower extremities and pelvis is often complicated by pulmonary embolism (see the complete body of knowledge). The most severe complications of thrombophlebitis include venous gangrene (ischemic thrombophlebitis, gangrenous thrombophlebitis), in which thrombosis of the entire venous bed of the limb develops. The blood flow persists for some time, which leads to the accumulation of a large amount of fluid in the tissues of the limb and an increase in its volume by 2-3 times, then arterial spasm occurs, a sharp violation of arterial circulation, a putrefactive infection joins (see the complete body of knowledge), a picture of septic shock develops (color picture 10). In some cases, purulent fusion of the affected vessels occurs with the formation of superficial or deep abscesses, phlegmon and a sharp deterioration in the general condition due to intoxication of the body.

Patients with unrecovered blood flow in the main veins and decompensation of collateral circulation subsequently suffer from post-thrombotic disease (post-thrombophlebitic syndrome) - chronic venous insufficiency of the lower extremities that developed after acute thrombophlebitis The cause of post-thrombophlebitic syndrome is blockage in veins or recurrent thrombophlebitis syndrome, which is more often the obstruction of the vein thrombophlebitis. as a result, thrombophlebitis turned out to be destroyed venous valves, as well as the presence of compressive paravasal fibrosis. Most often, post-thrombophlebitic syndrome develops after thrombophlebitis of the ilio-femoral or femoral-popliteal areas of the deep vein of the thigh. Often, recanalization of one segment of the vein is combined with blockage of another. Of particular importance is the failure of the valves of the perforating veins connecting the saphenous veins of the limb with the deep ones. In this case, reflux (see the complete body of knowledge) of blood from the deep veins into the saphenous veins is observed, leading to secondary varicose veins of the saphenous veins. Violations of venous hemodynamics in post-thrombophlebitic syndrome are reduced to dysfunction of the muscle-venous pump; this is accompanied by venous stasis, to which secondary lymphostasis joins, and then functional and morphological changes in the skin, subcutaneous tissue and other tissues of the limb. A sharp increase in venous pressure leads to pathological shunting of blood flow through arterio-venular anastomoses and desolation of capillaries, accompanied by tissue ischemia.

The characteristic symptoms of post-thrombophlebitic syndrome are bursting pains and a feeling of heaviness in the lower leg, edema of the foot and lower leg, varicose veins of the limb, and sometimes the anterior abdominal wall. In the stage of decompensation, pigmentation and induration of the skin and subcutaneous tissue appear in the lower third of the leg, more often along its medial surface. The skin is thinned, motionless (does not fold), hairless; after a minor injury, scratching or for no apparent reason, a trophic ulcer is often formed (see the complete body of knowledge), at first a small one, healing after treatment, and then recurrent, increasing in size.

Diagnosis. For the diagnosis of acute thrombophlebitis of the great veins, in addition to clinical signs, distal phlebography (see the complete body of knowledge), antegrade and retrograde iliokavography (see the complete body of knowledge: Cavography), and research with labeled fibrinogen are of great importance. These studies make it possible to determine the localization and prevalence of venous occlusion, to identify embologenous forms of the disease, and to find out the activity of the thrombotic process. An indirect assessment of the activity of thrombus formation can be made by analyzing the state of the hemostasis system. The most informative tests are thromboelastography (see the complete body of knowledge), determining the time of thrombus formation according to Chandler, plasma tolerance to heparin (see), the concentration of fibrinogen (see the complete body of knowledge), the intensity of spontaneous lysis of a blood clot (see the full body of knowledge: Blood clot) , antiplasmin activity of plasma (see the complete body of knowledge: Fibrinolysin), the aggregation ability of platelets and erythrocytes. The thrombotic state of the hemostasis system, revealed during the analysis of these indicators, confirms the diagnosis.

Diagnosis of acute superficial thrombophlebitis usually does not present any particular difficulties. However, with the spread of Thrombophlebitis to the saphenofemoral anastomosis, that is, to the place where the great saphenous vein of the leg flows into the femoral vein, as well as the presence of clinical signs of deep vein damage in the limb, it is necessary to perform a radiopaque study. The most dangerous forms of the disease, such as segmental occlusion of the venous line over a short length or floating, that is, a mobile thrombus that is freely located in the blood stream and has a single fixation point at the base, can only be detected using a radiopaque study method.

Radiation methods for diagnosing Thrombophlebitis include angiogrammeraphy, thermography and radionuclide (radioisotope) research. The most important among them is phlebography. It allows not only to identify the localization of blood clots and their length, but also to assess the state of collateral circulation and anastomoses between deep and superficial veins at various stages of thrombophlebitis. When interpreting a phlebogram, special attention is paid to the presence or absence of contrasting of the main veins, filling defects in them, amputation of the main veins at various levels. The phlebographic picture of vein obstruction is very diverse and largely depends on the factors that caused these changes. In this regard, difficulties often arise in the interpretation of the phlebogram. So, a filling defect on a phlebogram, which is one of the direct signs of thrombosis, can be with a tumor, an inflammatory process, with an increase in lymph, a node, and in the presence of intravascular organic formations (congenital and acquired septa). In these cases, differential diagnosis is extremely difficult and requires taking into account the entire set of clinical, laboratory and instrumental examination methods.

Methods of radionuclide diagnostics (see the complete body of knowledge: Radioisotope diagnostics) is advisable to apply in cases of suspicion of deep vein thrombosis. Radiopharmaceuticals are injected into the vascular bed - human serum albumin labeled with radioactive iodine (131 I), technetium pertechnetate (99m Tc) or inert radioactive gas xenon (133 Xe), dissolved in isotonic sodium chloride solution, and others. administration of radiopharmaceuticals that selectively accumulate in the thrombus, for example, fibrinogen labeled with 123 I, 125I, 131 I (see complete body of knowledge: Radiopharmaceuticals).

Any single-channel radiometric setup with a well-collimated detector can be used to measure radioactivity at selected points on the leg or thigh (see complete body of knowledge: Radioisotope diagnostic devices).

A study carried out with a gamma camera using the same radiopharmaceuticals makes it possible not only to trace their passage through the vessels, but also to obtain an image of this process on the screen. Such radionuclide venography using 99m Tc was proposed and developed by L. Rosenthal in 1966. Subsequently, M. M. Webber et al. (1969), Rosenthal and Grayson in 1970 proposed for the same purposes macroaggregate of albumin labeled with 99m Tc or 131 I. The use of the latter compound is especially indicated in patients with suspected pulmonary embolism, when it is advisable to simultaneously perform radionuclide venography and lung scintigraphy.

The research procedure is relatively simple. Labeled with 99m Tc or 131 I micro or macroaggregates of albumin are injected into the dorsal vein of the foot. Subsequent serial scintigraphy (see the complete body of knowledge) or radiometry (see the complete body of knowledge) allows you to observe the passage of the drug through the deep veins of the limb along their entire length, as well as assess the state of collateral venous circulation. The undoubted advantage of this technique is that the results can be obtained within 30 minutes from the start of the study.

Thermographic research (see the complete body of knowledge: Thermography) with thrombophlebitis and other lesions of the vascular system is based on the registration of natural infrared radiation. Thermography is most widely used in studies of the lower extremities with various lesions of the veins and arteries (figure). During thermography, attention is paid to the symmetry of the temperature in both extremities, the presence of foci of hypo and hyperthermia, the absolute and relative temperatures are measured in different parts of the investigated area. With varicose veins, accompanied by chronic venous insufficiency, a branched network of superficial vessels appears, the temperature above which is significantly higher than the temperature of the surrounding tissues. With thrombosis of a large venous trunk, there is a diffuse increase in temperature below the level of the lesion. The diagnostic capabilities of thermography in the recognition of occlusive lesions of the vessels of the lower extremities exceed the capabilities of the clinical ones, the examination of such patients, especially in the early stages of the process, and significantly complement the results of other methods of radiation diagnostics.

Diagnosis of post-thrombophlebitic syndrome is based on anamnesis data (past acute venous, more often ileo-femoral thrombosis), clinical, patient studies and functional tests (see the complete body of knowledge: Varicose veins). Clarification of the localization and nature of the violation of the patency of the main veins, the state of the valve apparatus of perforating veins and the presence of reflux of blood from deep veins into superficial veins are established using phlebography, phlebotonometry (see the complete body of knowledge) and other techniques.

Differential diagnosis. Acute superficial thrombophlebitis must be differentiated from acute lymphangitis (see the complete body of knowledge). With the latter, the red stripes of skin hyperemia are narrower and more delicate, and cord-like infiltrates along the way are absent or very thin and hardly noticeable. Acute deep vein thrombophlebitis of the lower extremities and pelvis is usually differentiated from diseases in which edema of the lower extremities occurs: with erysipelas (see the complete body of knowledge) and lymphostasis (see the complete body of knowledge), intermuscular hematoma (see the complete body of knowledge), deep phlegmon (see complete body of knowledge) in myositis (see full body of knowledge), edema of the lower extremities in heart failure (see full body of knowledge) or after injuries, lumbosacral radiculitis (see full body of knowledge) with femoral nerve neuritis, tumors (see full body of knowledge) ) or inflammatory infiltrates, squeezing the main veins. With all these diseases, cyanosis of the skin and expansion of superficial veins on the affected limb are usually absent. With lymphostasis and heart failure, there is no pain along the vascular bundle. With deep phlegmon of the thigh, there is a deterioration in the general condition, symptoms of intoxication, an increase in body temperature up to 39-40 °, sharp soreness not only in the projection of the vascular bundle, but also in other areas, and edema (without cyanosis) is limited to the area of ​​the thigh; in addition, you can find the entrance gate of infection (abrasions, injection sites, and others). With erysipelas, the disease begins with chills and high body temperature (up to 40 °); on the skin of the affected limb, bright hyperemia with a clear border is determined. In lumbosacral radiculitis with femoral nerve neuritis, there is a characteristic neurological symptomatology that is not characteristic of Thrombophlebitis. ...

Postthrombophlebitic syndrome is differentiated with malformations of veins, compression of the inferior vena cava or iliac vein by a tumor, as well as with chronic disorders of lymphatic drainage (see the complete body of knowledge: Elephantiasis). For this purpose, phlebography or lymphography is performed (see the complete body of knowledge).

Treatment. Patients with acute limited thrombophlebitis of the superficial veins of the leg and thrombophlebitis of the veins of the upper extremities are treated on an outpatient basis. Patients with thrombophlebitis of the main deep veins should be referred to a surgical hospital, preferably to specialized vascular surgical departments. Patients with purulent and septic thrombophlebitis should be hospitalized in purulent surgical departments.

Thrombophlebitis treatment is aimed at eliminating the inflammatory and stopping the thrombotic process, restoring the patency of thrombosed veins, eliminating hemodynamic disorders in the affected limb, and preventing complications.

All patients with thrombophlebitis, in the absence of the threat of embolism, remain active; an elevated position of the affected limb is recommended. To reduce inflammation, cold is applied topically, acetylsalicylic acid (aspirin), butadion, reopirin, brufen, venoruton (troxevasin) and others are prescribed internally. To improve hemodynamics in the affected limb, the leg is bandaged with elastic bandages. For thrombophlebitis associated with an infection, antibiotics and sulfa drugs are prescribed. Starting from the 10-12th day after the onset of clinical signs of the disease (with conservative treatment), as well as in the postoperative period, it is advisable to use magnetotherapy (see the complete body of knowledge), diadynamic currents (see the complete body of knowledge: Impulse currents) or chymopsin electrophoresis.

The methods of conservative treatment of acute thrombophlebitis of the great veins also include antithrombotic therapy aimed at stopping the thrombotic process. As an independent method, it is used for common occlusive (non-embologic) forms of thrombophlebitis, when radical treatment is not indicated or impossible. Since active thrombus formation in the great veins is due to the thrombotic state of the hemostatic system, the main pathogenetic principle of antithrombotic therapy is the simultaneous elimination of hypercoagulation, inhibition of fibrinolysis and increased aggregation of blood corpuscles through the combined use of anticoagulants, antiplatelet agents and fibrinolysis activators. The optimal method of such treatment is continuous intravenous infusion (within 3-5 days) of heparin (450-500 units / kg per day), rheopolyglucin (0.7-1.0 g / kg per day), nicotinic acid (2.0 -2.5 milligram / kilogram per day) and trental (3-5 milligram / kilogram per day). Then rheopolyglucin is canceled, and the rest of the drugs continue to be administered in fractional doses until the 20-21st day after the onset of clinical signs of Thrombophlebitis. arteries, nerve trunks and worsening tissue ischemia. Complex antithrombotic and anti-inflammatory therapy significantly improves microcirculation and helps to eliminate hemodynamic disorders in the affected limb.

The effectiveness of thrombolytic therapy of acute thrombophlebitis of the great veins with fibrinolysis activators (streptase, urokinase and others) is limited in case of widespread thrombosis with total occlusion of the venous lines due to the difficulty of contact of fibrinolysis activators with a thrombus, in the descending form of ileo-femoral thrombosis and Paget's disease. Thrombolytic therapy is contraindicated in embologenous thrombosis due to the risk of thrombus fragmentation and pulmonary embolism.

Therapeutic exercise helps to reduce hypodynamia that occurs with prolonged bed rest in patients with thrombophlebitis, to improve venous outflow, and in this regard, the prevention of recurrent thrombosis. Early activation of patients is shown mainly in acute thrombophlebitis of the veins of the lower and upper extremities (thigh, lower leg, subclavian and axillary veins). Physiotherapy is contraindicated in patients with acute thrombosis of the main veins of the pelvis and inferior vena cava before the removal of a thrombus or its organization, as well as in patients with thromboembolic complications of the venous system.

The timing of the activation of patients with thrombophlebitis depends mainly on the severity of the disease. In case of thrombophlebitis of the saphenous veins, exercise therapy is prescribed from the 2-3rd day, deep - from the 5-10th day, when the local inflammatory reaction decreases, the body temperature decreases and the pain stops. In patients with thrombophlebitis of the lower extremities, physical therapy begins with exercises for a healthy leg, arms and breathing exercises while maintaining the elevated position of the diseased leg. Classes are carried out 1-2 times a day, the duration of the session is 7-10 minutes. After 1-3 days, exercises are prescribed for the sore leg: a short-term change of an elevated position to a horizontal, slow flexion and extension of the foot. Gradually increase the range of motion in the affected leg, the number of exercises for the limbs and trunk in the position of the patient lying on his back, on his side; increase the degree of effort of the muscles of the foot, lower leg, thigh of the sore leg; include short-term sitting with the legs in a horizontal position and with the legs down; gradually move on to standing up and dosed walking with preliminary bandaging of the leg with an elastic bandage. Snatch exercises, squats, jumps are excluded. It is advisable during the day to repeat multiple movements in the ankle joints with the effort of the calf muscles to improve the pumping function of the muscles and the development of collaterals.

Spa treatment with the use of hydrogen sulfide or radon baths (see the complete body of knowledge) is carried out in cardiovascular sanatoriums for patients who have undergone thrombophlebitis of the main veins, in a cool season (spring or autumn), no earlier than 3-4 months after the acute phenomena subsided diseases.

In acute thrombophlebitis of the great saphenous vein of the leg with a clinically determined upper border in the middle or lower third of the thigh and the absence of signs of thrombosis spread to deep veins, an emergency operation is indicated - ligation of the vein at its confluence with the common femoral vein with revision of the saphenofemoral junction (see the complete body of knowledge: Dressing blood vessels). The presence of continued thrombosis of the femoral-iliac venous segment dictates the need to perform thrombectomy during this operation (see the complete body of knowledge) through the orifice of the great saphenous vein of the leg. If the lesion of the latter is limited to the lower third of the thigh, surgery can be performed on a delayed basis after clarifying the upper limit by the method of local radiometry with labeled fibrinogen.

In the postoperative period, complex antithrombotic therapy is indicated, the same as in conservative treatment. From the first day after the operation, in order to prevent thromboembolic complications, physiotherapy exercises are prescribed.

Surgical treatment is absolutely indicated for embologenous forms of the disease, primarily with the aim of preventing pulmonary embolism.

Thrombectomy, which, depending on the localization of the embolus, is performed through the femoral, retroperitoneal, laparotomic or combined approaches is considered radical surgery. After thrombectomy from the great vein, it is advisable to impose a temporary arteriovenous fistula to improve hemodynamics.

Full restoration of blood flow in the affected vessels is possible with a floating thrombus in the external and common iliac veins originating from the internal iliac vein, as well as with saphenofemoral thrombosis extending into the iliac venous segment. In this case, thrombectomy can be performed through the internal iliac or large saphenous vein of the leg.

Widespread occlusion of the deep veins of the leg in combination with damage to the overlying venous segments, as a rule, excludes the possibility of complete restoration of blood flow and is fraught with the risk of recurrent thrombosis in the postoperative period.

Palliative interventions are indicated when radical surgery is technically impossible or contraindicated due to the severity of the patient's general condition. These include partial occlusion of the great veins by plication using a mechanical suture or special clamps, as well as implantation of an intravenous filter, which allows the formation of several small-diameter channels in the lumen of the great vein, preventing massive pulmonary embolism. Plication can be performed as an independent intervention or in combination with thrombectomy, if complete restoration of blood flow was impossible, loose thrombotic masses remained in the vessel, or ascending phlebitis of the great vein was detected during the operation. The filter is implanted retrograde (through the internal jugular vein) or antegrade (through the large saphenous vein of the leg or the femoral vein of a healthy limb). Intravenous filter implantation ensures reliable prevention of pulmonary embolism; in addition, it is less traumatic than plication of the great veins. The ligation of the great veins in order to prevent pulmonary embolism can be performed only in exceptional cases when other interventions are impossible. This operation (especially the ligation of the iliac veins) subsequently leads to the development of severe post-thrombophlebitic syndrome (see the complete body of knowledge: above). In addition, it does not exclude the possibility of ascending thrombosis in the presence of pronounced phlebitis in the bandaging area.

Treatment of complications of thrombophlebitis. With purulent thrombophlebitis, they are usually limited to opening and draining the abscess. The occurrence of venous gangrene (see the complete body of knowledge) with an increase in ischemic disorders and the appearance of severe intoxication is an indication for amputation (see the complete body of knowledge) of the limb. However, many cases of incipient venous gangrene are amenable to conservative treatment - complex antithrombotic (without the use of heparin), detoxification and antibacterial therapy. Treatment of pulmonary embolism - see full body of knowledge: Pulmonary embolism.

Treatment of post-thrombophlebitic syndrome can be conservative, operative and combined. Conservative treatment is used with a favorable course of the disease and the presence of contraindications to surgery. It includes: compression of the affected limb using an elastic bandage or medical stocking; limitation of static loads, exclusion of heavy lifting and forced loads (running, jumping), elevated position of the legs during rest; training walking with a slow increase in loads, therapeutic swimming; repeated (once every 5-6 months) courses of drug therapy with the use of drugs that reduce the aggregation of blood corpuscles and improve microcirculation - trental, theonikol (komplamin), normalizing the catabolism of lipids and proteins (linetol, miskleron), metabolic, processes and permeability vascular wall (venoruton, glivenol, escusan, askorutin), as well as anti-inflammatory (acetylsalicylic acid, butadion, rheopyrin, brufen) and antihistamines (suprastin and others); repeated (simultaneously with drug treatment) courses of physiotherapy - magnetic field (see full body of knowledge: Magnetotherapy), diadynamic currents, chymopsin electrophoresis (see full body of knowledge: Electrophoresis).

Surgical treatment of post-thrombophlebitic syndrome aims to improve venous hemodynamics in the limb. According to VS Savelyev and GD Konstantinova (1980), the most widely used operation is to separate the deep and saphenous veins by subfascial ligation of the perforating veins of the lower leg in combination with the removal of varicose veins. Operations are also used to create additional pathways for the outflow of venous blood from the limb, for example, Palma-Esperon cross-over autovenous bypass grafting for occlusions of the iliac and proximal femoral veins, and others.Of the numerous operations aimed at the formation of valve mechanisms in the great veins, extravasal valve correction deserves attention spiral Vvedensky. The best effect can be obtained with a combination of various methods, including combined reconstructive operations on veins and lymphatic vessels.

Forecast. In patients with thrombophlebitis of superficial veins, the ability to work remains after elimination of inflammation. In patients with completely restored blood flow in the great veins, as well as those operated on for uncomplicated superficial thrombophlebitis, the prognosis is usually favorable: they recover and return to their previous work activity after 1-2 months. Less favorable prognosis in patients with unrecovered venous blood flow; they develop chronic venous insufficiency with pronounced edematous-pain syndrome, trophic ulcers, in connection with which a persistent disability occurs.

Prevention of acute thrombophlebitis should be carried out taking into account the potential etiological factor. Patients with varicose veins are recommended to regularly bandage the lower extremities with an elastic bandage or wear special elastic stockings. These measures are also indicated for women in the second half of pregnancy, when the enlarged uterus compresses the pelvic veins, which leads to a slowdown in blood flow in the lower extremities. Preventive measures for thrombophlebitis in the postoperative period include early activation of patients, the use of physiotherapy exercises, massage. For the prevention of thrombophlebitis, strict adherence to asepsis and antiseptics during intravenous infusion is necessary, especially in cases of prolonged catheterization with the aim of constant administration of medicinal solutions. With intravenous infusions lasting more than 3 days, catheterization of the subclavian or femoral veins is advisable; at the same time, small doses of heparin are added to the solutions (or introduced into the catheter between injections). If necessary, they resort to improving the rheological properties of blood, using hemodilution, the introduction of solutions with antiaggregatory properties (drugs of low molecular weight polyvinylpyrrolidone, rheopolyglucin and others). Particular attention in the prevention of thrombophlebitis is given to persons over 40 years of age.

Prevention of post-thrombophlebitic syndrome consists in the timely and complete treatment of acute venous thrombosis.

Wandering allergic thrombophlebitis (synonyms: allergic wandering phlebitis, migratory thrombophlebitis) is a type of systemic hyperergic vasculitis (see the complete body of knowledge: Vasculitis), characterized by segmental inflammatory lesions of the superficial subcutaneous, and sometimes at the same time, deep veins of the lower extremities. The process may also involve the veins of the upper extremities and trunk; at the same time, the thrombophlebitis of the venous vessels seems to migrate, manifesting itself in one place or another.

The etiology of allergic wandering thrombophlebitis has not been fully elucidated. It usually complicates the course of other diseases, in particular malignant tumors, tuberculosis, influenza, and chronic focal infection. With great constancy, this type of vasculitis is detected with thromboangiitis obliterans (see.

Obliterating vascular lesions of the extremities). Occasionally it is combined with rheumatoid arthritis (see the complete body of knowledge), periarteritis nodosa (see the complete body of knowledge: Periarteritis nodosa), Wegener's granulomatosis (see the full body of knowledge: Wegener's granulomatosis), hemorrhagic vasculitis (see the full body of knowledge: Shenlein - Genoch disease) , Chiari malformation (see complete body of knowledge: Chiari malformation). Inflammation of the veins and their thrombosis in this disease are associated with damage to the structures of the inner lining of blood vessels by immune complexes or sensitized immunocompetent cells. The antigenic stimulus remains unclear. At the same time, there is reason to believe that it is a protein of the tissue components of the vascular wall itself, subject to change under the influence of endogenous or exogenous pathogenic factors (see the complete body of knowledge: Autoantigens). The autoimmune mechanism of the development of such thrombophlebitis is confirmed by experimental data.

Wandering allergic thrombophlebitis is observed mainly in men. The disease, as a rule, begins acutely and is characterized by the appearance of painful nodules along the superficial veins of the extremities with reddening of the skin above them, and sometimes an increase in temperature. The disease lasts for a long time (up to 3-4 years) with remissions and relapses. The diagnosis of the disease is made on the basis of the migratory nature of the lesion of the superficial veins with the formation of painful nodules along their course. Histological examination of a thrombosed vein using the immunofluorescence method (see the complete body of knowledge: Immunofluorescence) allows to establish the immunopathological genesis of phlebitis.

The greatest effect in the treatment of the disease is observed with the use of cytostatics (see full body of knowledge: Antineoplastic agents), corticosteroid hormones (see full body of knowledge: Corticosteroids) and hyposensitizing agents (see full body of knowledge: Desensitizing agents). In some cases, the appointment of anticoagulants is recommended. Sometimes they resort to surgical methods of treatment.

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This is an inflammatory process in the internal venous wall with the formation of a thrombus. It is characterized by induration and redness along the dilated vein, severe pain, swelling, and an increase in local and general body temperature. With the spread of thrombophlebitis to deep veins, such a formidable complication as pulmonary embolism is possible. Typical clinical symptoms, ultrasound angioscanning data, ultrasound scan of veins, rheovasography help to diagnose thrombophlebitis. Conservative treatment of thrombophlebitis is aimed at preventing its spread and resorption of the resulting thrombus. Modern surgical treatment allows you to remove the affected vein along with thrombotic masses.

ICD-10

I80 Phlebitis and thrombophlebitis

General information

Thrombophlebitis is characterized by induration and redness along the dilated vein, severe pain, swelling, and an increase in local and general body temperature. In most cases, it requires surgical treatment due to the high probability of developing formidable consequences: septic complications, separation of a blood clot leading to deep vein thrombosis or thromboembolism of the branches of the pulmonary artery. Thrombophlebitis can be acute or chronic. If during the manifestation of acute thrombophlebitis the patient did not receive adequate treatment, it is highly likely that the disease will take on a chronic recurrent nature. Often, acute thrombophlebitis becomes chronic, even with timely adequate therapy. By the nature of the pathological process, purulent thrombophlebitis is distinguished.

Causes

Under certain conditions, thrombophlebitis can develop in the veins of any localization, however, most often the pathological process occurs in the vessels of the lower extremities. As a rule, thrombophlebitis affects the varicose veins of the superficial veins. In about 10% of cases, deep veins are involved in the process, along with superficial ones. A number of factors are important in the development of thrombophlebitis of various localization: a change in the composition of the blood and an increase in its coagulability, a slowdown in blood flow, damage to the venous wall of any genesis (trauma, disease, endocrine and neurotrophic disorders).

There is a danger of thrombophlebitis in the following diseases and conditions:

• local purulent processes;
• chronic diseases of the cardiovascular system;
• some blood diseases;
• conditions after surgery and medical abortion;
• postpartum period;
• trauma;
• oncological diseases;
• long-term catheterization of veins;
• common infectious diseases.

Thrombophlebitis symptoms

Acute thrombophlebitis of superficial veins is most often localized in the varicose veins of the upper third of the legs and lower third of the thighs. In about 95% of cases, the trunk of the great saphenous vein and its tributaries are affected. The patient complains of acute pulling pain along the affected vein, aggravated by walking. The temperature may rise to 37.5-38 ° C. There is hyperemia in the form of stripes. On palpation of a thrombosed vein, a local increase in temperature, a thickened painful cord, is determined.

Acute thrombophlebitis of superficial veins can develop in two directions. With a favorable course, thrombophlebitis phenomena gradually disappear (recovery occurs within 10 days to 3 or more months). In most patients, the lumen of the vein is subsequently restored; in some patients, the outcome is complete obliteration of the damaged vessel.

Possible unfavorable development of the disease. In this case, the process invades deep veins or spreads proximally (ascending thrombophlebitis). The risk of deep vein thrombosis increases with varicose veins, accompanied by valvular insufficiency of the perforating veins (vessels connecting the deep and superficial veins).

When the process spreads to deep veins, deep vein thrombophlebitis (phlebothrombosis) develops, the clinical symptoms of which depend on the localization of the thrombus. In some cases, phlebothrombosis is asymptomatic. It should be borne in mind that deep vein thrombophlebitis is a serious disease that poses a danger to the patient's life. The most formidable complication of phlebothrombosis is pulmonary embolism. The outcome of the disease can be chronic venous insufficiency.

Acute superficial and deep thrombophlebitis of the lower extremities, as a rule, occurs in patients with varicose veins. Varicose veins usually affect both limbs. With any variant of the development of thrombophlebitis, the formation of blood clots in the deep and superficial veins of the second lower limb is possible. Therefore, when choosing a treatment strategy, it is necessary to have complete data on the state of the venous system of both lower extremities. Chronic thrombophlebitis is the outcome of an acute process (the transition of an acute form to a chronic one is observed in 60% of patients), it is prone to a prolonged recurrent course.

Diagnostics

The clinical manifestations of thrombophlebitis are determined by the localization of the thrombus, the prevalence of the pathological process, the duration of the disease and the severity of inflammation of the surrounding soft tissues. When determining the length of a thrombus during an external examination, the border of vein soreness should be taken as its endpoint, and not the end of a dense cord along the affected vessel.

Instrumental studies (rheovasography, ultrasound angioscanning, ultrasound scan of the veins of the lower extremities) are carried out, with the help of which the nature, localization and length of the thrombus are established, the state of the venous wall and the degree of preservation of the lumen of the thrombosed vein are determined.

Thrombophlebitis treatment

Conservative therapy is carried out by a phlebologist when a process occurs in previously healthy veins, with limited damage to the superficial vessels of the foot and lower leg. UHF and dressings with heparin ointment are applied locally. Patients are prescribed anti-inflammatory drugs and drugs that help reduce stagnation in the veins (troxerutin, dihydroergocristin, hydroxyethylrutoside). With severe local inflammation, antibiotic therapy is recommended. Elastic bandaging of the affected limb is shown.

Superficial ascending thrombophlebitis, affecting the greater and lesser saphenous veins, is an indication for hospitalization due to the threat of further spread and involvement of deep veins in the process. The patient is transferred to bed rest (4-5 days), the limbs are given an elevated position. In the early stages, fibrinolytic drugs (chymotrypsin, trypsin, urokinase, streptokinase, fibrinolysin) are used to dissolve the thrombus. Anti-inflammatory drugs, anticoagulants, phlebotonics, topical heparin-containing gels and ointments are prescribed.

In the presence of contraindications to anticoagulants (ulcers, fresh wounds, hemorrhagic diathesis, liver and kidney disease, open forms of tuberculosis), hirudotherapy (treatment with leeches) is recommended. To improve collateral circulation and reduce pain, novocaine lumbar blockade according to Vishnevsky is used. Severe hyperthermia and suspicion of purulent thrombophlebitis are an indication for antibiotic therapy.

Contrary to popular belief, patients with superficial vein thrombophlebitis should not stay in bed for a long time. Muscle contractions increase blood flow in the deep veins, thereby reducing the likelihood of blood clots. During physical activity, the patient is recommended to use an elastic bandage to fix the blood clot in the superficial vein.

In the long-term period, patients who have undergone acute thrombophlebitis are recommended spa treatment with the use of hydrogen sulfide and radon baths. Treatment of exacerbation of chronic superficial thrombophlebitis is carried out similarly to the treatment of an acute process. Patients with chronic thrombophlebitis should be referred for sanatorium-resort treatment only in the absence of trophic disorders and signs of exacerbation.

Prophylaxis

It is necessary to treat chronic venous diseases in a timely manner. Patients who have suffered thrombophlebitis in the past should constantly use elastic compression, limit the amount of animal fats in the diet, eat foods high in rutin and ascorbic acid (berries, fruits, vegetables). For the prevention of relapses 2-3 times a year, a course treatment is prescribed, which includes taking phleboprotectors and physiotherapeutic procedures (treatment with currents and alternating magnetic fields).