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Deep vein thrombosis
June 1, 2012
The deep vein thrombosis is an illness of which formation of clots (that is blood clots) which create obstacles for a normal blood-groove is characteristic. According to supervision of physicians, the deep vein thrombosis of the lower extremities is more widespread pathology, than vein thromboses which are localized in other places. Emergence of blood clots is possible both in deep, and in superficial veins. But superficial thrombophlebitis is less serious illness. At the same time a deep vein thrombosis it is necessary to treat urgently as the complications provoked by this illness can be very dangerous to the person.
Reasons of a deep vein thrombosis
The deep vein thrombosis of the lower extremities develops at the person under the influence of a combination of some factors. First of all, this existence of damage of an internal vystilka of a venous wall which arose as an effect of chemical, mechanical, allergic or infectious action. Also development of a deep vein thrombosis directly depends on disturbance of system of a blood coagulation and delay of a blood-groove.
Under the influence of certain circumstances there can be an increase in viscosity of blood. In the presence of certain obstacles in vein walls the blood flow worsens owing to what possibility of blood clots sharply increases. After on a wall of a vein there is small blood clot, inflammatory process develops, the wall of a vein is damaged further, and premises to emergence of other blood clots as a result appear.
Direct premises to manifestation of a deep vein thrombosis is presence of developments of stagnation at veins of legs. Such stagnation arises owing to low mobility or in general an immovability of the person throughout a long span.
Thus, factors which are capable "to start" development of this disease are infectious diseases, existence of injuries and operations, too strong physical tension. The deep vein thrombosis often arises at patients who a long time were not mobile after the performed operations, at some neurologic and therapeutic diseases, at young mothers in a puerperal period. Malignant diseases, the uses of oral hormonal contraceptives owing to what the increased coagulability of blood called by hypercoagulation is shown become provocative factors also often.
If the person too long period holds legs lowered down in motionless situation, then the probability of a course of a disease sharply increases. Today in the countries of the West even define the terms "television thrombophlebitis" (a consequence of long sitting in front of the TV) and "a syndrome of economy class" (a consequence of frequent and long flights). In both cases long stay of the person in a pose with the bent legs becomes a major factor of development of a disease.
In certain cases the blood stream in deep veins is broken owing to manifestation of a Thrombangiitis obliterans.
In most cases thrombosis affects lower extremities. However it happens that thrombosis develops also in deep veins of hands. In this case stay in a catheter vein the long period, existence of the implanted kardiofibrillyator or electrocardiostimulator, emergence of a malignant tumor in a vein, too strong load of hands is the reasons of such state (it is shown generally at athletes).
There are also other important risk factors contributing to a deep vein thrombosis. Among those it should be noted anesthesia. There are researches proving that use of the general anesthesia with muscular relaxants provokes a deep vein thrombosis of the lower extremities much more often, than regional methods of anesthesia.
One more important factor — obesity. People at whom excess weight takes place suffer from displays of postoperative thrombosis much more often.
The age factor in this case also plays one of the defining roles. The person becomes more senior, the his general mobility decreases more, and, therefore, the blood stream is broken, vessels become less elastic.
If the patient in the anamnesis already has displays of thrombosis, then the possibility of its repeated manifestation increases several times.
Symptoms of a deep vein thrombosis
Symptoms of a deep vein thrombosis are shown by a complex of signs which demonstrate sharply arisen disturbance of venous outflow, at the same time inflow of an arterial blood remains.
Regardless of that, thrombosis is localized where exactly, at the patient cyanosis and hypostasis of the affected extremity, display of arching pains, increase of temperature of skin which is shown locally can be observed. The person can feel that saphenas are crowded, also pain can arise on the course of a vascular bundle.
Constraint of movements in joints and sensitivity change is not characteristic of symptoms of a deep vein thrombosis. Most of patients at fibrinferment has signs of a periphlebitis and aseptic phlebitis.
At damage of deep veins of a shin to establish the diagnosis, as a rule, most difficult as clinical displays of this disease are especially poor. Generally the illness can not cause fears in the patient, and sometimes and in the doctor. Most often as a symptom of a deep vein thrombosis of a shin only weak pain in muscles of calves which can become more intensive in the course of walking or when moving a leg to vertical position is shown. In the presence of hypostasis of distal departments of an extremity diagnosing of a disease is facilitated. As a rule, hypostasis develops in anklebones. At thrombosing of all deep veins of a shin there is a strong disturbance of venous outflow, therefore, symptoms are shown is more expressed.
Symptoms which are shown at fibrinferment of a femoral vein depend on that, the gleam of a vessel is how narrowed and blood clots are widespread. In general at this form of a disease brighter symptoms are shown. At the patient the volume of a hip and shin increases, skin cyanosis develops, on a shin and in distal part of a hip expansion of saphenas takes place. Inguinal lymph nodes can increase, the hyperthermia to 38 degrees develops.
The acute deep vein thrombosis differs in prevalence and duration of pathological process. At such state localization of blood clots is observed not only where the wall of vessels, but also in a vessel gleam is damaged. At the same time outflow of blood is blocked.
Rather often, approximately in 50% of cases, at development of a deep vein thrombosis blood flows through kommunikantny veins in saphenas, therefore, the asymptomatic course of thrombosis is observed. Existence of noticeable venous collaterals in the bottom of a stomach, on a shin, a hip, in the field of hip joints sometimes demonstrates that the person had thrombosis.
Complications of a deep vein thrombosis
As complication of a deep vein thrombosis at the patient chronic venous insufficiency owing to which there is a development of hypostases of legs can be shown over time, the trophicity is broken. In turn, it conducts to eczema, a lipodermatoskleroz, emergence of trophic ulcers.
The thromboembolism of a pulmonary artery is considered the complication of a deep vein thrombosis, most dangerous to the person. At development of this illness there is a separation of pieces of blood clot which with a blood flow move to lungs, and, getting into a pulmonary artery, provoke its embolism. Owing to the broken blood-groove in a pulmonary artery there is a development of acute respiratory and heart failure. It is fraught with a lethal outcome. If there is an obstruction of a small branch of a pulmonary artery, then at the patient the lung heart attack is shown.
Diagnosis of a deep vein thrombosis
Diagnosis of a deep vein thrombosis is carried out by the specialist phlebologist. Initially, after carrying out poll and survey of the patient special cordlike tests with use of an elastic roller are carried out. Adequately to estimate features of a blood-groove in deep veins, the method of a flebografiya, duplex scanning is used, and also ultrasonic diagnosis of veins of legs is carried out. The reovazografiya of the lower extremities is applied to obtaining information on a condition of microcirculation.
Treatment of a deep vein thrombosis
Carrying out treatment of a deep vein thrombosis, it is necessary to consider surely its localization, prevalence, illness duration, and also severity of a disease.
The purpose of therapy of thrombosis are several defining moments. First of all, an important task in this case is need to suspend further distribution of thrombosis. Extremely important at this diagnosis to prevent development of a thromboembolism of pulmonary arteries, to stop development of hypostases, preventing thereby probable gangrene and further — loss of an extremity. As not less important point it is necessary to consider recovery of passability of veins for the purpose of avoiding of emergence of a posttromboflebitichesky illness. It is also important not to allow manifestation of the recurrence of thrombosis affecting negatively the forecast of a disease.
For carrying out conservative treatment of a deep vein thrombosis of the patient it is desirable to place in specialized department of a hospital. Before carrying out full inspection he has to adhere to a bed rest strictly. At observance of a bed rest the extremity affected with thrombosis should be held surely in sublime situation. If there is no possibility of comprehensive and full inspection of the patient, to it appoint anticoagulants, and also use a local hypothermia on the course of a projection of a vascular bundle.
In certain cases use of elastic bandage will be reasonable, however only the attending physician has to make the decision on their use.
Treatment of a deep vein thrombosis medicamentous means assumes appointments of three main groups of drugs. First, it is anticoagulants, secondly, fibrinolitik and trombolitik, thirdly, dezagregant.
For prevention of display of new blood clots to the patient heparin then order it reception of "soft" anticoagulants (warfarin) for the term of about six months is, as a rule, appointed. For the purpose of tracking of a condition of coagulability of blood the patient needs to carry out a koagulogramma regularly.
Treatment by other drugs of the different accompanying diseases can influence process of treatment of a deep vein thrombosis with use of warfarin. It is not necessary to use the antiinflammatory, and also anesthetizing drugs which can affect coagulability of blood without approval of the doctor. It is also important to coordinate reception of antibiotics, peroral antidiabetic means with the doctor.
It is important to consider also the fact that reception of thrombolytic drugs has due effect only at early stages of thrombosis. At later stages of use of this type of drugs constitutes a certain danger in view of probable fragmentation of blood clot and the subsequent thromboembolism of a pulmonary artery.
If disturbances in the affected extremity very much of a yak are expressed, to the patient carrying out a thrombectomy is appointed. This method assumes surgical removal from a blood clot vein. Such operation is performed only when exist life-threatening the patient of complication of a deep vein thrombosis.
Prevention of a deep vein thrombosis
In order that the illness did not progress, it is necessary to know about some measures of prevention also to people who already have thrombosis.
Food of the patient with a deep vein thrombosis provides introduction to a diet of a large number of the crude fruit and vegetables containing cellulose. From cellulose the fibrous fibers strengthening venous walls are synthesized. It is not necessary to use very spicy and salty food which can promote liquid delays that, in turn, will increase blood volume. Also it is not recommended uporteblyat those products in which the high level of content of vitamin K as they counteract the carried-out treatment is noted. In this case it is about a liver, coffee, green tea, a green salad, spinach, cabbage.
The opinion that patients have to spend with a deep vein thrombosis constantly time in a bed is wrong. Actually bed rest is ordered only at high risk of a pulmonary embolism. In other cases the dosed walking, on the contrary, lowers probability of further development of thrombosis and its recurrence.
At the same time patients with thrombosis should not visit a sauna, a bath, to do any thermal procedures, massage. All these actions provoke activation of a blood-groove, therefore, filling of venous system blood increases. Acceptance of a bathtub is also not welcomed: sick thrombosis it is better to take a shower. At an acute state it is also not necessary to be under direct sunshine, to apply hot wax to an epilation.
To prevent manifestation of a deep vein thrombosis, healthy people have to try to exclude all possible risk factors: improper feeding, low level of activity. Fight against excess weight, smoking is not less important. Especially it concerns people who have tendency to display of thrombophlebitis. Sometimes it is reasonable to such people to carry special elastic linen. Patients in the postoperative period have to pay special attention to ensuring early physical activity. Sometimes after carrying out serious operative measures of purpose of small doses of aspirin and heparin which promote reduction of coagulability of blood.
Very much in a question of prevention of thrombosis regular performance of physical exercises and sports is important. It is extremely important to consider this moment to people who mainly lead an inactive life. However to the people inclined to a vein thrombosis, it is not necessary to stop on the sports connected with load of feet.
Section: Diseases of vessels