• 17 JUN 12
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    Thrombophlebitis occurs when a blood clot is formed in one or more of your veins, most ofen in your legs. After the clot organize the vein wall become inflamed and swollen. Rarely, thrombophlebitis can affect veins in your arms or neck.

           Locating thrombophlebitis process.

    Generally occur in the limbs, or neck.

           Causes of thrombotic process

    The lower limbs, especially on a plot of venous insufficiency with or without the presence of varicose veins and the veins of the neck and upper limbs, especially after venous catheterization maneuvers, harvesting repeated administration of chemicals (chemotherapy, different antibiotics). Another reason for the occurrence of thrombophlebitis is represented by local trauma damage vein walls in the region. Thrombosis occurring disorders are not only the limbs, every vein thrombosis can, under certain conditions.

    A number of factors have been shown as having a favorable role in triggering the process of venous thrombosis and of these the most important are prolonged immobilization in bed, or during trips that require immobilization (plane, car) dehydration, prolonged use of medication pills

    There are physiological states that may predispose to venous thrombosis naturally, the most common and most important the task.

    Perhaps the most important factor leading to the occurrence of thrombosis is individual genetic predisposition due to a slight imbalance in the balance of factors involved in coagulation / fibrinolytic generated by individual genetic consteletia. Condition that may enter in turn collectively thrombophilia disorders or platelet dysfunction may exist, or the factors that influence the coagulation cascade. Ion and fluid and electrolyte imbalances may also be involved.

    All these conditions can be found after some battery tests, some of them with special instructions, but which must be requested by a physician, surgeon, obstetrician, hematologist, when suspected such a situation.

    An important group of diseases that can lead to thrombosis are cancer by biochemical changes produced by impregnating neoplastic or by affecting the circulation of venous and lymph after surgery with radical character (mastectomies for example). Another mechanism of thrombosis generator can be direct compression of venous axis by a tumor, malignant or benign, or by a cyst, hematoma, local fibrosis resulting from a surgical maneuver, venous findings in children etc. Burns can also trigger thrombophlebitis.

    What should be noted is that the most common medical condition that is complicated by thrombophlebitis remains a venous disease. Varicose leg vein blood stasis favors the lower limbs. Stasis and poor quality of the vein wall and subsequently triggers thrombosis phlebitis inflammation of the vein wall.

    Smoking and obesity are risk factors for the onset of thrombophlebitis

             Thrombophlebitis can be of two types – superficial thrombophlebitis and deep thrombophlebitis.

    The surface appears when one or more are affected superficial veins (suprafasciale) or deep thrombophlebitis when deep veins are involved (subfascial).

    The differences between the two types of thrombophlebitis are important, both as symptoms and as a outcome, complications and treatment.

    The disease is found in both sexes, but women predominate.

              symptoms of thrombophlebitis

    Leg veins consist of local pain that can lead up to functional impotence if deep thrombophlebitis (the patient can not move because of pain intensity). Simultaneously with the appearance of thrombophlebitis leg pain swelling, edema causes changes in skin color white, there is a feeling of heaviness, tension. Superficial thrombophlebitis occurs when a hard cord under the skin, colored in red, hot, painful, inflamed. It is now suffering vein thrombosis and phlebitis in the process. Often the process can move from day to day in the extension usually, especially in the absence of treatment. Thus codon vein may extend, branch, ascend. In general edema and pain are reduced in superficial thrombophlebitis from the deep. Swelling of deep thrombophlebitis is more pronounced, often comprising entire leg.

    The patient may be fever and general condition can alter, as we shall see when we list the complications of thrombophlebitis. In rare cases phlebitis process can lead to a local abscess, with the appearance of a hole through which to express pus.

               diagnosis

    Although often possible clinical needs a Doppler ultrasound to evaluate the extent of thrombotic phenomena, possible extension in depth, including pelvic veins, and can measure the degree of obstruction in the case of deep thrombophlebitis. It is also important to have a benchmark to follow up, all ultrasound, the patient.

               Evolution of superficial thrombophlebitis therapy is generally favorable, although recent studies show that, especially if located in the calf thrombophlebitis, a significant proportion may progress to a deep vein thrombosis, popliteal, with often serious consequences, hence the need for an examination complete Doppler to investigate how both the superficial veins and the deep.

    There is also the reverse situation in which a thrombotic process to pass asymptomatic or subtle symptoms that can often be masked confused with symptoms of trauma that caused thrombosis or venous insufficiency and varicose veins symptoms existing at that level.

              Treatment consists of superficial thrombophlebitis and local antiinflammatory orally heparin ointments, local ice packs and alcohol local stockings. In some cases, after Doppler examination may reveal a progression of thrombus into the deep veins or in cases where the patient has had episodes of thrombophlebitis or if the asset is required by another condition, in general orthopedic injectable anticoagulants may be prescribed, heparin, for a period of time. Oral anticoagulants are not necessary.

              Evolution of deep thrombophlebitis, often in cases treated properly, can be serious complications that can make powerful life-threatening despite all resuscitative measures and existing support today. We meet these situations. patient is progressing well and treated properly and follow all idnicatiile doctor. Even in this case should be happy to note that the occurrence of an episode of deep vein thrombosis is an independent risk factor for another episode of deep vein thrombosis after. A complete profile for thrombophilia testing is required and the patient may need to stay on medication antithrombotic life.

    What you need to remember a patient who went deep thrombophlebitis is the foot that will never be as before, although often obtained dezobstructia vein while allows normal function of the foot, it will bear the stigmata of thrombosis and will leg remains vulnerable to be protected especially trauma.

    The most common trend is the post-thrombotic syndrome, a chronic condition that Passover be improved but will not disappear nciodata. Basically the sum of all efectelro resulting from principal axis venous thrombosis of the leg. Although a degree is obtained dezobstructie is not complete enough to fulfill the functions of the foot and this is often manifested by a swollen leg more edematous, other than at normal. Venous drainage, blood circulation is slow return to the area where it was partially obstructed thrombosis. There may be pain, especially in the second half of the day will be different leg color, brown, reddish rust spots dermatitis OCRA. There may be areas with trophic disorders, varicose ulcers, scaly patches on the skin.

    Anticoagulant medication often indicated for life, and treatment with compression stockings and gymnastic exercises and lymphatic drainage can bring the leg in a much better condition.

    A redoubtable complication is the evolution of pulmonary thromboembolism by repiratorie failure, and cardio-respiratory and often death.

    Basically the thrombosis develops, often the abdominal veins and the worst, fragments of thrombus detach and are carried in the circulation to the right heart and into the pulmonary circulation, which acts as a filter that retains these thrombi. Let thrombus occluded vessels without traffic segment more or less Amre, the lung, Scotland so it’s normal circuit gas exchange. But triggered processes are much larger, noisier, respiratory deficiency requiring intubation. Such cases can only be treated in intensive care services large and equipped with the necessary resources for such a pathology specialist. Medication is complex, initial anticoagulation. It can reach a very serious condition CID, disseminated intravascular coagulation with fatal consequences than EORI. A variation of this evoultii occurs when the heart between the left drapta and there is a small hole, called atrial septal defect. Many persons live completely asymptomatic with this small defect, genetic, but it becomes manifest allowing a thrombus fragment in circulation to go right in the left lung, General. From left heart, thrombus can get orinude in body, brain, heart, viscera, upper or lower states, leading to an infarction (lack of blood circulation) local variable effects, but generally severe, depending on the production lcoul.

                Treatment of pulmonary thromboembolism is the prerogative of resuscitation and intensive care services specialist, any suspected case of such a diagnosis should be transferred to an emergency service Thus. The diagnosis may be suspected of starting from the existence of a deep thrombosis in the leg in recent history, and copnfirma by lung scintigraphic examinations can be used and MRI examinations, radiology simply left only as a first step, often the focus of where patient transfer.

    The evolution of these cases is unpredictable and often fatal.

    Precisely to avoid such situations it is necessary to treat with utmost responsibility venous thrombosis, thrombophlebitis, and if possible to take all measures for prevention of these diseases.

                 Prevention is the safest on elastic compression. Stockings, medicine, varicose, veins compress suprafasciale, conduct in-depth blood, increases its speed and prevents stasis. Are recommended in all situations involving real estate, long surgery, prolonged bed hospital, long trips by plane or car, and May prosaic activities such as physical inactivity service, office work, especially if person has varicose veins.

    A series of venous tonic can help, but it can be considered as the only means of prevention.

    Regular exercise, especially those that strengthen leg muscles, true venous circulation pump, are important and should not be minimized. Mere cessation car trips to work or the market is helpful.

    Manual or mechanical lymphatic drainage is another weapon, especially for patients with venous insufficiency.

    Also as a measure of prevention of varicose veins can be seen and hydrostatic operation.

    A word about the abuse of injectable anticoagulants (low molecular weight hemoglobin) in pregnancy. There is a tendency among doctors, from obstetricians and haematologists from family doctors to abuse the injectable anticoagulants in pregnancy, putting this indication in the absence of any test or tests in normal as international tables. Personally I think that if you recommend such a medication in pregnancy, repeat tests and a second opinion is required.

    Dr. Eduard Ursuleanu, Phlebology Medical Center Proestetic

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