Varicose vein pain in patients at risk of blood clots

Varicose vein pain in patients at risk of blood clots
Thrombophlebitis, consult a venous physician, vascular surgeon A common complication of varicose veins, in which blood clots form in the vein cavity. The typical manifestation of the disease may be pain and redness of the skin at the projection of the thrombotic vein. A fairly common complication of varicose veins, in which blood clots form in the venous cavity. Thrombophlebitis is most common in the lower extremities, but other great saphenous veins may also be affected (jugular vein, breast vein, penis). Thrombophlebitis can occur after intravenous injection with an intravenous catheter. Generally, saphenous vein thrombophlebitis is a benign disease. At the same time, venous thrombosis tends to spread from the primary thrombosis site to the proximal and distal directions. This may lead to the transition of thrombosis to deep veins and the development of venous thrombosis, and may also lead to a dangerous complication-pulmonary embolism. Another threat to patients after venous thrombosis is the progression of chronic venous insufficiency. Approximately half of patients with venous thrombosis subsequently developed post-thrombotic disease, accompanied by nutritional diseases (skin pigmentation, fatty skin sclerosis, venous ulcers).

Thrombophlebitis can occur spontaneously, especially in the lower extremities of patients with varicose veins, and as a complication of medical interventions (intravenous injections, catheters, etc.). The occurrence of thrombophlebitis is related to any component of the triad: slowing of blood (stasis), tendency to thrombosis (thrombosis) and damage to the blood vessel wall. Regardless of the cause of thrombophlebitis, it is manifested as redness and soreness along the veins forming the thrombus, presenting dense, painful strands. The most serious risk factor for venous thrombosis is previous subcutaneous thrombophlebitis or other manifestations of complications of venous thrombosis, such as deep vein thrombosis and pulmonary embolism. Other factors that cause thrombosis are surgery, varicose veins, long-term fixation, tumor diseases, and vasculitis. The possibility of thrombophlebitis occurs most of the time during pregnancy and about 6 weeks after delivery. This is partly due to increased platelet adhesion and partly due to decreased fibrinolytic activity. The possibility of thrombophlebitis during pregnancy is increased by other risk factors (such as hereditary thrombosis).

Another potential risk factor for thrombophlebitis is the use of estrogen for therapeutic purposes or the use of hormonal contraceptives. Studies have shown that oral contraceptives containing high estrogen can increase the risk of thrombophlebitis by 3-13 times. Prothrombin gene mutation and protein and deficiency).
Thrombophlebitis is a common complication of varicose veins. Thrombophlebitis through the great saphenous vein can spread upward or downward or cause deep vein thrombosis. With thrombophlebitis, the varicose veins become dense and tender, and the skin above it becomes congested.

It is a blood clot that forms in the lumen of a blood vessel. Thrombus is mainly composed of platelet aggregates, fibrin and red blood cells. Thrombosis under physiological conditions is the body's response to blood vessel damage. As a result, blood vessel wall defects are closed and bleeding stops. On the other hand, in various situations that are not directly related to the risk of blood loss, similar reactions will be triggered, which will lead to the formation of blood clots in the blood vessel lumen, thereby disrupting normal blood circulation. In the vein, when the blood flow velocity index is low, the thrombus is mainly composed of fibrin and red blood cells, and the number of platelets is slightly less. The nature of thrombosis determines the use of various antithrombotic drugs to a certain extent.
Superficial thrombophlebitis is a common disease worldwide. Varicose vein thrombosis can occur at any age; thrombophlebitis occurs both in young patients and in the elderly. According to many venous biologists, age over 61 is another risk factor for thrombosis. In addition, as mentioned earlier, pregnancy, early postpartum and estrogen intake are important risk factors for thrombophlebitis. Generally, thrombophlebitis of the great saphenous vein progresses relatively smoothly and is rarely associated with thromboembolic complications. Although thrombosis from the great saphenous vein can spread to the deep venous system. On the contrary, deep vein thrombosis is often accompanied by occult thrombophlebitis. In patients with varicose veins, thrombophlebitis is likely to recur until the varicose veins themselves are treated.
It should be noted that thrombophlebitis, especially in the context of varicose veins, has a tendency for thrombotic complications to recur. Therefore, the main recommendation in this situation is to implement interventions aimed at eliminating varicose veins. It is also recommended to avoid prolonged static load to prevent venous congestion in the lower extremities. For this reason, it is recommended to use compression stockings during the day, especially when the patient has to sit for a long time or have his feet still.
The first symptoms of thrombophlebitis are usually local induration, soreness and redness of the skin at the projection of the thrombotic saphenous vein. Thrombophlebitis of the lower limbs is most common in patients with varicose veins.
In most cases, occult vein thrombophlebitis can be determined based on the chief complaint and external examination. On the other hand, symptoms such as pain, flushing and puffiness are found in many other diseases. Usually, deep vein patency disorders are accompanied by some degree of edema of the lower extremities. At the same time, lower limb edema may be related to liver, kidney, heart disease, trauma, infection and lymphedema. In varicose veins, the great saphenous vein expands, deforms and curves. Darkening of the skin, development of skin hardening, and trophic ulcers on the legs or scars indicate severe chronic venous insufficiency. On palpation, the painful umbilical cord will be identified, and skin inflammation and soreness will appear at the vein projection of the thrombosis. Complications can lead to death from thrombophlebitis. If superficial thrombophlebitis spreads to the deep venous system, it may be the source of pulmonary embolism. Violation of venous function, the development of reflux along the saphenous vein leads to increased pressure in the venous system of the lower extremities. The key problem in the diagnosis of thrombophlebitis is related to the location and degree of thrombosis, and the proximity to the deep venous system, that is, it is related to the saphenous femoral artery or saphenous-doddy anastomosis.

All patients with thrombophlebitis without obvious predisposing factors, such as varicose veins or installed venous catheters, should be additionally checked for the condition before thrombosis. For a more in-depth examination, the first is to rule out cancer. This examination should include colonoscopy, computed tomography of the abdomen and pelvis, radiographic examination of the lungs, and breast line photos.
The combination of functional, semi-anatomical or anatomical methods can completely determine the pathology of the venous system. Blood tests rarely help diagnose thrombophlebitis, unless tests are performed to identify the hypercoagulable state. It is not useful in the diagnostic evaluation of patients with suspected thrombophlebitis or deep vein thrombosis. In most patients with thrombophlebitis, examination can determine the normal level of and. At the same time, leukocytosis is not a specific symptom. Aseptic phlebitis can cause leukocytosis.

Beta-dimer is a unique fibrin breakdown product that is usually measured in pulmonary embolism and pulmonary embolism. However, this indicator has no clinical significance for the diagnosis of thrombophlebitis. It is not practically used to diagnose thrombophlebitis. Ultrasound can also diagnose deep vein thrombosis. If it is necessary to clarify the condition of the pelvic veins, venography can be performed.
A non-invasive test with sensitivity and specificity for the diagnosis of deep vein thrombosis. However, in most cases it is not always available. Ultrasonography is the preferred method of diagnosing venous thrombosis. The most accurate ultrasound diagnostic criterion for thrombosis is that there is no venous compression under the pressure of the transducer. All patients with superficial thrombophlebitis above the knee must undergo a double scan as a primary diagnostic study to rule out deep vein thrombosis. If it is superficial thrombophlebitis, especially above the knee, it is necessary to perform a subsequent duplex ultrasound examination within 49-73 hours to rule out the progression of the disease during the treatment. No progression of thrombosis indicates that the treatment was successful. If the progress of thrombophlebitis is noticed during the treatment, or the possibility of thrombosis spreading to the deep venous system is high, adequate anticoagulation treatment must be performed. The purpose of prescribing anticoagulants is to prevent thromboembolic complications and other consequences of deep vein thrombosis. Or is considered to be the drug of choice for thrombophlebitis. The American College of Chest Physicians recommends 45 days of anticoagulant therapy.
Local treatment of thrombophlebitis is not enough. Used in patients with thrombophlebitis can prevent neutrophil extravasation, thereby helping to reduce inflammation. Therefore, low molecular weight heparin not only has antithrombotic effects, but also has anti-inflammatory effects.
Patients showed that the use of low molecular weight heparin can reduce the possibility of thrombophlebitis development by approximately 71%. Another treatment option for recurrent thrombophlebitis is to use the direct oral anticoagulant Rivaroxaban. In the case of extensive varicose phlebitis, the proximal position of the apex of the thrombus and the proximity of the thrombus to the anastomosis of the saphenous femoral vein must be treated with anticoagulation.

The role of topical anti-inflammatory drugs is not fully understood, because there are currently insufficient data to confidently indicate the appropriateness of their use. Helps reduce pain and inflammation. According to many venous biologists, Esven Gel helps prevent the local manifestations of thrombophlebitis.

Emergency surgery for thrombophlebitis can effectively prevent complications. Surgical intervention is designed to minimize the risk of blood clots spreading to the deep venous system.
One way to prevent the recurrence of varicose phlebitis is to wear compression stockings (or grade compression stockings). Patients with thrombophlebitis are regularly checked by a doctor and undergo a controlled ultrasound examination (approximately once a week) until they have fully recovered. You can make appointments with vascular surgeons and phlebologists at any of the four centers in St. Petersburg. Blood Clots: When Pain Signals Venous Thromboembolism