What are the signs of femoral vein thrombosis. How is this condition diagnosed and treated. Can femoral vein thrombosis be prevented. What are the risk factors for developing blood clots in the thigh. How does femoral vein thrombosis differ from other types of DVT.

Understanding Femoral Vein Thrombosis: A Deep Dive into Thigh Blood Clots

Femoral vein thrombosis is a serious medical condition that occurs when a blood clot forms in the femoral vein, which runs along the inner thigh. This type of deep vein thrombosis (DVT) can have significant health implications if left untreated. Understanding the symptoms, causes, and treatment options is crucial for early detection and effective management of this condition.

What Exactly is Femoral Vein Thrombosis?

Femoral vein thrombosis is a specific type of DVT that affects the deep veins in the thigh. These veins are responsible for carrying blood from the legs back to the heart. When a clot forms in the femoral vein, it can impede blood flow and potentially lead to serious complications.

Is femoral vein thrombosis different from other types of DVT? While the underlying mechanism is similar, the location of the clot in the femoral vein distinguishes it from DVTs that occur in other areas, such as the calf or pelvis. The femoral vein’s proximity to major arteries and its role in venous return make thrombosis in this area particularly concerning.

Recognizing the Warning Signs: Symptoms of Femoral Vein Thrombosis

Early detection of femoral vein thrombosis is crucial for timely treatment and prevention of complications. Being aware of the symptoms can help individuals seek medical attention promptly.

Key Symptoms to Watch For

• Noticeable swelling of the entire leg
• Tenderness along the veins
• Pitting edema (swelling that remains indented when pressed)
• Low-grade fever
• Calf swelling more than 3 centimeters greater than the unaffected leg

How quickly do symptoms of femoral vein thrombosis develop? The onset of symptoms can vary, but often they develop gradually over a few days. In some cases, symptoms may appear suddenly, particularly if the clot is large or if it has traveled from another part of the leg.

Unraveling the Causes: Risk Factors for Femoral Vein Thrombosis

Understanding the risk factors associated with femoral vein thrombosis can help individuals and healthcare providers take preventive measures. While sometimes the cause is unknown, several factors can increase the likelihood of developing this condition.

Common Risk Factors

1. Prolonged immobility
2. Major medical conditions requiring extended bed rest
3. Recent surgery or leg trauma
4. Underlying blood clotting disorders
5. Cancer diagnosis
6. History of previous DVT

Are certain individuals more prone to developing femoral vein thrombosis? While anyone can potentially develop this condition, those with multiple risk factors or a history of blood clots are at higher risk. Age, obesity, and certain medications (such as hormone replacement therapy or birth control pills) can also contribute to increased risk.

Diagnostic Approaches: Identifying Femoral Vein Thrombosis

Accurate diagnosis of femoral vein thrombosis is essential for appropriate treatment. Healthcare providers employ various diagnostic techniques to confirm the presence of a blood clot in the femoral vein.

Primary Diagnostic Methods

• Compression Ultrasonography: A non-invasive imaging technique that visualizes the femoral veins
• Venography: An invasive imaging test used when ultrasound results are inconclusive
• MRI: A non-invasive alternative that provides high-resolution images of the anatomy

Why is compression ultrasonography the most commonly used diagnostic tool? This method is preferred due to its non-invasive nature, cost-effectiveness, and ability to provide real-time images of blood flow in the veins. It allows healthcare providers to quickly and accurately identify the presence and location of blood clots.

Treatment Strategies: Managing Femoral Vein Thrombosis

The primary goal of treatment for femoral vein thrombosis is to prevent the formation of new blood clots and manage existing ones. Treatment typically involves a combination of medication and lifestyle modifications.

Anticoagulation Therapy

Anticoagulants, or blood thinners, are the mainstay of treatment for femoral vein thrombosis. These medications help prevent the formation of new clots and reduce the risk of existing clots growing larger or breaking off.

• Initial treatment: Heparin injections or fondaparinux (Arixtra)
• Long-term management: Warfarin (Coumadin) or newer anticoagulants

What are the newer anticoagulants used in treating femoral vein thrombosis? Recently approved medications for DVT and pulmonary embolism (PE) include edoxaban (Savaysa), dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). These drugs offer potential advantages in terms of dosing and monitoring compared to traditional anticoagulants.

Additional Treatment Measures

• Leg elevation to reduce compression on veins
• Pain medication to alleviate discomfort
• Interior vena cava filter (IVCF) placement for patients unable to take blood thinners

How long does treatment for femoral vein thrombosis typically last? The duration of treatment can vary depending on the individual case and underlying risk factors. Some patients may require anticoagulation therapy for several months, while others with recurrent clots or ongoing risk factors may need long-term or even lifelong treatment.

Prevention Strategies: Reducing the Risk of Femoral Vein Thrombosis

Preventing femoral vein thrombosis is crucial, especially for individuals at higher risk. Several strategies can help reduce the likelihood of developing blood clots in the thigh veins.

Key Prevention Methods

• Maintaining mobility, especially during long periods of sitting or bed rest
• Staying hydrated, particularly during travel
• Using elastic compression stockings to improve circulation
• Taking prescribed blood thinners as directed
• Regular exercise to promote healthy blood flow

How effective are compression stockings in preventing femoral vein thrombosis? While compression stockings can help improve circulation and reduce the risk of blood clots, they are most effective when used in combination with other preventive measures. For individuals at high risk, such as those undergoing surgery or with a history of DVT, compression stockings may be particularly beneficial.

Special Considerations for Travel

Long-distance travel, especially by air, can increase the risk of developing blood clots due to prolonged immobility. Implementing specific preventive measures during travel can help mitigate this risk:

• Moving around regularly (e.g., walking the aisle on a plane every hour)
• Performing seated leg exercises
• Wearing loose, comfortable clothing
• Avoiding alcohol and caffeine, which can contribute to dehydration

Should all travelers take precautions against femoral vein thrombosis? While the risk is higher for long-distance travelers, particularly those with additional risk factors, implementing these preventive measures can benefit anyone undertaking extended journeys.

Complications and Long-Term Outlook: Understanding the Potential Consequences

While prompt treatment of femoral vein thrombosis often leads to successful outcomes, the condition can potentially lead to serious complications if left untreated or if treatment is delayed.

Potential Complications

• Pulmonary Embolism (PE): A life-threatening condition where a clot breaks off and travels to the lungs
• Post-thrombotic Syndrome: Long-term swelling, pain, and skin changes in the affected leg
• Chronic Venous Insufficiency: Ongoing problems with blood flow in the affected veins

What is the likelihood of developing complications from femoral vein thrombosis? The risk of complications varies depending on factors such as the size and location of the clot, the timeliness of treatment, and individual patient characteristics. Prompt diagnosis and appropriate treatment significantly reduce the risk of serious complications.

Long-Term Management

For many individuals who have experienced femoral vein thrombosis, ongoing management is necessary to prevent recurrence and monitor for potential complications:

• Regular follow-up appointments with healthcare providers
• Continued use of compression stockings
• Lifestyle modifications to reduce risk factors
• Vigilance for signs of recurrent thrombosis or post-thrombotic syndrome

Can individuals fully recover from femoral vein thrombosis? Many patients experience complete resolution of symptoms with proper treatment. However, some may have residual effects or require ongoing management to prevent recurrence. The outlook is generally positive with appropriate care and adherence to treatment plans.

Advancing Research: Future Directions in Femoral Vein Thrombosis Management

As medical understanding of femoral vein thrombosis continues to evolve, researchers are exploring new avenues for improved diagnosis, treatment, and prevention of this condition.

Emerging Areas of Research

• Novel anticoagulants with improved safety profiles and easier administration
• Advanced imaging techniques for more accurate and efficient diagnosis
• Personalized risk assessment tools to identify high-risk individuals
• Gene therapy approaches to address underlying clotting disorders

How might future advancements change the landscape of femoral vein thrombosis management? Ongoing research holds the potential to revolutionize the approach to this condition, potentially leading to more targeted treatments, improved prevention strategies, and better long-term outcomes for patients.

The Role of Artificial Intelligence

Artificial intelligence (AI) is increasingly being explored as a tool to enhance the diagnosis and management of vascular conditions, including femoral vein thrombosis:

• AI-assisted interpretation of diagnostic images
• Predictive models for identifying high-risk patients
• Personalized treatment algorithms based on individual patient data

Will AI play a significant role in the future of femoral vein thrombosis care? While still in its early stages, the integration of AI into vascular medicine shows promise for improving diagnostic accuracy, treatment selection, and patient outcomes in the management of conditions like femoral vein thrombosis.

As research continues to advance our understanding of femoral vein thrombosis, healthcare providers and patients alike can look forward to more effective, personalized approaches to managing this challenging condition. Staying informed about the latest developments and maintaining open communication with healthcare providers remain crucial steps in ensuring optimal care and outcomes for those affected by femoral vein thrombosis.

Femoral Vein Thrombosis: Symptoms, Treatment, and More

Overview

Have you ever heard anyone say the word DVT in reference to your legs and wondered what they’re talking about? DVT stands for deep vein thrombosis. It refers to a blood clot in your veins.

These blood clots usually occur in your:

• calf
• thigh
• pelvis

Your femoral vein runs along the inside of your legs from your groin area downward. Femoral vein thrombosis refers to a blood clot present in one of the branches of the femoral vein. The clot can form locally or travel upstream from the calf and relocate there. These veins are deep within the thigh and are more prone to blood clots than superficial veins.

Symptoms of femoral vein thrombosis are similar to symptoms of DVT.

They include:

• noticeable swelling of your entire leg
• tenderness along the veins
• abnormal swelling that stays swollen when you press it with your finger, also known as pitting edema
• low-grade fever

Additionally, the calf of your affected leg may swell to a size that’s more than 3 centimeters greater than the nonaffected leg.

Femoral vein thrombosis can occur as a result of surgery or complications from illness. It can also occur without a known cause or event.

Risk factors for femoral vein thrombosis include:

• immobility
• major medical conditions that require you to be on bed rest for an extended period of time
• recent surgery or leg trauma
• an existing, underlying blood clotting disorder
• cancer diagnosis
• history of past deep vein thrombosis

Your healthcare provider may be able to recognize signs and symptoms of a femoral vein thrombosis from a physical examination, but they’ll need to do additional testing to diagnose the condition.

Compression ultrasonography

Compression ultrasonography is the most commonly used imaging technique to diagnose a blood clot.

It’s a noninvasive test that allows your healthcare provider to see an image of your femoral veins down to your calf veins. It’ll display an image on the screen in different colors. If you have an obstruction, your healthcare provider can use this image to locate the clot.

Venography

Venography is an invasive imaging diagnostic test used to look for DVTs. It can be painful and expensive. This test is less likely used because of the discomfort and costs. Your healthcare provider may recommend venography if the results from an ultrasonography are inconclusive.

MRI

An MRI is a noninvasive diagnostic test that looks at a high-resolution image of your anatomy. Your healthcare provider may order an MRI if you’re unable to do an ultrasound.

Treatment for femoral vein thrombosis is focused primarily on preventing the formation of a blood clot. Treatment typically consists of anticoagulation therapy to thin your blood to help prevent clot formations.

Initially, your healthcare provider may prescribe heparin injections or fondaparinux (Arixtra) injections. After a period of time, they’ll discontinue the heparin and switch you to warfarin (Coumadin).

Newer drugs approved in the treatment of DVT and pulmonary embolism (PE) include:

• edoxaban (Savaysa)
• dabigatran (Pradaxa)
• rivaroxaban (Xarelto)
• apixaban (Eliquis)

If you have limited or reduced mobility, your healthcare provider may also recommend elevating your legs with a pillow to avoid compressing your veins.

If you develop a clot, your healthcare provider may also prescribe pain medication to help decrease the discomfort caused by the clot.

If you’re unable to take blood thinners, your healthcare provider may place an interior vena cava filter (IVCF) into your veins. An IVCF is designed to catch a blood clot if it starts to move through the vein.

If you’re scheduled for surgery or if you have limited or reduced mobility, speak to your healthcare provider about blood clot prevention methods. Preventing a blood clot is your best form of treatment.

The best prevention method for femoral vein thrombosis is trying to remain as mobile as possible.

The more immobile you are, the higher your risk of developing a DVT.

Here are some prevention tips:

• If you’re traveling long distances, stand up and move your legs regularly. If you’re on a plane, walk up and down the aisle every hour. If you’re in a car, take frequent stops so that you can get out of the car and move around.
• Stay hydrated, especially while traveling. Not only will this help you to remember to move because you’ll need to take trips to the restroom, but it’ll also help promote blood flow.
• Talk to your healthcare provider about elastic stockings, sometimes called TED hose or compression stockings. They may help improve circulation in your legs.
• If your healthcare provider prescribes blood thinners, take them as directed.

If you suspect a blood clot, contact your healthcare provider immediately. Early intervention can make you less likely to experience complications.

If you’re planning on having surgery, speak with your healthcare provider beforehand about ways to prevent blood clots.

You should also speak with your healthcare provider if you have any injury that affects your mobility. They can recommend safe ways to reduce your risk for blood clots.

Is your leg pain normal, or is it a blood clot?

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According to the American Society of Hematology, each year in the United States, approximately 900,000 people experience deep vein thrombosis or blood clots.

Know what to look for and avoid serious complications.

The first sign of a blood clot is mild pain. As the pain intensifies, the skin near the blood clot may become red and very warm to the touch. Since blood clots restrict blood flow, the pain often limits a person’s ability to move.

Most blood clots occur in the veins in the legs, but they can develop in arteries and other parts of the body, too.

Blood clots are serious.

If the blood clot breaks loose and travels through the veins or arteries to the heart, lungs, or brain, it could cause a heart attack, pulmonary embolism, stroke, or even death.

How do blood clots form?

In healthy people, blood clots form naturally after an injury or surgery. The platelets and plasma in the blood combine to start the clotting process. The first job of these cells is to build a dam to stop the blood, which prevents people from bleeding to death after a minor cut or scratch. The second job of this group of cells is to create a scab to protect the skin from infection while the body heals.

This is the body’s normal response to injury. As the tissues heal, the scab dissolves and is absorbed back into the body.

But blood clots that develop in the veins and arteries can be dangerous.

When circulation inside the blood vessels slows because of injury or other constricting conditions, the blood thickens. Platelets and plasma bond blood cells together and create the clot.

Blood clots that form for no apparent reason are the most dangerous.

Both arterial and venous clots can cause dangerous health complications if the clot travels.

A major cause of arterial blood clots is arteriosclerosis or hardening of the arteries. When plaque-build-up on the arterial wall ruptures, platelets and plasma rush in to repair the damage and create a blood clot. If the clot breaks free and travels to the lungs or the brain, it can have fatal consequences.

Deep vein thrombosis or DVT blood clots occur in the arms and legs but are more common in the latter.

People experiencing DVT blood clots will feel increasing levels of pain. The skin around the area will become warm and sensitive to touch. The skin may have a reddened appearance as the body works to get rid of the clot. If blood flow is restricted, people often feel pain when they move the affected area, Anyone suffering these symptoms should call 9-1-1 and seek immediate treatment.

Are you at risk for a DVT blood clot?

Several conditions increase the likelihood of deep vein thrombosis.

• Obesity slows blood flow, which creates the potential for blood clots.
• Sitting in one position for two or three hours or more while traveling in a car or plane hinders muscle movement and restricts proper circulation.
• Smoking decreases the oxygen in the blood and blood flow.
• Trauma or surgery can cause immobilization and stress the circulatory system, which heightens the risk.
• Age increases the risk, especially for people over 60 years of age.
• Diabetes damages nerves and interferes with circulation.
• Cancer and chronic inflammatory diseases increase the risk of circulation issues.
• Pregnancy, birth-control pills, and other hormonal treatments can impact the body’s clotting response.

Some research suggests endurance athletes may also have an increased risk of life-threatening blood clots because of injury, dehydration, and travel. The signs of a blood clot mimic the symptoms of many sports-related muscle injuries. Athletes may ignore a blood clot thinking it is an injury that will heal with time.

Can you prevent blood clots?

Yes. Many blood clots are preventable.

Prevent arterial blood clots by watching your diet, monitoring your blood pressure, and taking action to keep your cholesterol numbers in check. Work with your healthcare provider to determine the best prevention plan for your health. You can reduce your risk of clots in your veins by making lifestyle changes.

• If you smoke, stop.
• If you’re overweight, lose weight by eating nutrition-rich foods and exercising to burn excess calories.
• Avoid long periods of immobility. If you’re traveling by car, stop often. If you’re flying, stand up and walk around every hour or two.
• If you have diabetes or a chronic inflammatory disease, be vigilant, and maintain your health. Ask your healthcare provider for specific ways you can avoid blood clots.

How are blood clots treated?

If you receive a DVT blood clot diagnosis, your healthcare provider may refer you to a hematologist, a physician specialized in the treatment of blood-related conditions.

After your diagnosis, your healthcare team will determine which treatment is the most effective for your condition. Your treatment plan will be based on your current health, any underlying conditions, and the location of the blood clot.

Medication is an effective treatment for some types of blood clots.

Anticoagulants, like warfarin or heparin, prevent blood clots from forming.
Thrombolytics dissolve blood clots that have formed and are causing problems.

Catheter-directed thrombolysis. Other blood clots require more intervention. Catheter-directed thrombolysis is a procedure that inserts a catheter into the vein to deliver clot-dissolving medication directly to the clot.

Surgery. Clots located in critical areas or those that don’t respond well to medication or other minimally invasive techniques may require surgical removal.

What if I have leg pain, but I’m not sure if it is a blood clot?

Blood clots that cause symptoms are serious and need immediate medical attention.  If you have pain in your legs or arms accompanied by redness and swelling that seems to get worse, contact your healthcare provider or visit an urgent care facility for treatment.

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Named 6 signs by which a bruise can be distinguished from a blood clot

• Health

Under a harmless bruise on the leg, arm or abdomen, a formidable disease can be hidden. The main thing is to notice the signs of the problem in time and start treatment.

April 21, 2022

Source:

Getty Images

Thrombosis is one of those dangerous diseases that may not make themselves felt at all for a long time – but if they are not diagnosed in time, it can lead to death. However, as doctors say, in some cases, the formation of a blood clot can be seen by external signs.

The problem is that this symptom is often confused with a bruise. However, there are several important differences between these phenomena.

Factors that increase the risk of experiencing thrombosis:

• Taking oral contraceptives;

• Past COVID-19;

• Obesity;

• Diabetes mellitus;

• Diseases of the heart and blood vessels;

• Genetic predisposition.

See also

According to experts, the symptoms of a blood clot may become noticeable if the blood clot is close to the surface of the skin or if it interferes with blood flow. This most often happens when a blood clot appears in the legs, arms, or abdomen. And in people with pulmonary embolism, the skin tends to take on a bluish tint.

If a blood clot has clogged the veins, spots may appear on the skin that resemble hematomas, as excess blood enters the tissues.

These manifestations of a blood clot can be easily confused with a bruise, but hematomas have several distinguishing features:

• In the bruised area, the skin usually changes color as it heals;

• Bruises are usually painful to the touch, and the more time has passed since the bruise appeared, the less discomfort it causes;

• Bruising usually occurs after an injury.

In addition, there are several symptoms that indicate that the cause of the spot on the skin is a blood clot and that you need to seek professional help as soon as possible:

• Throbbing or cramping pain in limbs, severe swelling or redness;

• Sudden shortness of breath, sharp pain in the chest, aggravated by inspiration;

• Cough, hemoptysis.

Other symptoms of a blood clot:

• Feeling tired, easily fatigued;

• Pale skin;

• Blue lips;

• Coldness in extremities;

• Disorders of brain activity.

Read also

In what cases is a bruise dangerous? For example, sometimes hematomas are confused with symptoms of varicose veins. If your bruise consists of small vessels, they look like stars or spiders, do not put off a visit to the specialists.

By the way, bruises often appear on the background of taking anticoagulant therapy: it would seem that you don’t hit so hard – but a hematoma appears. This is normal: such drugs increase bleeding time due to blood thinning.

Read also

By the way

Proper nutrition is one of the most important components of a healthy lifestyle. There are healthy foods, and there are eating habits that, for example, can increase the risk of a blood clot. You can read more about it HERE.

Text author: Daria Gapionok

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Postpartum thrombophlebitis. What is postpartum thrombophlebitis?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Postpartum thrombophlebitis is an obstetric complication characterized by inflammation of the walls of the veins, thrombosis in the pelvis and lower extremities, which develops in women after childbirth. The disease is manifested by fever, tachycardia, local pain. The diagnosis is made on the basis of anamnestic data, the results of a clinical examination, an ultrasound examination of blood vessels with duplex scanning, and a coagulogram. The main method of treatment is anticoagulant therapy, with a high risk of arterial thromboembolism, surgical intervention is indicated.

ICD-10

O87.0 Superficial thrombophlebitis in the puerperium

• Causes
• Pathogenesis
• Classification
• Symptoms of postpartum thrombophlebitis
• Complications
• Diagnostics
• Treatment of postpartum thrombophlebitis
  • Conservative therapy
  • Surgical treatment
• Prognosis and prevention
• Treatment prices

General

Postpartum thrombophlebitis is an acute disease of the veins in puerperas with the formation of blood clots in the lumen, an inflammatory process, and impaired venous blood flow. The incidence of venous thrombosis with associated or primary phlebitis in the postpartum period is 3.5%, almost an order of magnitude higher than the prevalence of thrombotic complications during pregnancy. Pathology can develop in puerperas of any age, but is more often recorded in women older than 35 years. When a vein is obstructed by a thrombus, in contrast to arterial thromboembolism, ischemia is detected extremely rarely, however, thrombosis of the inferior vena cava system is the main source of pulmonary embolism.

Postpartum thrombophlebitis

Causes

Postpartum thrombophlebitis has a multifactorial nature. A favorable background for the occurrence of pathology are physiological changes in the body of a pregnant woman: compression of the vena cava by the pregnant uterus, slowing down of the peripheral blood flow and an increase in the potential for blood clotting, most pronounced by the end of pregnancy. Significant risk factors for thrombotic complications after childbirth:

• Complicated childbirth. Childbirth, accompanied by ruptures of soft tissues (especially with massive bleeding), delivery by surgery often lead to thrombophlebitis of the deep veins of the thigh and lower leg. With extensive injuries, tissue thromboplastin enters the bloodstream, exacerbating the activation of blood coagulation characteristic of late pregnancy.
• Pathological course of pregnancy. The likelihood of developing postpartum thrombotic complications significantly increases gestosis. This pathology is accompanied by vascular spasm with damage to the endothelium, the release of biologically active substances, leading to the loss of thromboresistant properties of blood vessels.
• Inflammation of the uterus. Postpartum metroendometritis triggers thrombosis in the uterine, pelvic and ovarian veins. The mechanism of development of thrombosis is similar to that in preeclampsia: the result of alteration is the release of prostaglandins, which are transformed into thromboxane A2, which stimulates the activation and aggregation of platelets.
• Extragenital pathologies. Venous thrombosis affects puerperas suffering from diseases accompanied by circulatory disorders – cardiac pathologies (especially of a rheumatic nature), hypertension. The main risk factors also include vasculitis of any etiology, malignant neoplasia.
• Taking hormonal drugs. To aggravate the hemostatic changes associated with pregnancy, long-term use of hormonal contraception (especially with a high content of estrogen) can. The likelihood of thrombosis is increased in puerperas who become pregnant after hormonal induction of ovulation (with or without IVF).
• Hemostasis defects. Postpartum thrombophlebitis often develops in women with a congenital mutation of factor V Leiden and the prothrombin gene, congenital hyperhomocysteinemia, deficiency of antithrombin III and proteins C, S, or acquired thrombophilia (antiphospholipid syndrome, hyperhomocysteinemia on the background of a deficiency of vitamins B12, B9, B6, B1).

Other risk factors include physical inactivity (when standing or sitting, long flights, long bed rest), heavy physical activity (overweight, regular weight lifting), late reproductive age. Increase the risk of thrombosis intravenous infusion, smoking. One of the main predisposing conditions for the development of complications not associated with gestation is nonspecific connective tissue dysplasia, the signs of which include varicose veins of the lower extremities, hemorrhoids that arose before pregnancy.

Pathogenesis

The mechanism of thrombus formation is based on the so-called Virchow triad, which includes changes in hemostasis (increased blood clotting) and hemodynamics (reduced venous blood flow), damage to the venous wall. Thrombogenesis can occur against the background of hypercoagulation (phlebothrombosis) with the subsequent development of reactive inflammation, or vice versa, a thrombus occurs due to damage and then inflammation of the endothelium. The blood clot is fixed to the vascular wall at the site of its lesion, its further evolution follows one of three paths.

The first way is characterized by the growth of a thrombus, the second – by its spontaneous lysis, the third – by the organization of thrombotic masses (their germination by connective tissue and capillaries). The process is accompanied by the formation of cavities in the clot, spontaneous recanalization of the thrombus due to fibrinolysis. In small vessels, occlusive thrombi are more often formed, completely blocking the lumen, in large vessels – floating, bathed in blood. The latter are embologenic – with a high probability of detachment, movement through the inferior vena cava and the right atrium into the arterial circulation.

Classification

Postpartum thrombophlebitis are superficial, extending to the saphenous veins of the lower extremities, and deep, with damage to the large main vessels of the legs and pelvis. According to the nature of inflammation, purulent and non-purulent forms are distinguished, according to the type of thrombus development – limited or segmental, with rapid delimitation, organization of a blood clot and progressive – with its further growth. According to localization, the following classification of the pathology that developed after childbirth was adopted:

• Thrombophlebitis of the leg veins. Superficial thrombophlebitis is manifested by lesions of the small, large saphenous veins of the leg and their tributaries, deep – tibial veins. Pathological changes in deep vessels can occur in isolation or spread from superficial vessels through communicants. With ascending thrombophlebitis, the femoral vein is involved in the process.
• Ileofemoral (ileofemoral) thrombophlebitis. Starting with physiological thrombosis of the vessels of the placental site, it spreads to small tributaries of the internal iliac vein, then to its trunk and further to the common iliac vein. With occlusion of the latter, the deep and superficial vessels of the thigh are involved in the pathological process.
• Pelvic thrombophlebitis. The venous plexus of the small pelvis – uterovaginal, cystic, rectal, pampiniform plexus of the ovary – undergoes the process of inflammation and thrombosis. With progression, the iliac vein is affected, and then the femoral vein.
• Metrothrombophlebitis. The defeat of the main uterine veins, originating from the uterine venous plexus. Thrombophlebitis of the veins of the uterus is almost always the result of postpartum endometritis.
• Thrombophlebitis of the ovarian vein. Pathology is characterized by changes in the cavity of the main vessel that collects blood from the venous plexus of the ovary. An extremely rare disease that develops almost exclusively after childbirth, most often against the background of congenital or acquired thrombophilia.

Symptoms of postpartum thrombophlebitis

Signs of a pathological condition can be detected as early as the fifth or sixth day after childbirth, but more often the manifestation is noted in the second or third week after delivery. Harbingers of the disease are long-term subfebrile temperature, increasing heart rate. The beginning is marked by a brief chill. Symptoms may vary depending on the location of the lesion.

Superficial thrombophlebitis is accompanied by the most striking manifestations: tension, soreness, redness along the affected vessels, local and general fever. With thrombophlebitis of the deep veins of the lower leg, swelling of the ankles is observed (usually pronounced in the evenings, subsiding after a night’s sleep), pain in the calves while standing up and walking, as well as with dorsiflexion of the foot (Homans symptom).

Pelvic vein thrombosis has no specific symptoms until the transition to the iliac and femoral vessels with the development of edema of the inguinal region on the affected side. Prior to this, only prolonged subfebrile condition with tachycardia is detected, pain during defecation, flatulence, and sometimes vomiting can be observed. Often, patients complain of dyspareunia, general weakness, vague pelvic and lumbar pain.

Ileofemoral thrombophlebitis proceeds for a long time with uncertain symptoms – fever, tachycardia. Sometimes there are pains in the lower abdomen and sacral region, difficulty urinating. Complete occlusion of the iliac vein is accompanied by sudden pain in the iliac, inguinal regions, radiating to the thigh, chills, swelling of the anterior abdominal wall, lower back, and external genitalia. Pain is accompanied by a feeling of fullness of the thigh and calf.

When the deep femoral veins are involved, fever, rapidly developing persistent edema of the limb (the volume of the affected thigh is increased by 5-15 cm or more), acute unbearable pain in the anterior-internal region of the thigh along the vascular bundle are detected. Inguinal-femoral lymph nodes are enlarged. The skin of the affected limb is pale, has a bluish-marble hue, its foot is colder than healthy. The general condition is severe.

Metrothrombophlebitis, which develops in the second week of the postpartum period, is accompanied by pelvic pain, bloody discharge from the genital tract, which increases by the end of the third week. The defeat of the veins of the ovary has no pathognomonic symptoms. Spontaneous abdominal pains are recorded (usually right-sided, since 90% of women thrombosis affects the right ovary), radiating to the groin, pain when pressing on the ovary, fever.

Complications

The most formidable complication of venous thrombosis is pulmonary embolism (PE), detected in 40-50% of patients. In 10% of patients, the pulmonary trunk and large arterial branches are affected with the development of massive pulmonary embolism (usually due to thrombosis of the iliac-femoral or popliteal-femoral segment, less often – pelvic venous plexuses), leading to acute cardiopulmonary failure, death. When emboli blockage of smaller branches (the result of deep phlebothrombosis of the vessels of the lower leg), a heart attack-pneumonia is observed.

The consequence of widespread thrombosis is the occurrence of varicose veins, post-thrombophlebitic syndrome, leading to chronic venous insufficiency (CVI) and disability. The defeat of the ileofemoral segment with complete obstruction of the vascular collaterals is accompanied by arterial spasm, can provoke limb ischemia, venous gangrene. Complications of ovarian vein thrombophlebitis include ovarian infarction, acute ureteral obstruction, acute renal and multiple organ failure.

Diagnostics

Diagnosis of postpartum thrombophlebitis is usually difficult due to the lack of specific signs. The only exceptions are lesions of the superficial veins of the extremities with their vivid symptoms. The diagnosis is established with the participation of an obstetrician-gynecologist and a phlebologist. It is possible to suspect thrombotic complications by analyzing the anamnestic data, the patient’s complaints. Further activities include:

• Clinical examination. Thrombophlebitis may be indicated by severe tachycardia, combined with hyperthermia, sometimes not corresponding to body temperature values. During a gynecological examination and a general examination with thrombotic complications in puerperas, the affected vessels are palpated, represented by dense painful bands.
• Ultrasonic angioscanning. The most informative method for diagnosing thrombophlebitis in modern phlebology is ultrasound. The study allows you to determine the boundary and degree of organization of the thrombus, assess the condition of the valves, the walls of deep and perforating veins. If ultrasound is not available, ultrasound is performed.
• Coagulation studies. To clarify the causes of thrombophlebitis, two methods are used – thromboelastography and coagulometry. With the help of the first method, changes in the coagulological cascade are studied in an integrated way, with the help of the second, its individual chains are evaluated in detail. A comprehensive analysis allows you to determine which of the links of hemostasis is broken.

Differential diagnosis is carried out with other purulent-inflammatory diseases (appendicitis, parametritis, sepsis), pathologies of the urinary system (nephrotic syndrome, pyelonephritis, urolithiasis), diseases of the skin and soft tissues (erysipelas, cellulitis, phlegmon). Thrombophlebitis should also be distinguished from regional metastases of cancer of the external genitalia.

Treatment of postpartum thrombophlebitis

Conservative therapy

The main tasks of therapeutic measures are the prevention of the spread of thrombosis, the relief of inflammation, and the prevention of the recurrence of the disease. Superficial thrombophlebitis is usually treated on an outpatient basis with the patient as active as possible (excluding static loads). Therapy of thrombophlebitis of deep veins of the extremities and intrapelvic localization is carried out on the basis of a surgical hospital. With floating thrombi, strict bed rest is prescribed in order to reduce the likelihood of a blood clot detachment and the development of arterial thromboembolism.

• Anticoagulant treatment. Anticoagulants do not promote the resorption of a blood clot, but they stop the progression of thrombosis. After establishing the diagnosis, systemic therapy with low molecular weight heparins is first used, after which they switch to long-term use of indirect anticoagulants.
• Antibiotic therapy. Antibacterial drugs are prescribed according to strict indications – with thrombophlebitis that developed against the background of a purulent-inflammatory process. With reactive (aseptic) inflammation, antibiotic treatment is not only useless, but can also be harmful, because it increases blood clotting, leading to the progression of the disease.
• Anti-inflammatory treatment. For the treatment of aseptic phlebitis, non-steroidal anti-inflammatory drugs (ketoprofen, diclofenac) are used. These drugs help to relieve inflammation, eliminate pain, and have an antiplatelet effect. Used parenterally, orally and topically.
• Angioprotectors and microcirculation correctors. Agents such as rutoside and troxerutin reduce the permeability of the vascular wall, reducing the inflammatory response. Assigned inside, topical application is ineffective. Intravenous administration of pentoxifylline improves the rheological properties of blood.
• Compression therapy. Elastic compression of the lower extremities is indicated for extra-pelvic varicose veins. The bandage reduces venous stasis, which prevents further thrombosis. As a rule, bandaging is initially used, after the pain subsides, they switch to long-term wearing of compression stockings.

Surgical treatment

Surgical intervention is prescribed for contraindications to anticoagulant pharmacotherapy (danger of bleeding, idiosyncrasy to drugs), the presence of a floating thrombus and repeated episodes of PE, aimed at preventing thromboembolism from entering the arterial bed. Another indication for surgery is venous ischemia. Treatment is carried out by an endovascular surgeon and includes the following methods:

• Recanalization of a thrombosed vessel. Removal of thrombotic masses in order to restore the patency of the vein is performed by a mechanical (thrombectomy) or biochemical (regional selective thrombolysis) method. Since the introduction of thrombolytics can provoke the separation of the floating “tail” of the thrombus, the patient is pre-installed with a cava filter.
• Cava filter implantation. Fixation to the walls of the vena cava of a device that allows blood to pass through, but delays emboli in order to prevent pulmonary embolism. The method is limited in use in young patients planning further implementation of the reproductive function due to the lack of data on long-term effects. An alternative is vessel suture filtration.
• Vein suture. It consists in the imposition of U-shaped sutures that capture both venous walls. As a result, a filter is formed that does not allow emboli to pass through. With thrombophlebitis, plication of the inferior vena cava, femoral veins, and iliac vein is practiced. The technique is used when it is impossible to implant a cava filter.

Prognosis and prevention

The prognosis depends on the prevalence and localization of the thrombotic process, the possibility of eliminating etiological factors, the age of the patient and the activity of her immune system. Relapses are recorded in 10-30% of patients. Primary prevention includes the fight against gynecological inflammatory diseases, drug correction of hemostasis in women at risk. Other activities include giving an elevated position to the legs in bed, early activation of patients after delivery, wearing compression stockings.

You can share your medical history, what helped you in the treatment of postpartum thrombophlebitis.

Sources

1. Complications of postpartum thrombophlebitis and their prevention / Khadzhieva E.