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.

Your Guide to Preventing and Treating Blood Clots

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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. D., Gordeev N.A. / / Journal of obstetrics and women’s diseases – 2004 – No. 2.
2. Thrombosis of rare localization and thrombophilia / Makatsaria A.D., Akinshina S.V.// Obstetrics, gynecology and reproduction – 2014 – V.8, No. 2.
3. Acute thrombophlebitis / Kirienko A.I., Matyushenko A.A., Andriyashkin V.V. – 2006.
4. This article was prepared based on the materials of the site: https://www.krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and 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.

Treatment of hematoma on the leg

Hematoma is an accumulation of blood in the tissues of the human body, and its occurrence is caused by damage due to falls and blows. In some cases, the appearance of a hematoma is not associated with physical effects, but is explained by the presence of a specific disease in a person.

In most situations (this applies to small hematomas), there are no serious consequences, and the inflammation itself disappears after a while. However, cases that require medical advice and qualified treatment are not uncommon. Ignoring a bruise can lead to cysts or tissue necrosis.

Signs of a hematoma on the leg after an injury

• pain at the site of the injury;
• tissue redness;
• appearance of edema;
• voltage, ripple in the impact area;
• difficulty in movement at the site of injury;
• fever.

Types of hematomas on the leg

There are two types of hematomas according to the nature of their manifestation: subcutaneous and internal. The first occurs when the vessels are damaged, it is easy to detect, due to the bright color of the skin (from red to purple in the early days, and in yellow-green tones in the future). The second is more difficult to diagnose, since the place of its occurrence is the muscles themselves, and there are no traces on the skin.

Why it is not recommended to treat a hematoma on the leg at home

If there is a large accumulation of blood under the skin, it must be removed. There are enough videos and articles on the Internet describing this procedure at home, but it is absolutely impossible to follow such advice. Firstly, a person runs the risk of injuring the leg even more and disrupting its normal functioning, up to disability. Secondly, and more likely, you can introduce an infection into the body and provoke even more inflammation. Thirdly, only an experienced doctor using special devices will do this carefully, but independent attempts can permanently disfigure the skin and leave unaesthetic scars on it.

Methods for diagnosing a hematoma on the leg

First of all, the specialist examines the hematoma. To clarify the severity of the injury, an x-ray may be ordered to ensure the integrity of the bone structures.

In case of damage to the knee joint, a puncture is performed – the joint is pierced to analyze the contents of the hematoma.