Post-Thrombotic Syndrome – Vascular Cures

What is Post-Thrombotic Syndrome (PTS)?

Post-Thrombotic Syndrome is when you have the ongoing symptoms of a blood clot, or deep vein thrombosis (DVT), in the leg. Some people who have had DVT or blood clots in the leg recover completely, but others still experience symptoms, and these symptoms are called PTS.

Why is PTS a problem?

PTS can cause leg pain and discomfort, as well as leg ulcers. These symptoms may last for many years, or for the rest of your life. PTS can interfere with some of your regular activities, such as walking or standing, and it can make your life less enjoyable. Treatment for PTS and PTS ulcers can be expensive and time-consuming.

What causes PTS?

The veins deep within the legs have tiny valves that control the direction of blood flow. A blood clot in a leg vein can cause inflammation and block blood flow, which damages the valves. When the valves are damaged, they can leak or cause blood to flow the wrong way, which creates pressure and fluid retention that people with PTS most often notice as swollen ankles or feet. The pressure makes the leg painful, swollen, and sometimes red in color. As PTS gets worse, poor blood flow through the leg can cause leg ulcers, which can be painful and difficult to treat. Ulcers occur in 5-10% of patients who have had a DVT.

What is the chance I will get PTS?

PTS occurs in 20-40% of patients after an episode of lower extremity DVT, so it is a common complication. One out of ten patients may develop severe PTS with leg ulcers.

You are more likely to get PTS if you:

• are over age 65 years
• have a blood clot in the deep veins above the knee (a condition called proximal DVT)
• have more than one blood clot in the same leg at least twice
• have blood clot symptoms one month after being diagnosed with the blood clot
• are very overweight
• have trouble keeping your blood thinner levels stable during your first three months of treatment

How soon after my blood clot can I get PTS?

It is difficult to predict who may or may not get PTS, but it may be any time in the first six months to two years after the blood clot develops in the leg.

How do I know if I have PTS?

These are the most common signs and symptoms of PTS that occur in the leg with the blood clot:
• Pain
• Swelling that gets worse after walking or standing for a long time, but feels better after resting or raising the leg
• Aching or heaviness in your leg or foot
• Cramping
• Itching
• Tingling
• Bluish or brownish pigmentation in the leg or foot
• An ulcer (sore) on the leg
• New varicose veins
• Skin that is flaky, dry, or red

These problems are different for every patient – you may have all of these problems or only a few. You may notice these problems all the time or the feelings may come and go.

What should I do if I think I have PTS?

Many of the signs of PTS are the same as those for new blood clots in the leg, so it is very important
for you to ask your health care provider to look at your leg. Only a health care provider can tell you if your problems are from a new blood clot or from PTS.

How is PTS diagnosed?

Your health care provider will look at your leg and ask you some questions about how your leg feels. Then he or she will tell you if you have PTS. You do not need any special scans or blood tests to find out if you have PTS.

How can I prevent PTS?

Since PTS can be such a long-term problem, prevention is very important. Here are some things you can do to prevent PTS:

• Prevent blood clots. Blood clots cause the damage to the leg veins that causes PTS. If you prevent blood clots, you will prevent PTS.
• Some people are at higher risk of getting blood clots, especially patients in the hospital who have had recent surgery or are confined to bed. Patients are often given compression boots, compression stockings, or medicine to prevent blood clots while in the hospital and when they go home. If you are in the hospital and you are not given any of these things, ask your health care provider if you need blood clot prevention.
• If you have already had a blood clot in the leg, you are at increased risk of getting a second blood clot. The best way to prevent a second blood clot is to take your blood thinner medication correctly and follow your health care provider’s instructions for having blood tests.
• Do not stop taking your blood thinner medication until your health care provider tells you to stop.

Lose weight if you are overweight.
Increased weight puts more strain on the legs and leg veins.

Wear graduated (elastic) compression stockings.
Wearing a special elastic stocking on the leg with the blood clot may help prevent PTS. See the flyer called “Focus on Elastic Compression Stockings” for information on how to get stockings and how to wear them correctly. See your health care provider regularly.

See your health care provider regularly
Your health care provider can examine your leg at every appointment to look for signs of PTS. He or she can also advise you about wearing elastic compression stockings and about taking your blood thinner medication correctly.

What is the treatment for PTS?

PTS can be a difficult health condition to treat, so your health care provider may tell you to use one or all of these possible treatments:

Leg elevation.
Often elevating your leg correctly can help with the pain and swelling from PTS.

Compression.
Your healthcare provider may prescribe either graduated compression stockings or a device worn on the leg (or both) to improve blood flow and control pain and swelling.

Medications.
Some studies have shown that herbal supplements such as aescin (horse chestnut extract) and rutosides can be helpful in relieving leg pain and swelling caused by PTS, but this preparation has not been approved by the FDA. Your health care provider may recommend these supplements if compression stockings are not enough to help your leg pain and swelling.

Special care for ulcers.
If you get a leg ulcer because of PTS, you should see a special health care provider who has extra training in helping ulcers to heal. That health care provider may give you special medications or bandages for the ulcer.

How can I tell the difference between PTS and a new blood clot?

It can often be difficult to tell whether your leg problems are caused by PTS or a new blood clot. Sometimes it takes 3-6 months for your blood clot symptoms to get better. Anytime you have new problems with your leg, you should see your health care provider. In most cases of PTS, leg pain and swelling will get better when you rest or elevate your leg. By contrast, if you have a blood clot, the pain and swelling will not get better with elevation and rest.

Why is PTS a problem?

PTS is a frequent side effect of DVT. Symptoms can come and go over time, but PTS is a chronic, lifelong condition. PTS leads to suffering and disability and is costly to society. Severe PTS can cause painful venous ulcers or sores on the arms or legs that are difficult to treat and tend to recur. Ulcers occur in 5-10% of patients who have PTS.

Why does PTS occur?

When a clot forms in a vein, the valves inside the vein can be damaged by the clot or by the surrounding inflammation. The damaged valves (as well as residual clot) block blood returning from the leg veins back to the heart, which results in increased venous pressure in the leg.

What is the difference between postthrombotic syndrome (PTS) and post-phlebitic syndrome?

Nothing – these are two names for the same condition. Another term sometimes used is “venous stress disorder.”

Does having varicose veins make me more likely to get PTS?

Varicose veins occur in the small, superficial veins just under the skin. These veins can appear for many different reasons. People may get varicose veins even if they have never had a blood clot. By contrast, PTS is caused by blood clot damage in the valves in the deep veins. If you have had a blood clot in your leg, you might develop varicose veins. Your health care provider will look for varicose veins to help determine whether you have PTS.

Are there medications or surgery to remove the blood clot in my leg so that my veins are not damaged?

Yes. This procedure is either called a thrombectomy, which is a surgery to remove the blood clot, or a thrombolysis, which is a surgery to dissolve the clot. These are risky procedures, and they are usually reserved for the most severe clots that may stop blood flow to the leg. It is not known whether these procedures would help prevent PTS.

If I already have PTS, can I have surgery to fix my veins?

Currently there is no safe or effective surgery which will replace or repair damaged deep vein valves.

Can I do special exercises to treat PTS?

Yes. Certain types of exercise that keep your leg stronger and more flexible will improve your overall physical fitness and might help treat PTS.

If I have a blood clot in my arm, can I get PTS?

Yes. This type of PTS is called upper-extremity PTS. It is less common than PTS of the leg, but the symptoms and treatments are similar. Patients with upper-extremity PTS have pain and swelling in the arm. The treatment is to wear a special compression sleeve on the arm, similar to compression stockings for the legs.

If my blood clot was only in my lungs, can I get PTS?

Based on what doctors know now, PTS only affects patients who have had a blood clot in the leg or arm. Sometimes the blood clot starts in the leg and then breaks off and moves to the lungs. If a blood clot was found in your leg as well as you lungs, you may still be at risk for getting PTS. If you have never had any blood clot symptoms in your leg, and a blood clot was not found in your leg, it is unlikely you will get PTS.

Blood clot: How do I know if I have a blood clot in my leg? SEVEN symptoms of a blood clot

• Blood clots are caused by platelets clumping together in the blood vessels
• Swollen legs could be a sign of a blood clot
• The leg may become increasingly painful or sore, and may develop a dull ache
• Other common symptoms include persistent cramps, difficulty breathing, and unexplained chest pain

Blood clots are very serious, and need to be treated as soon as possible. A clot could block up the blood vessels, which makes it increasingly difficult to deliver blood around the body. But it can be difficult to know if you’re at risk of the condition.

Blood clots are relatively common, and are caused by proteins and platelets clumping together in the blood vessels.

They usually develop in the legs or arms, but they can form almost anywhere in the bay, including around the heart, brain or lungs.

Left untreated, the clot may make its way into the lungs, which can be very serious. This is known as a pulmonary embolism.

It’s, therefore, absolutely essential that you seek medical attention if you think that you have a blood clot.

READ MORE: Four techniques to reduce your risk of blood clots

“When blood clots don’t fall apart, they can be dangerous and lead to serious medical conditions,” said medical website WebMD.

“You can get them in blood vessels in just about any part of your body. They’re most likely to affect a leg, especially if you sit for long periods of time.

“If you learn the warning signs, you’re more likely to get quick medical help that can make a huge difference in keeping you out of the danger zone.

“But it’s important to know that in some cases, clots can happen with few symptoms or none at all…”

If the clot is in the lower leg, you could develop persistent cramp.

Some patients also start to struggle to breathe, which is usually a sign that the clot has moved from the leg toward the lungs.

The difficulty breathing is likely to be accompanied by a bad cough, chest pain, and dizziness.

You should dial 999 and ask for an ambulance straight away if you think your blood clot has moved into your lungs.

Blood Clot in the Leg: Symptoms, Signs & Treatment

Signs And Symptoms Of A Blood Clot In The Leg

The signs and symptoms of a blood clot can be vague at first. In fact, the first sign may be a small pink area. The area becomes warm to the touch as the blood clot becomes worse. If felt with your hand, the pink area will feel like a cord. Other symptoms of a blood clot in the leg include:

• Calf pain or tenderness
• No pedal pulse (foot pulse)
• Swelling of the leg and/or foot along without weeping of the skin (the skin leaks small amounts of fluid)
• Anxiety
• Sweating
• Difficulty breathing
• Positive Homan’s Sign (pain in the calf when the leg is straight and the foot is flexed)

The Severity Of A Blood Clot

A blood clot is a very serious medical condition, with consequences that can be life threatening and at times, fatal. A clot in the leg can stop blood flow. When this occurs, there will be no pulse felt distal (away from, typically below) to the clot. This is why it is important to check the pedal pulse. Once blood flow to the leg is stopped by the clot, the leg will die. This can result in an amputation. A more serious scenario is a blood clot that detaches from the vein and gets stuck in a blood vessel in the lung. When this occurs the client is said to have a pulmonary embolism. The client will have shortness of breath and perhaps anxiety. This is life threatening and can quickly turn fatal. When a blood clot is suspected, always seek immediate medical attention. If shortness of breath, anxiety or sweating occur along with a suspected blood clot, call an ambulance.

Treatment Of A Blood Clot

Treatment is aimed at dissolving the blood clot, preventing the clot from traveling, and preventing the formation of new clots. Initially, the client should rest with the extremity elevated. A warm compress can be placed over the pink area to aid in healing. The client is started on anticoagulants (blood thinners). There are a variety of anticoagulants available, such as:

• Heparin
• Coumadin
• Lovenox
• Xarelto
• Eliquis
• Pradaxa
• Savaysa

Once there is a therapeutic level (the correct dosage of medication that keeps the blood at the desired consistency) of anticoagulants, the patient can go about his/her normal routine. However, use of any anticoagulant increases the risk of hemorrhage. Patients are advised to refrain from any activities that involve even a remote possibility of injury.

If the blood clot is a result of an injury or surgery, anticoagulants must be continued for 6-9 months. For other blood clots, it is recommended to continue the use of anticoagulants for one year.

Continuous routine blood tests are required for heparin, Coumadin, and Lovenox. If the blood test shows that the blood is too thin, the patient is given vitamin K, which reverses the effects of the anticoagulant. The remaining anticoagulants do not need any blood testing. However, vitamin K will not reverse the effects of these medications and the patient can easily die from a hemorrhage. Currently there is one medication that is useful in combating the effects of some of these anticoagulants however, at this time, the medication is only being used in a few hospitals.

Lesson Summary

A blood clot is a serious condition. Left undetected and untreated, it can be life threatening.

Always treat the signs and symptoms of a blood clot as an emergency and seek immediate medical attention. Call an ambulance if the patient becomes anxious or short of breath. This is an indication that the clot has moved to the lung. This is referred to as a pulmonary embolism and can quickly become fatal.

A blood clot in the leg can begin as a small pink area somewhere on the leg. As the clot worsens, the pinkness becomes larger, more intense in color and warm to the touch. Within the area of discoloration, you may feel a cord. If a blood clot is present, the patient will have a positive Homan’s sign (pain in the calf when the foot is flexed). You should always check for a pedal pulse ( a pulse over the top arch of the foot). If there is no pulse, the blood clot may stop blood flow to the leg causing serious damage and perhaps the need for amputation.

Treatment consists of anticoagulants (blood thinners), such as Coumadin, Lovenox, and Xarelto, to name a few. Anticoagulants thin the blood and help dissolve the blood clot that is present. They also prevent additional clots from forming. A blood clot that occurs after surgery or as a result of an injury or surgery is treated for 6-9 month. A blood clot that occurs without surgery or injury is treated for at least one year. In addition to anticoagulants, rest, elevation, and warm compresses are prescribed at the onset of symptoms. Once a therapeutic level of anticoagulants has been achieved, the patient can go about his/her day normally, but he/she must avoid any activities that may produce an injury.

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5 Ways to Avoid Blood Clots in Your Legs

Reviewed by: Dr. Satish Vayuvegula

Blood clots are not something to take lightly. Though they aren’t always life-threatening, they can be and you do not want to be putting yourself at risk.

These blood clots exist deep in your veins, particularly in the legs, and are often referred to as deep vein thrombosis, or DVT for short.

“A blood clot in my leg — how bad can that be?” you may be thinking. Well, it can be pretty bad. They can break off and get stuck in your lungs, which means you’re dealing with a potentially fatal situation known as pulmonary embolism.

There are many different things you may be doing in your life that could be putting you at risk of developing these blood clots and possibly further issues, but some simple changes can help.

Here’s how to avoid blood clots in your legs

1. Even while you’re relaxing, make time to move

Few things can relax you as much as parking our bodies on the couch and binge-watching our favorite show.

While we would never tell you to not do this, we are here to tell you that while you’re binging, you should be sure to get up and move around a little between episodes. While you’re waiting for the next episode to load, walk around for a few minutes to get your blood flowing again.

Sitting for extended periods of time without movement is one of the major risk factors for deep vein thrombosis, but thankfully, you can lower that risk with a quick and simple fix.

This is a great opportunity for you to elevate your legs, as well, which is great for keeping your circulation going, especially if you already have issues with your veins.

2. Stay hydrated while traveling

Whether you’re flying or driving, it is easy to get dehydrated.

When you’re driving, chances are good you don’t want to be chugging water or else you’ll find yourself often hitting every rest area along the way. And, when it comes to plane travel, no one likes an airplane bathroom, so some avoid it at all costs by limiting their water intake. However, when you are traveling, you should be upping your water intake.

Not only is flying dehydrating, but it also forces you to sit for long periods of time.

If you’re sitting for more than 2 hours in either a car or on a plane, then you are increasing your risk of blood clots. If traveling by car, try to stop every hour to hour and a half, get out and walk around. If you’re confined by the walls of an airplane, get up and walk around the aisles as often as you can to keep things moving.

Also, note that many airlines have seatback cards with suggested exercises that can be done while seated to help prevent blood clots. This includes calf pumps and writing the letters of the alphabet using your feet.

When traveling, you will also want to try and stay away from drinks that will dehydrate you even further, such as caffeine, alcohol and sugary drinks like soda.

A good thing to take with you when traveling to help avoid blood clots in your legs is compression stockings. It’s preferable to have them prescribed to you by a vein specialist but if you find yourself in a pinch, you can get them over the counter.

Schedule your consultation today

3. When pregnant, keep moving

It’s tough to remain on the go when pregnant because exhaustion sets in more quickly than usual. However, pregnancy and changes in hormones are one of the leading risks of blood clots so this is a good time to be sure you are not living a sedentary life. Pregnancy increases the pressure in the veins of your pelvis and legs. When your legs remain still for long periods, such as during bed rest, your calf muscles don’t contract to help blood circulate, which can increase the risk of blood clots.

When you can, try to go on regular walks and make sure you aren’t limiting yourself to the couch or your bed for too long without moving.

If possible, try sleeping on your left side to help promote circulation and blood flow where it might be more difficult during pregnancy.

4. Raise your feet when sleeping

Think about the amount of time you spend sedentary when sleeping. If you’re getting the proper amount of sleep, that equates to about 7-8 hours of little to no movement in your legs. And that does not bode well for your blood circulation.

To help promote circulation while you’re sleeping, try elevating your legs. You can do this by putting a pillow under your feet or by raising the foot of your bed. It doesn’t have to be a major lift — just a few inches will greatly help your circulation and reduce your risk of blood clots.

Pro tip: Just be sure that your legs are higher than your hips in order to get the full effect.

5. Know the Signs of a Possible Blood Clot

If you are noticing anything unusual, be sure to schedule an appointment with a vein specialist. Blood clots are the types of things that you do not want to leave untreated — they have the potential to be life-threatening.

Blood Clot in Foot | Symptoms & Treatment

What to do if you suspect a blood clot?

If you or someone you love suspects a blood clot, seek medical attention right away. The longer you wait, the higher your chance of developing a highly dangerous clot in one of your organs. Visit your doctor or go straight to the emergency room immediately. Clots can be life-threatening. You will want the peace of mind of a proper diagnosis. Your doctor may prescribe a blood thinner and monitor the clot. Surgery or the direct application of a clot-busting drug via a thin tube to the site of the clot may be needed. Clots are a dangerous condition that can travel through the circulatory system to anyplace in your body. If left untreated, they can become deadly. You won’t know for sure if you have one without undergoing a proper examination by a healthcare professional.

If you are experiencing any of the following symptoms, go straight to the hospital:

• Trouble breathing
• Chest pain
• Vomiting up blood
• Blood in your stool
• Dark foul-smelling stool
• Fainting spells
• Pain of numbness radiating into the left arm
• Slurred speech
• Droopy face
• Seizures
• Quick-onset confusion

What can I do to prevent a blood clot from forming?

You can take action to lower your odds of developing a blood clot. Follow a healthy diet low in fat, maintain a healthy weight, don’t smoke, and exercise regularly.

You should also:

• Avoid sitting for a long period of time, especially during a long flight or after surgery.
• If you have a desk job, set your alarm to remind you to get up and move at least every two or three hours. While sitting, flex the muscles in your legs, feet, and toes.
• Talk to your doctor about tight-fitting compression socks or garments. They may be able to help regular blood flow.
• Make an appointment with your healthcare provider. He or she may recommend taking a clot-fighting blood-thinner, sometimes called anticoagulants.

What is May-Thurner Syndrome?

May-Thurner syndrome (MTS) is a medical condition that increases one’s chances of developing blood clots. Also known as Iliac Vein Compression Syndrome, MTS occurs when the right iliac artery presses against the left iliac vein pinching the vein. This compression can cause damage to the vein and increase the risk of developing deep vein thrombosis (DVT) in the left leg. DVT is characterised by a potentially dangerous blood clot in the left leg. The clot can completely or partially block proper blood flow through the vein.

What are the warning signs for May-Thurner Syndrome?

Warning signs for MTS are subtle and very often go unnoticed. Because of this, most people do not realize they have MTS until a DVT presents itself. Individuals who experience symptoms should seek treatment. Symptoms include:

• discoloration (red or purple) of the skin, 
• enlarged veins in the leg,
• leg is warm to the touch, 
• swelling,
• tenderness or 
• pain in the leg. 

While the condition of DVT alone isn’t life-threatening, if the blood clot breaks free it has the potential to travel through the bloodstream and become lodged in the blood vessels of the lung (known as a pulmonary embolism). This is a serious and life-threatening condition.

DVT can also lead to pulmonary condition in the legs called post-thrombotic syndrome (also known as chronic venous insufficiency link). Post-thrombotic syndrome is characterized by:

• a pooling of blood in the leg, 
• chronic leg swelling, 
• increased pigmentation or discoloration of the skin,
• increased pressure and
• leg ulcers (known as venous stasis ulcers.)

I’ve never heard of May-Thurner Syndrome. What is it?

May-Thurner syndrome is rare. It is a vascular disorder that affects a vein in your pelvis. The right iliac artery presses against the left iliac vein, causing it to restrict blood flow. This is the vein that returns blood from your pelvis and legs back to your heart. The added pressure of the vessels pressing against each other will can cause one or both of them to narrow, impeding the blood from flowing properly. It may also cause scarring leading to a thickening of the wall. The constricted flow of blood in the leg can cause a variety of other symptoms and conditions in your legs or feet. The most problematic is perhaps a blood clot. Many people with from May-Thurner syndrome will go years without symptoms or a proper diagnosis. Over time May-Thurner syndrome can lead to:

• Swelling in the leg.
• Chronic venous insufficiency (CVI). CVI is a condition where the blood will pool within your veins, causing pressure, swelling, skin changes and venous ulcers or sores that will not heal on their own.
• Deep vein thrombosis (DVT). DVT is a blood clot in that occurs in a vein located deep below your skin. If a DVT breaks loose a moves to your lung, heart or brain it can lead to life-threatening emergencies. For example: a heart attack, stroke or a pulmonary embolism (a blood clot in your lung)

How will I know if I have May-Thurner syndrome?

Symptoms of May-Thurner syndrome can include:

• Swelling, heaviness, or a feeling of fullness in your leg or foot.
• Sores or venous ulcers on your legs or feet that don’t heal by themselves.
• Newly appearing varicose veins in your legs.

In many cases, patients have no symptoms and can go undiagnosed for years. Only when a deep vein thrombosis (DVT) develops, do many become aware of their condition.

Some symptoms of deep vein thrombosis (DVT) are:

• Swelling in the leg(s).
• Pain and/or tenderness in the leg(s).
• Changes in skin color (such as redness).
• Skin that is warm to the touch.

What are the common treatments for May-Thurner Syndrome?

You don’t have to live with the worries or symptoms of May-Thurner syndrome. It is treatable. After considering your symptoms and risk factors your healthcare provider will design a tailor-made treatment program. Any successful treatment program will effectively treat your condition while considering your lifestyle and overall health. 

Common treatments for May-Thurner syndrome may include:

• Taking blood thinners or anticoagulants. These medications can help prevent blood clots.
• Thrombolysis is an intravenous procedure that we use on larger clots. In it, a catheter is feed to the site of the clot, delivering high potency anti-clotting drugs directly to the blockage. We also refer to this as “clot busting.”
• A stent is a small tube made of metal mesh that is used to hold your vein open and restore proper blood flow.
• Compression stockings are tight-fitting stocking that can ease swelling in your leg. These snug stockings are worn over your legs from your toes to knee. They apply constant pressure to your lower legs. Putting continual pressure on the area, will improve swelling and increase blood flow.

Your doctor may suggest surgery in some cases. In certain cases, surgery can be beneficial in relieving the symptoms or reducing the risks of complicating conditions brought on my blood clots. Different surgerys can be used to:

• Circumvent the section of the vein where the clot or other circumstance that is causing reduced blood flow. In this procedure, a vein is taken from another place in the body and used as a bypass, opening up the flow of blood.
• Relocate the right iliac artery. Repositioning the artery so that it is no longer pressing on the left iliac vein can open up the blood flow.
• A stent may be placed in the vein to hold it open.

What are venous ulcers?

Venous ulcers are painful sores that occur on the lower leg or around the ankle. Sometimes called venous stasis ulcers or non healing wounds, venous ulcers are lingering open wounds that don’t heal easily on their own. They frequently take, weeks, months or even longer to heal.

What are the risk factors of venous ulcers?

Various medical conditions can lead to the persistent venous ulcers. Painful venous ulcers can present themselves if you suffer from:

• Obesity
• Certain groups of medicine
• Venous insufficiency
• Diabetes 
• Infections
• Venous hypertension
• Inflammatory diseases
• Kidneys failure
• Poor circulation and/or blood clots
• Varicose veins

How did I know if I have venous ulcers?

untreated swelling

If you are at risk for venous ulcers keep an eye out for the following signs and symptoms:

• Area around the sores might be shiny. The skin may be tight and warm (or hot) to the touch.
• Discolored skin (red, purple)
• Dull ache in the leg or calf.
• Feeling of fullness or heaviness in the leg or calf.
• Swelling and cramping in the legs.
• Symptoms of blood pooling in the legs (purple, dark red, and/or brown spots. Swollen, hardened skin.)
• The edges of the ulcers are often unevenly shaped.
• Tingling and itchiness in the lower leg and/or ankle, 

Stasis Ulcers: What are they?

Most commonly found on the ankle or calf, painful venous stasis ulcers are open sores that do not heal well on their own. They are typically red in color however a fibrous yellow tissue may cover them. The sores border is typically irregular. Red, purple, and brown spots may also be present on the lower legs and ankles. When suffering from venous stasis ulcers you may experience discharge and drainage. Venous stasis ulcers are common in people who have previously suffered from swollen legs and varicose veins.

Diagnosing and Treating Venous Ulcers

While diagnosing the venous ulcers is not difficult, finding the proper cause of these painful sores can be challenging. Some Western Pennsylvania providers use a duplex ultrasound. This is a noninvasive imaging test that we use to diagnose which veins are causing the venous ulcers. The difference in this approach is that it pinpoints the abnormal vein or veins. By finding the cause of the ulceration, we can treat the venous pathology and  thereby prevent the return of the ulcers once healed.

After your veins have been evaluated, your healthcare provider will recommend a personalized treatment plan based on your specific needs:

Compression Stockings for blood clot

• • • Placing the leg under constant compression is a vital aspect to healing venous ulcers.
    • While, compression stockings are the most commonly used tool for this treatment, there are other methods available.
    • The inward compression from the stocking will counteract the pressure from the veins of the leg and allows skin to heal.

  • Growth factors

    • Still in the testing phase, we can apply some medications to the wound. The hope is that these medicines will promote the growth of new tissue.

  • Hydrocolloid dressings

    • Hydrocolloid dressings is specially designed dressing that is applied over the venous ulcer.
    • It promotes healing and also helps to remove any debridement (non-living tissue) from the wound.

  • Surgery

    • Sometimes you need a minor surgery to clean the wound from non-living material. Wound debridement, as it is know, removes any non-living tissue that could keep a wound from properly healing.

  • Transparent dressings

    • We can apply a specialized clear plastic film over the wound. The pressure from the dressing, facilitates proper blood flow.
    • You should wear support stockings over the wrap to hold it securely.

  • Unna boots

    • Similar to a cast, we can custom fit a hard boot to your lower leg. Your physician will wrap a moist gauze around your lower leg (starting at the base of the toes and going to just below the knee.)
    • With time, the gauze hardens and forms a snug boot around your leg.
    • The boot provides additional support for the leg, improving the blood flow in your veins, healing the ulcer more quickly.

•  Vein Ablation for preventing a blood clot

Varicose Veins and Blood Clots in Your Leg

Gnarled, twisted veins slow blood flow and can cause it to clot. Look for these subtle signs to see whether a blood clot is superficial or something far more serious.

Posted
by The Iowa Clinic on Monday, December 31, 2018

Varicose veins are more common than you think. Nearly a quarter of adults have the condition. Due to their unsightly appearance, it’s probably one you may not often see despite its prevalence. Developing large, twisted, and sometimes colorful cords on the legs leads many people to cover up or seek treatment options to remove varicose veins entirely.

While common, varicose veins do more harm to your appearance and self-esteem than your health. They primarily affect the superficial veins in your legs. You may experience some aches, pains, swelling or skin discoloration. And in some cases, you may develop blood clots in your legs.

Blood clots? That sounds like a pretty big problem.

Rarely. Since most varicose veins are in the superficial veins, most blood clots form there, too. These veins are located just below the surface of the skin. So when a blood clot forms, your skin appears red, swollen and painful. This condition, known as superficial venous thrombosis, is directly correlated to varicose veins, but most people never get it.

That’s a relief. But how do you get superficial thrombophlebitis?

Superficial thrombophlebitis occurs when you have an injury. Even a slight injury to a varicose vein can cause it to become inflamed. That sudden inflammation in the vein causes blood flow to slow down and blood clots to form. And that’s a problem in the superficial veins.

Unlike deeper blood vessels, superficial veins aren’t surrounded by muscle. Muscles act as pumps for your veins. Without a pump to move it out, a blood clot can stick to the wall of your vein and be hard to dislodge. Your varicose vein feels like a hard cord and becomes painful.

Fortunately, the problem usually goes away on its own. In a few days, your inflammation should decrease. After a few weeks, the hardness of your vein subsides. Applying a warm compress and taking aspirin can ease your pain and symptoms until the problem is resolved.

What if you get a blood clot in a deeper vein?

That’s a much bigger issue. Severe varicose veins can affect the deeper veins, too. While there’s still research to be done, a study published in the Journal of the American Medical Association shows that people with varicose veins are five times more likely to develop deep vein thrombosis (DVT).

DVT is similar to superficial thrombophlebitis, but the blood clot forms in a deeper, larger vein. And those are bigger vessels that carry more blood and connect to other parts of the body. If your muscles squeeze one of these blood clots out of your leg, there’s a chance it could land elsewhere and do much more damage.

When a blood clot breaks free and enters your lungs, it causes a life-threatening condition known as a pulmonary embolism. Without emergency medical attention, a pulmonary embolism can be deadly.

How do you tell the difference between a blood clot in a superficial vein and one in a deep leg vein?

A vein specialist can spot superficial thrombophlebitis on appearance alone. The skin over the clotted vein is red, warm, and tender to the touch.

Diagnosing deep vein thrombosis is a little trickier. Some people experience no symptoms. And other symptoms are similar to superficial thrombophlebitis. If you have varicose veins, look for these signs of DVT:

• Swelling
• Tenderness
• Pain in your calf, foot or leg
• Skin that is warm, red, or discolored
• Sudden leg fatigue

The differences between the two conditions are subtle. If you think you have a blood clot in your leg or you aren’t sure if it’s superficial or deep, visit a vascular surgeon for an accurate diagnosis. For superficial thrombophlebitis, you’ll have peace of mind a few simple home remedies. For the more serious DVT, your vascular surgeon will prescribe the best treatment.

All information offered on The Iowa Clinic website is intended to serve as general educational information only. Any content, product or service is not intended to be a substitute for professional medical advice, diagnosis or treatment. If you believe you have a medical issue, always seek the personalized advice of your physician or qualified healthcare provider.

The Iowa Clinic may provide links to outside sources for additional resources or information and is in no way responsible for the information provided by other organizations or sources. © The Iowa Clinic, 2021

Causes of pulmonary embolism | British Lung Foundation

On this page, we explain what causes a pulmonary embolism and the risk factors for having a pulmonary embolism. You can read more about preventing a pulmonary embolism on our separate page.

What causes a pulmonary embolism?

A pulmonary embolism happens when a blood vessel in your lungs becomes blocked. Most of the time, this blockage is caused by a blood clot and happens suddenly.

Usually, a pulmonary embolism is caused by a blood clot travelling up from one of the deep veins in your body, usually in the leg. This kind of blood clot is called a deep vein thrombosis (DVT).

In some cases, the blood clot occurs because of a change in your physical condition, such as pregnancy or recent surgery. In about 20-30% of cases, your health care professional may be unable to find the cause of a pulmonary embolism. This can be called an ‘unprovoked’ pulmonary embolism.

What increases your risk of having a pulmonary embolism?

If you’ve been inactive for a long time, your chance of getting a pulmonary embolism increases. This is because when you’re inactive, blood tends to collect in the lower parts of your body, particularly in your lower legs.

This isn’t usually a problem because when you start to move, your blood flow increases, and blood begins to move more evenly round your body. But if you’re immobile for a long time, the flow of blood around your body can slow and clot, causing a DVT that can break off and cause a pulmonary embolism.

This can happen:

• after an operation or a serious limb injury
• after long periods of bed rest
• during a long-haul flight or a long train or car journey lasting more than 4 hours

Around half of all people with a pulmonary embolism get it during a long stay in hospital.

Read more about what you can do to prevent getting a pulmonary embolism.

What are other risk factors for having a pulmonary embolism?

Some people are at a higher risk of blood clotting which can cause a pulmonary embolism. This includes people who:

• are overweight
• are pregnant – your risk is increased for up to six weeks after giving birth
• smoke
• take some forms of hormone-based contraception or hormone replacement therapy (HRT)

Your chances of developing a blood clot are very small if you’re taking the contraceptive pill or HRT, and your health care professional will consider your individual risk before they prescribe them.

Less commonly, you might have a condition that causes your blood to clot more easily than normal, such as cancer. Cancer treatments such as chemotherapy and radiotherapy can also increase the chances of blood clots.

Routine testing for genetic risk of blood clots is not recommended. But in certain circumstances if you have a confirmed diagnosis of pulmonary embolism, your doctor may recommend a blood test to look for inherited conditions which increase the risk of clots. They may be more likely to suggest this if there is a family history of pulmonary embolism or deep vein thrombosis (DVT) and if you are due to stop anticoagulation treatment.

Read next: Diagnosing pulmonary embolism

 Download our pulmonary embolism information (PDF, 385 KB)

90,000 What are the signs of a blood clot in your leg?

A blood clot in the leg can be dangerous and even fatal if it travels to the lungs, so it is important for people to recognize the signs. The most common are pain in the area around the blood clot, redness, swelling, and warmth in the affected limb. In addition, the victim of such a clot may experience leg cramps or increase the pain when the calf is stretched. However, some people never experience these symptoms, which makes the condition especially dangerous.

When a clot develops in the leg, it is often called deep vein thrombosis, or DVT. This can happen for a number of reasons, although trauma to the area, such as a severe bruise or broken bone, is one of the most common causes. Some people are also simply more prone to blood clotting problems. Recent surgical procedures can also lead to blood clots, as they can remain in bed or sit in a chair for extended periods of time.The most common signs of a blood clot in the leg include pain and swelling, so if someone experiences these symptoms, he or she should see a doctor immediately to discuss various treatments such as anticoagulant medications.

Skin discoloration is another sign of a blood clot in the leg. Some people will notice that the area looks redder than the surrounding skin, as can be the case with any injury, while others may notice that the skin is blue or white.When touched, the skin may be warm compared to the surrounding area or the other leg. It can be painful to walk and especially unpleasant to stretch the calf, which is one of the most common places for blood clots.

These signs are easy to overlook, but it is important that people be vigilant, especially after any leg injury that makes a clot more likely. If the clot is left untreated and travels to the lung, it can cause pulmonary embolism or other serious problems that can lead to death.Shortness of breath, dizziness, fainting, or chest pain should always be considered urgent as they can also be signs that a blood clot has entered the lungs or heart.

OTHER LANGUAGES

City Clinical Hospital No. 31 – Hemorrhoidal thrombectomy: indications, operation, features

Briefly about the main points

Thrombectomy is a minimally invasive (less traumatic) operation, which is performed to eliminate a thrombus formed in hemorrhoids.Such an intervention is performed at acute hemorrhoids .

Thrombectomy is performed under local anesthesia and takes no more than 10 minutes . The procedure has the shortest list of contraindications and does not require the patient to be hospitalized. You can go home immediately after operation .

The recovery period passes quickly and is not associated with serious restrictions. It will be necessary to follow the basic rules of hygiene: wash the anal area with warm water after each bowel movement.You should also follow all the doctor’s recommendations:
___ • follow a diet,
___ • limit physical and nervous stress,
___ • avoid excluding thermal procedures,
___ • take prescribed medications,
___ • carry out local treatment of a postoperative wound.

Causes of hemorrhoidal vein thrombosis

Thrombosis can develop as a consequence of an acute, new-onset hemorrhoid attack, as well as a complication of chronic hemorrhoids. The likelihood of developing thrombosis in chronic pathology increases with the duration of the disease and the size of the nodes.

An attack can be provoked by:
___ • chronic stool disorders (constipation, diarrhea, constipation alternating with diarrhea),
___ • increased physical activity,
___ • labor,
___ • spicy food and / or alcohol,
___ • hypothermia, overheating.

The development of acute hemorrhoids is facilitated by all conditions accompanied by an increase in intra-abdominal pressure – from pregnancy to chronic cough and obesity.

Another factor in the occurrence of hemorrhoids is stagnation of blood in the veins of the small pelvis, which often occurs as a result of a sedentary lifestyle, “sedentary” work.

Mechanism of thrombus formation

Thrombosis of external hemorrhoids occurs more often. It is extremely rare that the process spreads from external to internal nodes. Even less often, it occurs in isolation in internal nodes.

Thrombosis of the external hemorrhoid occurs in both acute and chronic processes. In both cases, the pathology develops as a result of a combination of three factors:
___ • slowing down of blood flow in the node,
___ • blood thickening,
___ • damage to the vascular network of the hemorrhoid.

Signs of thrombosis

___ • The main symptom of thrombosis is acute excruciating pain that interferes with normal bowel movements. The pain syndrome increases many times with straining, movement, and also in a sitting position. In severe cases, the pain takes on a pulsating character and, depending on the location of the node, can be given to the leg, into the rectum or to the external genitalia.
___ • Bleeding often occurs, which has varying intensity – from single drops on the surface of the stool to a trickle of blood during bowel movements.
___ • Thrombosis of an internal node causes a foreign body sensation inside the rectum. Since the bleeding injured node comes into contact with the feces, a secondary infection is possible. In such cases, mucous or purulent discharge appears, the body temperature rises.

When is thrombectomy necessary

Indications for surgical intervention

Most cases of acute thrombosis of hemorrhoids (uncomplicated thrombosis, small node size) respond well to conservative treatment.The main thing is to consult a doctor in a timely manner.

Surgical manipulations are carried out if the time from the onset of the disease is 48-72 hours. If more time has passed since the onset of thrombosis, the doctor prescribes conservative treatment followed by surgical treatment. Surgical removal of the thrombosed node is carried out at a later date from the onset of the disease in the following cases :
___ fever, headache),
___ • contraindications to the appointment of thrombolytic agents (pregnancy, lactation),
___ • large hemorrhoids.

The decision on surgical intervention is made by the doctor after examination, which will reveal contraindications to surgery. Another goal of diagnostic manipulations is the choice of the method of surgical intervention.

Types of transactions

Removal of thrombus in case of external hemorrhoids

Removal of a blood clot in case of external hemorrhoids – a simple operation that takes only a few minutes. The doctor makes a small incision over the blood clot.Then the blood clot is removed with tweezers or a clamp, the wound is not sutured. The inflammatory edema subsides almost immediately, the pain subsides, and the patient’s general condition improves.

According to the indications, a more complex operation can be performed – excision of the external hemorrhoid with thrombi , which is also performed under local anesthesia and does not require the patient to be hospitalized. During excision, the pathological element is removed, which reduces the risk of recurrent thrombosis.

Removal of thrombus in case of internal hemorrhoids

Thrombosis of internal hemorrhoids occurs much less frequently and, as a rule, develops at the later stages of the development of the process (III-IV stages of hemorrhoids).

Treatment in this case is conservative. After stopping the acute process, treatment is carried out aimed at removing internal hemorrhoids (hemorrhoidectomy).

Diagnostics

Diagnosis of hemorrhoidal thrombosis is straightforward.The diagnosis is established by by external examination of the anal area .

If the proctologist decides to have surgery, it will be necessary to pass tests :
___ • complete blood count,
___ • coagulogram,
___ • blood glucose level.

It is necessary to tell the attending surgeon about all the drugs taken, since some drugs (oral contraceptives, non-steroidal anti-inflammatory drugs, etc.) affect blood clotting.

Contraindications

___ • The operation is not performed in case of an extremely serious condition of the patient (general exhaustion, complications of cardiovascular diseases, sepsis).
___ • Surgical interventions are not prescribed for severe pregnancy (severe anemia, poorly controlled early toxicosis with dehydration, late toxicosis with generalized edema, etc.).

Since thrombectomy is a minimally invasive (less traumatic) operation, the procedure can be prescribed after stabilization of the patient’s condition.The decision on the operation or its inadmissibility is made individually, taking into account all risk factors.

Preparation for procedure

If the doctor decides on thrombectomy, the patient is prescribed diet with the exclusion of foods that provoke gas formation in the large intestine (cabbage, legumes, fresh fruits and juices from them). The ban also includes products that cause a rush of blood to the rectum and / or irritate the mucous membrane (smoked meats, spicy foods, alcohol).

Immediately before the procedure (in the morning and in the evening on the eve of the operation), you will need to cleanse the intestines using the Microlax micro enema.

Preparation for thrombectomy is carried out when the patient’s condition allows. In case of severe pain syndrome and an impressive size of the node, intestinal cleaning is not carried out, and in case of a threat of the development of severe complications, surgical removal of a blood clot is carried out urgently.

How is the operation going

The procedure can be performed on a gynecological chair or on a couch and takes a few minutes.First, doctors give an anesthetic injection, which “freezes” the tissue like in a dental office. Therefore, the patient is conscious, but does not feel pain.

Surgical intervention takes several minutes and involves three manipulations:
___ • opening the affected node (small incision),
___ • removing a blood clot,
___ • stopping bleeding (the wound can be sutured, but more often it is not sutured)

After the procedure, you can go home.

Exceptions are those cases of thrombosis when severe complications occur (gangrene of the node, paraproctitis, severe bleeding) that require hospitalization.

Rules of conduct in the postoperative period

If the evacuation of blood clots from hemorrhoids was carried out against the background of a satisfactory condition of the patient, then the postoperative period does not provide for significant restrictions.

The ban covers:
___ • physical activity,
___ • thermal procedures (bath, sauna, beach rest),
___ • prolonged stay in a sitting or squatting position.

Foods that cause rush of blood to the vessels of the small pelvis or irritation of the mucous membrane are excluded from the diet: spicy, salty, smoked foods and alcohol.

Food should be rich in fiber that stimulates the intestines (prunes, apples). It is not recommended to eat foods that can provoke constipation (rice and semolina porridge, potatoes, pasta). In case of stool retention, a mild laxative (for example, Forlax) is prescribed.

After each bowel movement, wash the anal area with warm water and change the sterile napkin. If you experience suspicious symptoms (pain, bleeding, discharge from the wound), you should immediately consult a doctor.

Possible complications and side effects

Complications after thrombectomy of hemorrhoids are extremely rare. Nevertheless, it is necessary to observe a protective regime in order to avoid unpleasant consequences.

With physical exertion, systematic constipation and thermal procedures in the early postoperative period, bleeding or repeated wound thrombosis may develop.

Reviews of patients and recommendations of doctors

We analyzed the online reviews of patients who underwent removal of hemorrhoidal thrombosis.The vast majority of patients were satisfied with the procedure. The most common impression is: “The procedure itself is not as unpleasant as the expectation.”

No comments about complications of the operation were found. The most common complaint is soreness in the area of ​​the postoperative suture, which disappears after a few hours, but may reappear with a bowel movement.

A more serious drawback is the likelihood of a relapse. In order to avoid re-thrombosis, it is necessary to follow all the recommendations of the attending physician.

Advantages and disadvantages of method

Thrombectomy is a low-traumatic method of treating acute thrombosis of hemorrhoids, which has both advantages and disadvantages. The method provides for surgical intervention, therefore it is prescribed if conservative techniques are contraindicated or ineffective.

Positive aspects of thrombectomy:
___ • short list of contraindications,
___ • does not require hospitalization,
___ • the shortest recovery period with a minimum number of restrictions,
___ • insignificant severity of side effects of the operation (pain, weakness, edema),
___ • complications are extremely rare.

Disadvantages of the method. Thrombectomy does not provide for the removal of the hemorrhoid, therefore, the development of repeated thrombosis is possible. For this reason, with recurrent thrombosis, a more radical operation to remove thrombosed nodes is indicated ( hemorrhoidectomy ).

Prevention of relapse

Basic principles of prevention

Thrombosis of the hemorrhoid arises as a complication of hemorrhoids, therefore the prevention of recurrence consists in the prevention of the appearance of enlarged hemorrhoids.

Hemorrhoids is a disease with a hereditary predisposition. Therefore, if there has already been one attack, there is a high probability of relapse. However, the implementation of a negative scenario is possible in the presence of additional risk factors:
___ • pregnancy,
___ • taking hormonal drugs,
___ • overweight,
___ • permanent violation of the diet: intake of spicy and fatty foods, alcohol,
___ • abuse of thermal procedures (bath and sauna) or regular hypothermia,
___ • work associated with a long stay in a sitting position or hard physical work.

Necessary Precautions

The most common acute thrombosis occurs as a result of prolonged stool disturbance (chronic constipation). Therefore, you need to achieve daily bowel movements using a diet rich in fiber.

It is advisable to refrain from physical and nervous overload, as well as from hypothermia and overheating of the lower half of the body. You should not abuse alcohol, as well as spicy, smoked and salty foods.

With “sedentary” work, you need to take regular breaks, during which to carry out the prevention of hemorrhoids gymnastics.Many chronic diseases can contribute to the development of hemorrhoids, so taking care of your health is a reliable prevention of hemorrhoidal thrombosis.

Dangerous for the development of hemorrhoids and obesity. With this pathology, intra-abdominal pressure increases, the rheological properties of the blood change, problems with stool arise, and the hormonal background is disturbed. Therefore, a normal weight is not only beauty, but also health.

Is it possible to do without surgery?

If doctors recommended a thrombectomy of the hemorrhoid, this means that conservative therapy is not indicated in your case.You should not try to treat thrombosis with “folk” methods.

If treatment is inadequate or absent, complications may develop:
___ • bleeding,
___ • gangrene of the node,
___ • paraproctitis (purulent fusion of peri-rectal fatty tissue).

In some cases, the affected node can open up on its own and free from a blood clot. In place of the “bump” a skin fold is formed – an anal fringe, which causes unpleasant sensations (itching, oozing) and is an unpleasant cosmetic defect.

Treatment of thrombosis of hemorrhoids in City Clinical Hospital No. 31 (Moscow)

The Consultative and Diagnostic Center of the City Clinical Hospital No. 31 has the necessary medical and diagnostic equipment to help patients with hemorrhoids. An experienced proctologist will conduct a diagnostic examination and prescribe the method of treatment that best suits your case. If the patient’s condition allows, we try to carry out therapy with conservative and minimally invasive methods. We can also treat hemorrhoids during pregnancy and other conditions, when special care must be taken when prescribing medications.

If there are indications for surgery, the patient is referred to a short-term hospital or surgical department, where he undergoes treatment under the supervision of an experienced surgeon.

You can find out about the rules for the provision of paid services here. Also in our clinic there is a compulsory medical insurance policy. The list of services included in the Territorial program of state guarantees of free medical care in the city of Moscow can be found in the document.

Do not risk your health – consult a doctor at the first alarming symptoms!

Learn more about the direction Proctology

Make an appointment with our specialists

You can make an appointment for a paid appointment to the doctor by calling of the Consultative and Diagnostic Center +7 (499) 936-99-89 , or by filling out the form presented.

Conditions for the provision of paid services can be found here

To make an appointment for the OMS policy and in the direction of , you can call +7 (499) 936-99-71 .

Perianal thrombosis | GK Klinika

What is perianal thrombosis?

The blood vessels filling the hemorrhoidal corpus cavernosum can spontaneously rupture due to intense pushing, diarrhea, coughing or constipation, causing blood to splash under the skin.
The resulting clot can range in size from a few millimeters to 3 cm and is called a perianal thrombus.

What are the symptoms of perianal thrombosis?

The main symptom is sudden onset of pain in the sphincter area during moments of calm, before or after a bowel movement, blood may even appear. If a blood clot forms outside the anus, a dark blue, painful bulge may be seen. On the first day, this bulge is the source of very severe pain, over time the pain goes away, the bulge becomes softer.

What to do if you have the above symptoms?

You need to contact a proctologist who, during the first visit, will listen to all your complaints, establish the duration and nature of the disease, examine the anus, examine the anus tactilely or with an endoscope. In some cases, in the process of identifying this disease among other diseases of the colon, additional echoscopy or endoscopy may be necessary.

How is perianal thrombosis treated?

If a patient has acute perianal thrombosis, a small incision can be made and the thrombus removed using local anesthesia. If a thrombus has formed a long time ago, conservative treatment is prescribed, as well as the causes and factors that led to the occurrence of thrombosis are clarified and eliminated.

How to properly prepare for a visit to a proctologist?

2 hours before the consultation, you need to give yourself an enema (you can get the best result by buying a reusable enema sold in pharmacies).

If you have any questions, please call our GK Clinic on tel. (5) 255 33 53 and arrange for an individual doctor’s consultation.

90,000 Injuries. Hematomas. – Medsanbat

Author: Dmitry Androshchuk, trainer of Medsanbat

Hematoma – post-traumatic accumulation of blood inside the human body, resulting from rupture of blood vessels (for example, with bruises). Hematomas are minor and compressing soft tissues and adjacent organs.They can be localized under the skin, mucous membranes, in the thickness of the muscles, in the wall of internal organs, in the brain, etc. Small hematomas usually resolve on their own. Large hematomas can occur with the formation of connective tissue, disrupt the functions of nearby organs, or suppurate. Particularly dangerous are intracranial hematomas, which cause compression of the brain and can lead to the death of the patient. Treatment of hematomas is usually surgical, less often conservative therapy is performed.

Classification of hematomas.

There are several classifications of hematomas:

• By localization: subcutaneous, submucosal, subfascial, intermuscular hematomas. In addition, hematomas are isolated, which are localized in the tissues of the internal organs, as well as in the cranial cavity

• In relation to the vessel: non-pulsating and pulsating hematomas.

• According to the physical condition of blood in the area of ​​injury: fresh (without clotting), clotted, infected, hematomas with suppuration.

• According to clinical signs: diffuse, limited and enclosed hematomas. Intracranial hematomas (subdural, epidural, intraventricular, intracerebral and subarachnoid hemorrhages) should be distinguished into a separate group, which differ from all other types of hematomas in terms of clinical signs, characteristics of the course and possible consequences for the patient’s life.

Causes and risk factors.

In most cases, the cause of the development of hematoma is post-traumatic internal bleeding resulting from a shock, a blast wave, compression, pinching and other injuries.An exception to the general rule is subarachnoid hemorrhage, which can occur not only as a result of trauma, but also as a result of non-traumatic damage to the vessel. Sometimes hematomas (usually small ones) develop with certain diseases, one example of such a pathology is Mallory-Weiss syndrome (cracks in the lower part of the esophagus or upper part of the stomach due to vomiting when drinking alcohol or overeating). development and volume of hematoma, includes impaired vascular permeability, increased fragility of the vascular wall, as well as deterioration of blood coagulability.The likelihood of infection and suppuration of hematoma increases with a decrease in the body’s defenses due to exhaustion, chronic disease, old age and disorders of the immune system.

Subcutaneous hematomas

The following stages are distinguished:

Light. Usually, a hematoma appears quickly, within 24 hours from the moment of injury. It is characterized by mild to moderate pain in the area of ​​injury without dysfunction of the limb. It dissolves on its own.

Medium. This hematoma appears within 3-5 hours. after injury. Moderate pain and swelling with partial limb dysfunction are characteristic. Such an injury requires an assessment by a traumatologist to determine the management tactics.

Heavy. This hematoma appears within 1-2 hours after trauma. Severe pain, significant swelling, and loss of limb function are common. This injury urgently needs qualified trauma care.

Whatever the hematoma, it is accompanied by swelling and infiltration of the injury site.First, the area above the lesion becomes hyperemic, becomes red, subsequently, as a result of blood stagnation, it acquires a cyanotic-cyanotic hue. With an unauthorized breakthrough of a hematoma, infection and suppuration can occur, since the blood is an excellent breeding ground for the reproduction of microorganisms. Usually, the treatment of subcutaneous hematomas is conservative and does not require surgical intervention. First of all, it is necessary to apply cold to the site of injury, which is subsequently changed to a pressure bandage.In case of severe pain syndrome, the use of tableted analgesics and anti-inflammatory drugs with a fighter’s Pill-Pack and Troxevasin gel to lubricate the impact site and hematoma will be justified.

In case of large extensive hematomas, the subcutaneous space is first drained, then a pressure bandage is applied.

Intramuscular hematomas

The main difference from a subcutaneous hematoma is the depth of placement, and other symptoms (especially in the depths of large muscles), local signs are somewhat different: infiltration and swelling are in deeper layers, which reduces the effectiveness of palpation diagnostics.Instead of local edema, an increase in the volume of the limb is noted. Hematoma can usually be diagnosed on the basis of the appearance of the lesion site and clinical manifestations. Treatment of minor hematomas consists in the use of anti-inflammatory and angioprotectors (Troxevasin ointment, Lioton gel). Large hematomas immediately require fasciotomy and surgical treatment, as they are dangerous for the development of anaerobic infection.

Encapsulated hematomas

If the blood does not penetrate the tissues, but forms a cavity, this is called an enclosed hematoma.The danger of this type of hematoma is that if untreated, it usually does not disappear without a trace, but becomes denser due to the accumulation of fibrin and calcium salts, or suppurates, especially in injuries with damage to the integrity of the skin (abrasions). Large and enclosed hematomas must be opened and drained for acceleration of recovery, prevention of suppuration and complications. The expediency and necessity of opening a hematoma should be determined only by a physician, because sometimes a suppurative dangerous hematoma may be small in size and not attract the attention of a field paramedic.Small hematomas can be drained in honey. parts. Large, extensive, deep and suppurative are indications for hospitalization. Surgeons should scramble hematomas, but non-suppurative hematomas can be eliminated by a traumatologist. All manipulation is carried out using local anesthesia. After infiltration of the anesthetic, an incision is made in the conditional area of ​​the center of the hematoma, blood clots are removed, and the resulting cavity is washed. Chlorhexidine or hydrogen peroxide is good for rinsing.With regard to wound closure, the key signs are hematoma infection. If the wound is clean, it is sutured with tubular drainage and tightly bandaged to prevent postoperative hematoma. Sutures are usually removed on day 7-10. As for infected wounds, we treat them like any purulent wounds in field surgery (drainage without suturing, antibiotic therapy is mandatory).

Subungual hematoma

Subungual hematoma is an injury that can be endured as a separate item, because although it is not critical in terms of deterioration of vital signs or body functions, it causes significant pain and discomfort, and it is also very common in military personnel…. Usually, an injured fighter will come to a medic with a limb raised up, because this way his pain is significantly reduced. The concept of a subungual hematoma is understood as the presence of a post-traumatic blood clot under the nail plate. It can appear as a result of a shock, a concussion wave, or even wearing uncomfortable shoes, or unlacing ankle boots. Sometimes, severe trauma causes the nail to fall off. In the field, it is recommended to flush the wound with chlorhexidine and cover with sterile gauze with antibiotic ointment.In other cases, we must provide assistance to the soldier, since his capacity will significantly decrease. This manipulation is carried out only by a physician. To release the hematoma and reduce the pressure, you need to make a hole in the center of the nail plate (usually this is where the most blood accumulates.) This manipulation requires a paper clip, a multitool and a lighter. First, do not forget to fix the fighter and distract his attention with something. Next, with a red-hot “sharp” part of the paper clip, we burn through the nail plate pointwise, without excessive pressure and dips.For successful manipulation, remember to support the edge of your palm on the table before lowering the red-hot paperclip. This procedure is not very painful, since there are no painful nerve endings in the nail plate. After that, you need to apply a sterile wet dressing.

Intracranial hematomas

By localization, intracranial hematomas are divided into epidural (between the dura mater and the skull), subarachnoid (in the subarachnoid space), subdural (between the arachnoid and dura mater), intraventricular (in the cavities of the ventricles of the brain), intracerebral (in the brain tissues).Intracerebral and intraventricular hematomas are quite rare due to trauma, usually in severe TBI. Probably the most reliable symptomatology of intracranial hematoma after trauma is loss of consciousness, as well as a typical “light interval” (period of well-being), “hypertensive” headache, vomiting, and psychomotor agitation. Bradycardia, hypertension, the difference in blood pressure readings on the right and left hands, anisocoria, and epileptic seizures are also observed. Pyramidal symptoms appear (pathological reflexes, evidence of damage to the central neurons of the cortex).The severity of symptoms directly depends on the size of the hematoma and the location of the lesion. This damage occurs in 0.4-7.5% of cases of traumatic brain injury. This is a rather dangerous localization of the hematoma. The mortality rate for such damage reaches 60-70%.

According to the rate of increase of symptoms, three types of hematomas are distinguished:

• Sharp. A short light interval (from several hours to 1-2 days).

• Subacute. Symptoms of a hematoma appear in 3-4 days.

• Chronic.Long light period (from several weeks to several months).

Usually the cause of bleeding is rupture of arteries or veins in the affected area. Symptoms vary depending on the patient’s age, the severity of TBI and the location of the lesion. Initially, there are complaints of headache, then vomiting without relief, epileptic seizures, paresis, respiratory disorders, speech disorders are also possible. Sometimes the sign may be dilation of the pupil on the affected side.In severe cases, a coma may develop.

The diagnosis of intracranial hematoma is made on the basis of interviewing the victim, if he is unconscious, then one of the accompanying persons is interviewed, focusing on the circumstances, the light interval, neurological symptoms and additional research data. All injured with head injuries undergo an x-ray of the skull in two projections. However, the most reliable for diagnosis is CT, MRI and echoencephalography.