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Thrombophlebitis

Venous Thrombosis

Thrombophlebitis or Venous Thrombosis

There are four basic types of tissues: connective tissue, epithelial tissue, muscle tissue, and nervous tissue. The blood is considered to be connective tissue, just like bone or lymphatic tissues.

 

Blood is not just a liquid but also a tissue containing many different types of cells, proteins, water, chemicals, and particles. Blood is the primary transportation route in our body. Blood is responsible for transporting oxygen, nutrients, and many other vital substances, hormones or signaling factors to every cell in our body.

 

Blood has the capability of forming a clot to seal any extravasation from a compromised vessel wall. The blood clot is the end result of a complex cascade usually triggered when the vessel wall has been injured, or any other factors trigger the cascade without any injury to the blood vessel walls. The clotting cascade has been designed to prevent bleeding from any veins or arteries; however, if triggered within any blood vessel lumen without any injury, it can cause thrombosis or clot. These unwanted clots can cause obstruction of the blood vessels' lumen and prevent the flow of blood. In the arteries, the blood clot or thrombosis can form either after local trauma, exposing the artery's inner layers or a plaque rupture within the artery wall. In veins, blood clots are commonly referred to as thrombophlebitis since it is associated with local inflammation.

 

The three main risk factors forming blood clots within our veins were identified almost 150 years ago: These now commonly known factors are stasis of the blood within the veins, injury to the blood vessel wall, and a hypercoagulable state in which our body has a tendency to form blood clots. These three main risk factors are called "The Virchow's Triad," named after a German doctor, Dr. Vrichow, who contributed significantly to the field of medicine during the 19th century. A blood clot formed within the vein's lumen can trigger further clotting and propagate the clot's size. This process will stop the blood flow, causing backflow congestion in the veins distally, creating a local and/or systemic inflammation, severe pain, or even fever.

 

Fresh clots within the lumen of the veins are not entirely adherent to the lumen of the veins. With a sudden movement, they can break apart and travel in the stream of blood flow and end in another organ, usually the right heart or the lungs. These travelling blood clots are called an embolus. An embolus within the lungs' blood vessel is called a Pulmonary Embolus (PE). A large PE can cause cardiopulmonary distress and compromise the entire heart and lung function, leading to sudden death. Blood clots that remain stationary are called Thrombus. Thrombus forming within the deep veins is called Deep Venous Thrombosis (DVT). Thrombus forming within the superficial veins is called Superficial Venous Thrombosis (SVT). Thrombus can cause local inflammation of the vein wall, triggering an inflammatory process, which can manifest as pain, redness and swelling in the area. DVTs in the lower extremities can manifest as sudden limb swelling, redness, pain, or fever.

 

SVTs in the lower extremities can cause severe burning pain, skin itching, and redness. With time thrombosis can harden and adhere to the vein's lumen and eventually turn into scar tissue within the veins' lumen. If the thrombosis occurs where there is a valve, the scarring will permanently damage that given valve. DVTs can cause acute (immediate) or chronic (long-term) clinical problems for patients. Post-Thrombotic Syndrome manifests as chronic pain, swelling, or retractable skin ulcers. Post-Thrombotic Syndrome can be seen in 40% or more of patients with a history of DVT.

 

However, SVTs are benign; and after the clot has scarred, the superficial vein turns to scar tissue as well. The most common complaints from SVTs are short-term severe sudden pain and discomfort, driving patients to urgent care centers or emergency rooms. Yet, SVTs are considered a risk factor for DVT. Up to 20% of patients with a history of SVT may eventually suffer from DVTs in their lifetime. The best method to diagnose Venous Thrombophlebitis is to examine the veins with sonography combined with doppler, also called duplex ultrasound of the veins. The Duplex ultrasound can view the diseased veins clearly, examine its wall, and check the blood flow within the veins' lumen. The duplex ultrasound study is a non-invasive, widely available and affordable diagnostic tool with very high accuracy in diagnosis DVTs or SVTs.

 

The most common treatment for SVTs is cold or warm compression, nonsteroidal anti-inflammatory medication, and short-term anticoagulation (blood thinners). Long-term treatment of the vein with a history of SVT is either to surgically remove it or ablation (closing the vein by causing damage to its inner wall with heat or chemicals). Treatment for DVT is a little more involved than the SVTs since they are associated with more comorbidities. Long-term anticoagulation therapy from a minimum of six months to lifelong, depending on the underlying cause of the DVT, is the backbone of treating the DVTs. Patients with DVT should have an extensive work up (i.e., specific diagnostic testing) done to make sure they have no other disease process, such as any unknown malignancy or genetic predisposition to be hypercoagulable (tendency to form blood clots). If a patient with DVT is at high risk of bleeding, they cannot be treated with anticoagulation. Therefore, a filter is temporarily or permanently is placed into the Inferior vena cava (IVC filter) to protect the heart and lungs from large pieces of embolus. Some of these IVC filters are designed to be removed – these are called retrievable IVC filters. IVC filters left behind may fracture, migrate, penetrate the IVC wall or cause obstruction of the IVC, causing severe lower extremities swelling, pain or retractable ulcers with massive serum leakage.

 

Patients should be notified of the potential complications involved with the IVC filters prior to insertion of one. Large DVTs' recommended treatment is to either suction it via a specialized device (thrombectomy) introduced via small sheath and catheters or dissolve it with the insertion of a catheter with side holes and infusion clot-busting medications (thrombolytics) over 24 to 48 hours. This procedure eliminates the clot burden off the veins' lumen and preserves the venous valves' function. Since blood clots will harden over time, it is usually advised to treat the clots as early as possible, generally within three weeks of the symptoms. After these three weeks, thrombosis can become chronic, and hardens and adheres to the lumen of the vein, making it very difficult to remove. Post successful thrombectomy or thrombolysis patient will be treated with anticoagulation. There will be closely monitored with venous duplex ultrasound every three months to ensure no new clots form while the patients are on anticoagulation treatment. If patients form new blood clots, they may be candidates for an IVC filter to prevent potential large PE.

 

At Aurses Healthcare's office, We provide a comprehensive screening using the latest ultrasound technology.
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