Acute thrombophlebitis

Localization of the pathological process

Acute thrombophlebitis can develop in various venous systems of the body, although the frequency of involvement in specific areas varies significantly.

The most common localizations in clinical practice include:

• Veins of the lower extremities.
• Pelvic venous plexuses.
• Hemorrhoidal veins.

Significantly less frequently, the pathological process affects the following areas:

• Upper extremity veins.
• Portal venous system.
• Intestinal veins.
• Cerebral vessels.

Pathophysiological differences

The clinical presentation and leading damaging factor change radically depending on the depth of the affected vein.

1. Superficial vein thrombophlebitis: In this form of pathology, inflammation is absolutely dominant. It is the inflammatory reaction of the vascular wall that determines the severity of the patient's condition in the early stages of the disease.
2. Deep vein thrombophlebitis: In this case, pronounced hemodynamic impairment becomes the determining and most dangerous factor. The pathology rapidly leads to the development of acute, and subsequently chronic, venous insufficiency.

When studying the pathogenesis of the disease, it is crucial to clearly distinguish between such basic concepts as inflammation, thrombosis, embolism, and ischemia.

Principles of treatment

The choice of therapeutic strategy directly depends on the form of inflammation and the presence of concomitant purulent complications.

Treatment of initial (serous) forms At the stage of serous inflammation, predominantly conservative therapy is used. It is based on the following measures:

• Ensuring complete rest for the affected organ.
• Performing UHF therapy.
• Prescribing systemic antibiotic therapy.

In addition to directly targeting the affected vein, it is critically important to provide active treatment of the primary focus of infection:

• Timely surgical opening of abscesses or phlegmons.
• Rational drainage of the formed purulent cavity.
• Wide incision of all detected purulent streaks.

Complicated forms If the process progresses and purulent lymphadenitis develops, conservative measures are insufficient. Treatment of this form requires immediate surgical intervention.

Outcomes of thrombophlebitis

The further progression of the disease after acute symptoms subside can follow several scenarios. The main outcomes include:

• Sclerosis (phlebosclerosis). Characterized by scarring and induration. Not only the venous wall itself and the organized thrombus undergo sclerosis, but also the surrounding neurovascular bundle.
• Restoration of blood flow. The degree of restoration of the venous lumen depends entirely on the initial type of thrombus:
• Mural thrombosis: with this variant, complete restoration of the normal vessel lumen is possible.
• Occlusive thrombosis: following the stage of thrombus organization, either complete obliteration of the vein (its closure) or only incomplete lumen restoration (partial thrombus recanalization) occurs.

Among the most severe consequences of the pathology, one must always consider the risk of life-threatening thromboembolism.

Class and exam questions

What else to study on this topic

• Morphological stages of organization and recanalization of a venous thrombus.
• Surgical principles of rational drainage for phlegmons and purulent streaks.
• Mechanisms of acute and chronic venous insufficiency development.
• Thromboembolism: pathways of thrombotic mass migration and clinical consequences.
• Physiological rationale for the use of UHF therapy in serous inflammation.

Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

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