Download Thrombophlebitis and Occlusive Arterial Disease

Thrombophlebitis
 Formation of a venous clot depends on the
presence of of at least of one of Virchow’s
triad factors
-venous stasis
-injury to vessel wall
-hypercoagulable state
SIGNS AND SYMPTOMS
 pain in the part of the body affected
 skin redness or inflammation (not always
present)
 swelling (edema) of the extremities (ankle and
foot).
CAUSES
 Thrombophlebitis is related to a thrombus in the vein.
Risk factors include prolonged sitting and disorders
related to blood clotting
 Specific disorders associated with thrombophlebitis
include superficial thrombophlebitis (affects veins
near the skin surface) and deep venous thrombosis
(affects deeper, larger veins)
Clinical risk factors for deep vein
thrombosis
 Trauma, travel
 Obesity, obstetrics
 Hypercoagulable,
 Surgery, smoking
hormone replacement
 Recreational drugs(IV
drugs)
 Old (age >60y)
 Malignancy
 Immobilization
 Birth control, blood group
A
 Sickness
Pathophysiology
 Most common cause of hereditary hemophilia is factor V
Leiden
 Thrombi usually form at the venous cusps of deep veins
where altered or static blood flow causes clot formation
 Alternatively, clots form from intimal defects
 Clots are composed from fibrin, red cells and platelets
and cause partial/complete obstruction of vein
Pathophysiology
 Postphlebitic syndrome (PPS) may develop after the
resolution of a DVT
 PPS is due valvular incompetence, persistent outflow
obstruction and abnormal microcirculation.
Superficial Thrombophlebitis
 Thrombosis can occur in any superficial vein primarily
the saphenous vein and its tributaries
 Local pain, redness, and tenderness are characteristic
findings.
 Mild cases can be treated with warm compresses,
analgesia and elastic supports
 Severe cases can be debilitating and should be
managed by bed rest, elevation of extremity, support
stockings, and analgesia.
 Antibiotics and anticoagulants are useful in septic
thrombophlebitis
Deep Vein Thrombosis
 Clinical exam is unreliable for detection or exclusion
of a DVT
 Pain, redness, swelling, and warmth are present in
less than half the patients with confirmed DVT.
 Pain in calf with dorsiflexion of ankle with the leg
straight (Homan’s sign) is unreliable
Deep Vein Thrombosis
 the leg is white due to arterial spasm secondary to
massive iliofemoral thrombosis, often mistaken for
arterial occlusion.
 PPS can be difficult to differentiate from recurrent
DVT due to pain, swelling and ulceration of the skin.
 Up to to one third of the patients with DVT can
develop PPS.
Deep Vein Thrombosis-Diagnosis
 All patients with any signs or symptoms suggestive DVT
should undergo an objective diagnostic evaluation
 Venography was the historical “gold standard” for
detection of DVT with 100% sensitivity and specificity but
it is invasive and can cause contrast-related reactions,
phlebitis and DVT .
Axillary and Subclavian Vein
thrombosis
 2-4% of DVTs occur in axillary or subclavian vein
 Risks include recent central venous catheters or
pacemakers, IV drug use, malignancy,
hypercoagulable states and excessive or unusual
exercise, chronic compression(cervical rib, scalene or
web)
 Treatment includes anticoagulation alone or
preceded by thrombolysis.
Pelvic Vein Thrombosis
 Usually it’s an extension of a clot from the femoral
vein.
 An isolated pelvic vein thrombosis is rare and can be
a complication in the postpartum period, after pelvic
surgery or trauma.
 Septic pelvic vein thrombophlebitis is a lifethreatening condition after post-partum endometritis
and is usually diagnosed with CT or MRI.
COMPLICATIONS
 The most serious complication occurs when the blood
clot dislodges, traveling through the heart and occluding
the dense capillarynetwork of the lungs; this is a
pulmonary embolism which can be potentially life
threatening
Treatment
 Bed rest, leg elevation and elastic stockings are of
unproven benefit in the management of DVT.
 Aggressive anticoagulation will prevent extension of
the clot.
 Early ambulation after adequate anticoagulation is a
safe approach
 Primary objective of treating DVT is the prevention of
pulmonary embolus
Treatment
 Medications analgesics (pain medications)
 anticoagulants e.g warfarin or heparin to prevent new
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clot formation
thrombolytics to dissolve an existing clot such as
intravenous streptokinase.
nonsteroidal anti-inflammatory medications (NSAIDS)
such as ibuprofen to reduce pain and inflammation
antibiotics (if infection is present) selection will usually
depend with the causative agent.
Support stockings and wraps to reduce discomfort
Treatment
 In pregnant pt who cannot have heparin, danaproid
should be used.
 Warfarin is contraindicated in pregnancy, active bleeding,
recent major surgery (thoracoabdominal, nervous system,
spine, eye)
The patient may be advised to do
the following
 Elevate the affected area to reduce swelling.
 Keep pressure off of the area to reduce pain and decrease
the risk of further damage.
 Apply moist heat to reduce inflammation and pain.
 Surgical removal, stripping, or bypass of the vein is rarely
needed but may be recommended in some situations.
NAME :
JAFER ALI
GROUP:
317