Venous thrombosis in the elderly

Introduction to senile venous thrombosis There are two types of venous thrombosis: one is thrombophlebitis, which refers to inflammation as the first and thrombosis is secondary. The other is venous thrombosis, which refers to the first appearance of thrombosis, and the inflammatory process of the vein wall is secondary. However, the following deep vein thrombosis is the most common (57%), and the elderly are not only highly morbid, but also prone to fatal pulmonary embolism, which deserves attention. basic knowledge The proportion of illness: 0.003% Susceptible people: the elderly Mode of infection: non-infectious Complications: dermatitis varicose veins

Causes of senile venous thrombosis

(1) Causes of the disease

Slow blood flow, coagulation and venous changes are three important factors in venous thrombosis.

Slow blood flow

First of all, the elderly have poor physical strength, less activity and more opportunities to stay in bed, thus weakening the muscle elasticity of venous return. In addition, the elderly suffer from more heart disease, poor heart function, and significantly reduced cardiac output. Causes systemic congestion, and further, the incidence of abdominal tumors in the elderly increases. When lying down, abdominal organs and tumors can compress the veins. At the same time, in the anatomy, the veins of both lower extremities are blocked by tendons, ligaments and nerve compression in some parts. Venous blood return, the elderly are susceptible to varicose veins, varicose veins dilate, elastic decline, most accompanied by venous valve and traffic branch damage, resulting in stagnant blood flow in the lower extremities.

2. Coagulation mechanism

It is characterized by increased blood coagulability, increased fibrinogen activity, decreased fibrinolytic activity, and increased platelet aggregation. These aging changes are beneficial for thrombosis. In some pathological conditions such as fractures, trauma, and surgical tissue damage cause a large amount of blood clotting. Live enzymes enter the blood circulation; polycythemia, dehydration, abnormal plasma proteins and hypertonic infusion of hypertonic nutrient solution can cause blood concentration; pancreas, lung, ovarian malignant tumors and leukemia itself promote platelet destruction and release clotting factors, Both can promote thrombosis.

3. Intravenous changes

Intravenous aging is characterized by rough endometrial, venous atrophy, platelet adhesion at the sinus below the valve, thrombosis, and venous pacing catheters and electrodes can also cause venous intimal damage.

(two) pathogenesis

Deep venous thrombosis is mainly caused by stagnation of venous blood flow and hypercoagulability of blood. Most of the thrombus is composed of red blood cells with a small amount of fibrin and platelets. The thrombus formation process extends to the direction of blood flow, and the distal end of the thrombus The blood vessel wall has only mild adhesion, while the proximal end is free to float in the lumen of the blood vessel, so that the thrombus can not easily fall off and lead to pulmonary embolism. After venous thrombosis, limb venous return disorder can occur, and the distal venous pressure increases. Hypoxia in the tissue leads to increased hydrostatic pressure and vascular wall permeability in the capillaries, superficial varicose veins and limb swelling; in the case of venous thrombosis, a certain degree of arterial spasm may be accompanied, and the arterial pulsation is weakened. It can cause lymphatic stasis and reflux obstruction, which can aggravate limb swelling. In addition, during the process of venous thrombosis, inflammation of the vein itself and its surroundings can cause pain to the affected limb. Early, high blood pressure of the distal part of the venous thrombosis will be Use the traffic branch that does not usually play an important role to increase the reflux. Later, the thrombus can be mechanized and recanalized to make the venous cavity. Certain complex patency, while contraction of the lumen of the fibrous tissue by venous valve damage can also lead to venous insufficiency.

Elderly venous thrombosis prevention

Avoid entering a solution that is irritating to the vein wall, early removal of the venous cannula, and active treatment of varicose veins, which have a certain effect on preventing thrombophlebitis or deep vein thrombosis, and have certain effects on deep vein thrombosis or deep vein thrombosis. Role, for patients with a tendency to deep vein thrombosis and surgery, can be injected subcutaneously with low-dose heparin 5000U 2 hours before surgery, 2 times / d after surgery, for 5 to 7 days, or 4 days after surgery Lin; or before and after surgery, each with low molecular weight dextran (molecular weight 20,000 ~ 40,000) 500ml intravenous drip, the next day, a total of 3 times, oral assimilating steroid hormone activated by plasmin - Stein Alzolol (hydroxyl-androstane pyrazole) 5mg, twice / d, can reduce the incidence of thrombosis in patients with spontaneous superficial phlebitis; postoperative heparin 5000U and dihydroergotamine 0.5mg combined with subcutaneous injection, 2 Times / d, a total of 5 days, the prevention effect is better; oral dipyridamole or aspirin can also be used for prevention, the operation of adjacent limbs or tissues around the pelvic vein should be light, avoiding damage to the vein wall, avoiding the calf after surgery Or under the armpit, to It does not affect the venous return of the calf. For patients who need long-term bed rest after major surgery, postpartum or chronic diseases, patients should be encouraged to perform active activities of the lower limbs in the bed, and take deep breathing and coughing action; if necessary, they can be used for passive pedal movement of the ankle joint. Tube elastic stockings or intermittent compression of inflatable long boots and gastrocnemius electrostimulation; post-operatively get up as early as possible to get out of bed, promote calf muscle activity, increase venous return of lower extremities, early calf vein thrombosis should also be as early as possible Treatment, in order to prevent the thrombus from extending or falling off the proximal end, 36 hours after trauma, subcutaneous injection of low molecular weight heparin 4000 ~ 5000U, once every 12 hours, can prevent deep vein thrombosis.

Elderly venous thrombosis complications Complications dermatitis varicose veins

The most common pulmonary infarction in the acute phase, chronic varicose veins, and congestive dermatitis.

Symptoms of senile venous thrombosis Common symptoms Calf swell varicose veins inferior vena cava thrombosis venous thrombosis inflammation painful white swelling facial hemisphere blue black nodular vein stone skin hemosiderin subcutaneous tissue edema

The clinical manifestations of this disease depend on the location of the thrombus, the degree of venous obstruction, and common venous thrombosis in the elderly are as follows:

Superficial venous thrombosis

Mostly thrombotic phlebitis, inflammatory nature, more common in the limbs, often involving the great saphenous vein, small saphenous vein, cephalic vein, expensive veins and their branches, most can find the cause, a few unknown causes, intravenous saline, chlorine Calcium, iodine contrast agents, hypertonic glucose and other drugs can cause thrombosis, trauma, infection, varicose veins, temporary or permanent cardiac pacemakers can cause venous thrombosis, clotting mechanism It is easy to be combined with the disease. The symptoms are local pain, redness, fever, swelling, and elevated body temperature. The thin part of the subcutaneous tissue can touch the corrugated thrombus. Because the inflammation of the thrombus is significant, it is often closely attached to the wall. Pulmonary embolism occurs. If phlebitis develops further and spreads to deep veins, it may cause pulmonary embolism due to detachment of the embolus.

2. Deep vein thrombosis

In the early stage of the disease, a thrombus is formed intravenously, followed by inflammation at the site of the thrombus, so the inflammation is lighter.

3. Calf vein thrombosis

Most patients have no symptoms, a few feel the calf swell, urgency, symptoms in the standing position, sitting and walking, some edema of the calf and foot, tenderness of the gastrocnemius, invasion of the venous traffic, post-thrombotic syndrome If you suspect this disease, you can do a venography to confirm the diagnosis.

4. The iliac veins and femoral vein thrombosis symptoms are obvious. There are tenderness in the armpits, groin and thigh triangles. When the back is flexed, there are traction pain in the back of the thighs and the muscles of the gastrocnemius. The inflammation of the acute attack is very serious, and the lower limbs are sharp. Swelling, swelling for a few hours to peak, consciously have a sense of oppression, arterial spasm can occur when inflammation is obvious, the skin is pale, the subcutaneous vein is reticular, the tenderness of the affected limb is obvious, and the arterial pulsation is not touched, saying that the painful white hair is swollen. Large lesions, invasion of the pelvic veins and their branches, the lower extremity is highly edematous and cyanosis, called painful femoral bruises, severe cases can lead to venous gangrene of the lower extremities, and even shock.

5. Inferior vena cava thrombosis

May originate from this or from the development of iliac vein thrombophlebitis, the iliofemoral vein often occurs on the left side, then spread to the inferior vena cava, and finally invade the right iliac vein, so the signs are bilateral, the rest It is the same as iliac vein thrombosis.

6. Upper extremity thrombophlebitis is rare, often extending from superficial vein to deep venous system, common in thoracic tumor and aortic tumor compression subclavian vein or secondary to trauma, its clinical manifestations and deep venous thrombophlebitis of lower extremity the same.

Post-thrombotic syndrome

After the large veins of the lower extremities form thrombus, it is difficult to dissolve and re-circulate naturally, causing thrombosis and venous occlusion. The venous valve often has dysfunction even if it is dredged again. Deep vein thrombosis often violates the venous traffic branch. The condition causes the lower extremity capillaries and venules to dilate, the wall permeability changes, the red blood cells escape, the lymphatic circulation is blocked, the subcutaneous tissue edema, hypertrophy, fibrosis, skin hemosiderin, leather-like changes, eczema and ulceration This state is called post-thrombotic syndrome. The symptoms are edematous swelling, heavy feeling, and even pain in the entire affected limb. Standing or sedentary for a long time can aggravate the symptoms.

Elderly venous thrombosis

Coagulation mechanism examination: It has been reported that thrombosis globulin (B-thromboglobin) present in plasma in agglutinated platelets can be used to diagnose deep vein thrombosis, to determine platelet, coagulation factor and fibrinolytic system activity (euglobulin dissolution time, Fibrin degradants and serum fibrin-associated antigens help to determine the state of coagulation, but not directly determine the presence of thrombus.

1.131I or 125I fibrinogen scan

Check intravenous injection of 131I or 125I fibrinogen, which is involved in blood clotting, so it accumulates in the venous thrombus. If the dose measured from the body surface by the counter exceeds 20% of the original dose or the corresponding dose of the contralateral side. Positive, it is reported that this method is sensitive and convenient for clinical follow-up observation.

2. Ultrasound Doppler flowmetry and impedance plethysmography

The former changes in frequency and is proportional to the speed of movement when the ultrasound encounters a moving target (a blood cell in the venous blood flow); the latter changes according to the normal state, the blood volume of the limb changes with the venous pressure during breathing. The characteristics of these voltage changes caused by these small volume changes are detected by electrical impedance technology. When the main blood vessels are blocked, the limb volume does not change with the breathing, so there is no voltage change. These two methods are simple, non-invasive and can reflect the veins. Functional status, but poor accuracy, can not detect small thrombus and occluded veins and thrombosis in the collateral circulation.

3. Infrared imaging (thermography)

It is a non-invasive examination of deep vein thrombosis. Compared with venography, this method can detect deep vein thrombosis by 95%, and the coincidence rate of infrared imaging and venography is 85%.

4. Venous angiography

Through the dorsal vein of the foot or the contrast agent in the calcaneus cavity, and then the lower extremity film, the method can detect about 90% of the calf vein thrombosis, can determine the location and extent of the thrombus, dynamic venography can speculate the venous valve Features.

Diagnosis and diagnosis of senile venous thrombosis

Superficial venous thrombophlebitis often can be diagnosed according to the tenderness, swelling and painful cord-like veins of the thrombus. The symptoms and signs of acute venous thrombosis are prominent, and it is not difficult to make a diagnosis. Partial, especially insidious venous thrombosis with insidious onset and lack of symptoms is difficult to diagnose. The presence of venous thrombosis is often suspected after secondary pulmonary embolism. The patient's local skin temperature rises and the inside of the thigh follows. The tenderness in the direction of the vein, the sphygmomanometer sleeve is tied to the thigh, and the pain of the limb is helpful when the pressure is 8-20 kPa (60-150 mmHg). The measurement of the edema of the affected limb and the circumference of both limbs can be used as a reference. However, many of the saphenous vein thrombosis are asymptomatic, and the above methods are not easy to check out. The following tests can be used to confirm the diagnosis.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.