Thrombomuscularization

Introduction The post-thrombotic syndrome of senile venous thrombosis is characterized by the large vein formation of the lower extremity. It is difficult to dissolve and recanalize naturally, resulting in thrombosis and venous occlusion. The venous valve often has dysfunction even if it is dredged again. Lower extremity capillaries and venules dilate, wall permeability changes, red blood cells escape, lymphatic circulation is blocked, subcutaneous tissue edema, hypertrophy, fibrosis, skin hemosiderin deposition, leather-like changes, eczema and ulceration. This state is called post-thrombotic syndrome, and its symptoms are edematous swelling, heavy feeling, and even pain in the entire affected limb. Standing for a long time or sitting for a long time can make the symptoms worse.

Cause

The cause of thrombosis: After the larger veins of the lower extremities form a thrombus, it is difficult to dissolve naturally and then dredge, resulting in thrombosis.

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

1. 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, causing systemic congestion. Furthermore, the incidence of abdominal tumors in the elderly is increased. The abdominal organs and tumors can compress the veins when lying down. At the same time, in the anatomy, the veins of the lower extremities are subjected to tendon, ligament and nerve compression in some parts to block the venous return. Older people are prone to varicose veins, varicose veins dilate, and elasticity declines. Most of them are accompanied by venous valves and traffic branches, causing stagnant blood flow in the lower extremities.

2. Hypercoagulability: manifested as increased blood coagulation, increased fibrinogen activity, decreased fibrinolytic activity, and increased platelet aggregation. These aging changes are beneficial for thrombosis, and in some pathological conditions such as fractures, trauma, Surgical tissue damage causes a large amount of thromboplastin to enter the blood circulation; polycythemia, dehydration, abnormal plasma proteins and hypertonic infusion of hypertonic nutrient solution can cause blood concentration; pancreas, lung, ovarian malignant tumor and leukemia itself promote platelet Destruction, release of clotting factors, can promote thrombosis.

3. Intravenous changes: Intravenous aging is characterized by rough endometrial, atrophy of the venous valve, and easy platelet adhesion at the sinus below the valve to form a thrombus. Venous pacing catheters and electrodes can also cause venous intimal damage.

an examination

Related inspection

Plasmin D-dimer partial thromboplastin time-activated partial thromboplastin time (APTT) angiography

Examination of thrombosis:

Coagulation mechanism examination: It has been reported that thrombosis globulin (B-thromboglobin) present in plasma in agglutinated platelets can be diagnosed for deep vein thrombosis. Determination of platelet, coagulation factor and fibrinolytic system activity (euglobulin lysis time, fibrin degradant and serum fibrin-associated antigen) helps to determine the state of clotting, but does not directly determine the presence of thrombus.

1.131I or 125I fibrinogen scan: check intravenous injection of 131I or 125I fibrinogen, the substance is involved in blood clotting, so it accumulates in the venous thrombus, if the counter dose is measured from the body surface beyond the original measurement or the opposite side More than 20% of the site radiation dose is positive, and it is reported that this method is sensitive and convenient for clinical follow-up observation.

2. Ultrasound Doppler flowmeter examination and impedance plethysmography: the former is characterized by frequency changes and proportional to the speed of motion when the ultrasound encounters a moving target (a blood cell in the venous blood flow); the latter is based on Under normal conditions, the blood volume of the limb changes with the change of the venous pressure during breathing; the electrical impedance changes are used to detect the voltage changes caused by these small volume changes. 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 functional state of the vein, but the accuracy is poor. It is not possible to detect small thrombus and occluded veins and thrombus in the circumflex circulation.

3. Infrared imaging (thermography): is a non-invasive examination of deep vein thrombosis, this method combined with plethysmography and venography can be found in deep vein thrombosis up to 95%, the coincidence rate of infrared imaging and venography Up to 85%.

4. Venous angiography: through the dorsal vein of the foot or in the calcaneus cavity into the contrast agent, 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 vein Contrast can be used to predict venous valve function.

Differential diagnosis

Differential diagnosis of symptoms of thrombotic muscle susceptibility

1. Superficial venous thrombosis: Mostly thrombotic phlebitis, strong 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, and a few causes are unknown. Intravenous saline, calcium chloride, iodine contrast agents, hypertonic glucose and other drugs can produce thrombosis at the injection site. Intravenous leads of trauma, infection, varicose veins, temporary or permanent cardiac pacemakers can cause venous thrombosis, and those with hypercoagulable mechanisms are more likely to have this disease. Symptoms are local pain, redness, fever, swelling, and elevated body temperature. The thinner part of the subcutaneous tissue can reach the cord-like thrombus. Because of the obvious inflammation of the thrombus, it is often closely attached to the wall of the tube, and pulmonary embolism rarely occurs. If phlebitis develops further and spreads to deep veins, it can cause pulmonary embolism due to detachment of the embolus.

2. Deep vein thrombosis: In the early stage of the disease, a thrombus is formed in the vein, followed by inflammation in the thrombus, so the inflammation is lighter.

3. Calf vein thrombosis: Most patients have no symptoms, and a few feel the calf swelling and urgency. Symptoms worsened after standing, sitting, and walking. Some calves and feet are edematous, and the gastrocnemius muscles are tender. A post-thrombotic syndrome can occur when a venous traffic branch is violated. If you suspect this disease, you can do a venography to confirm the diagnosis.

4. The iliac vein and femoral vein thrombosis: obvious symptoms, tenderness in the armpits, groin and femoral triangle, traction pain in the posterior thigh and gastrocnemius muscles. The inflammation of the acute attack is very serious, the lower limbs are swollen and swollen, and the swelling reaches a peak in a few hours, and there is a sense of oppression. When the inflammation is obvious, arterial spasm can occur, the skin is pale, the subcutaneous vein is reticulated, the tenderness of the affected limb is obvious, and the arterial pulse is not touched, and the painful white hair is called swelling. If the lesion is large, invading the pelvic vein and its branches, the lower extremity is highly edematous and cyanotic, which is called painful femoral bruises. Severe cases can lead to venous gangrene in the lower extremities, and even shock.

5. Inferior vena cava thrombosis: may originate here or develop from iliac vein thrombophlebitis. The patellofemoral vein often occurs on the left side and then spreads to the inferior vena cava. Finally, the right iliac vein was invaded, so the signs were bilateral and the rest were the same as the iliac vein thrombosis.

6. Upper extremity thrombophlebitis: less common, often extended 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 vein thrombosis of lower extremities The same inflammation.

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