upper extremity deep vein thrombosis
Introduction
Introduction to upper extremity deep venous thrombosis -Subclavian vein thrombosis is a group of syndromes in which the upper limbs are swollen, pain, skin bruising and dysfunction are the main manifestations. In 1949, Hughes first described the disease as: Acute adult venous occlusion with different severity in healthy adults, and no clear etiology and pathology, called Paget-Schroetter syndrome. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Causes of upper extremity deep venous thrombosis
(1) Causes of the disease
-Subclavian vein thrombosis is usually divided into two major categories: primary and secondary.
1. The primary cause of the disease is the extravascular, usually due to the change in body position or strong activity of the upper limb, resulting in compression of the blood vessels, with or without anatomical abnormalities caused by thoracic outlet compression signs, such as When the subclavian vein passes through the rib cage triangle, it is compressed by the rib cage ligament, the subclavian muscle, the anterior scalene muscle and the protruding scalene nodules. When the upper limbs do strong activities (swim, climb, weightlifting, softball) , tennis, etc., or due to some occupations caused by the unaccustomed movements of the upper limbs, can cause repeated injury of the subclavian vein and thickening of the intima, eventually leading to thrombosis, which is known as Paget-Schroetter syndrome, Also known as "frustrated" intravenous thrombosis (effort thrombosis).
2. Secondary causes of secondary disease, such as intravascular catheters, steel wire, irritant drug injection, etc., after venous catheterization, about one-third of patients can develop thrombosis, of which 1% ~5% have clinical symptoms, in addition, heart failure, pregnancy, oral contraceptives, coagulation and fibrinolysis dysfunction, hemorrhagic arteriovenous fistula, etc., other causes of disease outside the blood vessels, such as cancer, radiation therapy , the first rib or clavicle fracture.
(two) pathogenesis
Molina divides the sacral-clavicular venous thrombosis into 3 types according to the course of the disease.
Type I: acute thrombosis, the course of disease within 1 week, can be divided into 3 subtypes: type Ia, the first onset, no history of thrombosis in the past. Type Ib has been treated with thrombosis in the past. Type Ic, had only a first ribectomy due to thrombosis.
Type II: subacute thrombosis, with a course of 1 to 2 weeks, divided into IIa, IIb, and IIc according to the criteria of 3 subtypes of type I.
Type III: chronic thrombosis, the course of disease for more than 2 weeks, patients with no thrombus in the vein, mostly caused by venous chronic fibrosis, accompanied by venous hypertension and dyskinesia of the affected limb, can be divided into short segmental stenosis by venography (< 2cm) and long segmental stenosis (>2cm) 2 classes.
Prevention
Prevention of upper extremity deep venous thrombosis
1. Do not drink alcoholic beverages for a long time, quit smoking and drinking hobbies, do not overeat pickles, sour, spicy and irritating foods, and banned mildew foods. It is more important for people with chronic pharyngitis to develop good eating habits. If you are less than enough, eat more fresh fruits and vegetables.
2. Maintain proper temperature and humidity in the cold season, pay attention to air circulation. Room temperature should be 20 ° C, do not cover too much bedding when sleeping at night, to avoid excessive temperature or excessive drying, causing throat discomfort. Do not sleep in the wind, take a break after strenuous labor, do not rinse the cold bath immediately. Those with acute pharyngitis caused by colds should drink hot water or ginger soup to increase sweating. Note that the stool is smooth. Timely treatment of acute inflammation, to prevent the evolution of chronic, chronically diseased organs, more likely to malignant.
Complication
Upper extremity deep venous thrombosis complications Complication
Pulmonary embolism and post-embolic syndrome are common complications of upper extremity deep venous thrombosis.
Symptom
Upper extremity deep vein thrombosis symptoms Common symptoms Venous thrombosis vascular beats or waveform changes Varicose veins skin blue-purple changes venous stone migration superficial vein thrombosis upper limb edema
Men, women and any age can be affected, secondary causes often have pathogenesis can be traced. The Paget-Schroetter syndrome is more common in young and middle-aged men, and 2/3 lesions occur in the right upper limb, which may be related to more exertion of the right upper limb. 4/5 patients have a history of frustration 24 hours before onset, strong in the upper limbs. The activity or long-term upper limbs are in an unaccustomed position, about 1/10 of the patients can have no incentives, but after a night of sleep, wake up in the morning.
Upper limb swelling, pain, skin bruising and superficial varicose veins are the four main symptoms. Upper extremity swelling is the earliest symptom. It extends from the finger to the upper arm to the entire upper limb, but is more severe in the proximal side. The pain can occur simultaneously with the swelling, or only the performance. For soreness, the upper limbs are aggravated, sometimes it can be licked and stripped, and there are tender thrombus veins. About 2/3 of the patients have venous congestion, the limbs are purple or blue-violet, and the superficial varicose veins are mostly Formed after 1 to 2 days, the shoulder and upper arm are most obvious. Most patients have acute symptoms such as swelling and pain. They may relieve themselves in a few days or weeks, but it is difficult to achieve complete recovery. After about 2/3 of patients remain Lesions, manifested as varying degrees of swelling and soreness, or swelling and pain after activity.
Examine
Examination of upper extremity deep venous thrombosis
1. Double function color check
Can observe the iliac vein, subclavian vein, innominate vein, transverse section and longitudinal section of the internal jugular vein. Direct signs can show the location and extent of venous stenosis or occlusion; indirect signs include amplitude attenuation, flow rate reduction, lack of pulse migration, and respiration Patients with obvious stenosis or occlusion at the end stage, and those with no direct indication of the lesion should be examined at the same time and compared with the affected side.
2. Deep venography
It is more valuable for the development of treatment plans. Venous angiography can show venous stenosis or occlusion.
Diagnosis
Diagnosis and differential diagnosis of upper extremity deep venous thrombosis
Diagnostic criteria
According to the sudden swelling of the upper limbs, the pain can make a preliminary diagnosis, but venography is the most reliable diagnosis method. Although the non-invasive examination technique has developed rapidly in recent years, due to the subclavian vein covered by the clavicle, the dual-function Doppler scan and It is often difficult to accurately determine the thrombotic lesions in the subclavian vein by NMR. Suspicious patients are screened by various noninvasive tests. Patients with direct signs without lesions should be examined at the same time and compared with the affected side. Passman is a group of blood. Through the patient's upper extremity vein, a double-color ultrasound and venography were used to conduct a comparative study, which proved that the sensitivity and specificity of double-function color Doppler ultrasound diagnosis of upper extremity venous occlusive disease were 81% and 97%, respectively. Venous angiography.
Differential diagnosis
1. Lower extremity lymphedema Lower extremity lymphedema There are primary and secondary primary lymphedema. There are often lower extremity edema after birth. Secondary lymphedema is mainly caused by surgery, infection, radiation parasites and other damaged lymphatic vessels. After the lymphatic drainage is blocked, it may have a related medical history. The early stage of lymphedema is characterized by depressed edema. The back is swollen. The tissue tension is smaller than that of the venous thrombus. The skin temperature is normal. The middle and late stage lymphedema is due to the subcutaneous tissue fiber. The skin is rough and thick, and the tissue becomes hard and agglomerate. Generally, there is no clinical manifestation of sequelae of lower extremity venous thrombosis, such as hyperpigmentation ulcer.
2. Lower extremity local hematoma Lower extremity trauma, localized such as hematoma formation, also manifested as lower extremity swelling due to the treatment of hematoma and venous thrombosis treatment, so need to pay attention to the identification of hematoma mostly traumatic history of swelling limited to the entire lower extremity with pain, late The skin may have ecchymosis or yellowing of the skin, and color Doppler examination may help to identify.
