chronic venous insufficiency
Introduction
Introduction Deep vein thrombosis: mainly caused by blood foreign body and hypercoagulable state, so the thrombus and the thrombus wall only have slight adhesion, easy to fall off into an embolism and form a pulmonary embolism, while deep vein thrombosis causes blood reflux to be significantly affected. , leading to distal tissue edema and hypoxia, the formation of chronic venous insufficiency syndrome. Focusing on the serious threat of pulmonary embolism, all high-risk patients with deep vein thrombosis should be prevented in advance. Femoral head fractures, larger orthopedics or pelvic surgery, middle-aged and elderly people with risk factors such as increased blood viscosity, mostly using low-dose heparin prevention before surgery for more than 1 hour.
Cause
Cause
Factors that contribute to venous thrombosis include venous stasis, vascular damage, and hypercoagulable states. Many clinical factors involving the above three aspects are even and objectively leading to venous thrombosis. The common ones are as follows:
1 surgery: especially in orthopedics, thoracic cavity, abdominal cavity and genitourinary surgery.
2 tumors: pancreas, lung, gonads, breast and urinary tract malignancies.
3 trauma: especially the spine, pelvis and lower limb fractures.
4 long-term bed rest: such as acute myocardial infarction, stroke, after surgery.
5 pregnancy, the role of estrogen.
6 hypercoagulable state: lack of antithrombin III, protein C or S protein, circulating lupus anticoagulant, myeloproliferative disease, abnormal fibrinemia, diffuse intravascular coagulation (DIC).
7 venous inflammation and intravenous intervention diagnosis or treatment lead to venous injury. The mechanism of venous thrombosis caused by the above various causes is not single, and is often a comprehensive factor. For example, surgery can cause damage to local veins. Long-term bed rest after surgery makes venous blood stasis; after the operation, the blood is in a hypercoagulable state. .
Examine
an examination
Related inspection
Ultrasound diagnosis of cardiovascular disease, electrocardiogram, cardiac vascular ultrasound
Diagnostic diagnosis of deep vein thrombosis is generally not difficult, and the following diagnostic methods can be used:
1, venous pressure measurement: the venous pressure of the affected limb increased, suggesting that the proximal pressure at the lateral pressure is blocked.
2, ultrasound: two-dimensional ultrasound imaging can directly see the thrombus in the large vein, with Doppler to measure the blood flow velocity in the vein, and observe whether the normal reaction of breathing and compression action exists. The positive rate of this type of examination for proximal deep vein thrombosis is up to 95%; the sensitivity to distal diagnosis is only 50%-70%, but the specificity is up to 95%.
3, radionuclide examination: 125I fibrinogen scan is used for the diagnosis of this disease. In contrast to ultrasonography, the detection rate of deep vein thrombosis in the gastrocnemius muscle can be as high as 90%, and the specificity for the diagnosis of proximal deep vein thrombosis is poor. The main disadvantage of this inspection is that it takes 48-72 hours to inject the radionuclide to show the effect.
4. Impedance plethysmography (IPG) and venous flowmetry (PRG): The former uses skin electrodes, and the latter uses a pneumatic cuff to measure changes in venous volume under physiological changes. When the vein is blocked, the volume wave of the volt is caused by the filling and deflation of the breathing and the sleeve. The positive rate of this type of test for the diagnosis of proximal deep vein snow mountain is up to 90%, and the sensitivity to the diagnosis of the distal is significantly reduced.
5, deep vein angiography injection of contrast agent from the superficial vein of the foot, the use of the cuff at the proximal end, it is easy to make the contrast agent directly into the deep venous system, if there is a venous filling defect, you can make a stereotype and location diagnosis. The diagnosis of superficial vein thrombosis is easier, and the local symptoms and signs are more obvious.
Diagnosis
Differential diagnosis
Differential diagnosis of chronic venous insufficiency:
1, venous return disorder: systemic venous tube to transport blood back to the right atrium. The systemic venous system has a large blood volume, accounting for more than half of the total blood. The vein is easily dilated and can contract, thus acting as a blood storage stock. The contraction and relaxation of the vein can effectively regulate the amount of blood return and cardiac output, so that the circulation function can adapt to the needs of the body in various physiological states. The basic force of venous return is the pressure difference between the venule (also known as the peripheral vein) and the vena cava or right atrium (also known as the central vein). An increase in venule pressure or a decrease in vena cava pressure is beneficial for venous return. Since the venous wall is thin and the venous pressure is low, the venous return is also affected by external force such as muscle contraction, respiratory motion, gravity, and the like. When the above factors hinder venous return, the body will exhibit various manifestations.
2, venous blood flow stagnation: venous blood flow stagnation: thrombophlebitis is a venous vascular disease characterized by acute non-suppurative phlebitis secondary to intracavitary thrombosis, affected by superficial veins of the skin redness, spontaneous involvement Sexual pain, can touch the tender strips or nodules, venous blood flow is slow.
Diagnostic diagnosis of deep vein thrombosis is generally not difficult, and the following diagnostic methods can be used:
1, venous pressure measurement: the venous pressure of the affected limb increased, suggesting that the proximal pressure at the lateral pressure is blocked.
2, ultrasound: two-dimensional ultrasound imaging can directly see the thrombus in the large vein, with Doppler to measure the blood flow velocity in the vein, and observe whether the normal reaction of breathing and compression action exists. The positive rate of this type of examination for proximal deep vein thrombosis is up to 95%; the sensitivity to distal diagnosis is only 50%-70%, but the specificity is up to 95%.
3, radionuclide examination: 125I fibrinogen scan is used for the diagnosis of this disease. In contrast to ultrasonography, the detection rate of deep vein thrombosis in the gastrocnemius muscle can be as high as 90%, and the specificity for the diagnosis of proximal deep vein thrombosis is poor. The main disadvantage of this inspection is that it takes 48-72 hours to inject the radionuclide to show the effect.
4. Impedance plethysmography (IPG) and venous flowmetry (PRG): The former uses skin electrodes, and the latter uses a pneumatic cuff to measure changes in venous volume under physiological changes. When the vein is blocked, the volume wave of the volt is caused by the filling and deflation of the breathing and the sleeve. The positive rate of this type of test for the diagnosis of proximal deep vein snow mountain is up to 90%, and the sensitivity to the diagnosis of the distal is significantly reduced.
5, deep vein angiography injection of contrast agent from the superficial vein of the foot, the use of the cuff at the proximal end, it is easy to make the contrast agent directly into the deep venous system, if there is a venous filling defect, you can make a stereotype and location diagnosis. The diagnosis of superficial vein thrombosis is easier, and the local symptoms and signs are more obvious.
