Тромбоз подколенной вены возникает при появлении тромба в просвете сосуда, находящегося в центральной подколенной области. Сгусток мешает нормальному течению крови и замедляет кровообращение в конечности.
Содержание статьи
Как правило, тромбоз подколенной артерии у большинства пациентов проходит без видимых симптомов. Единственным фактором, причиняющим дискомфорт, становится боль в голени и подколенной области сзади. Из-за ограниченной симптоматики болезнь могут не выявить на начальной стадии. Во многих случаях люди долгое время не обращают на нее внимания.
Тромбоз подколенной вены: симптомы
Стандартная симптоматика тромбоза подколенной вены проявляется лишь в половине случаев, поэтому болезнь сложно диагностировать. К основным симптомам патологии относится острая длительная боль в зоне голени, которая может усиливаться вечером и ночью. Также подколенный тромбоз может сопровождаться следующими изменениями:
- при занятиях спортом и физических нагрузках нога начинает резко болеть;
- если попытаться согнуть стопу на себя, в голени чувствуется боль;
- конечность отекает, синеет, кожа начинает блестеть;
- под местом расположения тромба кожа бледнеет;
- человек ощущает тяжесть и распирание в конечности;
- больная конечность при ощупывании кажется холодной.
Примерно через двое суток после проявления вышеописанных симптомов становятся видны расширенные вены. Человек может ощущать слабость и испытывать проблемы с движением.
Тромбоз подколенной вены: причины
Точную причину возникновения тромбов в сосудах пока не выявили. Но известно несколько факторов, провоцирующих тромбоз бедренно-подколенного сегмента. К ним относят:
- Возраст. Чаще всего болезнь поражает женщин после 40 лет. У пожилых людей шансы заболеть выше, чем у молодых. После 50 лет риск возрастает вдвое каждые десять лет.
- Хирургические операции. При операциях ткани травмируются, в них нарушается циркуляция крови, а в результате действия наркоза свертываемость крови может увеличиться.
- Переломы конечностей. Болезнь проявляется в более чем половине случаев после перелома ног. Такие травмы нарушают кровоток, а в результате долгой обездвиженности конечности мышцы ослабевают, и кровь в них застаивается. В результате в просвете сосуда появляется тромб.
- Варикозное расширение вен.
- Онкологические заболевания, сопровождающиеся опухолями различных органов, также часто приводят к появлению тромбов. Во многих случаях болезнь проявляется у пациентов, которым удаляли опухоли операционным путем.
- Малоподвижный образ жизни, долгий вынужденный постельный режим или сидячая работа.
- Тромбоз подколенной вены возникает при беременности и родах из-за высокого давления матки с плодом на органы малого таза и нижние конечности.
- Длительная статическая нагрузка, травмы или сдавливание вены, при котором нарушается кровообращение.
- Использование гормональных препаратов (например, противозачаточных), содержащих эстроген. Подобные препараты повышают свертываемость крови, что влечет и образование тромбов.
- Недостаточное употребление жидкости.
- Болезни сердца, воспаления, инфекционные заболевания.
- Переохлаждение конечности.
- Длительные переезды, при которых человек вынужден долгое время сидеть.
- Систематическое переедание, неправильное питание и ожирение.
- Курение и алкоголь.
Тромбоз подколенной вены: диагностика
Чтобы определить точные признаки тромбоза, применяют дуплексное ультразвуковое сканирование (УЗДС). Метод помогает найти тромб, измерить его, определить его точное расположение, распознать, двигается ли он в сосуде. Также метод помогает исследовать, в каком состоянии находятся стенки сосудов и выяснить стадию болезни. Кроме того, в ходе обследования врачи получают информацию, с какой скоростью движется кровь.
Также в диагностике применяется ультразвуковая доплерография. Этот способ служит для определения проходимости вен и поиска места, в котором расположен тромб.
Тромбоз подколенной вены: лечение
Если говорить о том, чем опасен тромбоз подколенной вены, то в первую очередь стоит упомянуть его осложнения. От них погибает больше 10% больных. Если болезнь не лечить, тромбы могут отрываться и перемещаться по сосудам. Когда они попадают в легкие, то полностью закупоривают просвет легочной артерии. Это и приводит в большинстве случаев к летальному исходу.
Именно опасность осложнения и учитывается при выборе способа лечения. Большинству пациентов рекомендуют лечиться в стационаре. Если риск тромбоэмболии у них высок, лечение будет длиться дольше. В первые дни лечения (от 3 до 10 дней) пациент должен соблюдать постельный режим. При этом пораженная конечность все время должна быть приподнята. Это особенно важно, если врачи не могут провести полное обследование.
Если консервативное лечение тромбоза не дает эффекта, врачи рекомендуют пациенту пройти операцию. Хирургическим путем тромб достают из сосуда, благодаря чему кровообращение быстро восстанавливается. Лучше проводить операции по удалению тромбов как можно быстрее, так как это повышает шансы полностью восстановить пораженную ногу. Примерно в течение 10 дней (максимум – двух недель) тромб плотно прикрепляется к венозной стенке и начинает разрушать клапаны, поэтому на таком этапе операции уже не делают.
Многим пациентам назначают медикаментозное лечение неокклюзивного тромбоза в сочетании с использованием компрессионных эластичных бинтов, которые помогают защитить клапаны и увеличивают отток крови. Для повышения эффективности лечения используют местные препараты наружного применения. Такие средства (кремы, мази, венотонизирующие тоники) рекомендуется регулярно применять и после обострений, в качестве профилактики.
Также лечение сопровождается внутренним приемом лекарств. Пациенту прописывают антикоагулянты для замедления свертываемости крови и защиты от возникновения сгустков. При сильных болях прописывают также анальгетики. Чтобы увеличить отток крови от ног, используют флеботоники.
Кроме того, в лечении сосудов при данном заболевании широко используются ангиопротекторы. Это специальные препараты комплексного действия. Они подавляют воспалительный процесс, восстанавливают сосудистые стенки, улучшают состав крови и ускоряют микроциркуляцию. Также такие средства помогают бороться с отеками.
Для растворения тромбов используют тромболитики. Их применение целесообразно на первичной стадии заболевания. В запущенных случаях они противопоказаны, потому что могут вызвать тромбоэмболию.
В некоторых случаях в лечении применяют и антибиотики. Подходящую терапию врач разрабатывает в каждом случае индивидуально.
Тромбоз подколенной вены: лечение народными средствами
При первых болях и симптомах тромбоза срочно обращайтесь к доктору. Важно помнить, что несвоевременное лечение или его отсутствие приводят к тому, что нормальное кровообращение на этом участке может быть утеряно безвозвратно, без восстановления.
Некоторые люди выбирают народную медицину для борьбы с образованием тромбов. И действительно, избранные рецепты, передаваемые из поколения в поколения, давали в отдельных случаях положительный результат. Испытывать на себе силу знаний предков без консультации врача не рекомендуется. Народные рецепты могут выступать противовесом традиционной медицине и мешать основному лечению. Рассказываем о способах, которые считаются самыми популярными в народе.
Можно попробовать настой вербены. Ложку вербены нужно заварить в стакане кипятка, а затем процедить и пить целый день небольшими глотками.
Снять боль могут ванночки с топяной сушеницей. Для этого 200 г растения заливают ведром кипятка и настаивают. Делать теплую ванночку для больных ног нужно в течение 30 минут. Регулярные процедуры носят отвлекающий характер.
Комбинируйте подобные процедуры с основным лечением, предварительно проконсультировавшись с врачом.
Вместо топяной сушеницы можно использовать обычную сушеницу. Подготовка к процедуре такая же, только держать ноги в настое нужно не более 20 минут.
Популярным средством народной медицины в лечении тромбов подколенной вены являются компрессы на основе отвара из бодяги. Они облегчают боль и оказывают заживляющее действие.
Видео: тромбоз вен нижних конечностей
Компания «ВЕРТЕКС» не несет ответственности за достоверность информации, представленной в данном видео ролике. Источник — DoctorElshanskiy
Для точной диагностики обращайтесь к специалисту.
Большое количество людей сталкивается с тромбозом — заболеванием, относящимся к разновидности сосудистых патологий, обусловленных ускоренным и избыточным свертыванием крови, а также вызывающих нарушения кровотока в просвете сосудов. Среди различных мест локализации болезни выделяют подколенную зону. Согласно мировой статистике, патология чаще всего диагностируется у женщин. Тромбоз подколенной вены относится к серьезному заболеванию, имеющему свои слабовыраженные симптомы и требующему проведения своевременной диагностики, лечения флебологом. Невнимательное отношение к своему здоровью, проблемам с сосудистой системы чревато летальным исходом.
Причины возникновения
Тромбы в подколенных венах, частично или полностью перекрывающие просветы сосудов, являются преградами для транспортировки и оттока крови. Циркуляция плазмы со взвешенными в ней клетками лейкоцитов, эритроцитов, тромбоцитов замедляется. Стенки сосудов под коленом начинают деформироваться, становиться тонкими и слабыми. Это приводит к развитию тромбоза подколенной вены. Такое состояние встречается редко и не имеет ярко выраженные симптомы. Кровяные сгустки, образующиеся в вене под коленным суставом, формируются у пациентов женского и мужского пола в возрасте после 40 лет по ряду причин. К ним относятся:
- перенесенные хирургические операции, в результате которых пациенты продолжительное время находятся в лежачем положении;
- применение наркоза;
- травмы всех отделов ног;
- отсутствие лечения варикозного расширения нижних конечностей и последующее течение патологии уже в тяжелой форме;
- диагностирование новообразований злокачественного и доброкачественного характеров в органах пациентов;
- нахождение в лежачем положении в течение длительной реабилитации;
- паралич нижних конечностей;
- беременность и роды;
- гормональная перестройка организма;
- употребление противозачаточных препаратов и других лекарственных средств, ухудшающих состояние тканей сосудистых стенок, в течение длительного периода времени;
- ношение неудобных предметов, одежды и аксессуаров, давящих на определенные участки тела и препятствующих нормальному оттоку крови;
- обезвоживание человеческого организма;
- нахождение в неудобных позах на протяжении длительного периода времени в путешествиях, поездках;
- диагностирование аутоиммунных заболеваний, вирусных и инфекционных патологий;
- пристрастие к курению и приему алкогольных напитков;
- избыточный вес.
Такие факторы негативно сказываются на состоянии сосудистой системы в целом и повышают риск появления тромбов.
Основные симптомы
Во время тромбоза подколенной вены происходит поражение нижней конечности. При этом проблематичной становится циркуляция крови вследствие частично или полностью перекрытого тромбом канала. Подколенная вена деформируется, ее стенки ослабевают и утончаются. Симптомы тромбоза подколенной вены не имеют ярко выраженный характер, но достаточно ясно сигнализируют о необходимости обращения к флебологу, специализация которого предусматривает диагностирование и лечение вен. Такая ситуация приводит к появлению трудностей для распознания недуга на начальной стадии его развития. Среди основных признаков тромбов в подколенной вене отмечают:
- болезненные ощущения в икроножных мышцах нижних конечностей;
- острые боли при сгибании стоп в тыльную сторону;
- повышение интенсивности болевых ощущений к концу дня;
- появление покраснений, отечности нижних конечностей, а также постоянная тяжесть в них и усталость;
- посинение кожного покрова в области локализации тромба;
- набухание, расширение, отчетливое проявление вен на коже;
- лейкоцитоз;
- слабость во всем организме;
- адинамия, сопровождающаяся значительным сокращением или полным прекращением двигательной активности пациента.
Виды диагностики
Своевременно проведенная диагностика тромбоза подколенной вены предоставляет возможность начать лечение сосудистого заболевания на начальной стадии его развития. Что исключит серьезные осложнения, непоправимые последствия, включая летальный исход. Выявление тромбов в подколенной вене начинается с визуального осмотра флеболога, который в дальнейшем назначает прохождение УЗДС.
Дуплексное ультразвуковое ангиосканирование считается наиболее эффективным методом диагностики, появление которого позволило устанавливать диагнозы сосудистых болезней, проверять состояние, а также получать четкое изображение поверхностных и глубоких вен, обнаруживать тромбы, определять их местонахождение, размеры и степень подвижности. А при проверке внутренних стенок пораженной подколенной вены удается проконтролировать давление кровяного тока, циркулирующего в этой области.
Консервативное лечение
Медикаментозная терапия при лечении тромбоза подколенной вены преследует несколько целей. К ним относятся:
- восстановление венозного оттока;
- снижение отечности мягких тканей ног;
- предотвращение интенсивного развития тромбоза;
- исключение риска возникновения тромбоэмболии легочной артерии;
- профилактика посттромбофлебитического синдрома.
Комплексный подход в решении проблемы образования тромбов в венах под коленом позволяет эффективно провести медикаментозную терапию, устранить симптомы и избежать осложнений.
Пациентам при диагностировании патологии на ранней стадии развития рекомендуется соблюдать строгий постельный режим с проведением эластической компрессии нижней конечности по всей ее длине. Такая процедура предназначена для сдавливания межмышечных венозных сплетений и увеличения проталкивающей способности мышечно-венозной помпы. Для усиления лечебного эффекта флебологи рекомендуют перед использованием компрессионных повязок или чулок, ноги смазывать специальными мазями: «Лиотон», «Индовазин». В основе медикаментозной терапии тромбоза подколенной вены лежит применение разных групп лекарственных препаратов. К ним относятся:
- антикоагулянты прямого и фракционированного действия: «Гепарин», «Эноксипарин», «Фраксипарин», «Клексан», «Анфибра»;
- противотромбические препараты, предупреждающие прогрессирование сосудистого заболевания в ямке под коленным суставом: «Маркумар», «Варфарин», «Тромексан»;
- нестероидные противовоспалительные препараты;
- венотонизирующие лекарственные средства для снятия усталости, болей, отечности нижних конечностей: «Детралекс», «Троксевазин», «Венитан»;
- ангиопротекторы для нормализации микроциркуляции крови: аскорбиновая кислота, «Рутин», «Эскузан»;
- антибактериальные препараты на основе пенициллинов, цефалоспоринов, фторхинолонов в случае развития ярко выраженного воспалительного процесса под коленом.
Хирургические методы лечения тромбоза подколенной вены
При отсутствии получения положительного результата после прохождения курса консервативной терапии назначаются хирургические методы лечения сосудистого заболевания. Среди них отмечают:
- тромбоэктомию, основанную на удалении тромба из рассеченный вены и последующей пластике сосудов;
- имплантацию постоянных или временных кава-фильтров;
- пликацию полой вены, заключающуюся в прошивании ее просвета П-образными швами для разделения на каналы, достаточные для оттока крови, но не пропускающие тромбы.
Способы лечения тромбоза подколенной вены определяются флебологом. Пациенты должны всегда помнить о том, что своевременное обращение за профессиональной медицинской помощью является залогом их долголетия и здоровых ног.
Тромбоз подколенной вены – заболевание, для которого характерно формирование кровяного сгустка в просвете сосуда в центре подколенной ямки. Такая патология возникает редко и в большинстве случаев протекает малосимптомно. Часто пациент не придают значения дискомфорту или списывают неприятные ощущения на проявления остеохондроза или других заболеваний опорно-двигательного аппарата. Несмотря на скудную симптоматику, заболевание не является безопасным, в ряде случаев возможно развитие тяжелых осложнений.
Причины
Причины развития подколенного тромбоза до конца не установлены. Однако существуют факторы, которые способствуют возникновению патологии:
- возраст старше 40 лет, причем каждые 10 лет риск повышается в 2 раза;
- женский пол;
- хирургические вмешательства;
- развитие тромбоэмболии после эндопротезирования коленного сустава;
- нарушение микроциркуляции в тканях;
- длительное нахождение под наркозом, которое способствует загустению крови и расслаблению мышц, что повышает риск тромбообразования;
- переломы приводят к нарушению оттока крови, более чем у половины пациентов с нарушением целостности костей возникает тромбоз вен;
- варикоз;
- злокачественные новообразования;
- длительная иммобилизация;
- беременность, роды, послеродовый период;
- гормональная терапия;
- патология сердечно-сосудистой системы, аутоиммунные болезни, эндартериит, васкулит;
- переохлаждение;
- малоподвижные образ жизни, сидячая работа или длительные путешествия;
- воспалительные процессы, вирусное или бактериальное инфицирование;
- курение, переедание, чрезмерное употребление алкоголя.
Симптомы
Симптомы тромбоза подколенной вены не всегда четко выражены, поэтому патологию зачастую сложно диагностировать. К типичным признакам заболевания относятся:
- длительная боль острого характера в области голени, неприятные ощущения могут усиливаться вечером, при физической нагрузке;
- появление дискомфорта в голени при сгибании стопы на себя;
- отечность ноги;
- посинение кожи, блеск;
- чувство распирания нижней конечности;
- похолодание кожного покрова;
- в случае воспаления сосудистой стенки присоединяются признаки интоксикации: повышение температуры тела, снижение аппетита;
- при прогрессировании болезни симптоматика венозного тромбоза усугубляется, примерно через 48 часов после начала болезни, появляются расширенные вены, пациент ощущает слабость и затруднение движений ногой.
Диагностика
При обнаружении первых симптомов тромбоза под коленом следует обратиться к врачу, который оценит жалобы пациента и анамнез, проведет осмотр и назначит пациенту необходимые анализы.
Лечение тромбоз подколенной вены проводят сосудистый хирург или флеболог.
В ходе осмотра специалист проводит ряд проб, которые позволяют подтвердить диагноз:
- проба Хоманса: в положении лежа пациент сгибает ногу в колене, врач производит движения голеностопным суставом, после чего больной ощущает боль в голени;
- проба Мозеса: появление боли при сдавливании голени, при движении ей вперед и назад, а также отсутствие неопрятных ощущений при надавливании — признак тромбоза;
- проба Ловенберга: нагнетание давления в манжету на голени, при достижении значений 100 мм.рт.ст. появляется боль.
Для подтверждения диагноза используются инструментальные методы диагностики:
- дуплексное ультразвуковое сканирование сосудов;
- допплерография;
- флебография с контрастированием;
- магнитно-резонансная и компьютерная томография.
Лечение
Медикаментозное лечение подколенного тромбоза предусматривает использование лекарственных средств следующих групп:
- тромболитики (Стрептокиназа) расщепляют и растворяют тромб;
- антикоагулянты прямого и непрямого действия (Гепарин, Варфарин) рассасывают тромб и профилактируют образование новых сгустков;
- нестероидные противовоспалительные средства (Ибупрофен, Диклофенак) снижают воспалительные процессы, подавляют боль и профилактируют тромбообразование;
- венотоники (Троксевазин) восстанавливают сосудистую стенку и устраняют застойные процессы;
- ангиопротекторы (Рутин) снижают проницаемость венозной стенки, улучшают трофику и микроциркуляцию.
- антибиотики при инфекционном осложнении патологии.
Прием медикаментов можно совмещать с другими методами лечения:
- ношение компрессионного трикотажа;
- выполнение упражнений лечебной физкультуры, занятия йогой.
Заболевание, особенно на ранних стадиях, поддается консервативной терапии. Тяжелые формы патологии требуют проведения операции.
В случае неэффективности консервативной терапии пациенту назначается проведение операции. Кроме того, в пользу данного метода делается выбор при тяжелой форме патологии.
Хирургические вмешательства, проводимые при тромбозе подколенной вены:
Осложнения и прогноз
В отсутствие адекватного лечения не исключен отрыв тромба. Эмбол может попасть в полость легочной артерии и вызывать ее закупорку. Это состояние является угрожающим жизни. Небольшой эмбол может не вызвать появления яркой симптоматики, в то время как крупные сгустки ухудшают перфузию легочной ткани, приводят к развитию гипоксии, отмиранию участка легкого и последующему воспалению.
При полной блокировке оттока крови от нижней конечности развивается белая или синяя флегмазия – состояния, которые могут привести к развитию гангрены и сердечной недостаточности.
Профилактика
В связи с тем, что причины тромбоза подколенной вены до конца не установлены, а также учитывая широкий спектр факторов риска, следует отметить, что профилактические мероприятия не разработаны. Рекомендации по предотвращению этого состояния сводятся к ведению здорового образа жизни, занятиям спортом, раннему началу двигательной активности после хирургических вмешательств, ношению компрессионного трикотажа, а также медикаментозной профилактике пациентам из группы риска.
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