23Mar

Diseases of veins and vessels of the upper extremities and their treatment

Subclavian vein thrombosis and upper vena cava occlusion, as well as post-injection thrombophlebitis, develop quite infrequently and asymptomatically in the initial stages. A person for a long time may not notice the presence of ailment, and only when the intolerable pains in their hands become known, patients go for medical help. The complex of diagnostic measures includes, among other things, angiography and tomography.

Diagnosis of upper extremity vessel diseases: dopplerography, duplex scanning and other

Diseases of the upper limb vessels are pathological conditions characterized by impaired blood flow in the peripheral( from the chest up to the arms) arteries. The blood flow is disturbed by narrowing or even clogging the lumen of these arteries.

Diseases of upper limb vessels, like most diseases that affect human arteries, can be triggered by atherosclerotic manifestations.

In medical practice, such diseases are relatively rare. This form of artery disease usually develops and progresses gradually, over a fairly long period. At the initial stages of the disease, the patient may not notice any significant symptoms. But with further progression of the disease, pain in the hands can be noted during even minor physical exertion. Loss of sensitivity or numbness of the fingers of the hand most often has the same cause.

Before you begin to treat upper limb vessels, you need to undergo a full medical examination.

From instrumental survey methods are used:

  • Ultrasound doppler ultrasound of the upper limbs is a non-invasive method for diagnosing vascular disease( arteries or veins) with the help of ultrasound. The method is used to assess blood flow and is based on the reflection of sound waves - ultrasound in the collision with objects changes its frequency. The method allows you to accurately determine the state of the vessels, the presence of obstructions to blood flow( thrombi, atherosclerotic plaques, tortuosity), patency of the vessels, pathological changes.
  • Duplex ultrasound scanning of upper limb vessels is one of the methods for diagnosing vascular disease( arteries or veins) with the help of ultrasound, but with more possibilities. This method allows you to visualize not only the structure of blood vessels, but also the movement of blood. With the help of duplex scanning, you can determine the speed, direction of blood flow, as well as see obstacles to normal blood flow and give recommendations for their elimination.
  • Angiography is an X-ray method for diagnosing blood vessels. Circulating blood in blood vessels does not retain X-rays, so in order for the vessel to become visible on X-rays, it is necessary to introduce a radiopaque material into the blood.
  • Computer tomography allows you to obtain a layered image of blood vessels with the help of X-rays and computer processing of information.
  • Magnetic resonance angiography is a research method that provides an image of organs and tissues of the body without the use of X-rays. It consists in the fact that when the patient is irradiated with radio waves in a strong magnetic field, electromagnetic energy is released, which is fixed and processed by a computer. With MRA, various parameters of vascular function, parameters and various kinds of abnormalities( aneurysms, thrombosis, atherosclerotic plaques) are evaluated.

Diseases of the veins and vessels of the upper extremities is a relatively rare form of artery disease. Usually they arise gradually and progress for a certain period of time.

Treatment of postinjectional thrombophlebitis of the subcutaneous veins of the upper extremities

Causes. Thrombophlebitis of the subcutaneous veins of the upper limb arises usually after intravenous infusions of drugs with the ability to cause irritation or tissue damage( calcium chloride, furagin, ristomycin, radiocontrast agents, etc.), catheterization of the vessel and prolonged drop transfusions, and occasionally after the bite of bloodsucking insects or localinjuries.

Symptoms of thrombophlebitis of superficial veins:

  • pain along the vein, pain at the injection site / insertion of the catheter;
  • vein tightness and severe pain when pressed;
  • local temperature increase;
  • redness of the skin over the vein;
  • swelling of the limb.

Treatment. With individually-adequate treatment of postinjectional thrombophlebitis of the subcutaneous veins of the upper extremities, the inflammatory events subsided, and the vein's patency is restored within 7-12 days.

If thrombophlebitis is caused by catheter placement, then the catheter should be removed. With a small damage to the veins in most cases, you can do with local treatment. If thrombophlebitis develops on the arm, provide its functional rest( without observing bed rest and using elastic bandages).

Locally applied:

  • compresses with 40-50% alcohol solution;
  • heparin-containing ointments( liotogel, hepatrombin);
  • ointments and gels with non-steroidal anti-inflammatory drugs( indomethacin ointment, gel with diclofenac, indovazin);
  • ointments and gels containing rutozide, troxevasin.

Acute thrombosis of the subclavian vein: symptoms and treatment

Acute thrombosis of the proximal subclavian veins with its extension to the axillary vein and vein of the shoulder and the violation of venous outflow in the upper limb are referred to in many reference books as the Pégette-Schreter syndrome.

Reasons. Initiation of acute subclavian vein thrombosis is attributed to most authors either by direct trauma or by overexertion of the upper limb. Usually, the syndrome occurs in young patients, more often in men;in the 1960s, he became known as the "thrombosis effort", when the association of this ailment with active physical activity was discovered, although the condition may arise spontaneously.

Symptoms. Symptoms of Paget-Shreter syndrome are sudden swelling and redness of the hand( most often right in right-handers and left-handed in lefties), heaviness, discomfort, shoulder and forearm turn blue, veins increase and become more prominent. When these symptoms occur, subclavian vein thrombosis should be consulted immediately.

Diagnostics. It is important to diagnose the disease as early as possible. This will avoid serious consequences, such as pulmonary embolism( ingress of a blood clot from the vein into the pulmonary artery and its obstruction), which can lead to death. According to various estimates, the probability of pulmonary embolism may reach 36% of the total number of patients suffering from Paget-Shreter syndrome. Another endpoint of vascular disorders of acute thrombosis of the subclavian vein may be a venous gangrene of the upper limb.

Treatment. With timely and adequate therapy, the condition improves after 2-4 weeks, but the disease becomes chronic. In the acute stage of the disease, fibrinolytics, anticoagulants, antiaggregants, angioprotectors, etc. are used to treat thrombosis of the subclavian vein, according to indications, surgical treatment( bypass surgery) is performed.

Syndrome of the superior vena cava: symptoms and treatment

Syndrome of the superior vena cava is an urgent condition associated with impaired circulation in the basin of the superior vena cava.

Symptoms. With occlusion of the superior vena cava, swelling and cyanosis of the face, upper half of the trunk and upper limbs, widening of superficial veins of the upper half of the body. Often when the outflow of blood through the superior vena cava occurs, nasal, esophageal and tracheobronchial bleeding due to increased venous pressure and rupture of the thinned walls of the corresponding veins. To these symptoms of the syndrome of the superior vena cava should be added headache, drowsiness, dyspnoea and cough.

Due to a significant increase in venous pressure, there are sometimes signs of increased intracranial pressure, that is, there are brain symptoms: headache, dizziness, drowsiness, nausea, vomiting, confusion and auditory hallucinations.

Reasons. Occlusion of the brachiocephalic and upper hollow veins( upper vena cava syndrome) is associated, as a rule, with previous vascular compression, intrathoracic neoplasm, enlarged lymph nodes or aortic aneurysm.

Diagnostics of can be performed by duplex scanning and phlebography methods, in which it is important to determine the patency of anonymous veins, which largely determines the ability to perform a shunt operation.

The main method of treatment of the syndrome of the superior vena cava is surgical.