The circulatory system of the upper extremities is a complex "construction" that transfers blood from other vessels. Therefore, thrombosis of the subclavian vein drastically changes the movement of blood along the entire arm.
The essence and causes of occurrence
The causes of thrombosis of the subclavian vein are the following factors:
- chaotic blood flow or significant slowdown;
- impaired blood clotting (under the influence of any factors, due to diseases of a genetic and hereditary nature);
- The subclavian vein may be occluded by a large and abnormally formed bony growth, which may result from a clavicular fracture or the appearance of an uncharacteristic cervical rib.
Subclavian vein thrombosis can only rarely be the result of a blood clot formed elsewhere in the body. This phenomenon is associated with the organization of the human circulatory system. Thrombosis of the upper extremities occurs as a result of the separation of a blood clot in the heart muscle. In most cases, subclavian vein thrombosis has little to no effect if the process is slow.
Symptomatics
Thrombosis of the subclavian vein occurs as a result of excessive physical activity and stress. This factor plays a major role in the formation of a thrombus. In some cases, a blood clot can come off regardless of the degree of physical activity, but this happens in very rare cases. Blockage of the subclavian vein has either increasing or disappearing symptoms, manifested by influxes. There are no serious consequences from thrombosis, because the blood circulation is replaced by other vessels. However, this blood is not enough to fully provide the tissues of the upper limbs. In the ICD-10, subclavian vein thrombosis has the code I82.8.
Main clinical picture
The main symptoms of subclavian vein thrombosis are as follows:
- pain in the arm;
- a rather bright pattern of veins shines through the skin;
- severe swelling of the arm with a glossy sheen;
- signs of a neurological disorder: limb numbness, twitching, etc.
Other symptoms of pathology
The appearance of a venous pattern on the arm is hard not to notice, especially for white-skinned people. The diameter of the veins will depend on the size of the thrombus and the increase in thrombus hypertension.
Pain process is usually observed during physical exertion. The pain may be present constantly, pulsate, "bursting", but in all cases it is quite intense. Basically, the pain is felt throughout the arm, in the area of the shoulder and collarbone, and in somecases also on top of the chest and back.
Swelling occurs on the entire arm completely. If you press on the edematous area, the fossa does not remain in this place. The hand acquires an unusual heaviness and hardness. If the swelling process has been going on for quite a long time, the blood circulation is disturbed and becomes reactive, as a result of which the thrombosis of the subclavian vein only intensifies.
Neurological disorder manifests differently for everyone. For many, the fingers of the limb twitch, they feel a tingling, burning sensation. The affected limb may be limited in movement.
If acute thrombosis of the subclavian vein becomes chronic, the clinical picture of the disease becomes blurred and not so pronounced. Puffiness and pattern of veins practically disappear. Most often, there remains a low reaction of the injured limb to external stimuli, restrictions in motor activity, muscle atrophy and pain during serious physical exertion. In some cases, disability is assigned for thrombosis of the subclavian vein.
Diagnostic measures
Diagnostic actions begin with the collection of anamnesis - that is, the doctor must interview the patient in detail about the symptoms that disturb him and about when and what types of physical activity could lead to such consequences. This is necessary in order to find out how long the thrombosis process has been going on.
To diagnose chronic or acute thrombosis of the subclavian vein, resort to the following diagnostic methods:
- radiography and magneticresonance imaging to establish the cause of the pathology and identify the location of the thrombus;
- subclavian vein duplex scan;
- assessment of blood circulation in the injured vein - dopplerography;
- contrast x-ray;
- ultrasound examination (ultrasound) of deep veins;
- venography;
- Computed tomography (CT) of the shoulder girdle.
Treatment
If the disease is the result of a catheter, then it must be removed. If the vessels are slightly clogged, then resort to local therapy. The limb should be in the so-called functional rest, moreover, no elastic bandages and complete bed rest are needed here. In a horizontal position, the arm must be raised slightly above the heart, and in a vertical position, it should be hung up, bending at the elbow, with a bandage or scarf. In local treatment, the following drugs are used:
- compresses based on alcohol (about 50%);
- "Hepatrombin", "Liotongel" - ointments, which contain heparin;
- gel-like ointments with troxevasin and rutoside in the composition;
- non-steroidal anti-inflammatory drugs such as Indomethacin Ointment, Indovasin, Diclofenac.
A little more about drug treatment
If the pathology becomes acute and is accompanied by extremely painful symptoms, then the patient is placed in a hospital. There treatment consists of the following medicines:
- fibrinolytic drugs – Fibrinolysin, Streptokinase, Urokinase, etc.;
- antiplatelet agents;
- angioprotectors;
- drugs against blood clotting (the first few days it can be "Heparin" and "Fibrinolysin", and then apply "Phenylin", "Sinkumar", "Fraksiparin");
- non-steroidal anti-inflammatory drugs.
The main task of treating subclavian vein thrombosis with medication is to restore impaired blood circulation in the subclavian vein, To summarize, drug treatment comes down to two types of drugs:
- drugs with antithrombotic properties that help destroy a blood clot and prevent new ones (such as "Heparin");
- drugs that improve the metabolism of the walls of the veins, painkillers and anti-inflammatory drugs.
When is surgery due?
Usually drug therapy lasts from one to several months. If during this period the thrombus has not resolved, then you have to resort to surgical intervention. If thrombosis of the subclavian vein (left or right) lasts too long, tissue necrosis of the upper limb may occur. In such a situation, an operation is also prescribed, during which it is necessary to remove tissues that have died.
To remove a blood clot, a special device called a laparoscope is used. It passes into the vein, captures the clot and pulls it out. For this purpose, a small incision is made in the armpit, whichallows you to get close to the subclavian vein, a puncture is also made in it - a laparoscope passes into it. With a slight injury to the vascular walls, a special catheter is inserted there. In some cases, a special shunt is inserted into the affected area of the vein.
It is also important to note that if the patient has a feeling of warmth, sharp pain, there is a swelling and the process of redness or blueness of the shoulder, then it is urgent to connect a new course of treatment. All of these symptoms may indicate a pulmonary embolism. If a patient is diagnosed with a stomach ulcer or gastritis, he is prescribed suppositories. Also, the usual "Aspirin" is excluded from the course of treatment, instead it is necessary to choose drugs of the same properties, but soluble in the intestine. To avoid relapses and repeated exacerbations, antihistamines are used as a preventive measure.
The severity of the venous outflow and how intensely the characteristic symptoms and signs of the disease manifest themselves are affected by the severity of the pathology of the main veins, the features of the formation of blood clots and the formation of bypass circulatory pathways. If a patient has idiopathic thrombosis, then in most cases he will need a special course of treatment for life.
Surgery
If the blood circulation through the veins is seriously impaired, and the thrombosis of the subclavian vein has become chronic, then resort to the following two types of surgical intervention.
To restore the outflow of venousblood. This operation includes several steps:
- removal of the thrombus itself, i.e. thrombectomy or recanalization;
- venous plasty: vein grafting or bypass;
- phlebolysis, that is, the isolation of a vessel from the nearest scar tissue, and scalenotomy, that is, the absolute intersection of the muscles that surround the bundle of vessels and nerves, or even the removal of sections of individual ligaments and muscles.
To improve the outflow of venous blood. This also includes several steps:
- removal of mechanical barriers, in particular bone growths;
- impact on the sympathetic nervous system, such as perivenous sympathectomy.
If the clinical picture is pronounced and the patient feels extremely painful symptoms, then surgery can be prescribed approximately 3-4 days after pain and swelling decrease slightly, but before blood clots appear and attach to the wall veins. Usually circulation is restored after thrombectomy. But the result of this procedure is not always possible to predict. Quite often, thrombosis occurs repeatedly, and the vein in the area where the surgical intervention took place becomes already laid. Once the thrombus has been removed, it is necessary to eliminate those factors that can cause injury to the subclavian vein. For this purpose, the central section of the subclavian muscle, clavicle or process of the first rib is removed, the costal-coracoid ligament and the anterior scalene muscle are excised.
Bypass and amputationhands
If it is impossible to do a thrombectomy, and if the disease becomes chronic, after removing the deformed section of the main vein, they make it plastic or resort to shunting. A shunt, that is, a bypass, can be a section of the jugular vein or a large saphenous vein. If the disease is completely untreatable, then the arm has to be amputated.
Preventive measures against thrombosis
Subclavian vein thrombosis is a problem from which no one is immune, it can occur in the life of every person. However, factors that may influence the development of this disease can be excluded. There is a risk of thrombosis of the subclavian vein due to an abscess, which must be eliminated in a timely manner. In many other cases, avoiding the disease is almost impossible. But there are some recommendations that can significantly reduce the risk of blood clots. Such measures include daily exercise and physical activity, regular walks in the fresh air, a complete balanced diet and the treatment of all diseases in a timely manner.
Prevention of folk remedies
To strengthen the vascular walls and maintain the normal functioning of blood circulation, it is advised to regularly drink tinctures of St. John's wort, cranberries or rose hips. And most importantly, as a preventive measure, it is worth visiting a doctor at the first painful manifestations in the upper extremities, since thrombosis in the initial stages is treated much faster and easier than in a neglected one.stages. It is better to prevent the development of the disease in time than to deal with its consequences later. If you want to know about subclavian vein thrombosis in the ICD, then this disease has the code I82.8.
