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Thrombotic vascular infection is an inflammatory disease that mainly affects medium and small arteries and veins, and most often the lower extremities. The causes of the ailments are unknown, but the influence of hormones and cigarette smoking are said to be the main risk factors. Most of the patients are men between the ages of 25 and 45.
What is thrombotic vascular infection?
Thrombotic vascular infection is a condition that combines the features of both inflammatory and vascular occlusive disease, and its causes are still unclear. However, infections, hormone influences, cold, and genetic predisposition are cited as possible causes. Most likely, inflammatory changes within the vascular endothelium are the cause of their proliferation, thrombosis, and then hardening. Most of the patients are male between the ages of 25 and 45; smoking is the main risk factor (the disease almost always occurs in the group of smokers). The first symptoms appear before the age of 40, while later in life they occur less frequently. The incidence of thrombophlebitis varies widely, with the highest incidence observed in Eastern Europeans and Asians. In Poland, about 3% of all patients hospitalized due to limb ischemia suffer from this ailment.
Thrombotic vascular infections – causes
The exact cause of thrombotic vascular infection is unknown, but there is evidence of a relationship between this disease and smoking (90% of cases). Also, chewing tobacco or using nicotine-containing patches and tablets are risk factors. In addition, nicotine increases the symptoms of the disease. Chronic inflammation and genetic predisposition may also play an important role. This is indicated by the frequent presence of HLA-B5, HLA-A9 and HLA-B54 antigens of the main histocompatibility complex than in the general population.
pathogenesis
Thrombotic vascular infection contributes to the formation of a large number of blood clots in the lumen of the vessels, especially in the muscle arteries that gradually narrow their lumen and become fibrotic and completely occlude the vessel. Thrombotic changes are usually located in the lower limbs (much less often in the upper limbs), in the visceral, cerebral and renal arteries. Thrombotic vascular infections can also attack nerves and veins.
Symptoms of thrombotic vascular infection
The location of thrombotic vascular infection are lower limbs – initially, the changes affect only one limb, but over time the disease process also affects the other limb. The upper limbs may be affected in the advanced form of the disease.
Clinical symptoms
An early symptom may be superficial thrombophlebitis; erythematous spots and hardened nodules appear in about 1/3 of patients. They are painful both under pressure and spontaneously. They usually disappear within 1-2 weeks with discoloration, but new changes appear at the same time.
The first symptoms of developing arterial occlusion are fatigue and heaviness in the legs, often accompanied by paraesthesia and a feeling of coldness. Sometimes the feet turn very pale. With an increase in the degree of vasoconstriction and a decrease in oxygen supply, various symptoms appear, which, depending on the degree of occlusion, have been divided into stages I-IV peripheral arterial obstruction.
Increased necrotic changes may even result in the loss of one or more fingers. The described changes are accompanied by very severe, nagging pain. In addition, there is an increased activity of the sympathetic nervous system, with excessive sweating, a feeling of cold and cyanosis. The incidence of dermatophyte and bacterial infections is also increasing. The coronary, mesenteric and central nervous system (CNS) arteries are extremely rarely involved.
In some patients, along with the symptoms of ischemia, there may be inflammation of the superficial veins located in the area of the feet and shins. The lesions resemble red nodules or cords. They can be wandering or jumping.
There are also sensory disturbances, especially at a later stage. They cause ischemic neuropathy.
Diagnosis of thrombotic vascular infection
An important symptom accompanying thrombotic vascular infection is the lack of pulse in the dorsal, elbow, tibial and radial arteries.
Histopathology: in early lesions of thrombotic vascular infection, neutrophilic infiltrates within the swollen walls of arteries are found, which confirms the role of inflammation in the pathogenesis of the lesions. Later features of occlusion with mixed infiltration, proliferation of endothelial cells, thrombosis, fine tunnels of thrombus recanalization, and corrugation of the inner elastic membrane.
No specific laboratory test is available. All tests used in the diagnosis of peripheral arterial obstruction can be used here.
The performed laboratory tests show in patients with thrombotic vein infection: high CRP concentration, accelerated ESR and high serum fibrinogen concentration. Imaging tests in the form of arteriography (revealing distal closure of smooth-sided arteries and the presence of a characteristic corkscrew-shaped collateral circulation), however, it is not a necessary method for proper diagnosis. Many doctors use the Doppler method to measure blood pressure on the extremities. This examination allows to visualize the obstruction of the lower limbs or forearms found earlier (during the palpation examination) and to exclude the possible coexistence of atherosclerosis.
When diagnosing thrombotic vascular infection, it is important to differentiate the disease from other ailments with similar symptoms. Among others:
- peripheral arterial embolism (also causes limb ischemia),
- systemic connective tissue diseases (in women: systemic scleroderma),
- degenerative and inflammatory diseases (causing pain in the limbs).
Thrombotic vascular infection – treatment
In the treatment of thrombotic vascular infection it is important to stop smoking completely (which may stop further progression in the early stages of the disease). It is also very important to avoid cold and minor injuries, carefully care for the feet, and to prevent and treat infections. Sympatectomy can help reduce the symptoms of arterial failure, as long as you stop smoking. Agents for improving vascular flow are of limited effectiveness.
In relieving disease symptoms, it is recommended to take paracetamol at the beginning, and when the pain is unbearable – opioid analgesics. Sometimes epidural anesthesia is used to relieve pain, relieving it for several days. In the treatment of ulcers, the standard procedure is applied in the form of gauze dressings previously soaked in physiological saline. The resulting necrosis should be lubricated with a polyvinylpyrrolidone solution, and in a developed infection with a severe inflammatory reaction – intravenous antibiotic therapy is indicated. In the case of necrotic lesions, it is important to drain the abscesses and surgically separate the suppurated tissues.
What’s the prognosis?
Better for life than in atherosclerotic sclerosis, because the disease process does not affect the heart and CNS vessels. However, as a result of the developed disease, necrosis of the fingers and even feet often occurs, which requires the limb amputation.
Lit .: [1] Kurata A., Franke FE, Machinami R. et al .: Th romboangiitis obliterans: classic and new morphological features. Virchows Arch 2000; 436-59. [67] Braun-Falco O., Plewig G., Wolff HH, Burgdorf WHC: Dermatology, Gliński W., Wolska H. ed. pol., Czelej Publishing House, Lublin 2, 2002-869.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House