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Abstract: This is a case of an elderly male patient who presented with a history of untreated varicose veins for more than 30 years, and 20 days ago presented with scattered redness and pain in the skin of the right lower extremity, with progressive worsening of the pain. After admission, the ultrasound was completed, suggesting thrombosis of the saphenous vein in the right lower extremity, and the patient was diagnosed with thrombophlebitis. After the patient was given symptomatic treatment such as anti-inflammation, anticoagulation and improvement of circulation, the patient’s symptoms gradually subsided.
Basic information】Male, 60 years old
Disease Type】Thrombophlebitis
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】September 2021
Treatment plan】Anticoagulation therapy (Rivaroxaban tablets) +Anti-inflammatory therapy (Etimicin sulfate injection) +Vascular dilation therapy (Prostil injection) +Improve microcirculation (Calcium hydroxybenzene sulfonate capsules) +Promote venous reflux therapy (Horse chestnut seed extract tablets) +Physical therapy (elevation of affected limbs + cold compresses)
[Treatment period] 10 days of inpatient treatment, 1 month of outpatient review
【Treatment effect】The patient’s pain, redness and other acute inflammatory symptoms disappeared
I. Initial consultation
In September 2021, a 60-year-old male patient came to the department with varicose veins of both lower extremities for more than 30 years and redness and pain of the right lower extremity for more than 20 days, the patient developed varicose veins of both lower extremities more than 30 years ago without any obvious cause, and the symptoms were obvious after sitting and standing for a long time, and the symptoms were slightly relieved by elevating the affected extremities. More than 20 days ago, the patient presented with scattered red skin color and pain in the right lower extremity, and the pain worsened progressively. The patient had a 3-year history of hypertension, which was well controlled by oral antihypertensive drugs, and no other past history. On examination, he saw local tortuous dilated veins in both lower limbs, and scattered subcutaneous hard nodules along the saphenous vein in the thigh and calf of the right lower limb, with red skin color, high skin temperature, positive pressure pain, no desquamation, bilateral dorsalis pedis arteries could be reached, and the sensory-motor function of both lower limbs was still acceptable.
II. Treatment history
After the patient was admitted to the hospital, he completed relevant routine examinations and performed lower extremity venous ultrasound indicating thrombosis of the right lower extremity saphenous vein. The coagulation function indicated that the patient was in a hypercoagulable state, and the D-dimer was 1.65 mg/L. The patient was clearly diagnosed with acute thrombophlebitis. However, the patient currently had varicose veins for many years and had no intention of surgery for the time being, so the patient was advised to be treated conservatively. The patient was given rivaroxaban tablets for anticoagulation, etimesine sulfate injection for anti-inflammatory treatment, prostilbestrol injection for vasodilation, calcium hydroxybenzoate capsules to improve microcirculation, and horse chestnut seed extract tablets to promote venous reflux. At the same time, the patient was advised not to go down to the ground as far as possible, elevate the affected limb, and apply cold compresses locally, and the symptoms of redness, swelling and pain of the affected limb were obviously relieved after 5 days.
III. Treatment effect
The patient had acute thrombophlebitis induced by varicose veins. After 5 days of conservative treatment including anticoagulation, anti-inflammation and vasodilatation, as well as treatment to improve microcirculation and promote venous return, the patient’s symptoms improved significantly, and no obvious redness, swelling and pain symptoms were observed after 10 days, so he was discharged from the hospital. The patient was reviewed in the outpatient clinic 1 month later, and the examination results showed that all indicators were improved, and the patient indicated that there was no recurrence of thrombophlebitis.
IV. Notes
1. We are glad that the patient’s disease was effectively controlled after treatment. After the acute phase of thrombophlebitis, it is recommended that the patient continue to take oral anticoagulants for a period of time after discharge to avoid recurrence. Also drink more water, low salt and low fat diet and light diet are recommended. Extra attention should be paid to whether redness, swelling and pain in the lower limbs appear again, especially the hardness of the strips along the vascular walk, inflammation recurrence should be considered and timely medical consultation is needed.
2, after the acute inflammation subsides, it is recommended that patients wear medical compression stockings all year round to promote venous reflux, and if physical conditions allow, it is recommended that varicose vein surgery be performed as soon as possible so as to inhibit the occurrence of phlebitis.
V. Personal insight
The acute phase of thrombophlebitis mostly shows acute inflammatory manifestations such as redness, swelling, pain, etc. The thrombophlebitis of the lower extremities are mostly varicose veins, deep vein thrombosis, venous insufficiency, so conventional anticoagulation, promotion of venous reflux, improvement of circulation and other treatments are very effective for such patients. It is worth noting that it is important to investigate the cause of phlebitis, as symptomatic treatment alone is prone to recurrence of the disease, so treatment of the cause is more important.