ISSN 2398-2977      

Cardiovascular: vein - thrombosis

pequis
Contributor(s):

Christopher Brown


Introduction

  • Venous thrombosis and thrombophlebitis most commonly seen in the jugular vein.
  • Cause: often associated with venipuncture and catheterization.
  • Signs: painful swelling and cording of vein, with sloughing and suppuration. If thrombophlebitis present, possibly sepsis and embolic spread.
  • Diagnosis: clinical signs, aided by ultrasonographic examination.
  • Treatment: thrombosed veins may recanalize if left alone.
  • Prognosis: many cases resolve spontaneously.

Pathogenesis

Etiology

Spontaneous Iatrogenic
  • Inadequately performed venepuncture, and/or aseptic technique.
  • Long-term use of indwelling catheters and cannulae.
  • Administration of strong concentrations of irritant drugs, particularly perivascular.
  • Venipuncture while patient in hypercoagulable state, eg disseminated intravascular coagulation   Disseminated intravascular coagulation  , toxemia.
Thrombophlebitis
  • Perivascular injection of irritant substances.
  • May arise as sequel to 'spontaneous' thrombosis.

Specific

Pathophysiology

  • Extensive venous obstruction (especially where both jugular veins involved)   →   generalized venous engorgement and coagulation; gross edema; venous distension and/or necrosis of tissues in distal capillary beds.
  • Thrombophlebitis may   →   sepsis and systemic complications as a result of embolic spread.
Thrombosis
  • Localized/diffuse endothelial inflammation   →   exposure of endothelial collagen   →   adherence of fibrin, platelets and cells   →   thrombus formation.
  • Occlusion of major veins   →   increased venous pressure in distal capillary bed   →   edema, ischemia   →   further damage and progressive deterioration.
  • Rate of development important - collateral circulation compensates where present and where occlusion develops slowly or is non-complete.
  • Rapid development of occlusion or bilateral occlusion   →   severe edema (exacerbated by horse's tendency to hang head).

Thrombophlebitis

  • Perivascular reaction   →   damage to adjacent muscles of ventral neck, carotid artery, vago-sympathetic trunk and recurrent laryngeal nerve   →   ipsilateral laryngeal paralysis   Larynx: hemiplegia  , Horner's syndrome   Neurology: Horner's syndrome  and other circulatory effects.
  • Where complicated by sepsis   →   serious systemic consequences - pyrexia, depression, endocarditis   Heart: endocarditis  and embolic dissemination of infection or occluding thrombi.
  • Increased risk of embolic disease where site infected.
  • Deposition of irritant substances and/or bacterial infection medial to jugular is more likely to result in neurologic damage.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Herschl M A et al (1992) Effects of 5% and 10 % guaifenesin infusion on equine vascular endothelium. Vet Surg 21 (6) 494-497 PubMed.
  • Gardner S Y et al (1991) Ultrasonographic evaluation of horses with thrombophlebitis of the jugular vein - 46 cases (1985-1988). JAVMA 199 (3) 370-373 PubMed.
  • Dickson L R et al (1990) Jugular thrombophlebitis resulting from an anesthetic induction technique in the horse. Equine Vet J 22 (3) 177-179 PubMed.

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