Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis (DVT) occurs when a blood clot forms in a vein, frequently in the leg. It can lead to pulmonary embolism (PE), a sudden blockage in a lung artery due to a clot that breaks free and travels from the leg. PE is a potentially fatal condition, so rapid treatment is vital. 

DVT strikes 400,000 Americans yearly, including postsurgical patients and long-distance travelers. Another 200,000 develop PE and nearly one-third of them die.

DVT

When a blood clot or thrombus forms in the large veins of the body, usually in the thigh or calf, it can serve as a “roadblock,” disrupting the flow of the blood returning to the heart. This can cause swelling, pain, and serious complications.  

Risks

Anyone can be affected, but certain factors increase your risk:

• Cardiovascular disease
• Family history of DVT
• Increased estrogen levels from birth control pills, hormone replacement therapy, or having given birth in the past six weeks
• Obesity
• Sitting for long periods of time
• Injury to the vein from major surgery, fractures, or severe muscle injury

Talk to your doctor about how to reduce your risks.

DVT symptoms

• Visible swelling of the leg, along a vein, or behind the knee
• Pain or tenderness in the leg, or fluid collecting in the foot
• Increased warmth in the affected area 
• Red or discolored skin 

PE symptoms

• Unexplained shortness of breath
• Pain during deep breathing
• Coughing up blood
• Rapid breathing or heart rate
• Symptoms can be “silent” and can mimic heart attack, pneumonia, or even anxiety. 

Prevention

“Awareness of DVT and PE is the best way to prevent these conditions,” says John Muir Health hematologist Michael Sherman, M.D. Prevention strategies include:

• Avoiding inactivity, obesity, and smoking
• Getting out of bed and moving around after surgery or illness
• Exercising your lower leg muscles during long trips
• Taking all medicines your doctor prescribes to prevent or treat blood clots
• Using compression stockings to prevent swelling

Your doctor can help develop a prevention strategy with you.

Diagnosis

Many people who experience DVT think that they simply have a cramp, and delay seeking treatment. This is most devastating if the clot goes to the lungs, and causes more serious issues. 

According to Dr.  Sherman, “There are two reasons to move quickly if you suspect you are having a DVT: to get an accurate diagnosis, and to get immediate treatment with a specific blood thinner.” 

He recommends going directly to the ER where diagnostic tests such as ultrasound and venography can be done very quickly. Ultrasound uses sound waves to show blood flowing, and venography uses dye and an x-ray.

If you have symptoms during travel, alert a flight attendant. “You will need to go to an ER for medical attention, to prevent further issues,” says vascular specialist Soo Kim, M.D.

Treatment

Medical treatment options include injectable anticoagulants or blood thinners in pill form, such as Warfarin, to decrease the blood’s ability to clot and to stop existing clots from getting bigger. Therapy usually lasts three to six months while your body dissolves the clot over time.

 In a newer option, vascular specialists can now remove clots in a minimally invasive way for some patients. Using ultrasound, a vascular surgeon pinpoints the clot’s location, and removes it via a catheter.  

According to Dr. Kim, “Very quickly, blood flow is restored, pain is gone, and swelling subsides. This can eliminate long-term effects, as well.  Outcomes have been excellent.”

Traveling

If you are planning a trip that lasts longer than four hours, here are ways to reduce your DVT risk:

• Walk up and down the aisles of the bus, train, or airplane every hour, or if traveling by car stop and walk around
• Wear loose clothing and compression stockings to aid blood flow
• Stay well hydrated and avoid alcohol

If you’re at higher risk, your doctor may prescribe medication before you travel.

Deep Venous Thrombosis (DVT) Causes, Symptoms, and Treatment

Page Navigation

OverviewSymptomsRisksDiagnosisTreatmentsSpecialists

Overview

What is a Deep Vein Thrombosis (DVT)?

Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a deep vein and usually develops in the lower leg, thigh or pelvis.   DVT can happen to anyone and can cause serious complications and disability.  If the blood clot breaks loose, travels to your lungs and gets stuck in your lungs, it will cause a pulmonary embolism and block the flow of blood.  A pulmonary embolism is a serious condition that can cause death.  If DVT is discovered early, it is preventable and treatable. 

There are several conditions that can increase your risk for a DVT: 

• You have an inherited condition that increases your risk of blood clots. 
• Being older than 60 increases your risk, but it can happen at any age. 
• Cancer treatments such as chemotherapy. 
• Injury. 
• Long periods of inactivity such as when traveling or prolonged bed rest.

• Pregnancy and first 6 weeks after giving birth. 
• You are overweight. 
• Smoking. 
• Inflammatory bowel disease. 
• Heart failure. 
• Taking birth control pills. 
• Hormone therapy. 

Your Saint John’s Physician Partners cardiologist can diagnose and treat deep vein thrombosis.   Schedule an appointment today if you have symptoms or are concerned you may have this condition.   

Symptoms

DVT Symptoms 

DVT can occur without any discernible symptoms, but visible signs and symptoms of DVT may include: 

• Swelling the affected leg. 
• Red skin on the leg. 
• Pain in the affected area. 
• Feeling of warmth in the affected leg. 

It’s important to know the warning signs of a pulmonary embolism and that you get immediate help or call 911: 

• Chest pain that worsens when you take a deep breath. 
• Very low blood pressure and feeling light headed, dizzy or fainting. 
• Sudden shortness of breath. 
• Rapid pulse and breathing. 
• Coughing up blood.   

Risks

DVT Risks and Complications 

Complications of DVT may include: 

• Pulmonary embolism is a life-threatening complication when a blood clot travels to your lung and blocks blood flow.  
• Postphlebitic syndrome is damage to your veins due to a blood clot reducing the blood flow to the affected area and causing swelling and pain and skin discoloration. 
• Treatment complications due to prescribed blood thinners that may cause bleeding. 

Diagnosis

DVT Diagnosis

Tests used to rule out or diagnose DVT include: 

D-dimer blood test

D-dimer blood test checks for increased blood levels of D-dimer, a protein produced by blood clots. 

Ultrasound

Ultrasound uses sound waves to create pictures of how the blood flows through your veins. 

Venography

Venography is when a dye is injected into a large vein in your foot or ankle and an X-ray to look for blood clots. 

Magnetic resonance imaging

Magnetic resonance imaging is used to diagnose DVT in your abdomen.

Treatments 

DVT Treatments 

The primary goals of DVT treatment is to stop the blood clot from getting bigger, preventing the clot from breaking off and going to your lungs, reducing the possibility of another blood clot and mitigating long-term complications. DVT treatment options your cardiologist may recommend include: 

Blood thinners

Blood thinners to help prevent the clots from getting bigger and reduce the risk of developing more.

Clot busters

Clot busters, called thrombolytics, are often prescribed in serious cases with severe blood clots. 

Filters

Filters are inserted into a large vein in your abdomen to prevent clots that break loose from going into your lungs. 

Compression stockings

Compression stockings reduce the chance that your blood will pool and clot.  They help prevent swelling.

Surgery

In severe cases, the clot might have to be removed surgically 

Your cardiologist will review your treatment plan and discuss benefits and possible risks and complications so you can make an informed decision. 

Specialists

DVT Specialists 

Michael Broukhim, MD

310-829-7678

2001 Santa Monica Blvd. ,

Suite 360W,

Santa Monica,

CA

90404

Shephal Doshi, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Jordan Kawano, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Alexandra Lajoie, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Robert Merz, MD

310-829-7678

2001 Santa Monica Blvd. ,

Suite 280W,

Santa Monica,

CA

90404

Paul Natterson, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Peter Pak, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Peter Pelikan, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Rigved Tadwalkar, MD

310-829-7678

2001 Santa Monica Blvd. ,

Suite 360W,

Santa Monica,

CA

90404

Stephen A. Tang, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Sarina van der Zee, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Nicole Weinberg, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Richard Wright, MD

310-829-7678

2001 Santa Monica Blvd. ,

Suite 280W,

Santa Monica,

CA

90404

George Wu, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Arshia Mehdi Noori, MD

310-746-5335

8631 West 3rd St.,

Suite 610E,

Los Angeles,

CA

90048

Devin Kehl, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Chenpang Soong, MD

310-829-7678

2001 Santa Monica Blvd. ,

Suite 280W,

Santa Monica,

CA

90404

Seth J. Lichtenstein, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Christiane Schaeffler, MD

310-829-7678

2001 Santa Monica Blvd.,

Suite 280W,

Santa Monica,

CA

90404

Deep vein thrombosis of the lower extremities

Vein thrombosis is a dangerous condition, often accompanied by pain in the legs. Do not put off a visit to the doctor, early treatment and treatment will help prevent complications and keep your feet healthy.

The concept of vein thrombosis

Thrombosis of the veins of the lower extremities is a disease in which blood clots form in the deep veins. Blood clots form inside the lumen of the vessel, which can cause circulatory disorders. More often, blood clots appear at the level of the lower leg or thighs, but they can also be in other places. For example, at the level of the inferior vena cava or the small pelvis.

Thrombosis is dangerous because a detached blood clot can enter the pulmonary arteries, which will cause a violation of gas exchange and oxygen starvation. May end in death.

Thrombosis classification

There are several classifications of deep vein thrombosis according to different criteria. According to the nature of the thrombus, there are:

• Occlusive thrombosis, when a blood clot completely clogs the lumen of the vessel and prevents blood flow.

• Parietal thrombosis – a thrombus is located close to the wall of the vessel, and the lumen remains open.

• Floating thrombosis – a blood clot is freely located inside the vessel and clings to the wall only at one point. At the same time, there is a high probability of its detachment and getting into a vital organ, for example, into the respiratory system through the pulmonary arteries.

According to the form of the course, acute and chronic venous thrombosis are distinguished, and in accordance with the source of the thrombus – congestive, inflammatory and homeostatic.

Causes of formation

The development of venous thrombosis can be caused by various reasons. The main risk factors are:

• Violation of blood flow – it can be caused by a long stay in a sitting or standing position, restriction of movement of the legs, a consequence of injuries and operations on the lower extremities, the presence of tumors that can compress the veins.

• Hereditary predisposition – the presence of genetic mutations that lead to impaired blood clotting.

• Some diseases – the risk of venous thrombosis increases oncology, cardiovascular diseases, infections, blood diseases.

• Hormonal changes – during pregnancy, menopause, as a result of taking hormonal drugs.

• Age over 60 years – the likelihood of venous thrombosis in older people increases, especially in women.

• Excess weight – with obesity or during pregnancy, pressure on the veins of the lower extremities increases.

• Smoking – it negatively affects blood circulation and blood clotting.

In the presence of risk factors, it is necessary to take measures to eliminate or control them in order to prevent the development of deep vein thrombosis of the lower extremities.

Symptoms of thrombosis

The main typical symptoms of thrombosis of the veins of the lower extremities are similar to the signs of thrombophlebitis of the legs. Most often manifested:

• Pain and swelling are one of the first signs of thrombosis. The pain usually starts in the calves and gradually gets worse. There is swelling and swelling around the thrombosed vein. The skin may become hot to the touch and acquire a reddish or, conversely, pale tint.

• Heaviness and fatigue in the legs. Due to the stagnation of venous blood and tissue hypoxia, patients may feel severe heaviness and dull or throbbing pain. When pressing on the calf muscle, the pain intensifies.

• Burning and tingling. Some people feel a burning sensation in the area of ​​the thrombosed vein. This is due to a violation of the normal blood supply in the lower extremities.

• Dilated superficial veins. An expanded venous network may appear on the surface of the skin of the legs. When pressed, the seal is clearly felt.

Depending on the individual characteristics of the body, the location and nature of the blood clot, the symptoms may vary.

Disease diagnosis

Diagnosis of venous thrombosis of the legs covers various research methods:

• Medical examination and history taking. The doctors of our center conduct a detailed examination of patients, assess the manifestation of symptoms, and study the medical history.

• Ultrasound duplex examination. This is a safe and non-invasive procedure that allows you to visualize the structure of the veins and detect the presence of blood clots. Ultrasound combined with Doppler ultrasound can determine the location of the blood clot, its size, and the degree of vein obstruction.

• Analysis for D-dimer. An additional lab test your doctor may order to diagnose thrombosis. D-dimer is a protein fragment, a fibrin degradation product. With thrombosis, its level in the blood rises.

Accurate diagnosis is important to prescribe appropriate treatment and prevent possible complications.

Treatment of disease

Depending on the severity of the condition and the general health of the patient, treatment for deep vein thrombosis may vary. Doctors of the “First Phlebological Center” primarily aim to prevent the separation of a blood clot, prevent the blood clot from increasing and restore the patency of the vessel.

Initial therapy for deep vein thrombosis of the lower extremities is based on the use of anticoagulants. They help prevent further clots from forming and help thin existing ones. The doctor determines the dosage and duration of taking anticoagulants depending on the severity of thrombosis and associated risk factors in the patient.

In difficult cases, thrombolytics are prescribed for treatment. They are administered intravenously through a catheter. If the patient has contraindications to taking anticoagulants, the doctor installs a special filter in a large vein to prevent the displacement of the formed blood clot to the lungs and heart.

In parallel with the main treatment, compression therapy is prescribed. Special elastic stockings help compress the veins and improve blood flow, thereby reducing swelling and preventing the formation of new blood clots.

Prophylaxis

Simple non-drug preventive measures will help prevent the pathological process:

• Create an optimal regimen with physical activity. Regular exercise improves blood circulation and prevents venous blood stasis.

• Maintain normal weight. Overweight and obesity increase the likelihood of thrombosis. Maintain a healthy body weight through a balanced diet and an active lifestyle.

• Avoid prolonged sitting or standing. This leads to slower blood flow in the legs and increases the likelihood of blood clots. During long periods of sitting or standing, take regular breaks to stretch and move around.

• Wear compression stockings. They are especially useful for people at increased risk of venous thrombosis, on long flights or after surgery.

• Avoid smoking. It narrows the blood vessels and increases the likelihood of thrombosis. Quitting smoking will also help improve overall vascular health.

• Monitor the progress of chronic diseases. Take your medications regularly and follow your doctor’s recommendations to control venous disease.

A phlebologist will help draw up the correct prevention scheme after analyzing your specific situation and risk factors.

Conclusion

Deep vein thrombosis of the lower extremities is a serious disease of the venous system that requires medical intervention. Modern diagnostic methods allow you to accurately determine the presence of blood clots and their location. Treatment of leg thrombosis includes anticoagulant therapy to prevent further growth of blood clots and the risk of their separation. Physical activity, proper nutrition, weight control and wearing compression garments will help reduce the likelihood of developing the disease.

Take care of the health and beauty of your legs, sign up for a consultation at the “First Phlebological Center” by phone +7 (495) 185-96-83.

Thrombophlebitis – symptoms, causes, diagnosis and treatment of superficial vein thrombosis

Thrombophlebitis is a disease of the circulatory system, as a result of which a blood clot forms in the vascular lumen. In the process of progression of the pathology, a local inflammatory process develops, accompanied by a violation of blood flow in the affected area. If left untreated, thrombophlebitis may cause serious complications, even death.

The most common disease affects the lower extremities. Pathology can be diagnosed against the background of varicose veins.

Thrombophlebitis: classification

There are several types of the disease, taking into account the origin of the pathology, location, extent of vein damage and other factors:

90 185

Depending on the affected area, the diagnosis is:

Migrating thrombophlebitis. With such a pathology, a thrombus develops in one place. Over time, he disappears and appears in another area. With thrombophlebitis of this type, the patient needs prompt treatment. Local thrombophlebitis. In this case, a thrombus forms and develops in a certain area.
Depending on the presence of pathogens, there are: With this form of the disease, the infection immediately spreads through the bloodstream, which can cause sepsis. Septic thrombophlebitis may be preceded by childbirth, surgery, erysipelas, etc. Treatment involves antibiotic therapy. Aseptic thrombophlebitis. With this pathology, infection does not occur. The disease develops against the background of an injury, incorrect or missing treatment.
Depending on the size of the thrombus, the diagnosis is: In the course of the development of the disease, the lumen of the vein is completely blocked. This becomes the main reason for the violation of the outflow of blood. If left untreated, the risk of tissue necrosis of the extremities increases. The patient needs surgery. Non-occlusive thrombophlebitis. In this case, there is a partial overlap of the venous lumen. Blood circulation is not completely disturbed.
According to the scale of development of pathology in patients, the following can be detected:	Thrombophlebitis of superficial veins. The characteristic symptoms appear immediately. The patient notes pain in the area of ​​the vein. Hyperemia is observed, after which puffiness is formed. With superficial thrombophlebitis, subfebrile temperature sometimes occurs. To eliminate inflammation, the patient is prescribed drug therapy. Deep vein thrombosis. Pathology of this type is detected less frequently and is characterized by a more complex course. The main symptoms remain the same, but they are much more pronounced compared to superficial thrombophlebitis. With deep vein thrombosis, there is severe swelling and blueness of the limb. If the risk of detecting pulmonary embolism increases, this is a direct indication for surgical treatment. It is important to consider that the development of superficial thrombophlebitis is diagnosed first. In the absence of therapy, the pathology develops into deep vein thrombosis.

Thrombophlebitis and varicose veins: main differences

Varicose veins involve increased pressure in weakened and thinned veins. Thrombophlebitis is an inflammatory process accompanied by thrombus formation. In most cases, it develops as a result of varicose veins.

In both cases, there is a violation of blood circulation. It should be borne in mind that with varicose veins, the inflammatory process does not develop.

Causes and risk factors for the development of pathology

Most often, thrombophlebitis of the lower extremities develops as a complication. Provocative factors can be:

• Mechanical damage to the walls of blood vessels. Injury can be observed with severe compression of the limb, illiterate injection, prolonged droppers, surgery, etc.

• Circulatory disorders. Blood flow may slow down due to prolonged wearing of a cast, physical inactivity, heart failure.

• Impaired blood outflow due to venous insufficiency. Pathology is most often diagnosed during pregnancy, as well as when certain diseases of the internal organs are detected.

• Increased blood clotting. Changes may appear on the background of hormonal treatment, with the development of infections.

Other causes may contribute to the development of thrombophlebitis, for example, obesity, allergies, a history of venous thromboembolic complications, autoimmune diseases, etc.

The risk of detection of pathology increases in patients who:

• have diseases of the cardiovascular system, as well as phlebological problems;

• belong to the category of recumbents;

• have a genetic predisposition to impaired hemostasis.

What signs indicate the development of thrombophlebitis?

The most common symptoms include:

• swelling of the affected limb;

• skin redness;

• discoloration of the affected vessel;

• the appearance of painful indurations that are felt on palpation;

• difficulty in performing simple actions: raising a limb, rotation;

• feeling of heaviness and fullness of the veins.

As the pathology progresses, the general condition of the patient worsens. There is a decrease in mobility, the impossibility of prolonged walking, weakness in the limbs and other characteristic symptoms. Flexion of the foot is accompanied by tension in the lower leg.

Why is the disease dangerous?

With thrombophlebitis, a blood clot can break off. If, together with the blood flow, it enters the pulmonary artery, thromboembolism is diagnosed, which can cause death.

In case of untimely appointment of therapy, the risk of developing phlebolith increases. Pathology is characterized by the filling of the lumen of the vein with connective tissue. This, in turn, leads to impaired blood supply and lymph outflow.

Diagnostic features of thrombophlebitis

To make an accurate diagnosis, the doctor prescribes:

• Ultrasound and dopplerography. In the course of the study, the blood flow of superficial and deep veins is determined, areas of narrowing of the lumen of the vessels are identified.

• Computed tomography. The area of ​​transition of the femoral vein into the iliac is usually poorly visible on ultrasound. With K. T. with contrast, visualization improves significantly.

• D-dimer analysis. It must be performed after the ultrasound.

• Blood test. Elevated coagulogram parameters are the basis for confirming the diagnosis. The presence of C-reactive protein indicates an inflammatory process. There is also an increase in leukocytes and ESR.

Depending on the clinical picture, other examinations may be prescribed during the diagnostic process at the discretion of the doctor.

Features of the treatment of thrombophlebitis

Therapy for this pathology is aimed at stopping the inflammatory process, resolving the thrombus and thinning the blood.

Drug treatment	anticoagulants to normalize blood clotting. With an exacerbation of the disease, they are administered in the form of injections; – antibacterial preparations; – angioprotectors to improve venous tone; – anticoagulants; – painkillers for pain relief.
Compression therapy	Special bandages, elastic stockings and sleeves help improve blood flow and prevent blood clots. In addition, well-chosen compression devices can reduce pain.
Physiotherapy treatment	After the acute inflammatory process has been controlled, the patient can be prescribed magnetic therapy, UV therapy, darsonvalization and other procedures. As a result, blood circulation improves and venous walls are restored.
Surgical treatment	Surgical intervention is indicated when the thrombus increases and the probability of vascular lumen occlusion increases. Depending on the complexity of the situation, the following is performed: – crossectomy . With such an operation, access to the vein is carried out through the groin, the doctor makes an incision in the femoral zone; – thrombectomy . With this intervention, the thrombus is removed through one incision; – intussusception stripping . Surgical intervention is performed using a probe; – stenting . A mechanical expansion of the vein is carried out by installing special equipment.

Prevention of thrombophlebitis development and medical recommendations

give up bad habits;

wear comfortable shoes.

Prohibited:

• High-heeled shoes. Allowable size – 3 centimeters;

• give intensive limb massage;

• lift heavy objects;

• visit a bathhouse and sauna;

• be in direct sunlight;

• wear stockings and tight elastic socks.

In agreement with the attending physician, it is recommended to stop hormone therapy. If a woman uses COCs, other methods of contraception should be considered.

Patients who are at risk should regularly visit a phlebologist and undergo ultrasound of the vessels of the extremities.