Deep Vein Thrombosis and Pulmonary Embolism | Mount Sinai

When a blood clot forms in your arm or leg vein, we call it deep vein thrombosis (DVT). If left untreated, the clot may become larger and cause significant swelling or pain in your arm or legs. An embolism can also break off and travel to your lungs, causing breathing difficulty, chest pain, and putting stress on your heart. We call this condition pulmonary embolism (PE). The bigger the clot, the more dangerous this becomes.

Generally, DVT stems from a combination of factors, including an injury (e.g., surgery, motor vehicle accident), inactivity (due, perhaps, to a long plane ride, hospitalization, or recuperation from surgery), and a condition that makes you more likely to experience clotting (such as pregnancy, cancer, or genetics). Using tobacco or contraceptives also increases your risk of a blood clot.

If you don’t have any of these factors, we consider the DVT to be “unprovoked.” It is important to determine whether your blood clot is provoked or not, as it affects treatment and prognosis. Certain conditions can increase your risk of blood clots, including:

• May-Thurner syndrome occurs when the main vein in your left leg (common iliac vein) gets compressed between your right leg artery and the spine. This may cause scarring and increase your risk of a blood clot in the left pelvis and thigh.
• Thoracic outlet syndrome (TOS) happens when your large arm vein is compressed between the first rib and collar bone (clavicle). This can form scar tissue, which leaves you vulnerable to DVT. If you suddenly develop DVT in your arm, usually when you’re involved with some sports activity such as swimming, we call it effort thrombosis or Paget-Schroetter’s syndrome.

If you have DVT, you may have a number of symptoms including sudden swelling and/or pain in the affected arm or leg, reddish skin, and dilated veins on the surface of the arm or leg.

If you develop PE, you might have sudden shortness of breath and chest pain. . You could also experience dizziness, fast or irregular heart rate, low blood pressure, low oxygen level, or fainting (syncope). If you have these signs, please go to the nearest emergency room.  

The best way to prevent DVT and PE is by reducing the risk factors that can lead to these conditions. It can help to exercise regularly, elevate your legs, avoid prolonged standing, and stop smoking. If you are going to be immobile due to surgery or hospitalization, we may prescribe blood thinning medication in advance.

To diagnose DVT, we start with a physical exam, an electrocardiogram or EKG, and assess your symptoms. We may also need to do blood work and imaging. We typically use one or more of these imaging tests:

• Arm or leg ultrasounds are sonograms that check your veins for a blood clot. This test is highly accurate and non-invasive.
• Computed tomography angiography (CTA) uses X-ray technology and contrast material to generate 3D pictures of the arteries of the lung. This quick exam is the gold standard for diagnosis of PE.
• Ventilation/perfusion scan (VQ scan) is less common than the CTA though it is more accurate. This nuclear medicine exam compares the parts of the lung that are receiving blood to those that are receiving air. If there are areas that don’t match up, it indicates a blocked artery caused by PE.

If you have urgent PE symptoms, such as low blood pressure, fainting, heart strain, or low oxygen level, we may start some treatment immediately.

We may start by doing blood work, to see whether we need to do an imaging test. We often start with the D-timer test, which measures blood clotting and can help us rule out a DVT or PE.

If we diagnose PE, we may conduct additional testing to evaluate the strain on your heart and the extent of blood clotting in the legs. We may do ultrasounds of your heart (transthoracic echocardiogram) and both legs.

Mount Sinai vascular specialists are experts in the treatment and long-term management of VTE. We often use blood thinning medication to stabilize the blood clot and prevent further PE. Blood thinners do not break down an existing blood clot, but they stop it from growing and progressing to PE. We tend to use one of these blood thinners:

• Heparin agents (enoxaparin) are injectable medications that you take twice a day or as continuous infusions (unfractionated heparin) that we administer only in the hospital.
• Warfarin is an oral blood thinning agent. We adjust your dose to meet your specific needs, which can take anywhere from a few days to a few weeks to establish the proper dosage for you. During this time, we may give you heparin to protect you from blood clots. Taking other medications and a number of common foods can make you vulnerable to bleeding or blood clots while on this medication. Our doctors will discuss these considerations with you before starting a prescription plan.
• Novel oral anticoagulants act by blocking blood factors involved with clotting. Dosing varies: you take dabigatran and apixaban twice a day and rivaroxaban and edoxaban once daily. These medications help you achieve the appropriate level of blood thinning without having to adjust the dose or monitor your blood.

For those very rare occasions when blood thinning medication is not an option, we may use a device called an inferior vena cava (IVC) filter to protect you from PE. We implant the filter in your groin or neck vein through a minimally invasive procedure, then deploy it into your abdomen.  We use both temporary filters (for a few months) and permanent ones.

We may use a clot-busting medication if you have a life-threatening PE. The medicine will break down the blood clot in the lung immediately, a process called thrombolysis. We deliver this medication either by injection in the vein (systemic thrombolysis) or through a small tube (catheter) in the groin area, a procedure called mechanical and catheter-directed thrombolysis. In rare cases, we remove the blood clot surgically.

If you have May-Thurner or thoracic outlet syndrome, we may also need to remove the clot from your blood vessel. We can do this by mechanical and catheter-directed thrombolysis, performing surgery to remove the first rib, or implanting a mesh tube (stent) inside your vein to keep it open long-term.

You might experience long-term effects of DVT and PE. The major effects may be:

• Venous insufficiency or “leaky veins” and post-thrombotic syndrome (PTS) affects about half of everyone who’s experienced DVT. It happens when blood pools in the legs because the veins are not functioning properly. Symptoms include leg swelling, redness, varicose veins, dark-stained skin, and, in severe cases, non-healing ulcers. The best treatment is prevention; we recommend wearing compression stockings (prescription grade) to prevent PTS.
• Chronic thromboembolic pulmonary hypertension (CTEPH) results from an old or recurrent PE that causes high blood pressure in the lungs and heart strain over time. While this doesn’t happen often, symptoms include shortness of breath, limited ability to exercise, dizziness, leg swelling, chest pain, and palpitations. Our vascular surgeons work together with a cardiologist to manage these cases.

Leg Swelling: Could It Be Deep Vein Thrombosis?: Minneapolis Vein Center: Interventional Radiologists

Leg Swelling: Could It Be Deep Vein Thrombosis?: Minneapolis Vein Center: Interventional Radiologists

Sudden leg swelling and pain are some of the telltale symptoms of deep vein thrombosis (DVT), a serious condition in which a blood clot forms in the deep veins of the leg or pelvis. Other symptoms include abnormal warmth and discoloration. Leg swelling and other symptoms are almost always present in just one leg. If you’re at risk for developing a blood clot and you notice leg swelling or other symptoms, contact your physician right away.

Risk Factors for DVT

• Inherited blood-clotting disorder
• Prolonged bed rest, such as a hospital stay, or prolonged sitting, such as in a long plane ride
• Recent injury or surgery
• Pregnancy
• Being overweight
• Smoking
• Personal or family history of DVT

Complications

As many as 600,000 cases of DVT occur in the United States each year. DVT is a medical emergency. The condition could be fatal if it develops into a pulmonary embolism, in which portions of the DVT clot break off and block blood vessels in the lungs. Symptoms of a pulmonary embolism include sudden shortness of breath, chest pain, dizziness or lightheadedness, or coughing up blood.

Deep Vein Thrombosis Treatment

The interventional radiology experts at Minneapolis Vein Center use pharmacomechanical thrombolysis (PMT) to break up the DVT and prevent potential complications like post-thrombotic syndrome (PTS) or pulmonary embolism. During the procedure, a very small catheter is used to deliver the clot dissolving drugs right into the clot. Only a very small nick in the skin is left behind and no stitches are necessary. Early diagnosis – when the DVT has existed for less than three to four weeks – allows the PMT to completely dissolve the clot for most patients.

What to Do if You Have Leg Swelling

If you have one or more risk factors for developing deep vein thrombosis and you notice leg swelling, or any other DVT symptoms, contact your physician right away. Your physician can refer you to a specialist, who can treat your clot quickly to prevent any complications.

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Complications of varicose veins – Phlebology Center

The main complications of varicose veins are phlebitis, thrombophlebitis, widespread thrombosis, pulmonary embolism.

Thrombophlebitis

Thrombophlebitis is diagnosed when there are blood clots in inflamed varicose veins. Thrombophlebitis usually occurs after phlebitis, if appropriate measures are not taken in time. A thrombus is a blood clot that should be distinguished from a lump of just coagulated blood. Coagulation occurs when blood stops as a result of platelets settling on the internal damaged areas of the veins. A thrombus is more formed and dense than a clot of coagulated blood.

Blood clots are five times more common in veins than in arteries. And in the veins of the lower extremities, blood clots form three times more often than in the rest. Usually, the thrombus is only partially associated with the vessel wall, and most of it floats freely in the lumen of the vein. These peculiar “tails” can periodically break away from the places of their formation and be carried away with the blood flow farther towards the heart. The signs of thrombophlebitis are almost the same as the signs of phlebitis: the same aching dull pains in the legs, swelling of the legs is possible, characteristic of venous varicose veins . Usually, these clots rarely break away from the sites of education. In such cases, this complication does not pose any particular danger. But sometimes these blood clots can break away from their places and roam freely through the circulatory system. And this can end very badly.

A blood clot in one of the trunks of the pulmonary artery can lead to instant death. Therefore, with developing thrombophlebitis, many doctors recommend removing those parts of the veins that are affected by thrombophlebitis as soon as possible. Of course, there are cases when the patient cannot be operated on immediately or in the near future. In such cases, it is necessary to resort to active conservative therapy under regular medical supervision.

Thrombosis

Thrombosis is usually a development of thrombophlebitis. This disease occurs as a result of a blood clot entering the deep veins. This complication is much more dangerous than the previous two. It is deadly because the deep veins are directly connected to the heart, and through it to the pulmonary artery. In addition, deep vein thrombosis is extremely difficult to recognize. All existing diagnostic methods that we talked about above are ineffective for this. Since thrombosis primarily occurs, as a rule, in the thickness of the calf muscles, its most striking signs can be a sharply manifested swelling of the ankle and a feeling of expansion of the calf muscles, especially when they are strained. .

If the blood clots spread to the veins of the abdominal cavity, then swelling and pain will seize the entire leg. However, there are times when pain appears in one leg, while thrombosis affects the other. Statistics show that more often thrombosis affects the left leg. With these symptoms, it is urgent to go to the clinic and do an ultrasound of deep veins.

Pulmonary embolism

What happens when a blood clot breaks away from the wall of a vein and begins to move up along it towards the heart? The blood stream carries this thrombus, now called a thromboembolus, to the right side of the heart. From there, the thromboembolus is ejected into the pulmonary artery. There, this clot gets stuck in one of the lumen of the pulmonary artery, reducing the flow of oxygen-enriched blood to the left atrium. The larger the thromboembolus, the more the lumen of the pulmonary artery will be blocked by it, and the more serious the consequences of such blockage will be. In such cases, the patient suddenly feels a sharp pain in the chest, he begins to cough, shortness of breath, breathing becomes frequent and intermittent. A similar attack in the case of a very large blood clot can even be fatal.

Trophic ulcers usually occur on the inner surface of the lower leg. With self-treatment, when the patient is treated on the “Internet” with the use of ointments, tablets, leeches. These ulcers are not only unpleasant in themselves: they get wet and itch.

Named 6 signs by which a bruise can be distinguished from a blood clot

• Health

A harmless bruise on the leg, arm or abdomen can hide a formidable disease. The main thing is to notice the signs of the problem in time and start treatment.

April 21, 2022

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Thrombosis is one of those dangerous diseases that may not make themselves felt at all for a long time – but if they are not diagnosed in time, it can lead to death. However, as doctors say, in some cases, the formation of a blood clot can be seen by external signs.

The problem is that this symptom is often confused with a bruise. However, there are several important differences between these phenomena.

Factors that increase the risk of experiencing thrombosis:

• Taking oral contraceptives;

• Past COVID-19;

• Obesity;

• Diabetes mellitus;

• Diseases of the heart and blood vessels;

• Genetic predisposition.

See also

According to experts, the symptoms of a blood clot may become noticeable if the blood clot is close to the surface of the skin or if it interferes with blood flow. This most often happens when a blood clot appears in the legs, arms, or abdomen. And in people with pulmonary embolism, the skin tends to take on a bluish tint.

If a blood clot has clogged the veins, spots may appear on the skin that resemble hematomas, as excess blood enters the tissues.

These manifestations of a blood clot can be easily confused with a bruise, but hematomas have several distinguishing features:

• In the bruised area, the skin usually changes color as it heals;

• Bruises are usually painful to the touch, and the more time has passed since the onset of the bruise, the less discomfort it causes;

• Bruising usually occurs after an injury.

In addition, there are several symptoms that indicate that the cause of the spot on the skin is a blood clot and that you need to seek professional help as soon as possible:

• Throbbing or cramping pain in the limbs, severe swelling or redness;

• Sudden shortness of breath, sharp pain in the chest, aggravated by inspiration;

• Cough, hemoptysis.

Other symptoms of a blood clot:

• Feeling tired, easily fatigued;

• Pale skin;

• Blue lips;

• Coldness in extremities;

• Disorders of brain activity.

Read also

In what cases is a bruise dangerous? For example, sometimes hematomas are confused with symptoms of varicose veins. If your bruise consists of small vessels, they look like stars or spiders, do not put off a visit to the specialists.

By the way, bruises often appear on the background of taking anticoagulant therapy: it would seem that you don’t hit so hard – but a hematoma appears. This is normal: such drugs increase bleeding time due to blood thinning.

Read also

By the way

Proper nutrition is one of the most important components of a healthy lifestyle. There are healthy foods, and there are eating habits that, for example, can increase the risk of a blood clot.