Kishore K. Arcot , MD, FACC, FSCAI, FSVM, RPVI: Cardiology

The Centers for Disease Control and Prevention (CDC) estimates that every year, one or two of every 1,000 people have deep vein (venous) thrombosis (DVT). And every year, 60,000 to 100,000 of them die from a DVT complication called pulmonary embolism. 

At Memphis Vein Center, board-certified cardiologist Kishore Arcot, MD, has years of experience diagnosing and treating DVT, helping our patients prevent long-term complications and live a thriving, active life. 

We know how important it is to seek prompt treatment for DVT. The only way to know you need treatment is to learn the five signs. 

If you have questions about your symptoms, we’re here to help, so don’t hesitate to call. In the meantime, here’s the information you need to know about your risk for DVT and how you can recognize its symptoms. 

Risk factors for deep vein thrombosis

Any time a blood vessel is damaged, specialized cells go to the area and stop the bleeding by forming a gel-like clot. When the bleeding risk is over, your body naturally dissolves the blood clot.

Unfortunately, blood clots can form when they shouldn’t, and sometimes they fail to dissolve. An unwanted blood clot is called a thrombosis. When the clot develops in a vein deep in your leg, it causes DVT.

Unwanted blood clots form when one or more of the following three things happen: Your blood flow slows down, something makes your blood clot more easily than normal, or you suffer damage to the veins.

The top risk factors contributing to the three criteria include:

• Sitting for a long time
• Obesity
• Smoking
• Diabetes
• Pregnancy
• High blood pressure
• High cholesterol
• Traumatic injuries
• Hip or leg surgery
• Certain medications
• Chronic inflammatory disease
• Family history of blood clots

You also have a higher risk of developing blood clots as you get older.

Signs of deep vein thrombosis

Your symptoms could appear suddenly, making it obvious you have a problem. The signs can also develop so slowly you barely notice them. And for about half of all people with DVT, the signs never appear until they have a pulmonary embolism.

These are the five primary signs of DVT:

Leg pain

Leg pain occurs in about half of all people who have DVT. Your pain may occur suddenly and cause severe discomfort. If that happens, you know you need immediate medical attention.

Your leg pain could also be generic or nonspecific and easy to mistake for a muscle ache. In some cases, you may find that the pain feels worse when you bend your foot up.

Edema or swelling

When a blood clot blocks the vein, fluids start to build up in the tissues of your lower leg. As a result, you have swelling in your lower leg.

Tenderness

At least 70% of patients develop tenderness in the affected leg. Your leg may feel tender to touch above the calf muscles or along the vein where it runs through the inner side of your thigh.

Warm, red skin

The skin over the blood clot may turn red and feel warm.

Skin discoloration

The skin on your affected leg may turn a reddish-purple or blue color. Though it’s quite rare, your skin may appear pale or blanched, a color change that happens if the clot completely blocks the vein.

Signs of pulmonary embolism

DVT turns into a life-threatening condition when the clot breaks away from your leg vein, travels through your body, and gets stuck in your lungs.

This condition, pulmonary embolism (PE), can happen even when you don’t have symptoms of DVT, so it’s good to know the signs of PE:

• Sudden chest pain
• Shortness of breath
• Coughing (with or without blood)
• Excessive sweating
• Irregular or fast heartbeat
• Lightheadedness or dizziness

As the clot stops blood from flowing through your lungs, essential organs don’t get the oxygen they need to survive. That’s when PE turns into a life-threatening problem.

If you suspect you have DVT or you’re concerned about symptoms, don’t wait to call us at our Memphis, Tennessee, center or schedule an appointment online.

What is Deep Vein Thrombosis

What is Deep Vein Thrombosis (DVT)?

DVT is a condition where a Thrombosis, a blood clot, is formed in a deep vein of the vascular system. Veins help move blood to the heart so this condition can be fatal and immediate medical attention is necessary. 

In severe cases, the blood clot can break loose (embolize). The embolus (dislodged clot) can travel to the lungs and block arteries causing a pulmonary embolism (PE). A PE can be fatal. Most of the time, the blood clot will dissolve on its own. 

The CDC states that anyone traveling for more than four hours can be at risk of forming a blood clot.  The longer you are immobile, the greater your risk of developing a blood clot. Other risk factors include age, family history, obesity, and previous surgeries. Due to the wide range of risk factors, a medical professional must perform a deep review of the patient before determining if a DVT is suspected. 

Visit one of our Center for Vascular Medicine Locations for a comprehensive diagnosis. 

Deep Vein Thrombosis

Signs & Symptoms

Symptoms of DVT will only be present in the affected limb.  Symptoms may range from mild to severe and may any combination of the symptoms below. In some cases of DVT, symptoms may not be present.

• Swelling
• Pain – typically worse with flexing the foot of the affected leg even when the pain is in the calf
• Redness
• Warm to touch

If the DVT has traveled to the lungs, known as a pulmonary embolism(PE), you may experience the following symptoms:

• Chest pain
• Shortness of breath
• Persistent cough
• Productive cough with pink discoloration or blood in the sputum

Deep Vein Thrombosis

Causes & Risk Factors

DVT occurs when a clot forms that blocks normal blood flow in the deep veins.   This most often occurs in the large veins in the leg.

DVT develops in 350,000-600,000 people in the US per year.  Approximately 250,000 of these cases are a first time diagnosis. 

A shortlist of Risk factors can include the following:

• Long periods of inactivity including:
  • Long flights
  • Long road trips
  • Long periods of limited activity due to recovery from illness or injury
• Underlying medical conditions that make you more prone to developing DVT
  • Clotting disorders, which are typically hereditary. Many patients may have a family history of DVT. These may include:  
    • Cancer
    • Sickle Cell trait
    • Factor V Leiden
    • Protein C Deficiency 
    • Methylenetetrahydrofolate reductase (MTHFR)
    • Protein S Deficiency
• Pregnancy, including the postpartum period for up to 6 weeks
• Hormone replacement therapy(HRT)
  • Higher risk with oral therapy compared to transdermal HRT
• Oral contraceptives (particularly with smokers)
• Joint replacement surgeries(hip and knee)
• Prior history of DVT
• Obesity

Some DVTs may occur with no known related cause (unprovoked DVT)

List of what causes DVT and patients who have high risk

High-Risk Patients with DVT

Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This condition, on its own, might not cause blood clots unless combined with one or more of the other risk factors.

Prolonged bed rest, such as during a long hospital stay, or paralysis. When your legs remain still for long periods, your calf muscles don’t contract and help blood circulate, which can increase the risk of blood clots.

Injury or surgery. Injury to your veins or surgery can increase the risk of blood clots.

Pregnancy. Pregnancy increases the pressure in the veins of your pelvis and legs. Women with an inherited clotting disorder are at increased risk. The risk of blood clots from pregnancy can continue for up to six weeks after childbirth.

Birth control pills (oral contraceptives) or hormone replacement therapy. Both can increase your blood’s ability to clot.

Being overweight or obese. Being overweight increases the pressure in the veins of your pelvis and legs.

Smoking. Smoking affects blood clotting and circulation, which can increase your risk of DVT.

Cancer. Some forms of cancer increase the amount of clotting factors in your blood. Some forms of cancer treatment also increase the risk of blood clots.

Heart failure. This increases your risk of DVT and pulmonary embolism. The symptoms caused by even a small pulmonary embolism are more noticeable because people with heart failure have limited heart and lung function.

Inflammatory bowel disease. Bowel diseases, such as Crohn’s disease or ulcerative colitis, increase the risk of DVT.

A personal or family history of deep vein thrombosis or pulmonary embolism.  If you or someone in your family has had one or both of these, you might be at greater risk of developing a DVT.

Age. Being older than 60 increases your risk of DVT, though DVT can occur at any age.

Sitting for long periods of time, such as when driving or flying. When your legs remain still for long periods, your calf muscles don’t contract and help blood circulate. Blood clots can form in the calves of your legs if your calf muscles don’t move for long periods.

Caprini Model used before surgery helps determine a patient’s risk of developing a DVT

In 2005, Dr. Joseph Caprini created the “Caprini Model” to help physicians determine if patients are at risk of developing DVT. Today, this is widely used by vascular specialists to help determine patients’ risk of developing DVT after surgery. 

The chart below shows a portion of the comprehensive assessment used by our medical professionals to determine DVT risk after surgery. 

The risk of DVT increases with the presence of more risk factors. CVM’s vascular specialists determine a score of 0-2, to be of low risk. Patients with a risk score of 3 or more should consider anticoagulation (anti-blood clot) medication to decrease the risk of developing DVT. In addition, compression therapy may be recommended. You can also read How do you know if you have blood clot after surgery?

Deep Vein Thrombosis

Diagnosis

D-dimer testing may be initially performed to rule out the presence of DVT. A d-dimer test detects elevated protein levels in the blood which may indicate the presence of DVT. However, there are many other conditions that may also elevate blood protein levels so d-dimer is never relied upon as the sole diagnostic test. 

Duplex ultrasound studies should be done to confirm a diagnosis of DVT and determine location of the clot.  This study is done by placing an external probe on the skin in the area(s) of the suspected DVT.  The veins are visualized by sound waves that pass through the tissues of the limb.

If a PE is suspected, a CT (or ventilation/perfusion VQ) scan may be performed to evaluate for clots that have traveled to the lungs.

Deep Vein Thrombosis (DVT)

Treatment

Venography is a test where dye is injected into the veins. This dye allows blood flow through the veins to be seen under x-ray, CT scan or MRI. 

Treatment of DVT depends on location of the DVT and may include use of compression stockings, anticoagulants, placement of IVC filter, thrombolysis or thrombectomy. 

DVT present in the veins below the knee may only require monitoring with repeat ultrasound studies and use of compression stockings depending on the particular vein the clot is present in.  

Anticoagulants are medications which prevent further formation of blood clots.  Anticoagulants come in a variety of forms including oral medications, intravenous(IV) medications and injectable medications. Anticoagulants are typically given for 3-6 months after initial diagnosis of DVT for patients at low risk for recurrence of DVT.  Further evaluation may be required by a Hematologist to determine if life long anticoagulation therapy is needed, especially in cases of recurrent or unprovoked DVT.

• Heparin
  • IV Heparin:  given in a hospital setting when DVT is first diagnosed
  • Injectable: Unfractionated Heparin and Low Molecular Weight Heparin (Lovenox) may be given by subcutaneous injection under the skin
• Coumadin/Warfarin
  • Oral medication taken once a day
  • INR levels must be monitored on a routine basis
  • Dosage adjustments may be required based on INR levels
  • Heparin is required initially until INR levels are within a therapeutic range
  • Dietary restrictions to foods high in Vitamin K (typically green leafy vegetables)    

• Xarelto and Eliquis
  • No dietary restrictions
  • No need for routine blood level testing
  • No need for additional medications when first initiating therapy
• Pradaxa
  • No dietary restrictions
  • No need for routine blood level testing
  • Heparin products should be given for the first 5-10 days after initiating therapy
  • May be used for DVT treatment but should not be used for DVT prevention.
• IVC filter placement may be recommended in patients who have had PE with DVT history or in patients who are not able to be treated with anticoagulation therapy. IVC filters can be removable or permanent.
• Thrombolysis and thrombectomy are indicated for cases where the DVT/PE is life-threatening, limb-threatening, organ threatening or pose long term complications 
• Thrombolysis is delivery of a medication directly into the vein at the area of the DVT to dissolve the clot.  
• Thrombectomy is mechanical removal of the clot by using special devices placed directly inside the vein.

This article is a comprehensive overview of Deep Vein Thrombosis. However, it should not take the place of speaking with a physician. If you are experiencing any of the symptoms listed above, or know someone who is, contact us today to schedule a consultation.

You can also view other vascular diseases below:

Pelvic Congestion Syndrome

May-Thurner Syndrome

Peripheral Arterial Disease (PAD)

Chronic Venous Insufficiency

Post-Thrombotic Syndrome

FAQs

How to recognize and prevent life-threatening blood clots

If you’ve ever been in a hospital for any length of time, chances are you’ve come in contact with leg cuffs. You know the ones.

Medically known as intermittent pneumatic compression devices, the cuffs wrap around your calves and occasionally tighten to keep blood flowing.

They can be annoying, but their ability to help prevent blood clots could potentially save your life.

Behind heart attacks and strokes, venous thromboembolism (VTE) is the third leading vascular disease affecting between 300,000 to 600,000 Americans each year.   Though treatable, VTEs can lead to complications and, in some cases, death.

It is important to know the signs and symptoms and to take steps with your doctor to treat it.

VTE is a blood clot that starts in the vein. There are two types. Deep vein thrombosis (DVT) is a blood clot in a deep vein, usually in the leg. Pulmonary embolism (PE) occurs when a DVT clot breaks free and travels to the lungs and blocks the blood supply, sometimes proving fatal.

The most common causes for VTEs are immobilization (think long drives, being laid up after an injury, or a long plane ride), surgery, hospitalization and cancer. Other factors such as your weight, whether you smoke, if you’ve taken hormones and your age can play a role as well.

According to the Centers for Disease Control and Prevention (CDC), 60,000 to 100,000 people die each year from VTEs. The CDC estimates as many as 900,000 Americans are affected by VTEs (approximately 1 or 2 out of every 1,000 people).

Some of the warning signs of DVT include:

• Leg pain or tenderness in the thigh or calf
• Swelling in the leg
• Skin that feels warm to the touch
• Redness of the skin or reddish streaks

If you experience any of the following symptoms, it could be a PE:

• Unexplained shortness of breath or rapid breathing
• Chest pain under the rib cage
• Coughing up blood
• Fainting

Both DVT and PE are serious conditions and early diagnosis is key. Contact your doctor if you experience any of the symptoms. Your doctor may run tests that include blood work, CT scans or ultrasounds of the leg to determine if you have a clot. Treatment may include blood thinners, medication to break up the clot or, in some cases, surgery to remove the clot.

There are simple steps you can take to help prevent VTE. The best one is simply to move around. If you sit for long periods of time at work, get up from your desk and walk around for a few minutes.

If you are going to be laid up for a lengthy period due to an injury, talk to your doctor about what you can do to help prevent clotting. And if you’re in the hospital, wear the leg cuffs and take a walk down the hallway when you are able.

At Edward-Elmhurst Health, you’ll find expert, high quality care for peripheral vascular disease (PVD), the broad term for circulatory disorders. Learn more.

Spotting the Warning Signs of a Blood Clot

Blood clots are your body’s natural response to an injury. They serve to stem the bleeding on a cut and seal off the wound so you can heal.

Your blood’s ability to clot is a good thing; however, the formation of a blood clot poses a risk when it blocks the flow of necessary blood to certain areas of your body. Should a blood clot break free and travel through a major artery, it becomes a sudden, and very dangerous threat to your life.

The causes of dangerous blood clots

Your blood can pool if it isn’t flowing well, forming a clot. A few different vascular conditions are also known contributors to the formation of blood clots in your limbs.

Atherosclerosis

This is a disease in which the walls of your arteries become coated with a substance known as plaque. Plaque formations made up of cholesterol and fatty substances that stick together can cake the walls of an artery; if they break off, they can cause a rupture within the artery. This can trigger the body’s natural response to form a blood clot.

Peripheral artery disease (PAD)

A narrowing of the arteries in your body’s periphery — typically in your legs — is called peripheral artery disease. As the arteries narrow, it becomes increasingly difficult for blood to pass to critical areas of your body. If there is a rupture in the artery, a blood clot forms.

Usually, PAD is associated with atherosclerosis. If you notice that your legs are cold or numb, that wounds are slow to heal in your lower body, or that your toenails and leg hair are slow to grow, or if you’re a man experiencing erectile dysfunction, you may have PAD.

Deep vein thrombosis

Blood clots can form deep within the veins of your legs and break off. When the clot travels through the bloodstream, it can form an embolism in your lung, known as a pulmonary embolism. This highly critical condition requires immediate medical attention.

Warning signs of a blood clot

Blood clots, especially in your limbs, cause dangerous medical complications, and even can lead to death. Many people assume blood clots come on suddenly, seemingly out of nowhere and without warning. While many people don’t experience any symptoms, there are some warning signs. 

These signs come on subtly over time or suddenly and severely. Recognizing the possible presence of a blood clot is instrumental in preventing life-threatening results. Be alert for these signs: 

• Leg pain, such as cramping or a charley horse, from which there’s no relief; you may also experience a dull and constant aching deep within your legs, or a weakness, accompanied by pain, especially after exertion
• Swelling in your legs, especially the calf, feet, and ankles
• Legs inexplicably warm to the touch

• Discoloration to your skin — redness or what’s often described as a blue tinge to the legs is common when a blood clot is present
• Legs tender to the touch

Seek immediate medical attention for:

• Shortness of breath; trouble taking a breath
• Coughing, especially if you cough up blood

• Chest pain
• Dizziness or fainting

Don’t take any warning signs lightly. At Advanced Vein & Laser Center, we partner with you to determine the exact cause of your symptoms and develop a customized treatment plan to address blood clots and eliminate your health risks. Our doctors specialize in treating peripheral artery disease and a host of other venous issues.

If you live in the York and Lancaster, Pennsylvania, areas, there’s no need to live with leg pain or the fear of developing blood clots in your legs. Contact Advanced Vein & Laser Center today by calling or using our online appointment request form, and let us put your fears to rest.

Deep Vein Thrombosis (DVT) Risks Signs, Tests & Treatment

Deep vein thrombosis

(DVT) occurs when a blood clot develops in a vein deep in the body. Deep veins are found within groups of muscles. The veins close to the skin are called superficial veins. While these clots most often develop in the lower legs or thighs, they may appear in the upper body, such as the arms or other locations in the body. Deep vein thrombosis is a risk for any major surgery, but patients who have surgery of the legs or hips are at higher risk.

Risk Factors of Deep Vein Thrombosis

Risk of deep vein thrombosis

and thrombophlebitis include, but are not limited to, the following:

• obesity
• an inherited tendency that increases risk for blood clots
• age (greater than 60)

type A blood group

Symptoms of Deep Vein Thrombosis

Deep vein thrombosis occurs without symptoms about 50 percent of the time. When

symptoms of deep vein thrombosis

do occur, they may include:

• swelling in the leg
• red, discolored, or white skin
• a cord in a leg vein that can be felt
• rapid heart beat (tachycardia)
• slight fever
• warm skin
• more visible surface veins
• dull ache, tightness, tenderness or pain in the leg (these symptoms may only occur while walking or standing)

The symptoms of deep vein thrombosis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis of Deep Vein Thrombosis

In addition to a complete medical history and physical examination,

the diagnosis of deep vein thrombosis

may include any, or a combination, of a duplex ultrasound, MRI or venogram.

Deep Vein Thrombosis Treatment

Deep vein thrombosis treatment

may include medications or a vena cava filter.

Specific deep vein thrombosis treatment will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your signs and symptoms
• your tolerance of specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Blood clot symptoms to look out for

In the United States, blood clots claim a life every six minutes.  

While people of all ages can be affected, there’s good news: With proper care, it’s preventable.

The risk of deep vein thrombosis (DVT), a clot in a deep vein, usually in the lower leg, thigh or pelvis, does increase with age. 

WHO IS AT RISK FOR DEVELOPING BLOOD CLOTS?

Clots can also occur in other parts of the body, such as the arm, and if one breaks off and travels through the bloodstream to the lungs, it can cause a pulmonary embolism (PE) – a blockage of arteries in the lungs. 

DVT and PE together are known as venous thromboembolism (VTE). which can cause serious illness, disability or death. 

As many as 100,000 people die from blood clots each year in the U.S., according to the U.S. Centers for Disease Control and Prevention, and VTE affects as many as 900,000 Americans each year.

People who are obese, have lung, heart or inflammatory bowel disease, recent or recurrent cancer, or are on an estrogen-based medication are at higher risk for blood clots.

WASHINGTON WOMAN DEAD AFTER RARE J&J COVID VACCINE-INDUCED BLOOD CLOT

Other major risk factors include hospitalization, surgery, pregnancy, trauma, smoking, a family history of blood clots and immobility or sitting for long periods of time.

Experts say people should be alert for clot symptoms during or shortly after a prolonged car or plane ride.

In addition, AARP notes that scientists have found a link between the COVID-19 virus and abnormal blood clots that are potentially triggered by high levels of inflammation.

Symptoms of DVT include pain or tenderness not caused by an injury, leg or arm swelling, skin that is warm to the touch with swelling or pain, and redness of the skin with swelling or pain. 

Symptoms of PE include difficulty breathing, chest pain that worsens with a deep breath, coughing up blood, very low blood pressure or light-headedness and fainting, and a faster-than-normal or irregular heartbeat.

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If a blood clot is found, most patients will be put on a blood-thinning medicine and surgery may be required in rare cases, the AARP said.

To prevent clots, individuals are advised to know risks and recognize symptoms, see a doctor as soon as is possible if experiencing symptoms, and talk with a doctor about blood clots before any surgery.

Deep Vein Thrombosis (DVT) – Foot Health Facts

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What Is Deep Vein Thrombosis?  

The blood supply of the leg is transported by arteries and veins. The arteries carry blood from the heart to the limbs; veins carry blood back to the heart. The leg contains superficial veins, which are close to the surface, and deep veins, which lie much deeper in the leg. Deep vein thrombosis (DVT) is a condition in which a blood clot (a blockage) forms in a deep vein. While these clots most commonly occur in the veins of the leg (the calf or thigh), they can also develop in other parts of the body.

DVT can be very dangerous and is considered a medical emergency. If the clot (also known as a thrombus) breaks loose and travels through the bloodstream, it can lodge in the lung. This blockage in the lung, called a pulmonary embolism, can make it difficult to breathe and may even cause death. Blood clots in the thigh are more likely to cause a pulmonary embolism than those in the calf.

Causes of DVT

Many factors can contribute to the formation of a DVT. The more risk factors a person has, the greater the risk of having a DVT. However, even people without these risk factors can form a DVT.

Risk Factors for DVT:

Blood or vein conditions:

• Previous DVT
• Varicose veins
• Blood clotting disorders
• Family history of DVT or blood clotting disorders
  
   

Other medical conditions:

• Heart disease
• Chronic swelling of the legs
• Obesity
• Inflammatory bowel disease
• Cancer
• Dehydration
• Sepsis
  
   

Women’s health issues:

• Hormone replacement therapy
• Birth control pills containing estrogen
• Pregnancy or recent childbirth
  
   

Other:

• Age over 40 years old
• Immobility (through inactivity or from wearing a cast)
• Recent surgery
• Trauma (an injury)
• Smoking
  
   

Signs and Symptoms of DVT in the Leg

Some people with DVT in the leg have either no warning signs at all or very vague symptoms. If any of the following warning signs or symptoms are present, it is important to see a doctor for evaluation: 

• Swelling in the leg 
• Pain in the calf or thigh 
• Warmth and redness of the leg
  
   

Diagnosis

DVT can be difficult to diagnose, especially if the patient has no symptoms. Diagnosis is also challenging because of the similarities between symptoms of DVT and those of other conditions, such as a pulled muscle, an infection, a clot in a superficial vein (thrombophlebitis), a fracture and arthritis. If DVT is suspected, the doctor will immediately send the patient to a vascular laboratory or a hospital for testing, which may include a blood test, Doppler ultrasound, venogram, MRI or angiogram.

Treatment of DVT

If tests indicate a clot is present, the doctor will make a recommendation regarding treatment. Depending on the location of the clot, the patient may need hospitalization. Medical or surgical care will be managed by a team of physicians, which may include a primary care physician, internist, vascular (blood vessel) surgeon or hematologist (blood disease specialist).

Treatment may include:

• Medication. A blood-thinning medication is usually prescribed to help prevent additional clots from forming.
• Compression stockings. Wearing fitted hosiery decreases pain and swelling.
• Surgery. A surgical procedure performed by a vascular specialist may be required.
  
   

Complications of DVT

An early and extremely serious complication of DVT is a pulmonary embolism. A pulmonary embolism develops if the clot breaks loose and travels to the lung. Symptoms of a pulmonary embolism include:

• Shortness of breath
• Chest pain
• Coughing up blood
• A feeling of impending doom
  
   

A long-term consequence of DVT is damage to the vein from the clot. This damage often results in persistent swelling, pain and discoloration of the leg.

Preventive Measures

For those who have risk factors for DVT, these strategies may reduce the likelihood of developing a blood clot:

• Take blood-thinning medication, if prescribed.
• Reduce risk factors that can be changed. For example, stop smoking and lose excess weight.
• During periods of prolonged immobility, such as on long trips:
  • Exercise legs every two to three hours to get the blood flowing back to the heart. Walk up and down the aisle of a plane or train, rotate ankles while sitting and take regular breaks on road trips.
  • Stay hydrated by drinking plenty of fluids; avoid alcohol and caffeine.
  • Consider wearing compression stockings.

Treatment of deep vein thrombosis below the knee

Relevance

Venous thromboembolism (VTE) is a condition in which a blood clot forms in a vein, most often in the deep veins of the lower extremities or pelvis. This condition is known as deep vein thrombosis or DVT. The blood clot can move and move in the blood, especially in the pulmonary arteries. This condition is known as pulmonary embolism or PE. The term VTE includes both DVT and PE.

Distal DVT (also known as isolated distal DVT, DVT of the calf, or DVT below the knee) occurs when a blood clot develops in the veins of the legs (below the knee). The most common complications are proliferation of the clot into the proximal (above the knee) veins and migration of the clot into the lungs (PE). The best treatment for distal DVT is not clearly defined. Distal DVT can be treated with either anticoagulants (drugs that help prevent blood clots), with or without the additional use of compression stockings, or without drugs, and it can be monitored with repeated ultrasounds to see if clots are growing, which requires anticoagulation …The main side effect of anticoagulant drugs is an increased risk of bleeding.

Research characteristics and main results

We identified eight randomized controlled trials (clinical trials in which participants were randomly assigned to one of two or more treatment groups) that reported 1239 participants. In five of these trials, participants were randomized to receive anticoagulants for up to three months versus no anticoagulation.Three clinical trials compared anticoagulant treatment over different time periods.

Our review showed that in participants with distal DVT, anticoagulation reduced the risk of DVT recurrence compared to no anticoagulation or placebo (sham treatment). Similar results were obtained with recurrent DVT, although there was no clear effect on the risk of PE. This benefit was noted as an increase in clinically significant minor bleeding but not major bleeding.

In a direct comparison of the duration of treatment, anticoagulant therapy for three or more months was superior to a shorter course of up to six weeks, showing a reduced risk of recurrence of VTE and DVT in the absence of a clear difference in the incidence of severe bleeding and clinically significant minor (minor) bleeding.

Strength of Evidence

When comparing anticoagulation with no anticoagulation or placebo, the reliability of the evidence was high for recurrent VTE, DVT, and clinically significant minor bleeding, and low for PE and severe bleeding. When comparing anticoagulation for three months or more versus six weeks, the reliability of the evidence was high for recurrent VTE and DVT and low for PE, severe bleeding, and clinically significant minor bleeding. The reliability of the evidence was diminished by variations (or imprecision) in the results due to the low number of events.

Conclusions

Our review found benefit for people with distal DVT receiving anticoagulant therapy with little or no clear difference in major bleeding events, although there was an increase in clinically significant minor bleeding compared with no treatment or placebo.The small number of participants in this meta-analysis and the strength of the evidence suggest that more research is needed on the management of distal DVT. Randomized controlled trials comparing different treatments and different treatment periods with placebo or compression therapy are required.

Deep vein thrombosis – Symptoms, diagnosis and treatment

Deep vein thrombosis (DVT) is the formation of a blood clot inside a vein deep in the plane of muscle tissue. DVT most commonly affects the legs, but it can also affect the arms and other parts of the body.

Patients who develop DVT usually have risk factors such as cancer, trauma, major surgery, hospitalization, immobilization, pregnancy, or oral contraceptive use. DVT can also be unprovoked (idiopathic) and occur in the absence of any identifiable external risk factors.

DVT usually causes asymmetric leg swelling, one-sided leg pain, enlargement or distension of superficial veins, and redness or discoloration of the skin, but may also be asymptomatic.

For diagnosis, laboratory and instrumental confirmation of the presence of a blood clot in a deep vein of the leg, pelvis or vena cava is required using duplex ultrasound scanning of veins or computed tomography. However, patients with suspected DVT should undergo an algorithmic diagnostic approach to avoid unnecessary imaging when the likelihood of DVT is low.

DVT is usually treated with anticoagulants such as unfractionated heparin, low molecular weight heparin, fondaparinux, rivaroxaban, apixaban, edoxaban, dabigatran, and / or warfarin. Interventional therapy, including thrombolysis, is rarely indicated.

Typically, patients with DVT require anticoagulant therapy for at least 3 months. Thereafter, individual patients are indicated to continue anticoagulant therapy for secondary prophylaxis in order to reduce the risk of relapse.

Post-thrombotic syndrome may present with symptoms of chronic pain, swelling, skin discoloration, or venous ulcers following chronic venous outflow obstruction and / or venous valve failure.

Deep vein thrombosis (DVT) is the formation of a blood clot in a large deep vein in the leg, hip, pelvis, or abdomen. It can also happen in less common places, such as the veins of the arms; portal, mesenteric, ovarian or retinal veins; or the veins and venous sinuses of the brain. DVT can lead to impaired venous blood flow and, subsequently, to swelling and pain. DVT itself is rarely life-threatening, but it can cause pulmonary embolism (PE), which can be fatal.Venous thromboembolism is a broad term that includes DVT and PE. Superficial vein thrombosis, a common concomitant disease, affects the veins above the muscles. This topic focuses on DVT of the lower and upper extremities.

DEEP VENOUS THROMBOSIS: SYMPTOMS AND TREATMENT

When making a diagnosis, it is not enough to indicate “venous thrombosis of the extremities”. With this pathology, it is important to distinguish between deep and superficial thrombosis of the extremities. These are two different pathologies, with different origins, frequency of cases and causes of occurrence, which, however, are often confused.

We spoke with Dr. Paolo Carlo Righini, angiosurgeon at the Vascular Surgery Department of the Policlinico San Donato Clinical Research Institute, about what venous thrombosis is, its symptoms and treatment.

WHAT IS DEEP AND SURFACE VEIN THROMBOSIS ?

“First of all, it is necessary to distinguish between the functions of the superficial and deep venous systems in the human body. The deep venous system is responsible for the return of venous blood to the heart and center of the body. The superficial venous system is responsible for ensuring that the venous blood of the most superficial part returns to the deep venous circulation and, therefore, to the right chambers of the heart. ”

THROMBOFLEBIT OR THROMBOSIS OF SURFACE VINS

“Superficial vein thrombosis is a pathological condition that often affects the lower extremities.For example, with the well-known varicose veins, the blood flows more slowly, the walls of the vessels are damaged, exposing the molecules of cell adhesion, which can contribute to the development of prothrombotic conditions.

Among the consequences of superficial vein thrombosis:

• thrombus formation;
• Inflammation of the subcutaneous fat near the vein.

With thrombophlebitis, the surface layer of the skin turns red. “

The following vessels are most often involved:

• leg veins,

• great saphenous vein,

• small saphenous vein,

• superficial collateral veins,

• medial saphenous vein of the hand,

• head vein.

Reasons

“Thrombophlebitis can result from stroke, trauma, or prolonged effort. Superficial vein thrombosis has been reported in healthy patients. For example, among the marathon participants, which is an intense and repetitive exercise.

In addition, thrombosis of the upper extremities can be the result of blood sampling, which can be resolved with the use of heparin ointments and / or the introduction of low molecular weight heparin under the skin.

All superficial thrombophlebitis are not a cause for concern, since the superficial venous system is an auxiliary system and if a thrombus is present in a small area of ​​the vein, it is not considered a serious disease, ” says Dr. Righini.

DEEP VEIN THROMBOSE

However, when a blood clot forms in a vein, which is part of the venous system of the lower extremities, that is, blood circulates through it from the foot to the heart, we are talking about deep extremity thrombosis.The venous system of the lower extremities includes:

• tibial veins,

• gastrocnemius veins,

• popliteal vein,

• superficial femoral vein,

• deep femoral vein,

• common femoral vein.

Thrombosis of the iliac veins, which are located in the abdominal cavity, and thrombosis of the systems of the inferior vena cava or superior vena cava, which carry blood to the heart from the lower or upper body, respectively, are also possible.

Symptoms and Causes

“The formation of a clot in the above veins manifests itself in a different way and carries with it a more serious clinical picture than thrombophlebitis. With DVT in the extremities, the patient will have swelling and fever. ”

Causes of DVT can be different and not related to trauma:

• Neoplasms .Some masses are associated with a prothrombotic status, which increases the likelihood of blood clots;

• Thrombophilia . This is a congenital pathological condition characterized by a violation of the blood coagulation system, in which pathologies such as Leiden mutation, deficiency of protein C or protein S, lupus anticoagulant are observed, which also affect young people;

• Extensive Abdominal Fired , Orthopedic Fired , Gynecological Fired Surgical Intervention or any other reason for prolonged bed rest .When we are in motion, our muscles and veins contract, which promotes venous return and outflow of venous blood. Prolonged bed rest reduces venous return of blood and, in susceptible individuals, promotes the formation of deep vein thrombosis, as a result of which prophylaxis with heparin is necessary. The greatest risk is movement, which can lead to pulmonary embolism. For the prevention of this pathology, it is necessary to use therapeutic elastic stockings with graduated compression.

• Electrophysiological procedures for the installation of defibrillators / pacemakers. These procedures involve the insertion of catheters into the subclavian vein and, in rare cases, can contribute to the formation of blood clots in predisposed subjects, especially during reimplantation or replacement of previously implanted catheters.

DIAGNOSIS

“Deep vein thrombosis occurs when three factors are present:

• change in blood flow velocity,
• damage to the endothelium (anomaly of the inner surface of the vessel),
• hypercoagulation (inherent in Virchow’s triad).

Patients have swelling and tenderness of the limb, as well as increased body temperature.

With an echococordopler, you can check the blood flow in the vein and its compressibility (compression ultrasound – CUS). If the vein is not compressed, there is a risk of a blood clot being present.

In addition, for patients with bleeding disorders and thrombophilia who are related to people with genetic mutations or neoplasms, it is necessary to take a biochemical blood test.

If edema occurs, perform a venous echococordopler immediately and check for the presence of D-dimer in the blood. D-dimer is a protein, the absence of which a priori excludes the presence of deep vein thrombosis. On the other hand, its presence does not necessarily indicate DVT, except for extremely high rates and typical clinical signs. ”

With inflammation of superficial veins, as with thrombophlebitis, it is easier to recognize the pathology:

“The venous clot can be detected by touch, it is hard and painful on palpation. Redness is observed on the skin, the tissues around the affected vein become hard. ”

PREVENTION AND TREATMENT

With timely diagnosis, venous thrombosis (even of deep veins) is not a complex pathology.

“Thanks to anticoagulant therapy (NAO and TAO drugs), blood clots dissolve and the risk of deep vein thrombosis or pulmonary embolism is reduced.In addition, the use of compression elastic stockings reduces the risk of blood clots, movement and edema.

The presence of varicose veins is a risk factor for the development of thrombophlebitis. Concludes Dr. Righini:

“In the presence of varicose veins, it is necessary to consult an angiosurgeon and undergo Doppler ultrasound. In addition, to prevent the development of pathologies, it is necessary to wear compression elastic stockings, take venotonic drugs as prescribed by a doctor, and, if necessary, perform an operation to remove varicose veins. “

Date: 03.06.2021

Translation and editing: Viktoryia Luhakova

90,000 Phlebology on Vasilievsky Island St. Petersburg, treatment of venous diseases

Phlebology – a branch of medicine that deals with the study, diagnosis and treatment of venous diseases, is a subsection of angiology – the science of blood vessels.

Types of vein pathologies

Varicose veins disease of the lower extremities is an expansion and deformation of the veins that occurs due to a malfunction of the venous valves, as a result of which there is a difficulty in the outflow of blood from the lower extremities, which in turn increases the pressure inside the vein.As a result: thinning and stretching of the walls. Bulges appear in the thinnest places. Varicose veins are progressive. If you delay with its treatment, you can get complications: thrombosis, trophic ulcers and thrombophlebitis.

Thrombosis is the formation of blood clots (thrombi) in deep veins that obstruct blood flow. The reasons may be damage to the vascular wall, violations of the composition of the blood and the nature of the blood flow.

Thrombophlebitis. Causes inflammation of the walls of superficial veins and the formation of a blood clot, which closes their lumen and clogs smaller veins. It is a common complication of varicose veins of the lower extremities.

Chronic venous insufficiency is a symptom complex associated with impaired venous outflow in the legs. It is manifested by rapid fatigue and heaviness, pain, edema in the lower extremities.

Post-thrombophlebitic syndrome is a symptom complex that occurs as a result of deep vein thrombosis and leads to hemodynamic disorders of various severity and localization, which are manifested by edema, trophic skin disorders (pigmentation, dermatitis, eczema, ulcers).

It is necessary to visit a phlebologist if you have symptoms such as:

• Feels heaviness and fullness in the legs;
• after walking, severe fatigue and rapid fatigability are felt;
• periodically disturbed by muscle cramps of the calf muscles, pulsation;

90,096 veins are visually protruding and enlarged;

• there are swelling of the legs;
• spider veins appear or under the skin you can see blood vessels of red or blue shades;
• worried about pain in the legs and burning, tingling, itching.

Methods of treating varicose veins

They use conservative and surgical methods of treating venous pathologies.

Surgical methods play a major role and are reduced to the removal of veins in various ways:

• Minimally invasive surgery: performed using laser coagulation of veins (EVLK) – based on the thermal effect of laser radiation on the vein wall.
• Miniflebectomy is a minimally invasive procedure when a vein is removed through a small puncture or incision.
• Sclerotherapy (compression phlebosclerosis) is a method of treating varicose veins, based on the introduction of a special preparation of sclerosant into a vein, as a result of which the affected veins stick together and gradually disappear.

Benefits of minimally invasive vein treatment:

• do not require hospital stay;

90,096 pass under local anesthesia;

• take 20-60 minutes;

90,096 are painless;

• allow you to return to your usual way of life on the same day. The patient continues to be able to work throughout the treatment.

The operative method of treatment is used for advanced varicose veins, requires hospitalization in a hospital, general anesthesia is used.

Conservative vein treatment methods are used in conjunction with surgical methods, they help relieve symptoms, recover faster after minimally invasive interventions or operations. Tablets, ointments and compression garments are additional means to the main therapy that must be taken as prescribed by a doctor.

Services

Sclerotherapy is a procedure used to treat diseases of the vascular (venous) system. It is performed on the veins of a smaller diameter. To do this, a special drug is injected into the lumen of the vessel with a syringe, which causes sticking of its walls and further resorption.

Sclerotherapy in the treatment of varicose veins is not inferior in efficiency to classical surgery, practically painless. The procedure takes about ten minutes.The course of treatment consists of several procedures (on average up to 5 sessions), which are performed on an outpatient basis.

Foam-form technology or foam sclerotherapy for varicose veins is used to remove the larger saphenous veins of the legs. A sclerosant in the form of finely dispersed foam is injected into the vein. The advantage of this method is that when a substance enters the venous lumen, it does not mix with blood, but pushes it out. There is a chemical destruction of the surface of the endothelium of the vessel, as a result of which the walls stick together and the vein gradually disappears.

Endovasal (endovenous) laser coagulation (obliteration) of varicose veins (EVLK, EVLO) is a modern method designed to eliminate blood reflux in superficial and perforating veins using the thermal energy of laser radiation. It is performed on the veins of a larger diameter.

Miniflebectomy – removal of varicose veins through micro-punctures of the skin.