What are the warning signs of DVT in different parts of the body. How can you identify a potentially dangerous blood clot. What factors increase your risk of developing DVT.

Understanding Deep Vein Thrombosis: A Comprehensive Overview

Deep vein thrombosis (DVT) is a serious medical condition that occurs when a blood clot forms in a deep vein, typically in the legs or arms. While blood clots play a crucial role in stopping bleeding from cuts and injuries, they can become dangerous when they form inappropriately or fail to dissolve naturally. DVT poses significant health risks, as these clots can potentially break free and travel to vital organs, causing life-threatening complications.

The formation of blood clots in deep veins can occur in various parts of the body, each presenting unique symptoms and risks. Understanding these symptoms is crucial for early detection and prompt medical intervention.

What causes Deep Vein Thrombosis?

DVT can be caused by several factors, including:

• Prolonged immobility (e.g., long flights, bed rest after surgery)
• Injury to blood vessel walls
• Increased blood clotting tendency due to medical conditions or medications
• Obesity
• Smoking
• Pregnancy and postpartum period
• Certain medical conditions (e.g., cancer, heart failure)

Recognizing DVT Symptoms in the Arms and Legs

DVT most commonly occurs in the lower extremities, but it can also affect the arms. Identifying the symptoms early is crucial for timely treatment and prevention of complications.

Common symptoms of DVT in the arms and legs include:

• Swelling in the affected limb
• Pain or tenderness, often described as a cramping sensation
• Redness or discoloration of the skin
• Warmth in the affected area
• Visible surface veins

Is it possible to have DVT without noticeable symptoms? Yes, in some cases, DVT can occur with minimal or no symptoms, making regular check-ups crucial for those at high risk.

Pulmonary Embolism: A Life-Threatening Complication of DVT

One of the most serious complications of DVT is pulmonary embolism (PE), which occurs when a blood clot breaks free and travels to the lungs. This condition can be life-threatening and requires immediate medical attention.

Symptoms of pulmonary embolism include:

• Sudden shortness of breath
• Chest pain that worsens with deep breathing
• Rapid heartbeat
• Coughing, sometimes with bloody sputum
• Lightheadedness or fainting

How quickly can a pulmonary embolism develop after DVT? A pulmonary embolism can occur within hours to days after the formation of a deep vein thrombosis, emphasizing the importance of prompt diagnosis and treatment of DVT.

DVT and Its Impact on Cardiovascular Health

While DVT primarily affects the venous system, it can have significant implications for overall cardiovascular health. The relationship between DVT and heart health is complex and multifaceted.

Potential cardiovascular complications associated with DVT:

• Increased risk of heart attack
• Strain on the heart due to pulmonary embolism
• Development of chronic venous insufficiency
• Potential for paradoxical embolism in patients with patent foramen ovale

Can DVT directly cause a heart attack? While DVT itself doesn’t directly cause heart attacks, the systemic inflammation and hypercoagulable state associated with DVT can increase the risk of arterial thrombosis, potentially leading to heart attacks in some cases.

Neurological Manifestations of Blood Clots

Blood clots can have severe neurological consequences, particularly when they affect the blood vessels supplying the brain. Stroke is one of the most serious neurological complications associated with blood clots.

Key neurological symptoms to watch for include:

• Sudden weakness or numbness, especially on one side of the body
• Confusion or difficulty speaking
• Vision problems
• Severe headache
• Loss of balance or coordination

How quickly should one seek medical attention for suspected stroke symptoms? Immediate medical attention is crucial for stroke symptoms. The “golden hour” for stroke treatment is within the first 3-4.5 hours after symptom onset, making rapid response essential for better outcomes.

Abdominal and Renal Complications of Blood Clots

Blood clots can also affect the abdominal region and kidneys, leading to a range of symptoms and potential complications. These areas are often overlooked but can be significantly impacted by thrombotic events.

Symptoms of abdominal and renal blood clots may include:

• Severe abdominal pain
• Nausea and vomiting
• Blood in urine
• Decreased urine output
• Swelling in the legs or abdomen

Can blood clots in the abdomen or kidneys be life-threatening? Yes, blood clots in these areas can be life-threatening if left untreated. They can lead to organ damage, intestinal ischemia, or kidney failure, requiring urgent medical intervention.

Risk Factors and Prevention Strategies for DVT

Understanding the risk factors for DVT is crucial for prevention and early intervention. While some risk factors are unavoidable, many can be modified through lifestyle changes and medical management.

Common risk factors for DVT include:

• Advanced age (over 60 years)
• Obesity
• Smoking
• Use of hormonal contraceptives or hormone replacement therapy
• Recent surgery or trauma
• Prolonged immobility
• Family history of blood clotting disorders
• Certain medical conditions (e.g., cancer, heart failure, inflammatory bowel disease)

What are effective strategies for preventing DVT? Prevention strategies include maintaining a healthy weight, staying physically active, avoiding prolonged periods of immobility, quitting smoking, and discussing risk factors with healthcare providers. For high-risk individuals, medical interventions such as anticoagulant therapy or compression stockings may be recommended.

Diagnostic Approaches and Treatment Options for DVT

Accurate diagnosis of DVT is crucial for appropriate management and prevention of complications. Various diagnostic tools and treatment options are available, depending on the severity and location of the clot.

Common diagnostic methods for DVT include:

• Duplex ultrasound
• D-dimer blood test
• Venography
• CT or MRI scans

Treatment options may include:

• Anticoagulant medications (blood thinners)
• Thrombolytic therapy for severe cases
• Inferior vena cava (IVC) filters
• Compression stockings
• Lifestyle modifications

How long does DVT treatment typically last? The duration of DVT treatment varies depending on the individual case. Anticoagulant therapy may be prescribed for 3-6 months or longer, while lifestyle modifications and preventive measures may be lifelong.

Emerging Therapies and Research in DVT Management

The field of DVT management is continuously evolving, with ongoing research into new treatments and preventive strategies. Some areas of current interest include:

• Novel oral anticoagulants with improved safety profiles
• Catheter-directed thrombolysis techniques
• Personalized medicine approaches based on genetic risk factors
• Advanced imaging techniques for early detection

What promising new treatments are on the horizon for DVT? Researchers are exploring targeted therapies that can dissolve clots more effectively with fewer side effects, as well as developing new preventive strategies for high-risk populations.

Living with DVT: Long-Term Management and Quality of Life

For many individuals, a DVT diagnosis can have long-lasting impacts on their lifestyle and overall health. Managing the condition effectively involves a combination of medical treatment, lifestyle modifications, and ongoing monitoring.

Key aspects of long-term DVT management include:

• Adherence to prescribed anticoagulant therapy
• Regular follow-up appointments with healthcare providers
• Maintaining an active lifestyle within medical guidelines
• Managing related conditions such as post-thrombotic syndrome
• Emotional support and coping strategies

Can patients fully recover from DVT and resume normal activities? Many patients can recover and return to their normal activities after DVT treatment. However, some may experience long-term effects such as chronic venous insufficiency or post-thrombotic syndrome, requiring ongoing management.

The Importance of Patient Education and Support

Educating patients about DVT, its symptoms, and prevention strategies is crucial for improving outcomes and reducing the risk of recurrence. Support groups and patient resources can play a vital role in helping individuals cope with the physical and emotional challenges of living with DVT.

How can patients stay informed about their condition and treatment options? Patients should maintain open communication with their healthcare providers, participate in educational programs, and stay updated on the latest research through reputable medical sources and patient advocacy organizations.

Global Impact and Public Health Initiatives for DVT Awareness

Deep vein thrombosis and its complications represent a significant global health concern. Efforts to raise awareness and implement preventive strategies on a population level are crucial for reducing the burden of this condition.

Public health initiatives focused on DVT may include:

• Awareness campaigns about DVT symptoms and risk factors
• Implementation of DVT prevention protocols in hospitals and long-term care facilities
• Travel-related DVT prevention strategies, such as in-flight exercises and recommendations
• Integration of DVT risk assessment into routine health check-ups

What role do international health organizations play in addressing DVT globally? Organizations like the World Health Organization (WHO) and International Society on Thrombosis and Haemostasis (ISTH) work to establish guidelines, promote research, and coordinate global efforts to reduce the impact of DVT and related conditions.

The Economic Burden of DVT and Related Conditions

The financial impact of DVT on healthcare systems and individuals is substantial. Understanding the economic aspects can help drive policy decisions and resource allocation for prevention and treatment.

Factors contributing to the economic burden of DVT include:

• Direct medical costs of diagnosis and treatment
• Indirect costs due to lost productivity and disability
• Long-term care costs for chronic complications
• Costs associated with preventive measures and education

How can healthcare systems balance the costs of DVT prevention with potential savings from reduced complications? Implementing cost-effective screening and prevention programs can potentially lead to significant savings by reducing the incidence of severe DVT complications and associated treatments.

Future Directions in DVT Research and Management

As our understanding of DVT continues to evolve, researchers and clinicians are exploring new frontiers in diagnosis, treatment, and prevention. The future of DVT management holds promise for more personalized and effective approaches.

Areas of ongoing research and development include:

• Advanced imaging techniques for early and accurate diagnosis
• Personalized risk assessment tools incorporating genetic and environmental factors
• Novel anticoagulants with improved safety profiles and easier management
• Minimally invasive interventions for clot removal
• Artificial intelligence applications in DVT prediction and management

How might artificial intelligence impact DVT care in the future? AI technologies could potentially revolutionize DVT management by improving risk prediction, optimizing treatment selection, and enhancing patient monitoring through wearable devices and data analysis.

The Role of Telemedicine in DVT Management

The growing field of telemedicine offers new opportunities for DVT care, particularly in remote or underserved areas. Virtual consultations, remote monitoring, and digital health tools can enhance access to specialized care and improve patient outcomes.

What are the potential benefits and limitations of telemedicine for DVT patients? Telemedicine can provide convenient access to specialists, facilitate ongoing monitoring, and improve medication adherence. However, challenges include the need for physical examinations and potential limitations in diagnostic capabilities.

In conclusion, deep vein thrombosis remains a significant health concern with wide-ranging impacts on individuals and healthcare systems worldwide. By understanding the symptoms, risk factors, and management strategies, we can work towards better prevention, earlier detection, and more effective treatment of this potentially life-threatening condition. As research continues to advance, the future holds promise for innovative approaches that will further improve outcomes for those affected by DVT.

Symptoms in Legs, Lungs, and More

Written by WebMD Editorial Contributors

• Arms, Legs
• Heart
• Lungs
• Brain
• Belly
• Kidneys
• More

Ever get a paper cut or nick yourself while shaving? When that happens, a blood clot saves the day. It quickly stops the bleeding, and when it’s done its job, it usually breaks up. Sometimes, though, things can go wrong.

When blood clots don’t fall apart, they can be dangerous and lead to serious medical conditions. You can get them in blood vessels in just about any part of your body. They’re most likely to affect a leg, especially if you sit for long periods of time.

You might get a clot in your arteries, which carry oxygen in your blood from your heart to all the cells of your body. The result can be really serious. It can keep oxygen from getting to your heart, lungs, or brain, and cause a life-threatening emergency, like a heart attack or stroke.

You could also get a clot in the veins that carry blood back to your heart. When that happens, symptoms usually come on more gradually, but can still mean trouble.

If you learn the warning signs, you’re more likely to get quick medical help that can make a huge difference in keeping you out of the danger zone. But it’s important to know that in some cases, clots can happen with few symptoms or none at all..

See More: Dos and Don’ts of a Blood Clot

When a blood clot forms in one of the deep veins in your arm or leg, way beneath your skin’s surface, it could be something called a deep vein thrombosis (DVT). That’s dangerous because the clot could travel to your heart or lungs.

You’re more likely to get a DVT if you haven’t moved around for a long time, say after surgery or during a long plane trip. Get medical help right away if you notice any of these symptoms:

• Swelling. This can happen in the exact spot where the blood clot forms, or your entire leg or arm could puff up.
• Change in color. You might notice that your arm or leg takes on a red or blue tinge, or gets itchy.
• Pain. As the clot gets worse, you may hurt or get sore. The feeling can range from a dull ache to intense pain. You may notice the pain throbs in your leg, belly, or even your arm.
• Warm skin. The skin around painful areas or in the arm or leg with the DVT may feel warmer than other skin.
• Trouble breathing. If this happens, it could mean that the clot has moved from your arm or leg to your lungs. You may also get a bad cough, and might even cough up blood. You may get pain in your chest or feel dizzy. Call 911 to get medical help right away.
• Lower leg cramp. If the clot is in your calf or lower leg, you may feel like you have a cramp or charley horse.
• Pitting edema. DVT can cause fluid buildup (edema) in the arms or legs. It typically happens quite quickly with DVT. When you press on the swollen area, it can cause a dimple or “pit” (pitting) that remains for a few seconds.
• Swollen, painful veins. The pain may increase with touch.

A blood clot that forms in or around your ticker may cause a heart attack. Watch out for symptoms like these:

• Severe pain in your chest and arm
• Sweating
• Trouble breathing

A blood clot in your lung usually starts out in a deep vein in your arm or leg, then breaks off and travels to your lung. When this happens, you get what’s called a pulmonary embolism, an extremely dangerous condition.

Get medical help right away if you:

• Feel short of breath or have problems breathing
• Get pain in your chest
• Start to cough
• Begin to sweat
• Feel dizzy

Blood clots here may be caused by fatty deposits in the walls of the blood vessels that bring blood to your brain. Or sometimes, they may form because of a blow to your head that leads to a concussion.

In other cases, a clot that starts out in a different part of your body, like your chest or neck, might enter your bloodstream and travel to your brain, where it can cause a stroke.

Watch out for these symptoms:

• Problems with your vision or speech
• A seizure
• General feeling of weakness

Blood clots can happen in the veins that drain blood from your intestines. They can be caused by conditions like diverticulitis or liver disease, or even by birth control pills.

How will you know if this is going on? Check with your doctor if you have problems like these:

• Nausea or vomiting
• Severe pain in your belly, which may be worse after you eat
• Diarrhea
• Bloody stools
• A bloated feeling

A blood clot in your kidneys can keep them from removing waste from your body. That can cause high blood pressure or even kidney failure.

This is dangerous, so look out for these symptoms:

• Pain in the side of your belly, legs, or thighs
• Blood in your urine
• Fever
• Nausea or vomiting
• High blood pressure
• Sudden severe leg swelling
• Trouble breathing

Top Picks

Symptoms in Legs, Lungs, and More

Written by WebMD Editorial Contributors

• Arms, Legs
• Heart
• Lungs
• Brain
• Belly
• Kidneys
• More

Ever get a paper cut or nick yourself while shaving? When that happens, a blood clot saves the day. It quickly stops the bleeding, and when it’s done its job, it usually breaks up. Sometimes, though, things can go wrong.

When blood clots don’t fall apart, they can be dangerous and lead to serious medical conditions. You can get them in blood vessels in just about any part of your body. They’re most likely to affect a leg, especially if you sit for long periods of time.

You might get a clot in your arteries, which carry oxygen in your blood from your heart to all the cells of your body. The result can be really serious. It can keep oxygen from getting to your heart, lungs, or brain, and cause a life-threatening emergency, like a heart attack or stroke.

You could also get a clot in the veins that carry blood back to your heart. When that happens, symptoms usually come on more gradually, but can still mean trouble.

If you learn the warning signs, you’re more likely to get quick medical help that can make a huge difference in keeping you out of the danger zone. But it’s important to know that in some cases, clots can happen with few symptoms or none at all. .

See More: Dos and Don’ts of a Blood Clot

When a blood clot forms in one of the deep veins in your arm or leg, way beneath your skin’s surface, it could be something called a deep vein thrombosis (DVT). That’s dangerous because the clot could travel to your heart or lungs.

You’re more likely to get a DVT if you haven’t moved around for a long time, say after surgery or during a long plane trip. Get medical help right away if you notice any of these symptoms:

• Swelling. This can happen in the exact spot where the blood clot forms, or your entire leg or arm could puff up.
• Change in color. You might notice that your arm or leg takes on a red or blue tinge, or gets itchy.
• Pain. As the clot gets worse, you may hurt or get sore. The feeling can range from a dull ache to intense pain. You may notice the pain throbs in your leg, belly, or even your arm.
• Warm skin. The skin around painful areas or in the arm or leg with the DVT may feel warmer than other skin.
• Trouble breathing. If this happens, it could mean that the clot has moved from your arm or leg to your lungs. You may also get a bad cough, and might even cough up blood. You may get pain in your chest or feel dizzy. Call 911 to get medical help right away.
• Lower leg cramp. If the clot is in your calf or lower leg, you may feel like you have a cramp or charley horse.
• Pitting edema. DVT can cause fluid buildup (edema) in the arms or legs. It typically happens quite quickly with DVT. When you press on the swollen area, it can cause a dimple or “pit” (pitting) that remains for a few seconds.
• Swollen, painful veins. The pain may increase with touch.

A blood clot that forms in or around your ticker may cause a heart attack. Watch out for symptoms like these:

• Severe pain in your chest and arm
• Sweating
• Trouble breathing

A blood clot in your lung usually starts out in a deep vein in your arm or leg, then breaks off and travels to your lung. When this happens, you get what’s called a pulmonary embolism, an extremely dangerous condition.

Get medical help right away if you:

• Feel short of breath or have problems breathing
• Get pain in your chest
• Start to cough
• Begin to sweat
• Feel dizzy

Blood clots here may be caused by fatty deposits in the walls of the blood vessels that bring blood to your brain. Or sometimes, they may form because of a blow to your head that leads to a concussion.

In other cases, a clot that starts out in a different part of your body, like your chest or neck, might enter your bloodstream and travel to your brain, where it can cause a stroke.

Watch out for these symptoms:

• Problems with your vision or speech
• A seizure
• General feeling of weakness

Blood clots can happen in the veins that drain blood from your intestines. They can be caused by conditions like diverticulitis or liver disease, or even by birth control pills.

How will you know if this is going on? Check with your doctor if you have problems like these:

• Nausea or vomiting
• Severe pain in your belly, which may be worse after you eat
• Diarrhea
• Bloody stools
• A bloated feeling

A blood clot in your kidneys can keep them from removing waste from your body. That can cause high blood pressure or even kidney failure.

This is dangerous, so look out for these symptoms:

• Pain in the side of your belly, legs, or thighs
• Blood in your urine
• Fever
• Nausea or vomiting
• High blood pressure
• Sudden severe leg swelling
• Trouble breathing

Top Picks

Thrombosis of limbs | Symptoms, Treatment

Deep vein thrombosis, along with subcutaneous vein thrombophlebitis and pulmonary embolism, are combined into a single concept – venous thromboembolic complications (VTEC).

Venous thrombosis is an acute disease characterized by the formation of a thrombus in the lumen of a vein with a more or less pronounced inflammatory process and impaired blood flow. The presence of an inflammatory component in the thrombosis zone determines another name for this disease – thrombophlebitis.

Most phlebologists, understanding the conditionality of such a division of venous thrombosis, use the term “thrombophlebitis” to refer to damage to the saphenous veins (in which symptoms of inflammation are pronounced), and the terms “thrombosis”, “deep vein thrombosis”, “phlebothrombosis” – to refer to the defeat deep veins.

Deep vein thrombosis (DVT) is a disease that negatively affects not only the venous and lymphatic return system, but also worsens the function of the cardiovascular system as a whole.

If no active steps are taken to eliminate this pathology, the further course of the pathological process becomes persistent, prone to self-development and irreversible.

The disease does not have strictly characteristic symptoms and has many risk factors and trigger factors, which requires additional involvement in clarifying its presence and type of course of additional high-precision modern instrumental diagnostic tools, the main of which in modern clinical conditions is the method of ultrasonic angioscanning with color mapping .

• According to the International Consensus Statement, the incidence of deep vein thrombosis in the general population is about 160 cases per 100,000 population, with a fatal pulmonary embolism rate of 60 per 100,000 population.
• In Russia, 240,000 people fall ill with venous thrombosis every year, and pulmonary embolism, including fatal, develops in 100,000 of them, which significantly exceeds the incidence of tuberculosis, viral hepatitis, and HIV infection.
• Approximately 200,000 people are hospitalized each year for deep vein thrombosis in the United States. At the same time, 1/3 falls on repeated thrombosis. Among the inhabitants of Italy, who are in the most active working age (from 20 to 55 years), deep vein thrombosis is diagnosed within 1%.
• Venous thrombosis occurs in a wide variety of clinical situations and complicates the course of many diseases. The incidence of postoperative thrombosis, according to different authors, is 20-59%.

The history of the study of phlebothrombosis

The study of phlebothrombosis of deep veins has more than 400 years.

Occlusion of the main veins as a cause of gangrene was first described by F. Hildanus in 1593. The first mention of ileofemoral phlebothrombosis appeared in the medical literature 300 years ago, it was made by Mauriceau.

The concept of “thrombophlebitis” was first introduced into medicine by the English surgeon John Hunter (1728-1793), who operated on gunshot and other wounds a lot and noted the frequency of inflammatory processes, combined with the formation of blood clots in the veins.

Interest in deep vein phlebothrombosis increased significantly after the creation of the theory of venous thromboembolism by the eminent German pathologist R. Virchow. Opening in 1844 the corpse of a young man who died suddenly after he developed pain in the thigh, Virchow found a blood clot in the right femoral vein and a twisted clot in the pulmonary artery. After that, he introduced the concepts of “thrombus” and “embolus” into medical terminology. In 1845, having found venous thrombi in 18 cases out of 76 autopsies, in 11 cases revealing the presence of thromboembolism in the pulmonary artery, he came to the conclusion that blood clots form in the veins and are transferred with the blood flow to the pulmonary artery. He also formulated the classical triad, which is still the most complete reflection of the links in the pathogenesis of local vascular thrombosis.

The first Russian-language monograph devoted to this problem was the work of I.F. Klein “On thrombosis, embolism and ichorremia”, published in 1863.

Despite the fact that acute deep phlebothrombosis in different types of localization and clinical course differ significantly from each other, they are united by the commonality of the main etiopathogenetic processes. The idea of ​​phlebothrombosis as a nosological group is based on the classical Virchow triad.

More than 150 years ago, Rudolf Virchow described the main mechanisms of intravascular thrombosis. Its classic triad includes hypercoagulability, damage to the vessel wall, and slowing of blood flow. Sometimes, for the occurrence of this pathology, a pathological change in only one of these factors is sufficient.

Despite the fact that the thrombotic process can develop at any level of the main veins, in more than half of the cases, the starting point of its development in the centripetal direction is the veins of the leg.
In the vast majority of cases, thrombosis is primarily localized in the veins of the leg, and then grows in the proximal direction in the popliteal, femoral and iliac veins.

It is this type of development that is very often embologenic, since the growth of a thrombus occurs in the direction of veins with an increasing inner diameter, where thrombus masses are not always fixed along the entire perimeter of the vein. Such thrombi are called floating.

One of the main causes of blood flow slowdown is immobilization. Under normal conditions, the outflow of blood from the lower extremities is carried out by contraction of the calf muscles, which act as a peripheral pump, pushing blood in the proximal direction, assisted by the function of the valves. Restriction of physical activity significantly disrupts this mechanism. In this case, the blood lingers in the venous sinuses of the lower leg.

The question of the significance of risk factors and triggering factors of thrombosis has been studied in sufficient detail:

• Congenital thrombophilias (deficiencies of various factors of the hemostasis system or their pathological changes)
• Activation of coagulation factors and fibrinolysis disorders (trauma, surgery, neoplasms, pregnancy, childbirth, etc. ).
• Pathology of platelets.
• Slowdown and / or disturbance of blood flow (age over 40 – 45 years, immobilization, pathology of the central circulatory mechanisms, obesity, etc.).
• Changes in the rheological properties of blood.
• Damage to the endothelium and vascular wall (contrast agents, intravascular devices, venous catheters, vein dilatation, etc.).
• Drug therapy (anesthetics, muscle relaxants, chemotherapy, contraceptives, contrast agents). For example, the incidence of postoperative thrombosis after various surgical interventions can reach 20-59%.

Symptoms of thrombosis

Symptoms of acute deep vein thrombosis include:

• edema,
• bursting pains,
• cyanosis of limb,
• dilatation of the saphenous veins,
• local increase in skin temperature,
• pain along the vascular bundle.

However, local hyperthermia and pain are more characteristic of superficial thrombophlebitis. The latter should be attributed rather to risk factors for the development of deep vein thrombosis.

Classic DVT symptoms:

• pain,
• soreness,
• puffiness,
• hyperemia,
• Homans symptom.

The overall sensitivity/specificity of these symptoms is 3 to 91%.
The presence of symptoms does not confirm DVT. The absence of symptoms does not rule out DVT (up to 50% of patients have no clinical symptoms).

Thrombosis Probability Calculation

In 1997, Wells et al developed and tested a clinical DVT probability model

The presence of each sign is estimated at 1 point:

The primary development of thrombosis in the deep veins of the leg is most common. This is facilitated by the conditions under which such an important hemodynamic factor as the contraction of the calf muscles is turned off. Such localization occurs in more than half of the observations.

Physical examination reveals positive symptoms:

• Moses – pain when pressing the lower leg in the anteroposterior direction,
• Homansa – pain in the calf muscles with dorsiflexion of the foot,
• Lowenberg – pain in the calf muscles at pressure up to 150 mm Hg. Art., created by the cuff of the sphygmomanometer.

However, the same symptoms will be positive in any other inflammatory process in the limb under study.

When the femoral vein is involved in the process, patients notice aching pains along the medial surface of the limb, according to the projection of the Günther canal.

Thrombosis of the common femoral vein is manifested by a more pronounced increase in the volume of the lower leg and even the thigh, cyanosis of the skin, the intensity of which increases towards the periphery. There is an expansion of the saphenous veins in the distal part of the thigh and lower leg. If thrombosis extends to the mouth of the great saphenous vein of the thigh, then the hypertension developing in the superficial venous system leads to the exclusion of anastomoses crossing with the contralateral limb. At the same time, there is an increase in the pattern of saphenous veins in the pubic and groin area. On palpation, the vascular bundle is painful throughout the thigh. The period of pronounced venous stasis lasts 3-4 days, after which a slow decrease in edema occurs. This phenomenon is due to the inclusion of collateral systems in the circulation. Thus, a reduction in pain and less swelling can create illusory well-being and often result in a late referral to a specialist. In addition, phlebothrombosis can occur without any complaints from the patient (asymptomatically), especially in postoperative patients.

More or less typical symptoms:

• bursting pains,
• edema (increased leg circumference),
• skin cyanosis.

Edema is of the greatest importance in terms of making a preliminary diagnosis. However, none of the listed clinical symptoms can be considered absolutely reliable in the diagnosis of this nosology. Any, even the most minimal patient complaints (for example: simple discomfort in the distal segments of the lower limb), especially in combination with the presence of risk factors, require an additional examination of the patient for the presence of phlebothrombosis.

Thus, it can be concluded that the presence of phlebothrombosis on the basis of anamnesis, patient complaints and clinical symptoms can only be suspected in order to confirm or exclude its existence during further examination, to determine the localization and embologenic danger. The absence of pathognomonic symptoms and the presence of a period of imaginary improvement are the cause of late hospitalization of patients, which in many cases limits the possibility of effective surgical treatment.

Diagnostic tests in patients with suspected DVT

• Assessment of the clinical likelihood of DVT,
• D-Dimer,
• Ultrasound examination of veins,
• MRI phlebography,
• MSCT.

Treatment of thrombosis

The tasks or goals of the treatment being carried out are formulated very specifically for today:

1. Stop the spread of thrombosis.

2. Prevent pulmonary embolism.

3. Prevent progression of edema and prevent venous gangrene.

4. Restore the patency of the veins and the functions of the valvular apparatus in order to avoid the development of post-thrombophlebitic disease in the future.

5. Prevent recurrence of thrombosis.

Conventionally, modern approaches to the treatment of patients with acute phlebothrombosis in the basin of the inferior vena cava can be divided into three main ones:

1. Conservative.

2. Minimally invasive.

3. Surgical aggression.

Conservative therapy

This approach includes:

• early activation with elastic compression,
• anticoagulant,
• non-specific anti-inflammatory therapy,
• hemorheological therapy,
• intermittent pneumatic compression.

With the timely application of the above methods, it is possible to restore the patency of the veins and minimize the manifestations of post-thrombotic disease.

Minimally invasive methods

To date, this is the most common group of methods in clinical use, designed to solve all of the above tasks or goals of treating patients with deep phlebothrombosis.

Three subgroups of methods should be distinguished here:

1. Installation of cava filters and partial cavaplication.

2. Regional and systemic thrombolysis.

3. Catheter thrombectomy and pharmacomechanical thrombectomy.

Installation of cava filters and partial cavaplication

At the beginning of the formation of phlebology as a separate scientific specialty, one of the main issues that needed to be addressed immediately was the issue of preventing pulmonary embolism in phlebothrombosis. After the development in 1959 of the method of external plication of the vena cava with mattress sutures and external plication with clamps, it was possible to determine the further direction for solving the problem of acute deep phlebothrombosis and their complications – PE. Until 1967, the method in combination with conservative therapy remained the only clinical approach to this problem. Despite the fact that the implementation of the technology of external partial clipping with clamps is associated with the need for a traumatic surgical approach and is practically impossible in seriously ill patients, this approach has been used and improved to date in limited situations (for example, using endovideoscopic technique, plication from a mini-access).

The Mobin-Addin intraluminal umbrella cava-filter created and applied clinically, which required the study of methods for delivering the device to the object, was the first experience of intraluminal catheter intervention and, in fact, served as the beginning of the development of a new branch of angiology – interventional radiology. Further development of this direction was carried out mainly along the path of improving the design of cava filters and studying their influence on hemodynamics and the clinical course of the main process.

Temporary cava filters are currently preferred. The temporary cava filter is removed no later than the third week.

In the vast majority of cases, the installation of a cava filter is not required at all.

Why is it not advisable to install a permanent cava filter?

Always remember that a permanent cava filter is a lifelong intake of anticoagulant drugs and a lifelong risk of filter thrombosis (a foreign body in the lumen of a vein is often complicated by thrombosis).

It has been repeatedly noted that as a result of the installation of cava filters in the near future, PE may occur with a frequency of 1.5-8%, and in terms of up to 3 years, thrombosis of the inferior vena cava occurs with a frequency of 12-25%.

For thrombosis below the inguinal ligament, the installation of a cava filter is not advisable, since there are other methods for preventing PE.

Regional and systemic thrombolysis, catheter thrombectomy, rheolytic thrombectomy

Thrombolytic therapy. The method is based on the introduction of drugs that activate endogenous fibrinolysis (streptokinase, urokinase, tPA, etc.).

Probably because the means used in this method to influence the thrombus can be effective only in relatively fresh areas of the thrombus (up to 3-5 days), so its effectiveness is low. Meanwhile, the use of regional catheter thrombolysis in 44% of cases allowed some authors to preserve valvular function and thereby prevent the development of post-thrombotic disease.

Catheter thrombus extraction . It should immediately be clarified that this method is applied only to the high segments of the inferior vena cava basin, since the technology itself does not allow it to be used in the infrainguinal position due to the obstacles formed by the valve apparatus of the veins at this and lower levels. The method is based on capturing thrombus masses from accessible segments of the inferior vena cava and iliac veins into a special bag-container and removing them by removing them through the phlebotomy opening.

Pharmaco-mechanical thrombectomy . The newest of all interventional and surgical technologies. While in the literature there are descriptions of individual cases. The method is based on the Bernoulli effect, where the velocity of a hydrodynamic jet creates areas of negative pressure in the environment. The method has the same scope as catheter thrombectomy.

Surgical interventions for femoral-popliteal phlebothrombosis

It is known that the most effective thrombectomy is possible only with thrombi older than 3-7 days.

Currently, most authors still adhere to a cautious approach in surgical removal of thrombus masses from the femoral-popliteal segment, completing the operation with ligation or resection of the ostium segment of the proper femoral vein, assessing the immediate results as good in terms of the absence of symptoms of chronic venous insufficiency. The calculation with this approach is to switch the main venous flow, to the deep vein of the thigh, which should provide a stable main outflow. In some cases, arteriovenous fistulas are used as a prevention of retrombosis.

A number of researchers use the tactics of surgical antegrade thrombectomy without subsequent ligation or ligation of the proper femoral vein, in some cases supplemented by plication of the proper femoral vein or without it.

symptoms, causes, diagnosis, treatment| JSC “Medicina” (clinic of Academician Roitberg)

Contents of the article

1. General information
2. Causes of deep vein thrombosis
3. Symptoms of deep vein thrombosis
4. Diagnostics of thrombophlebitis
5. Treatment
6. Prevention of deep vein thrombosis
7. Questions and answers
8. Sources

General information

Deep vein thrombosis (DVT) is a pathological condition associated with impaired blood flow in the veins due to the formation of blood clots and blockage of the lumen of blood vessels. This pathology is classified as an emergency requiring immediate medical attention. Its absence or refusal by the patient can cause pulmonary embolism, which threatens the life of the patient.

Causes of deep vein thrombosis

Among the most common causes of thrombosis:

• Inflammatory process in the tissues of a general or local nature.
• Deceleration of blood flow, which leads to stagnation of blood in the limbs.
• Hereditary or acquired factor of increased thrombus formation.
• Damage to the wall of the vessel, which causes its blockage with subsequent stagnation of blood.

Thorough diagnostics and study of the patient’s history can clarify the specific cause of the disease. Among the risk factors are invariably distinguished:

• Pregnancy and childbirth.
• Prolonged bed rest during complex illness.
• Varicose disease.
• Prolonged immobility of the body.
• Consequences of infectious diseases.
• Stroke, which is accompanied by paralysis of the limbs.
• Obesity.
• Oncological diseases.
• Uncontrolled use of hormonal contraceptives.
• Increased blood clotting.
• Consequences of vein puncture.

The action of one of the listed factors is sufficient for the development of thrombosis. Therefore, with an increased risk of the disease, regular preventive medical examinations should be carried out.

Symptoms of deep vein thrombosis

Invariable signs of the disease are:

• Pain in the area of ​​vein blockage.
• Local swelling of the limb.
• Increased body temperature.
• Seals in the direction of blood flow in the vessel.

Patients report an increase in the listed symptoms over several days, which leads them to seek medical help. In some cases, the development of the disease is asymptomatic, and only edematous phenomena indicate it.

If the increase in swelling and a sharp increase in pain is accompanied by chest pain, fever or coughing, it is recommended to immediately contact the nearest medical facility or call an ambulance. Otherwise, there is a risk of separation of the thrombus and blockage of the vessels of the lungs.

Diagnosis of thrombophlebitis

The initial diagnosis can be made already at the initial examination of the affected areas with noticeable swelling and blood stasis. The following types of studies can confirm assumptions about DVT:

• Clinical blood test, coagulogram.
• X-ray study with contrast, which allows you to see the lumen of the vessels and the formed blood clots, which caused a violation of blood flow.
• CT and MRI in vascular mode.
• Ultrasound diagnostics and its varieties – dopplerometry or angioscanning.

It is possible to conduct additional studies to clarify the cause and dynamics of the pathological process, especially if the symptoms increase rapidly and cause significant inconvenience to the patient.

Treatment

If the patient does not show a rapid increase in symptoms, he is given a conservative course of treatment. In the list of recommended drugs:

• Anticoagulants that reduce the likelihood of blood clots.
• Blood thinners. Their reception is possible only on the recommendation and under the supervision of a specialist.

Also among the methods of treating the disease:

• Wearing compression bandages and underwear ordered individually. They have preventive and therapeutic value, especially if the selection is carried out taking into account the recommendations of the doctor.
• Implantation of a cava filter into the cavity of the main vein, which prevents the migration of blood clots and reduces the risk of blockage of pulmonary vessels. The installation of the filter can be temporary or permanent, carried out under local anesthesia and does not involve prolonged hospitalization of the patient.
• Thrombolysis procedure. It involves the introduction into the blood of thrombolytic drugs that contribute to the dissolution of blood clots. It is used in the initial stages of the disease, has a number of contraindications.

In case of extensive damage, the patient is indicated for surgical treatment – thrombectomy to remove the blocked part of the vessel, venous angioplasty to restore the walls of the veins and venous bypass to ensure stable blood flow. The volume and nature of the intervention are determined on an individual basis.

Prevention of deep vein thrombosis

To reduce the risk of developing pathology can:

• Sleep and rest with elevated limbs.
• Refusal of long-term static loads, reduction of daily physical activity.
• Avoid situations that increase the risk of overheating or dehydration.
• Wearing compression stockings, comfortable shoes with orthopedic inserts.
• Regular moderate physical activity – running, cycling, long walks.

For further advice on treating deep vein thrombosis, contact your phlebologist.

FAQ

• Which doctor treats deep vein thrombosis?
• For examination, consultation and diagnosis of pathology, you should contact a phlebologist or phlebologist surgeon.
• Is there a risk of recurrence of deep vein thrombosis?
• The reappearance of symptoms of the disease indicates insufficient intensity and effectiveness of the treatment course. Perhaps, in order to consolidate the initial success, it is necessary to change the tactics of treatment and focus on preventive measures. Details can be obtained from your physician.
• Is a diet indicated for thrombophlebitis?
• Eating ginger, garlic, hawthorn berries, whole grain breads, seasonal vegetables and fruits, cereals, and nuts can reduce symptoms and reduce the risk of blood clots.