What are the signs of DVT in the calf. How is deep vein thrombosis diagnosed. What factors increase the risk of developing a DVT. What complications can arise from DVT. How is deep vein thrombosis treated.

Understanding Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a serious medical condition characterized by the formation of blood clots in the deep veins of the body, most commonly in the legs. This condition affects approximately one in every 1200 New Zealanders annually, but its prevalence is not limited to this region. DVT can have life-threatening complications if left untreated, making it crucial to understand its symptoms, causes, and treatment options.

Recognizing the Symptoms of DVT in the Calf

Identifying the signs of DVT in the calf is crucial for early detection and treatment. While DVT doesn’t always cause noticeable symptoms, when they do occur, they can include:

• Cramp-like aching pain in the affected muscle
• Swelling of the lower leg
• Tenderness in the calf muscle
• Localized redness and warmth
• Mild fever
• More prominent lower leg veins
• Darkening of the skin in the affected area

It’s important to note that these symptoms may worsen with exercise but typically do not subside with rest. If you experience any of these signs, especially if they persist or worsen, it’s crucial to seek medical attention promptly.

Risk Factors for Developing DVT

Several factors can increase an individual’s risk of developing deep vein thrombosis. Understanding these risk factors can help in prevention and early detection.

General Risk Factors

• Obesity
• Smoking
• Being over 40 years old (although DVT can occur at any age)
• Previous history of DVT
• Family history of DVT

Factors Affecting Blood Flow

Certain conditions or situations that slow blood flow through the deep veins can increase the risk of DVT:

• Prolonged immobility (e.g., after surgery, during long-distance travel)
• Paralysis
• Injury to a vein
• Heart disease, particularly heart failure
• Varicose veins
• Phlebitis (inflammation of vein walls)

Factors Affecting Blood Clotting

Some conditions or medications can make the blood more likely to clot, increasing DVT risk:

• Hormone medications (e.g., some oral contraceptives and hormone therapies)
• Inherited blood clotting disorders
• Inflammatory bowel diseases
• Certain cancers and cancer treatments
• Pregnancy

Complications of Deep Vein Thrombosis

DVT can lead to serious, potentially life-threatening complications. The most significant risk is the development of a pulmonary embolism (PE). This occurs when a blood clot breaks free from its original location and travels through the bloodstream, lodging in the lungs. Pulmonary embolism can cause severe breathing difficulties, chest pain, and in some cases, can be fatal.

Other potential complications of DVT include:

• Chronic venous insufficiency
• Post-thrombotic syndrome
• Recurrent DVT

Given these serious risks, prompt diagnosis and treatment of DVT are crucial.

Diagnosis of Deep Vein Thrombosis

Diagnosing DVT can be challenging, especially when symptoms are mild or absent. However, several methods are used to confirm the presence of a blood clot:

Initial Assessment

When DVT is suspected, a healthcare provider will typically:

• Conduct a physical examination of the affected area
• Take a detailed medical history
• Assess risk factors

D-Dimer Blood Test

A D-Dimer blood test may be recommended as an initial screening tool. This test measures the levels of a protein fragment produced when a blood clot dissolves in the body. Elevated D-Dimer levels can indicate the presence of a blood clot, but further testing is usually required for confirmation.

Imaging Tests

The most common diagnostic test for DVT is a Doppler ultrasound. This non-invasive imaging technique uses sound waves to create pictures of blood flow through the veins. It can effectively detect blockages or abnormal blood flow patterns indicative of DVT.

In some cases, additional imaging tests may be necessary:

• Venography: An X-ray test using contrast dye to visualize veins
• CT or MRI scans: These can provide detailed images of blood vessels and surrounding tissues

Treatment Options for DVT

Once diagnosed, prompt treatment of DVT is essential to prevent complications and relieve symptoms. The main goals of treatment are to:

• Stop the blood clot from growing
• Prevent the clot from breaking loose and causing a pulmonary embolism
• Reduce the risk of recurrent DVT

Anticoagulation Therapy

The primary treatment for DVT is anticoagulation therapy, often referred to as blood thinners. These medications don’t actually thin the blood but instead interfere with the clotting process, preventing new clots from forming and existing clots from growing larger.

Common anticoagulants used in DVT treatment include:

• Heparin (usually low molecular weight heparin)
• Warfarin
• Direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban, or dabigatran

The choice of anticoagulant and duration of treatment depend on various factors, including the location and severity of the clot, underlying risk factors, and individual patient characteristics.

Thrombolytic Therapy

In severe cases or when anticoagulation alone is insufficient, thrombolytic therapy may be considered. This involves administering clot-dissolving medications directly into the vein through a catheter. While effective, this treatment carries a higher risk of bleeding complications and is typically reserved for life-threatening situations.

Mechanical Interventions

In some cases, mechanical interventions may be necessary:

• Inferior vena cava (IVC) filters: These devices are implanted in the large vein in the abdomen to catch blood clots before they reach the lungs.
• Compression stockings: These help improve blood flow in the legs and reduce swelling.

Preventing Deep Vein Thrombosis

While not all cases of DVT can be prevented, several strategies can help reduce the risk:

• Stay active and maintain a healthy weight
• Avoid prolonged periods of immobility
• Exercise regularly, especially during long trips
• Stay hydrated
• Quit smoking
• Manage underlying health conditions that increase DVT risk
• Follow post-surgery instructions carefully, including early mobilization when appropriate
• Consider wearing compression stockings if at high risk

For individuals at high risk of DVT, such as those undergoing major surgery or with a history of blood clots, preventive anticoagulation therapy may be recommended.

Living with DVT: Long-term Management and Recovery

Recovery from DVT is a gradual process that requires ongoing care and attention. Here are some key aspects of long-term management:

Adherence to Medication

Strict adherence to prescribed anticoagulation therapy is crucial. This may involve regular blood tests to monitor medication levels and adjust dosages as needed.

Follow-up Care

Regular follow-up appointments with healthcare providers are essential to monitor progress, assess for complications, and adjust treatment plans as necessary.

Lifestyle Modifications

Incorporating lifestyle changes can help prevent recurrence and promote overall vascular health:

• Maintain a healthy diet rich in fruits, vegetables, and whole grains
• Engage in regular physical activity as approved by your healthcare provider
• Avoid prolonged periods of sitting or standing
• Elevate legs when resting to improve circulation
• Wear compression stockings as recommended

Mental Health Considerations

Coping with DVT can be emotionally challenging. Some individuals may experience anxiety about the risk of recurrence or complications. It’s important to address these concerns and seek support when needed, whether through support groups, counseling, or open communication with healthcare providers.

Monitoring for Complications

Patients with a history of DVT should remain vigilant for signs of recurrence or complications such as post-thrombotic syndrome. This condition can develop months or years after DVT and cause chronic pain, swelling, and skin changes in the affected limb.

Understanding the signs of DVT in the calf and other parts of the body is crucial for early detection and treatment. By recognizing risk factors, seeking prompt medical attention when symptoms arise, and adhering to treatment and prevention strategies, individuals can effectively manage DVT and reduce the risk of serious complications. As research in this field continues to advance, new treatments and preventive measures may emerge, offering hope for improved outcomes for those affected by this condition.

Deep vein thrombosis – symptoms, causes and treatment

A deep vein thrombosis (DVT) is a blood clot that forms in the major veins of the body – usually the legs. It is estimated one in every 1200 New Zealanders will develop a DVT each year.

Life-threatening complications can arise from DVT when blood clots dislodge, travel in the bloodstream, and then lodge in other veins or arteries causing a blockage (this blockage is called an embolism). This can be life threatening, especially when the embolism occurs in the lungs, heart, or brain. Pulmonary embolism (a blood clot in the lung) is the most common of these serious DVT complications.

Causes

Veins are blood vessels that carry blood from the tissues of the body back to the heart. Veins that lie just beneath the skin surface are referred to as “superficial veins” while veins found deep inside the muscles are referred to as “deep veins”. Other veins connect the superficial and deep veins, allowing blood to flow between them.

When a blood clot occurs in a vein it is referred to as a venous thrombosis. A DVT is a blood clot that occurs in the deep veins. DVTs can occur in any of the deep veins but most commonly occur in the leg veins. The clot will either partially or completely block the flow of blood through the affected vein.

A DVT is usually more serious than a blood clot in one of the superficial veins, as there is a much greater risk with a DVT that part of the clot may dislodge and circulate through the body.

Risk factors

General factors that indicate an increased risk of developing a DVT include:

• Obesity
• Smoking
• Being older than 40 years (although DVT can occur at any age)
• Having previously had a DVT
• Having a family member who has had a DVT.

A DVT is also more likely to occur when the blood flow through the deep veins is slowed. Immobility is one such factor; blood flow is slowed when a person remains immobile for long periods of time as a result of such things as:

• Paralysis, eg: following a stroke or injury
• Being bedridden, eg: following surgery or due to illness
• Having a leg in a plaster cast or splint
• Sitting for long periods of time while travelling, eg: in a bus, train, plane, or car.

Other factors that can slow blood flow include:

• Injury to a vein, eg: as a result of a broken bone or severe muscle injury
• Surgery – particularly orthopaedic and cancer surgery
• Heart disease – particularly heart failure (where a weakened heart doesn’t pump blood as well as it should)
• Varicose veins
• Phlebitis (inflammation of the walls of the vein).

A DVT is also more likely to occur where there is some factor that makes the blood more likely to clot, including:

• Hormone medications – some research studies have indicated that there may be a small increased risk of DVT associated with some types of oestrogen-containing oral contraceptive pills, as well as some menopausal hormone therapies (formerly known as hormone replacement therapy or HRT).
• Inherited disorders – such as the deficiency of some blood clotting factors
• Inflammatory bowel diseases, eg: Crohn’s disease or ulcerative colitis
• Certain cancers and some cancer treatments
• Pregnancy.

Signs and symptoms

A DVT does not always cause symptoms. If symptoms do occur, the first symptom is usually a cramp-like aching pain in the affected muscle. This pain might worsen when exercising but does not subside with rest. Symptoms of a DVT in the calf muscle may include:

• Swelling of the lower leg
• Tenderness of the calf muscle
• Localised redness and warmth
• A mild fever
• Lower leg veins may become more prominent (darker and raised) and sometimes the skin becomes darker.

A DVT can also occur in the upper leg, arms or neck and cause similar symptoms in those areas of the body.

If a pulmonary embolism occurs as a result of a DVT it may produce barely noticeable symptoms such as chest discomfort and mild breathlessness, or more noticeable symptoms such as sharp chest pain, a rapid heart rate, breathlessness, and coughing-up blood.

Diagnosis

If a DVT is suspected – even if symptoms are mild – it is important to seek medical attention promptly. Accurate diagnosis and appropriate treatment of a DVT are necessary to reduce the risk of potentially life-threatening complications, such as pulmonary embolism.

Because a DVT can occur without any obvious symptoms, diagnosis can sometimes be difficult. Initially, the doctor will examine the affected area and take a full medical history. The doctor may recommend a blood test called a D-Dimer, which measures a protein essential for blood clotting. If the D-Dimer test is positive, further tests to confirm the diagnosis are likely to be ordered.

The most common diagnostic test for DVT is an ultrasound scan. The specific type of scan used is called a doppler ultrasound, which determines how fast blood is flowing through a blood vessel.

If there is doubt about the diagnosis, venography may be recommended. This diagnostic test involves injecting a specialised dye that can be seen by x-ray as it flows through the veins, allowing them to be easily visualised.

Blood tests may be done to check for irregularities in the blood clotting system or for inherited disorders

If a pulmonary embolism is suspected a range of additional tests may be used.

Treatment

The immediate goal of treatment for a DVT is to limit the size and movement of the clot, and to prevent complications. Treatment will depend on the location and severity of the clot. Some small clots may resolve spontaneously without treatment but a DVT is generally treated intensively. Admission to hospital for treatment and observation for signs of complications may be required. Treatment may include:

Medications

Anticoagulants:

These medications “thin” the blood, reducing its ability to clot. They prevent an existing clot from getting bigger and reduce the risk of developing more clots.

Anticoagulant medications such as heparin may be administered initially as a continuous infusion into a vein (intravenously) because it acts quickly to prevent further clotting. After initial treatment, anticogulant medication may be given in tablet form (e.g. warfarin) or as an injection under the skin.

Regular blood tests will usually be required to monitor the effectiveness of the medication and to adjust dosage. Anticoagulant treatment is usually maintained for at least three months to be fully effective in treating a DVT. In some cases, it may be required on a long-term basis.

Thrombolytic agents:

In some cases, these medications are given by intravenous injection to help dissolve the clot. However, they can cause side effects, such as severe bleeding, so are usually used only in life-threatening situations, eg: the presence of a large pulmonary embolus.

Compression stockings

Elasticised compression stockings give support to the lower legs and encourage the return of blood to the heart and helps to reduce swelling. It is generally recommended that compression stockings are worn in situations where immobility is likely.

Surgery

In high-risk cases, where there have been recurrent or severe DVTs, or where anticoagulant medication is not appropriate or has not worked, surgery to insert a small filter or sieve into the main vein leading to the heart (the vena cava) may be recommended. This traps any blood clots travelling through the blood stream thus preventing the clot travelling to the heart and lungs.

Prevention

General measures to help lower the risk of developing a DVT are to quit smoking, maintain a healthy body weight, and take regular exercise. When certain medical conditions or inherited disorders are present, long-term anticoagulant treatment to minimise the risk of DVT may be recommended.

Measures that can reduce the risk of DVT associated with long-distance travel include:

• Compression stockings
• Drinking plenty of non-alcoholic fluids to avoid dehydration
• Leg and ankle exercises to encourage blood flow in the legs
• People at high risk of DVT may be prescribed aspirin or anticoagulant tablets or injections whilst travelling.

Anyone at risk of DVT is advised to see their doctor prior to travelling to discuss preventative measures. Measures that can reduce the risk of DVT associated with being bedridden as a result of surgery or illness include:

• Compression stockings
• Anticoagulant medications
• Specific leg and breathing exercises to promote blood flow.

Long-term complications

After a DVT some people may develop a long-term condition called “chronic venous insufficiency” or “post-phlebotic syndrome”. This is due to damage and scarring to the veins and is characterised by swelling, discomfort, and skin pigmentation in the affected area. It can increase the likelihood of subsequent DVT.

Repeated pulmonary emboli can lead to a condition called pulmonary hypertension, which is where the blood pressure within the lungs is increased. This can cause serious problems with the functioning of the heart. Certain medications, compression stockings, and, in rare cases, surgery, may be recommended to help treat these long-term complications.

References

Douketis, J.D. (2018). Deep vein thrombosis (DVT) [Web Page]. MSD Manual Consumer Version. Kenilworth, NJ: Merck and Co., Inc. https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/venous-disorders/deep-vein-thrombosis-dvt [Accessed 22/08/19]
Liao, S. et al. (2014). Incidence of venous thromboembolism in different ethnic groups: a regional direct comparison study. J Thromb Haemost 2014;12:214-9.
Mayo Clinic (2018). Deep vein thrombosis (DVT) [Web Page]. Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557 [Accessed: 22/08/19]
Ministry of Health (2015). Travel and blood clots (Web Page). Wellington: New Zealand Ministry of Health. www.health.govt.nz/your-health/healthy-living/environmental-health/travelling/travel-and-blood-clots [Accessed: 22/08/19]
NHS (2016). Deep vein thrombosis (Web Page). Redditch: National Health Service (NHS)
England. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/ [Accessed: 22/0/19]
New Zealand Medicines and Medical Devices Safety Authority (Medsafe) [2014]. Hormonal contraceptives and blood clots (Leaflet). Wellington: New Zealand Ministry of Health. https://www.medsafe. govt.nz/Consumers/educational-material/Hormonal%20Contraceptives.pdf [Accessed: 22/08/19]
O’Toole, M.T. (Ed.) (2017). Deep vein thrombosis (DVT). Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
Tran, H.A., et al. (2019).New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. Med J Aust. 2019 Mar;210(5):227-235.

Last reviewed – August 2019

Go to our Medical Library Index Page to find information on other medical conditions.

What is Deep Vein Thrombus or DVT?

What is Deep Vein Thrombosis?

Blood clots are your body’s first line of defense against bleeding. As a response to a wound, clotting is an essential — perhaps even life-saving — function. But when the body’s normal mechanisms are disrupted, blood clots can form when they aren’t needed in places that make them dangerous. A blood clot that develops in a major deep vein is called deep vein thrombosis (DVT). DVT can pose a serious threat to your health if it is not diagnosed and treated in a timely manner.

Deep vein thrombosis is a condition in which the blood clots or forms a thrombus in one of the deep veins in your body. This occurs primarily in the lower extremities, but deep vein blood clots can also develop in other areas of the body. DVT is a serious condition because a blood clot that has formed in your vein can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow. Even if a blood clot remains in place, it may permanently damage the valves inside the vein. This damage can lead to chronic problems in the leg such as swelling, pain and leg sores.

Every year, approximately 2 million people will develop deep vein thrombosis and around 200,000 of them die. DVT kills more people than AIDS, breast cancer and motor vehicle accidents combined. It’s important to find and treat DVT early for the best prognosis.

What Causes DVT?

In the event of an injury, bleeding triggers a biological “domino effect” that sets a series of steps in motion. Platelets and proteins called coagulation factors clump together to seal the damaged blood vessel and stop the bleed. The blood clot dissolves when it is no longer needed. Blood clotting disorders can occur if the lining of a vein is damaged, if blood flow is too slow or if a condition or medication makes the blood clot more easily. DVT is the result of a clot that forms inside a deep vein and prevents blood from circulating normally through your body.

What Can Happen If DVT Is Not Treated?

Untreated DVT can lead to illness, disability, and in some cases, death. The most serious complication of DVT is pulmonary embolism — a blockage that occurs when part of the clot breaks free and travels through the bloodstream to the lungs. A small enough clot can be treatable, but a large clot can stop blood from reaching the lungs, making the condition fatal.

DVT can also damage the vein and lead to long-term complications from chronic venous insufficiency or post-thrombotic syndrome. These conditions are characterized by chronic swelling, pain, discoloration of the skin, scaling and venous stasis ulcers. The symptoms may eventually become so severe that they cause disability. But there are treatments available.

What Are the Warning Signs of Deep Vein Thrombosis?

DVT can occur without any noticeable symptoms, making it difficult to detect. For this reason, it is even more important to understand the risk factors and prevent the development of DVT in the first place.

Talk to a doctor immediately if you have any risk factors and experience the following deep vein thrombosis symptoms:

• Swelling in the affected leg
• Tenderness over the affected vein
• An area of skin that feels warmer than areas around it
• Pain in the affected leg (it often starts in the calf and can feel like cramping)
• Discolored skin on the affected leg

Who Is at Risk for Deep Vein Thrombosis?

A “risk factor” is anything that might increase an individual’s chance of developing a disease. While DVT can affect anyone, risk factors that may contribute to deep vein thrombosis include:

• Stagnation (e.g. traveling by plane or car for over three hours)
• Lying in bed for hours (e.g. while recovering from surgery)
• A change in blood chemistry (e.g. taking hormones or certain prescriptions, or having transfusions during surgery)
• Trauma (e.g. a car accident or broken bone)
• Recent surgery
• A catheter located in a central vein
• Genetic blood clotting disorders
• Pregnancy and the initial weeks after giving birth
• Obesity
• Having certain other diseases or conditions (e.g. stroke, chronic heart disease, high blood pressure, cancer)
• Tobacco use
• Increasing age
• Personal or family history of DVT

Some patients do not know they have a DVT until they experience a pulmonary embolism. The symptoms and warning signs of a pulmonary embolism include:

• Rapid pulse
• Irregular heartbeat
• Coughing up blood
• Shortness of breath
• Chest pain that worsens when taking a deep breath or coughing
• Feeling lightheaded or dizzy, or fainting
• A feeling of anxiety
• Excessive sweating

Pulmonary embolism can be life-threatening. Seek out urgent medical attention if you experience these symptoms.

How are they treated?

Quick, effective outpatient visits treat the root cause, not just the symptoms.

How Is DVT Diagnosed?

Developing a comprehensive treatment plan starts with a thorough assessment. Detection of deep vein thrombosis is most commonly done by having a color duplex ultrasound. Ultrasound is a noninvasive, painless technology used to evaluate blood flow through the blood vessels. During the test, a wand called a transducer is moved over the area being examined. The wand emits soundwaves and creates images based on how the waves reflect back off the moving blood. The images show where blood slows down or stops, indicating the possible presence of a clot.

It is important that this is done by a qualified sonographer or technologist. Different organizations have different quality standards when it comes to venous imaging, but the Intersocietal Accreditation Commission (IAC) has the highest standard for vascular testing. The Vein Center of Arizona performs testing according to the standards set forth by the IAC and only employs highly experienced Registered Vascular Technologists.

How Is DVT Treated?

A timely diagnosis and proper treatment can help prevent the complications of blood clots. Deep vein thrombosis treatment aims to stop the blood clot from growing larger, prevent the clot from breaking off and migrating to the lungs, and reduce the chance of developing another blood clot in the future. Treatment options include compression stocking therapy, prescription of blood thinners or clot busters, and possibly the insertion of a filter into a large vein in the abdomen.

Compression stockings are among the most impactful innovations in the treatment of venous disease. When worn, these garments apply constant gentle pressure to help blood circulate freely, making it harder for it to pool in your veins and form a clot. Compression garments can be used as part of your DVT treatment, as well as for preventative care.

Medications prescribed for DVT may include anticoagulants (also known as blood thinners), which increase the time it takes for blood to clot. Over time, your body works with the medication to diminish the size and consistency of the clot. Several anticoagulant medications are available to treat DVT. Less commonly, medications called thrombolytics are used to quickly dissolve a clot that is large and causing severe symptoms.

If other treatments are not an option, a filter may be placed inside the large abdominal vein called the vena cava. The filter cannot stop a blood clot from forming, but it can prevent a life-threatening clot from entering your lungs. Filters themselves have risks and should only be used for a short-term period.

Can DVT Be Prevented?

If you think you are at risk for a blood clot, talk to a doctor about strategies for deep vein thrombosis prevention. Although the risk will never be gone completely, there are steps you can take to minimize it and improve your venous health overall. The following conservative measures are recommended for deep vein thrombosis treatment at home:

• Stay physically active
• Maintain a stable, healthy weight
• Exercise your leg muscles if you’re sitting for a long time while traveling
• Get up and move as soon as possible after illness or surgery
• Take medications to prevent blood clots if prescribed by your doctor
• Wear compression stockings
• Wear loose-fitting clothing
• Elevate your legs while at rest
• Get to know your family history
• Follow your doctor’s recommendations based on your specific risk factors

Visit Us and Experience the Vein Center Difference

Because a blood clot can quickly become life-threatening, you should see a doctor right away if you notice any symptoms of DVT. Dr. Paul Larson and the staff at The Vein Center of Arizona are dedicated to the diagnosis, treatment and management of vein disease. Dr. Larson is board-certified by the American Board of Venous and Lymphatic Medicine and is one of the few vein doctors in the country to have also received the advanced venous imaging credential RPhS (Registered Phlebology Sonographer). It’s never too early to inquire about your risk of developing deep vein thrombosis. Call us at (928) 726-8346 to request a vein screening in Yuma today.

The Vein Center of Arizona offers patients a wide variety of treatment options:

Comprehensive Treatment Plan

Developing a comprehensive treatment plan follows a thorough assessment. The assessment will normally consist of a review of your venous symptoms, a visual inspection of your problems and a thorough review of your history. The assessment completed by Dr. Paul Larson, supplemented by the diagnostic ultrasound if indicated by a registered vascular technologist will aid in the process.

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Conservative Management

Before seeking out a surgical or non-surgical treatment for varicose veins and other uncomfortable vein disorders, doctors may recommend conservative management techniques for patients. Conservative treatments may be required by an insurance company before other treatments can be considered.

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Radiofrequency Ablation (RFA)

Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.

Endovenous Laser Treatment

Endovenous Laser Treatment for the elimination of unhealthy varicose veins is the gold-standard for minimally invasive treatment of varicose veins. EVLT uses laser energy, which is a highly concentrated beam of light. They work by delivering this light energy to the tissue that is targeted with extreme precision, so as not to damage the surrounding tissue.

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Sclerotherapy

Sclerotherapy is the primary treatment for spider veins and small superficial varicose veins that usually appear on the legs. They less commonly appear on other parts of the body. Sclerotherapy involves the injection of a chemical solution into a targeted spider vein or a reticular vein through a very fine needle.

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Foam Sclerotherapy

Foam sclerotherapy is a minimally invasive technique for men and women to eliminate unsightly varicose veins and spider veins. The procedure involves injecting a foam sclerosant in a blood vessel to close it. The blood reroutes itself through healthy veins, restoring more normal blood flow.

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Ambulatory Micro-Phlebectomy

Also known as ambulatory phlebectomy, this is a procedure that can be performed in the office and is commonly performed at the time of endovenous ablation. The procedure is intended to remove larger bulging varicose veins near the skin surface.

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Deep vein thrombosis of the lower extremities – treatment in ON CLINIC Ryazan, price

A condition in which the blood becomes too thick and clots form in the veins that can interfere with normal blood flow is called deep vein thrombosis. This disease is dangerous primarily because sooner or later a blood clot can break off and rush with the blood flow to the upper sections of the circulatory system. If it enters the veins located in the lungs, this can lead to a threat to the life of the patient. It is in connection with the potential danger of serious complications that deep vein thrombosis of the lower extremities requires urgent medical attention.

In general, any diseases of the veins – whether it be thrombosis or thrombophlebitis, varicose veins or venous insufficiency – should be treated immediately, without waiting for the development of possible complications. The key to timely diagnosis and successful treatment of such diseases is a consultation with a qualified phlebologist. It is these specialists who conduct appointments in the corresponding department of ON CLINIC in Ryazan and have vast experience in the treatment of thrombosis.

Varieties of this disease

First of all, deep vein thrombosis can affect both the upper and lower extremities. The latter, in turn, is divided into the following types:

• affecting the veins of the leg;
• affecting femoral veins;
• affecting the popliteal vein.

In the vast majority of cases, thrombosis is observed only on one arm or leg. Bilateral deep vein thrombosis is extremely rare. Be that as it may, with rapid swelling of one or two limbs, urgently seek medical help .

In addition, there are acute and subacute course of the disease. In subacute thrombosis, the pain is not very intense, and the swelling is less pronounced than in acute thrombosis. However, this type of disease is no less dangerous, and neglecting to see a doctor or trying to self-medicate is simply unacceptable.

You can not do without contacting a specialist in case of thrombosis of the external hemorrhoid. A symptom of this condition is a sharp pain in the anus, which prevents the patient from moving normally and significantly reduces his quality of life. To prevent this kind of thrombosis, one should not ignore the signs indicating the presence of hemorrhoids. If you observe anal itching or pain during bowel movements, then immediately contact a proctologist. In the colonoproctology department of ON CLINIC in Ryazan, qualified specialists receive patients daily.

Signs of deep vein thrombosis

The following symptoms may indicate the development of this disease:

• sensation of fullness and heaviness in the affected limb, as well as pain in it;
• on palpation – a sharp pain that becomes stronger when approaching the vein in which the blood clot is located;
• swelling and bluish appearance of the skin of the affected limb;
• reddening of the skin and fever.

If you do not consult a doctor immediately when the first signs of deep vein thrombosis appear, this disease can provoke the development of the following complications:

• eczema;
• lipodermatosclerosis;
• trophic ulcers;
• chronic venous insufficiency, etc.

Detection and treatment of deep vein thrombosis of the lower extremities in ON CLINIC in Ryazan

If all the symptoms indicate this disease, then the phlebologist first of all directs the patient to an ultrasound scan of the veins of the lower extremities. This examination allows us to draw conclusions about how far the disease has gone, as well as to find out how dangerous for this patient is the risk of migration of a blood clot with blood flow and sudden blockage of an artery supplying blood to the lung – this complication can lead to the death of the patient. After the diagnosis is confirmed, treatment is prescribed.

Truly effective treatment should be complex. It can combine both surgical and conservative techniques. The classical scheme of conservative treatment of deep vein thrombosis involves the use of anticoagulants – direct and indirect – as well as thrombolytics. Sometimes this is enough to prevent further progression of the disease, and in all other cases, minimally invasive surgery to remove a blood clot through a small incision is indispensable.

In order for the treatment of deep vein thrombosis to bring a greater effect, the patient is not recommended to drastically limit his mobility. Nothing but harm will bring the habit (or forced necessity) to stay in one position for a long time. Reasonable physical activity – at least exercise therapy – is the best way to prevent the recurrence of the disease.

Thrombosis prevention

Patients with reduced tone of the venous walls are at risk of developing deep vein thrombosis. To avoid this deadly disease, eat more raw vegetables and fruits – a source of fiber, which helps strengthen the fibers that make up the walls of the veins. In addition, take the following precautions:

• give up a sedentary lifestyle;
• do not spend your holidays in countries with a hot climate, and also avoid visiting saunas and baths;
• do not neglect wearing tights and stockings with a compression effect.

Remember – a timely appeal to a qualified phlebologist will help not only maintain health, but can also save a life!

Interested in the price of thrombosis treatment at ON CLINIC in Ryazan? Call us and sign up for a consultation, in which the doctor will answer all your questions!

Have you been diagnosed with thrombophlebitis of the extremities?

Post-thrombophlebitic syndrome (post-thrombophlebitic disease, PTFB, PTFS) is a symptom complex that develops as a result of previous deep vein thrombosis of the lower extremities.

It is a typical type of chronic venous insufficiency (CVI), manifested by secondary varicose veins, persistent edema, trophic changes in the skin and subcutaneous tissue of the leg. According to statistics, in various countries this disease affects 1.5 – 5% of the population.

The formation of post-thrombophlebitic syndrome is associated with the fate of a thrombus formed in the lumen of the affected vein.

The most common outcome of deep vein thrombosis is partial or complete restoration of the patency of the vein (recanalization) with the loss of the valve apparatus, less often the complete closure of its lumen (obliteration). The process of resorption of a thrombus with its replacement by connective tissue (organization) begins from the 2-3rd week from the onset of the disease and ends with partial or complete recanalization of the vein within a period of several months to 3-5 years. As a result of inflammatory-dystrophic changes, the vein turns into an unyielding sclerotic tube with destroyed valves.

Gross organic changes in the valves and walls of the vein lead to the occurrence of a pathological discharge of blood from top to bottom (vertical reflux), a significant increase in pressure in the veins of the leg, expansion and development of valvular insufficiency of the perforating veins (the path of blood flow from the superficial venous system to the deep) with secondary transformation and development of saphenous vein insufficiency. Thus, static (due to a decrease in the throughput of the venous bed) and dynamic (due to the destruction of valves and the occurrence of pathological blood flows) venous hypertension occurs, which in turn leads to deterioration of lymphovenous microcirculation, increased capillary permeability, tissue edema, sclerosis of the skin and subcutaneous tissue ( lipodermatosclerosis), the development of inflammatory changes in the skin (venous eczema) and subcutaneous tissue (indurated cellulitis), skin necrosis and the frequent formation of trophic ulcers.

The clinical picture of PTFB consists of the phenomena of chronic venous insufficiency of varying severity and dilation of the saphenous veins (strengthened vascular pattern or varicose veins), which take on most of the function of ensuring the outflow of blood from the lower extremities. Only 12% of patients develop noticeable symptoms in the first year of illness. This figure increases over several years and reaches 40-48% by the age of 6, and a trophic ulcer is detected in 10% of these patients.

Severe limb edema is one of the first and main symptoms of PTF. Arising during the period of acute venous thrombosis, as the vein lumen is recanalized and collateral pathways are formed, the outflow gradually regresses, but usually does not completely disappear. PTFB is characterized by the development of edema both in the distal parts of the limb (lower leg) and in the proximal parts (thigh, with ileofemoral localization of thrombosis), which is never observed with edema of a different etiology.

Edema in PTF develops both due to the muscular component (a significant increase in the volume of the calf muscles or the muscle mass of the thigh), and due to soft tissues, which leads to a violation of the anatomical configuration of the limb (smoothing of the dimples around the ankles, swelling of the rear of the foot, etc.). ). The dynamics of the edematous syndrome in PTF has a certain similarity with that in varicose veins: in the evening, edema increases due to soft tissues – the patient notes a “reduction in the size of shoes”, the appearance of a deep mark from socks or golf, swelling of the back of the foot, smoothing of the dimples around the ankles, with when pressing on the soft tissues of the lower leg, a noticeable dimple remains for a long time, and after a night’s rest it decreases, but as a rule does not completely disappear.

The second most important symptom of PTF is a feeling of heaviness and pain in the affected limb, aggravated by prolonged stay in immobile orthostasis (standing or sitting without movement in the ankle joint). The pain is pulling, dull, bursting, only occasionally intense, calms down in the supine position with a raised leg. Often disturbed by cramps of the calf muscles during prolonged standing and at night. Sometimes there are no independent pains in the limb, but they appear with palpation of the calf muscles, pressure on the inner edge of the sole, or squeezing of the tissues between the tibia.

Secondary subcutaneous varicose veins (varicose syndrome) develop in 65-70% of cases. For most patients, a loose type of expansion of the lateral branches of the main venous trunks on the lower leg and foot is typical. Relatively rarely, there is an expansion of the trunks of the GSV or SSV.

PTFB is one of the main causes of severe and rapidly progressive trophic disorders with the early development of a venous trophic ulcer, which is usually localized in a typical place – on the inner surface of the lower third of the lower leg of the affected limb, above the inner malleolus. The formation of an ulcer is preceded by other trophic changes: darkening of the skin (hyperpigmentation due to leakage of erythrocytes and their degeneration), thickening of the skin (due to the development of connective tissue against the background of chronic hypoxia), inflammatory changes in the skin and subcutaneous tissue (venous eczema and indurative cellulitis, due to blood stasis and release of activated leukocytes from the capillaries), areas of white atrophy (due to deep degeneration of the skin against the background of chronic inflammatory-dystrophic disorders) – more details in the CVI section.

Depending on the predominance of certain symptoms, four clinical forms of post-thrombophlebitic syndrome are distinguished:

• varicose,
• ulcerative,
• mixed.

Diagnostics.

In addition to the clinical picture, the gold standard for diagnosing deep vein thrombosis and subsequent post-thrombotic changes is ultrasonic angioscanning with color flow mapping (USAS, triplex angioscanning), which allows assessing not only structural changes in the vein (patency, the presence of thrombotic masses), but and its functional state (blood flow rate, the presence of pathological blood flows, the solvency of the valves).

USAS in PTF has several goals:

• primary diagnosis of the presence and age of post-thrombotic changes in case of suspected PTF;
• dynamic monitoring of the state of the venous bed and the course of the recanalization process from the moment the progression of the thrombotic process stops;
• exclusion of recurrent deep vein thrombosis, which usually has a poor clinical picture; ??Assessment of the condition of the saphenous veins and perforators.

Treatment.

The treatment of post-thrombophlebitic syndrome is predominantly conservative and includes traditional measures: elastic compression, lifestyle correction, physical therapy and gymnastics, physiotherapy, pharmacotherapy aimed both at stopping the effects of chronic venous insufficiency and at preventing recurrence of thrombosis, local treatment of trophic disorders .

Prevention of recurrent deep vein thrombosis.

All patients with a history of deep vein thrombosis are indicated for anticoagulant therapy with direct (heparin, fraxiparin, fondaparinux) or indirect (warfarin) anticoagulants. The duration of therapy is determined individually based on the reasons for the development of DVT and the persistence of risk factors. With provoked deep vein thrombosis (trauma, surgery, acute illness, prolonged immobilization), the period of anticoagulant therapy ranges from 3 (with localization of the process in the veins of the leg) to 6 (femoral veins) months. In idiopathic thrombosis (the cause of which could not be established), the period of taking anticoagulants should be at least 6 months. In case of recurrent thrombosis, the presence of confirmed thrombophilia (a blood disease with a tendency to thrombosis), cancer, implantation of a permanent cava filter, anticoagulants must be taken indefinitely (for life).

Elastic compression

Compression therapy is used throughout the treatment of chronic venous insufficiency and trophic leg ulcers. The effectiveness of compression therapy has been confirmed by many years of clinical observations. Prolonged use of well-chosen elastic stockings or bandages for the patient can achieve an improvement of 90% and healing of a leg ulcer in 90-93% of cases. Depending on the severity of trophic disorders, the use of an elastic bandage from bandages of medium and short stretch or a special individually selected compression stocking of 2-3 compression classes is indicated.

Pharmacotherapy

Drug therapy of PTFB is aimed at combating the symptoms of chronic venous insufficiency. To do this, various drugs are used that improve microcirculation, blood rheology, increase venous tone, protect the vessel wall from damage, prevent the release of activated leukocytes into the surrounding tissues, and improve lymphatic drainage function. Polyvalent phlebotonics are most commonly used, of which the micronized purified fraction of diosmin (Detralex) exhibits the greatest proven effectiveness in combating edema, heaviness in the legs, cramps in the calf muscles, and trophic disorders. Anti-inflammatory drugs are also used in the form of topical forms (ointments and gels), deaggregants, courses of infusion-rheological therapy.

Drug treatment should be carried out in periodic courses lasting up to 2-2.5 months. Treatment should be strictly individualized in accordance with the clinical manifestations of the disease.

Surgical intervention

Surgical treatment of post-thrombophlebitic syndrome is usually used after the completion of the deep vein recanalization process, when the blood flow in the deep, communicating and superficial veins is restored. With partial or complete recanalization of deep veins, accompanied by dilation of the saphenous veins, the operation of choice is safenectomy in combination with ligation of incompetent perforators.

The operation allows to eliminate blood stasis in varicose saphenous veins, eliminate retrograde blood flow through communicating veins, reduce venous hypertension in the area of ​​the affected lower leg, accelerate blood flow through deep veins and reduce the risk of recurrent thrombosis and, consequently, improve blood circulation in the microcirculatory vascular bed.