What are the signs of a blood clot in the leg. How can you prevent deep vein thrombosis. When should you seek medical attention for DVT symptoms. What are the risk factors for developing blood clots in the lower extremities. How is deep vein thrombosis diagnosed and treated.

Understanding Deep Vein Thrombosis (DVT): A Comprehensive Overview

Deep vein thrombosis (DVT) is a serious medical condition that occurs when a blood clot forms in one of the deep veins of the body, typically in the lower legs. This potentially life-threatening condition can lead to complications if left untreated, making early detection and prompt medical intervention crucial.

DVT often develops during periods of prolonged immobility, such as long flights or extended bed rest. The clot can obstruct blood flow, causing discomfort and potentially leading to a pulmonary embolism if it breaks free and travels to the lungs.

What causes deep vein thrombosis?

Several factors can contribute to the formation of blood clots in the deep veins:

• Prolonged periods of inactivity
• Recent surgery, especially involving the hips or legs
• Injury to the lower body
• Certain medical conditions that affect blood clotting
• Hormonal changes, such as those caused by birth control pills or hormone replacement therapy
• Obesity
• Smoking
• Family history of blood clots

Recognizing the Symptoms of DVT: When to Be Concerned

Identifying the signs of deep vein thrombosis is crucial for timely treatment. While some individuals may not experience noticeable symptoms, others may encounter various discomforts in the affected leg.

What are the common symptoms of DVT?

Be aware of the following signs that may indicate the presence of a blood clot in your leg:

• Leg pain or discomfort resembling a pulled muscle
• Swelling in the affected leg
• Redness or discoloration of the sore area
• Warmth in the affected area
• A throbbing sensation in the leg
• Tightness or cramping in the leg muscles

If you experience any of these symptoms without an apparent cause, such as a recent injury or overuse, it’s essential to seek medical attention promptly.

Risk Factors for Developing Deep Vein Thrombosis

Understanding the risk factors associated with DVT can help individuals take preventive measures and seek timely medical care when necessary.

Who is at higher risk for developing blood clots in the legs?

Certain groups of people are more susceptible to developing DVT:

• Individuals over 60 years of age
• Those who smoke
• People with obesity
• Individuals taking birth control pills or hormone replacement therapy
• Those with a personal or family history of blood clots
• People who have undergone recent surgery
• Individuals confined to bed rest
• Those with certain medical conditions affecting blood clotting

Deep Vein Thrombosis in Children: A Less Common but Serious Concern

While deep vein thrombosis is more prevalent among adults, it can also affect children, albeit rarely. Understanding the risk factors and symptoms in pediatric cases is crucial for early detection and treatment.

Can children develop DVT?

Yes, children can develop deep vein thrombosis, although it’s less common than in adults. DVT in children is more likely to occur in hospitalized patients or those with specific risk factors.

What factors increase the risk of blood clots in children?

Several factors can contribute to the development of DVT in pediatric patients:

• Recent surgery
• Placement of a catheter or PICC line in a vein
• Extended periods of bed rest
• Family history of blood clots
• Use of birth control pills (in teenage girls)

Parents and caregivers should be vigilant for signs of DVT in children, especially those with known risk factors or recent hospitalizations.

Seeking Medical Care for Suspected Deep Vein Thrombosis

Prompt medical attention is crucial when suspecting a blood clot in the leg. Early diagnosis and treatment can help prevent potentially life-threatening complications, such as pulmonary embolism.

When should you seek medical care for a possible blood clot?

If you or your child experience symptoms suggestive of DVT, it’s important to seek medical care as soon as possible. This may involve:

• Scheduling a same-day appointment with your primary care physician
• Visiting an urgent care center if immediate care is needed
• Going to the emergency room for severe symptoms or if other options are unavailable

Remember, it’s always better to err on the side of caution when dealing with potential blood clots.

What are the warning signs of a pulmonary embolism?

In some cases, a blood clot may break free and travel to the lungs, causing a pulmonary embolism. This is a medical emergency requiring immediate attention. Seek emergency care if you experience:

• Sudden difficulty breathing or shortness of breath
• Chest pain that worsens with deep breathing
• A sudden cough, especially if accompanied by bloody mucus
• Rapid heartbeat
• Dizziness or loss of consciousness

Diagnosis and Treatment of Deep Vein Thrombosis

Accurate diagnosis and timely treatment are essential for managing deep vein thrombosis effectively and preventing complications.

How is DVT diagnosed?

Diagnosing DVT typically involves a combination of clinical evaluation and diagnostic tests:

• Physical examination
• Medical history review
• Ultrasound imaging of the affected leg
• Blood tests to check for clotting factors
• In some cases, additional imaging studies such as CT scans or MRI

What are the treatment options for deep vein thrombosis?

Treatment for DVT aims to prevent the clot from growing, reduce the risk of pulmonary embolism, and alleviate symptoms. Common treatment approaches include:

• Anticoagulant medications (blood thinners) to prevent further clotting
• Compression stockings to improve blood flow and reduce swelling
• In severe cases, thrombolytic therapy to dissolve the clot
• Rarely, placement of a vena cava filter to prevent clots from reaching the lungs

Your healthcare provider will determine the most appropriate treatment plan based on your individual circumstances and medical history.

Preventing Deep Vein Thrombosis: Lifestyle Changes and Precautions

While not all cases of DVT can be prevented, certain lifestyle modifications and precautions can help reduce your risk of developing blood clots.

How can you lower your risk of developing blood clots?

Incorporate these healthy habits into your daily routine to minimize the risk of DVT:

• Stay active and avoid prolonged periods of sitting
• Take regular breaks to walk and stretch during long trips or workdays
• Maintain a healthy weight through proper diet and exercise
• Quit smoking or avoid starting
• Stay hydrated, especially during travel
• Wear loose-fitting clothing that doesn’t restrict blood flow
• Consider wearing compression stockings during long flights or if you have a history of blood clots

What precautions should be taken before surgery or during hospitalization?

If you’re planning to undergo surgery or expect a hospital stay, discuss DVT prevention with your healthcare provider. They may recommend:

• Early mobilization after surgery
• Use of compression devices during and after surgery
• Prophylactic anticoagulant medications
• Customized prevention plans based on your individual risk factors

By taking these precautions and maintaining open communication with your healthcare team, you can significantly reduce your risk of developing deep vein thrombosis.

Long-Term Management and Follow-Up Care for DVT Patients

Proper long-term management and follow-up care are crucial for individuals who have experienced deep vein thrombosis. This ongoing care helps prevent recurrence and manages potential complications.

What does long-term management of DVT involve?

Long-term management of deep vein thrombosis typically includes:

• Regular follow-up appointments with your healthcare provider
• Continued use of anticoagulant medications as prescribed
• Monitoring for signs of post-thrombotic syndrome
• Ongoing use of compression stockings if recommended
• Lifestyle modifications to reduce the risk of recurrence

How long does recovery from DVT take?

Recovery time from deep vein thrombosis can vary depending on the severity of the clot and individual factors. Generally, patients may experience:

• Improvement in symptoms within a few days to weeks of starting treatment
• Complete dissolution of the clot over several months
• Ongoing monitoring and management for 3-6 months or longer

It’s important to follow your healthcare provider’s instructions closely and attend all scheduled follow-up appointments to ensure proper healing and prevent complications.

What Do Blood Clots in the Leg Feel Like?

Have you ever sat on a long flight, then stood up to leave the plane and noticed that your leg hurt in a way that it hadn’t at the start of your journey? Prolonged sitting may increase the risk of developing a blood clot in the leg, which is also called deep vein thrombosis (DVT).

DVT typically forms deep within a vein in the leg. When a blood clot forms, it can obstruct blood flow, leading to uncomfortable symptoms. If a clot breaks free from the spot where it formed, it may cause a potentially life-threatening condition known as pulmonary embolism, when the clot travels through blood vessels and enters the lung.

Not all blood clots in the leg lead to pulmonary embolism; some resolve on their own. But if you notice signs that you may have DVT, seeing a doctor quickly may help you avoid dangerous complications.

“There are effective treatments for a blood clot in the leg, most notably blood thinners, which hinder clotting ability while they’re being used,” says Vikalp Jain, M. D., vascular surgeon at Jersey Shore University Medical Center. “Seeking medical help early when you think that you may have a blood clot is always the right decision, even if it turns out to be nothing. It’s better to be safe than sorry when pulmonary embolism could be a possibility.”

Signs that you may have a blood clot

Many people who have a blood clot notice discomfort in the affected leg and can’t attribute the problem to a recent injury, overuse or another factor. They’re more common after surgery and among people on bed rest or those who sit for long periods without stretching.

Symptoms include:

• leg pain or discomfort that may feel like a pulled muscle, tightness, cramping or soreness
• swelling in the affected leg
• redness or discoloration of the sore spot
• the affected area feeling warm to the touch
• a throbbing sensation in the affected leg

Some people don’t experience noticeable symptoms, which makes it difficult for them to recognize that they should seek care.

Blood clots are more common among people who:

• smoke
• are obese
• take birth control pills or hormone replacement therapy
• have a personal or family history of blood clots

Can kids get blood clots in the leg?

“Blood clots are more common among people age 60 and older, but it’s possible for kids to experience DVT. They’re rare in healthy children, but they’re more common among kids who are hospitalized,” says Katherine Armstrong, M.D., MS, pediatric hematologist-oncologist of Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center.

Factors that may increase the risk of blood clots in children include:

• having had surgery
• having a catheter or PICC line placed in a vein
• being confined to bed
• having a family history of blood clots
• taking birth control pills (teenage girls)

When to seek care for a possible blood clot

If you think that you or your child may have a blood clot in the leg, seeing a doctor that day may help you avoid complications. If you can’t get a same-day appointment with your regular doctor, visit an urgent care center or emergency room. Quick care may help you ward off a pulmonary embolism, which may be deadly.

Whether or not you’ve noticed symptoms of DVT, seek emergency care if you have symptoms of a pulmonary embolism, including:

• sudden difficulty breathing or shortness of breath
• chest pain that worsens when you try breathing deeply
• a sudden cough, especially if you produce bloody mucus
• a fast heartbeat
• dizziness or losing consciousness

Healthy habits may lower your risk of blood clots

If you have a family history of blood clots or you’re about to have surgery, talk to your doctor about ways to lower your risk of DVT.

To lower your risk of blood clots in everyday situations, make lifestyle changes, including:

• breaking up long periods of sitting (whether at home, at work or while traveling)
• being more physically active
• maintaining a healthy weight
• quitting smoking

Next Steps & Resources:

• Meet our sources: Vikalp Jain, M. D., Katherine Armstrong, M.D., MS
• To make an appointment, call 800-822-8905 or visit our website.
• Find an urgent care center near you.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

Deep Vein Thrombosis – OrthoInfo

Deep vein thrombosis, or DVT, occurs when a blood clot forms in one of the deep veins of the body. This can happen if a vein becomes damaged or if the blood flow within a vein slows down or stops. While there are a number of risk factors for developing a DVT, two of the most common are an injury to your lower body and surgery that involves your hips or legs.

A DVT can have serious consequences. If a blood clot breaks free, it may travel through the bloodstream and block blood flow to the lungs. Although rare, this complication—called a pulmonary embolism—can be fatal. Even if a blood clot does not break free, it may cause permanent damage to the valves in the vein. This damage can lead to long-term problems in the leg such as pain, swelling, and leg sores.

In many cases, DVT occurs without noticeable symptoms and is very difficult to detect. For this reason, doctors focus on preventing the development of DVT using different types of therapies, depending upon a patient’s needs. Your doctor will take steps to prevent DVT if you have a major fracture or are having lower extremity surgery—including total hip or total knee replacement.

Blood clots may form in one of the deep veins of the body. While DVT can occur in any deep vein, it most commonly occurs in the veins of the pelvis, calf, or thigh.

Arteries are the blood vessels that carry oxygen-rich blood from the heart to all other parts of the body. Veins return the oxygen-depleted blood back to the heart. There are two types of veins in the body:

• Superficial veins lie just below the skin’s surface
• Deep veins are located deep within the muscles

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms within one of the deep veins. While DVT can occur in any deep vein, it most commonly occurs in the veins of the pelvis, calf, or thigh.

Several factors can affect blood flow in the deep veins and increase the risk for developing blood clots. These include:

• Increasing age
• Personal or family history of DVT or pulmonary embolism
• Having cancer
• Having a vein disease, such as varicose veins
• Smoking
• Using birth control pills or hormone therapy
• Pregnancy
• Being overweight or obese
• Inheriting a blood-clotting disorder

A broken hip or leg, or having major surgery on your hip, knee or lower leg can affect normal blood flow and clotting. In these orthopaedic situations, three primary factors contribute to the formation of blood clots in veins: slow blood flow, hypercoagulation, and damage to the veins.

Blood that Flows Slowly through Veins (Stasis)

The walls of the veins are smooth. This helps blood flow freely and mix with naturally occurring agents (anticoagulants) in the blood that keep the blood cells from clotting. Blood that does not flow freely and does not mix with anticoagulants may be more likely to clot. This is why it is important to watch for signs of DVT in people who are on bed rest, immobilized in a splint or cast, or not able to move for long periods of time.

Hypercoagulation

Blood thickens, or coagulates, around matter that does not belong in the veins. During surgery, matter such as tissue debris, collagen, or fat may be released into the blood system and can cause the blood to coagulate. In addition, during total hip replacement, preparing the bone to receive the prosthesis may cause the body to release chemical substances called antigens into the blood system. These antigens can also stimulate clot formation.

Damage to the Vein Walls

During surgery, the doctor must move, or retract, soft tissues such as ligaments, muscles, and tendons to reach the area being operated on. In some cases, this can release naturally occurring substances that promote blood clotting.

Pulmonary Embolism

A pulmonary embolism is a blood clot that breaks free and travels through the veins. This can happen right after the formation of the blood clot or it may happen days later. If the blood clot reaches the lungs, it can block the flow of blood to the lungs and heart.

A pulmonary embolism is a serious medical emergency and can lead to death.

Post-thrombotic Syndrome

Some people who have a DVT develop long-term symptoms in the calf, a condition called post-thrombotic syndrome. Post-thrombotic syndrome is caused when damage to the veins results in venous hypertension—or higher than normal blood pressure in the veins. This increased pressure can damage the valves that control blood flow through the veins. This allows blood to pool at the site—sometimes causing lasting impairment.

Patients with post-thrombotic syndrome may experience symptoms that can impact their quality of life, including pain, swelling, skin changes, and leg sores.

Symptoms of DVT occur in the leg affected by the blood clot and include:

• Swelling
• Pain or tenderness
• Distended veins
• Red or discolored skin
• A firmness or thickening of the vein called a “cord”

Many patients, however, experience no symptoms at all.

In some cases, a pulmonary embolism may be the first sign of DVT. Symptoms of pulmonary embolism include:

• Shortness of breath
• Sudden onset of chest pain
• Coughing
• Spitting up or vomiting blood

If your doctor suspects DVT, he or she will order diagnostic tests.

Tests

Duplex ultrasound. This is the most common test for DVT. Ultrasound uses high-frequency sound waves that echo off the body—much like the technology used to check fetal well-being. This creates a picture of the blood vessels. Duplex ultrasound combines traditional ultrasound technology with Doppler technology, which generates a color image showing blood as it flows through the body.

Ultrasound is both noninvasive and painless. It can be repeated regularly because it does not require radiation. If you do not have a blood clot, duplex ultrasound may be helpful in revealing other causes for your symptoms.

(Left) In an ultrasound, the technician places a noninvasive probe called a “transducer” over the patient’s leg. (Right) The transducer sends images to the ultrasound machine and screen.

Magnetic resonance imaging (MRI) scan. An MRI produces detailed, cross-sectional images of structures inside the body, including blood vessels and veins. The test is painless and noninvasive. Although used infrequently, some doctors may use an MRI to locate blood clots in the pelvis and thigh.

MRI allows both legs to be viewed at the same time. However, it cannot be used for patients with certain implanted devices, such as pacemakers.

Venography. In venography, the doctor injects a contrast solution (or dye) into a vein. The solution mixes with the blood and flows throughout the veins. An x-ray of the affected leg will then show whether there are any blockages in the veins of the calf and thigh.

Venography is rarely used because it is invasive and requires radiation.

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Since DVT may occur after a major fracture or surgery, many patients are already hospitalized when the condition is diagnosed. The goals of treatment for DVT are to:

• Stop the blood clot from getting bigger
• Prevent the clot from breaking off and traveling to the lungs where it could lead to pulmonary embolism
• Reduce the chance of developing another clot
• Minimize the risk of developing other complications

Most often, treatment for DVT is nonsurgical.

Nonsurgical Treatment

Anticoagulants. Nonsurgical treatment usually consists of taking anticoagulants—blood thinning medications that will prevent further clotting and help dissolve existing clots. Anticoagulant medications are started immediately after the clot is diagnosed.

Anticoagulants can cause bleeding problems if the dosage is too high so their use must be monitored closely whether you are in the hospital or at home. Depending upon the medication you are taking, your doctor may order frequent blood tests to check how long it takes for your blood to clot. It is important to make sure that the medication level in your blood is high enough to prevent clots, but not too high to cause excessive bleeding.

The most common anticoagulants used to treat DVT are Xa inhibitors, heparin, low molecular weight heparin (LMWH),  and warfarin (Coumadin).

• Xa inhibitors. These newer anticoagulants are given orally. The are easy to administer, do not require blood test monitoring, and doses do not need to be adjusted.  Because of this, they are widely prescribed.

• Warfarin. Heparin or LMWH therapy is usually followed by 3 to 6 months of warfarin, which is taken orally. Warfarin takes at least 36 hours to start working, and from 4 to 5 days to reach its maximum effectiveness. For this reason, both heparin and warfarin are given at the start of treatment; the heparin protects the patient, keeping his or her blood anticoagulated until the warfarin “kicks in.”  Warfarin is less commonly used since the advent of Xa inhibitors because it requires frequent blood monitoring, while Xa inhibitors do not.

There are benefits and risks to all types of anticoagulants. Your doctor will talk with you about which medication will work best for you.

Observation and serial ultrasound. Depending on your individual risk factors, your doctor may manage an isolated, below the knee or calf DVT with observation and monitoring through serial duplex ultrasound scans, rather than anticoagulant therapy. Your doctor will discuss which type of treatment is right for you.

Thrombolytics. In some cases, your doctor may recommend using thrombolytics. These clot-dissolving medications are injected via a catheter directly into the blood clot and are used only when there is an extremely high risk for pulmonary embolism.

Surgical Treatment

If anticoagulants do not stop your blood clot from increasing in size, or if you have a medical condition that does not allow you to take anticoagulation medications, your doctor may recommend surgery to insert a small device called a vena cava filter into the main vein leading to your heart. This filter is designed to capture most blood clots traveling through your blood stream before they reach your lungs and cause a pulmonary embolism. In rare cases, surgery might be recommended to remove a blood clot from the veins or lungs.

If you are having orthopaedic surgery, your risk for developing DVT is highest from 2 to 10 days after surgery and includes the time after you have been discharged from the hospital. You remain at risk for about 3 months.

The measures your doctor uses to help prevent DVT are called prophylaxis. He or she will use several preventive measures in combination. For example, if you are having total knee or total hip replacement, your doctor may prescribe early movement and exercise, compression stockings, and medications that thin the blood and reduce the body’s ability to form blood clots.

Early Movement and Physical Therapy

Most patients begin walking or doing other leg exercises as soon as possible after surgery. Performing simple leg lifts while lying in bed will help increase blood flow through the veins. In addition, a physical therapist will teach you specific exercises to restore joint range of motion, strengthen your lower body, and improve circulation in your deep veins. If pain after surgery makes it difficult for you to move, you may be given pain medication so that you can move more comfortably.

Compression Devices

Graded elastic compression stockings are tight at the ankle and become looser as they go up the leg. The compression they provide may help circulation by preventing blood from pooling in the veins.

In addition, your doctor may recommend that you use an external pneumatic compression device after surgery. This device, which is worn like a boot, applies pulsing pressures to the calf. This pressure is similar to that which you experience while you are walking. Compression devices not only improve venous blood flow but also stimulate the body’s own ability to prevent blood clots.

A pneumatic compression device.

Anticoagulants

Anticoagulants, or blood thinners, are used to stop blood clots from getting bigger and to prevent new blood clots from forming. If you are having joint replacement surgery, you will start anticoagulants the day after surgery and continue in the hospital and at home. The length of time that you take the medication will vary, depending on the type of surgery you have had, as well as other risk factors.

Additional Measures

If you have experienced a traumatic lower body injury, you may be treated with additional prophylactic measures. Rarely, if you are unable to take anticoagulants, your doctor may recommend inserting a vena cava filter in the main vein leading to your heart. This is done to help prevent a potential DVT from reaching your heart and lungs and causing a pulmonary embolism.

Learn more: Preventing Blood Clots After Orthopaedic Surgery (Video)

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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 you do not take active steps 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 symptom 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 leg 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 that develops 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 very specifically formulated 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 developed 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?

It must always be remembered 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 not 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.

Self-care: Taking care of yourself: Lenta.ru

Phlebologist Avakyan called throbbing pain and numbness of the limbs clear symptoms of thrombosis

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, and atypical signs of the development of a life-threatening disease that should not be ignored, said Armen Avakyan, phlebologist surgeon of the First Professional Network of Orthopedic Salons ORTEKA. In an interview with Lenta.ru, he listed the most obvious warning signs, including throbbing pain and numbness in the limbs.

Blood clots are blood clots that form in arteries and veins and can partially or completely obstruct blood flow, the doctor explained. The signs of this pathology depend on where exactly the blood clot formed.

The first and most obvious symptom of arterial thrombosis is a problem in the functioning of an organ whose circulation is impaired. In the event of a blood clot in the vessels going to the brain, there is a headache and dizziness, speech disorder. A blood clot in the heart causes a heart attack. It can be recognized by severe pain in the chest area. For arterial thrombosis, the character is a sharp throbbing pain at the site of blockage of the vessel, which extends to other nearby areas. Due to a violation of the blood supply to an organ or tissue, a pathological condition develops – ischemia

Armen Avakyan surgeon-phlebologist of the First Professional Network of Orthopedic Salons ORTEKA

If the arteries of a limb are affected, a person feels pain, coldness and subsequent numbness of the limb, the skin becomes pale, Avakyan continued. He called pain in the legs a symptom of thrombosis of the veins of the lower extremities. Depending on the site of clot formation, swelling appears in the lower leg, thigh or ankle, sometimes the entire leg swells.

“If the superficial veins are affected, you can notice their swelling at the site of the formation of a blood clot, redness and thickening of the skin in this area. In case of damage to the deep veins, the leg becomes bluish in color. If you lightly press on the blue area with your finger and release it, a white spot will remain, ”added the phlebologist.

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The physician attributed the worsening of the general condition to non-obvious signs of thrombosis. According to him, a person usually feels weakness, chills, malaise, his temperature rises. However, such signs are characteristic of many pathologies, so few immediately associate them with thrombosis, Avakyan noted.

In conclusion, the phlebologist recalled that factors such as a sedentary lifestyle, constant work on the legs, pregnancy, age (the risk of the disease increases after 60 years, but young people can be under its blow), the impact of certain drugs, taking contraceptive pills, overweight, unhealthy diet, smoking and alcohol use, family history and genetic predisposition.