What are the symptoms of deep vein thrombosis. How can you prevent blood clots in the lower legs. What are the risk factors for developing DVT. How is deep vein thrombosis diagnosed and treated.

Understanding Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis (DVT) is a serious medical condition characterized by the formation of blood clots in deep veins, typically in the lower legs. These clots can interfere with blood flow and potentially break off, traveling to other parts of the body and causing severe complications. Understanding the symptoms, causes, and preventive measures is crucial for maintaining vascular health and reducing the risk of this potentially life-threatening condition.

Recognizing the Symptoms of DVT

Identifying the symptoms of DVT early can be crucial for prompt treatment and prevention of complications. The most common signs include:

• Leg pain or tenderness, typically in one leg
• Swelling (edema) in one leg
• Increased warmth in the affected area
• Changes in skin color, often redness
• Visible surface veins

Is leg pain always a sign of DVT? While leg pain is a common symptom, it’s important to note that not all cases of DVT present with pain. Some individuals may experience only swelling or changes in skin color. Additionally, in some cases, DVT can be asymptomatic, making regular check-ups and awareness of risk factors crucial.

Risk Factors and Causes of Deep Vein Thrombosis

Several factors can increase the likelihood of developing DVT:

1. Prolonged immobility (long flights, bedrest)
2. Recent surgery, especially orthopedic or pelvic procedures
3. Trauma or fractures
4. Pregnancy and postpartum period
5. Use of estrogen-containing medications
6. Cancer and certain blood disorders
7. Obesity
8. Advanced age (over 60)
9. Family history of blood clots

Can DVT occur in young, healthy individuals? While less common, DVT can affect people of all ages and health statuses. Certain circumstances, such as long-distance travel or the use of birth control pills, can increase the risk even in otherwise healthy young adults.

Diagnostic Procedures for DVT

Accurate diagnosis of DVT is essential for appropriate treatment. Healthcare providers may use various methods to confirm the presence of blood clots:

• Doppler ultrasound: A non-invasive imaging technique to visualize blood flow in the veins
• Venography: An X-ray procedure using contrast dye to highlight veins
• D-dimer blood test: Measures a substance released when blood clots break down
• Plethysmography: Measures changes in blood flow in the legs

Are blood tests alone sufficient to diagnose DVT? While blood tests like the D-dimer can be helpful, they are typically used in conjunction with imaging studies for a definitive diagnosis. A negative D-dimer test can help rule out DVT, but a positive result requires further investigation.

Additional Blood Tests for Hypercoagulability

In some cases, especially for recurrent or unexplained DVT, doctors may order additional blood tests to check for conditions that increase clotting tendencies:

• Antithrombin III, protein C, and protein S levels
• Factor V Leiden mutation
• Prothrombin 20210a mutation
• Lupus anticoagulant and anticardiolipin antibodies

Treatment Approaches for Deep Vein Thrombosis

The primary goals of DVT treatment are to prevent the clot from growing, reduce the risk of embolism, and prevent recurrence. Standard treatment options include:

1. Anticoagulant medications: Heparin (intravenous or subcutaneous) and warfarin (oral)
2. Direct oral anticoagulants (DOACs): Newer medications that don’t require regular blood monitoring
3. Thrombolytic therapy: For severe cases, medication to dissolve clots may be administered
4. Inferior vena cava (IVC) filters: Used in patients who cannot take anticoagulants

How long does DVT treatment typically last? The duration of anticoagulation therapy can vary depending on the individual case, ranging from 3-6 months to indefinite treatment for recurrent DVT or ongoing risk factors. Regular follow-ups with healthcare providers are essential to monitor treatment effectiveness and adjust as needed.

Preventive Measures to Reduce DVT Risk

While it’s not always possible to completely eliminate the risk of DVT, several preventive measures can significantly reduce the likelihood of clot formation:

• Regular movement and exercise, especially during long periods of sitting
• Use of compression stockings or intermittent pneumatic compression devices
• Proper hydration, particularly during travel
• Maintaining a healthy weight
• Quitting smoking
• Following prescribed anticoagulation regimens for high-risk individuals

Do compression stockings completely prevent DVT? While compression stockings can help improve blood flow and reduce the risk of DVT, they are not a foolproof method of prevention. They should be used in conjunction with other preventive measures, especially for high-risk individuals.

Specific Preventive Strategies for Different Risk Levels

Prevention strategies may vary based on an individual’s risk profile:

1. Low-risk individuals:
   • Leg elevation
   • Ankle flexion and extension exercises
   • Walking and stretching during long trips
2. Higher-risk individuals:
   • Anticoagulant medications
   • Intermittent pneumatic compression devices
   • Combination of physical and pharmacological methods

Complications and Long-Term Outlook of DVT

Understanding the potential complications of DVT is crucial for emphasizing the importance of prevention and prompt treatment:

• Pulmonary embolism: A potentially life-threatening condition where a clot travels to the lungs
• Post-thrombotic syndrome: Long-term swelling, pain, and skin changes in the affected limb
• Chronic venous insufficiency: Ongoing problems with blood flow in the affected veins

Can DVT recur after successful treatment? Yes, individuals who have experienced DVT are at higher risk for recurrence. This risk can be mitigated through ongoing preventive measures, lifestyle modifications, and, in some cases, long-term anticoagulation therapy.

Emerging Research and Future Directions in DVT Management

The field of DVT research is continually evolving, with several promising areas of investigation:

1. Novel anticoagulants with improved safety profiles
2. Personalized risk assessment tools using genetic markers
3. Advanced imaging techniques for earlier detection
4. Targeted therapies to dissolve clots more effectively
5. Improved mechanical devices for DVT prevention

How might future advancements change DVT management? Ongoing research aims to develop more precise risk prediction models, allowing for tailored prevention strategies. Additionally, new treatments may offer more effective clot dissolution with fewer side effects, potentially changing the standard of care for DVT patients.

The Role of Lifestyle Modifications in DVT Prevention

Beyond medical interventions, lifestyle changes play a crucial role in reducing DVT risk:

• Regular physical activity to improve circulation
• Maintaining a healthy diet rich in fruits, vegetables, and whole grains
• Avoiding prolonged periods of immobility
• Managing underlying health conditions like obesity and diabetes
• Limiting alcohol consumption and avoiding tobacco use

These lifestyle modifications not only reduce DVT risk but also contribute to overall cardiovascular health, underscoring the importance of a holistic approach to vascular wellness.

Patient Education and Self-Management in DVT Care

Empowering patients with knowledge and self-management skills is essential for effective DVT prevention and management:

1. Understanding personal risk factors
2. Recognizing early signs and symptoms
3. Adhering to prescribed medication regimens
4. Proper use of compression stockings or other devices
5. Regular follow-ups with healthcare providers
6. Lifestyle modifications to reduce risk

How can patients actively participate in their DVT care? Patients can take an active role by educating themselves about DVT, consistently following their treatment plan, and communicating openly with their healthcare team about any concerns or changes in symptoms. This collaborative approach enhances the effectiveness of DVT prevention and management strategies.

The Importance of Multidisciplinary Care in DVT Management

Effective DVT management often requires a team approach, involving various healthcare specialists:

• Vascular specialists
• Hematologists
• Primary care physicians
• Interventional radiologists
• Physical therapists
• Nutritionists

This multidisciplinary approach ensures comprehensive care, addressing all aspects of DVT prevention, treatment, and long-term management.

Deep Vein Thrombosis (DVT) – Heart and Blood Vessel Disorders

Although the risk of deep vein thrombosis cannot be entirely eliminated, it can be reduced in several ways:

• Intermittent pneumatic compression devices

Preventive measures are selected depending on the person’s risk factors and individual characteristics.

People at low risk of deep vein thrombosis, such as those who must be temporarily inactive for long periods, as during an airplane flight, and those who are undergoing minor surgery but have no other risk factors for deep vein thrombosis, can take simple measures. Such people should elevate their legs, flex and extend their ankles about 10 times every 30 minutes, and walk and stretch every 2 hours while awake during long flights.

People at higher risk of deep vein thrombosis require additional preventive treatment. Such people include

• People undergoing minor surgery who have specific risk factors for deep vein thrombosis (for example, cancer or excessive blood clotting)

• People without risk factors undergoing major surgery (especially orthopedic surgery)

• People who are hospitalized with a serious illness (for example a heart attack or serious injury)

Alternatively, intermittent pneumatic compression (IPC) leggings are an effective way to prevent clots in higher risk people, particularly those who are having surgery associated with a high risk of bleeding or who just had a serious injury and thus should not use an anticoagulant drug. Usually made of plastic, these leggings are automatically pumped up and emptied by an electric pump. They repeatedly squeeze the calves and empty the veins. The leggings are put on before surgery and kept on during and after surgery, until the person can walk again.

Continuously wearing high-compression elastic stockings (support hose) makes the veins narrow slightly and the blood flow more rapidly. As a result, clotting may be less likely. However, elastic stockings are not sufficient protection against developing deep vein thrombosis. Also, they may give a false sense of security and discourage more effective methods of prevention. If not worn correctly, they may bunch up and aggravate the problem by blocking blood flow in the legs.

Blood Clot Leg – UCLA Lung Cancer, Los Angeles, CA

Patient Education – Lung Cancer Program at UCLA

Educating yourself about lung cancer:

Signs and symptoms: Blood clot in the legs

Deep venous thrombosis

Definition

Deep venous thrombosis is a condition in which a blood clot forms in a vein that is deep inside the body.

Alternative Names

DVT; Blood clot in the legs

Causes

Deep venous thrombosis (DVT) mainly affects the veins in the lower leg and thigh. A clot (thrombus) forms in the larger veins of the area. This clot can interfere with blood flow, and it may break off and travel through the bloodstream (embolize). The traveling blood clot (embolus) can lodge in the brain, lungs, heart, or other area, severely damaging that organ.

Risks for DVT include prolonged sitting (such as on long plane or car trips) or bedrest. It also may be caused by recent surgery (especially hip, knee, or female reproductive organ surgery), fractures, childbirth within the last 6 months, and the use of medications such as estrogen and birth control pills.

Risks also include overproduction of red blood cells in bone marrow (polycythemia vera), cancerous (malignant) tumor, and having a condition in which the blood is more likely to clot (hypercoagulability).

Deep venous thrombosis is most common in adults over age 60, but it can occur in any age group.

Symptoms

• Leg pain in one leg
• Leg tenderness in one leg
• Swelling (edema) of one leg
• Increased warmth in one leg
• Changes in skin color (redness) in one leg

Exams and Tests

An exam may show a red, swollen, or tender leg.

The presence of deep venous thrombosis may be seen on:

• X-rays to show veins (venography) in the legs
• Doppler ultrasound exam of a limb
• Plethysmography of the legs
• D-dimer blood test

Many causes of increased clotting (hypercoagulability) can be found by these blood tests:

• Antithrombin III, protein C, protein S
• Factor V Leiden
• Prothrombin 20210a mutation
• DIC screening
• Lupus anticoagulant and anticardiolipin antibodies

Treatment

DVT treatment helps prevent a pulmonary embolus from forming and helps prevent another DVT.

For years, the standard treatment has been a medication called heparin to stop blood clots from forming (anticoagulant). Heparin is given through the vein. It results in quick anticoagulation and it treats the clot. A person with DVT also may get an oral medication called warfarin with the heparin.

Warfarin usually takes several days to fully work. Heparin is continued until the warfarin has been fully effective for at least 24 hours. People will take warfarin for about 6 months. Usually warfarin is started after heparin.

Because heparin is given continuously through a vein (IV), it requires a hospital stay. However, newer forms of heparin known as low molecular-weight heparin (usually a drug called enoxaparin) can sometimes be used. This heparin can be given by injection once or twice a day to shorten or avoid the need for a hospital stay.

Warfarin causes an increase in the time it takes blood to clot, known as prothrombin time (PT). A system called the International Normalized Ratio (INR) is used to report the ability of the blood to clot properly. Doctors will adjust warfarin to keep the INR between 2 and 3.

Outlook (Prognosis)

Most DVT’s disappear without a problem, but they can recur. Some people may have chronic pain and swelling in the leg, known as post phlebitic syndrome. Pulmonary embolus is uncommon when DVT’s are treated properly, but it can occur and can be life threatening.

Possible Complications

• Pulmonary embolus
• Post-phlebitic syndrome

When to Contact a Medical Professional

Call your health care provider if you have DVT-like symptoms.

Go to the emergency room or call the local emergency number (such as 911) if you have DVT and you develop chest pain, difficulty breathing, fainting, loss of consciousness, or other severe symptoms.

Prevention

Doctors may prescribe anticoagulants to help prevent DVT in high-risk people or those who are undergoing high-risk surgery. To help prevent DVT, move your legs often during long plane trips, car trips, and other situations in which you are sitting or lying down for long periods of time.

Signs and Symptoms DVT | Thrombosis Adviser

In some, there may be no symptoms of DVT, but most common symptoms include:1,2

1. Pain, swelling and tenderness in one leg most commonly in the calf (symptoms in both legs is uncommon)
    
2. Warm skin around the area of the clot
    
3. Skin turning to a reddish or bluish colour over the affected area.

Signs and Symptoms of DVT1,2

What is a Pulmonary Embolism? A pulmonary embolism is when a clot that has formed from DVT travels to the lungs and causes a blockage. Read more DVT poses many risks to your long-term health; If the blood clot becomes dislodged it can travel to the lungs and cause pulmonary embolism (PE). Following a DVT you are also at risk of developing post-thrombotic syndrome (PTS) whereby damage to the veins (from the presence of the DVT) leads to permanent disruption to how well the blood flows back up from your feet/lower limbs. Over time this leads to swelling, pain and can cause chronic disability.3

What risk factors increase the risk of DVT?

DVT can develop at any age but is most common in people over the age of 40. Other risk factors for developing DVT include:

• Having a family history of DVT
   
• Being overweight or obese
   
• Having damaged blood vessels
   
• Having certain conditions that cause your blood to clot more easily than usual, such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Hughes syndrome
   
• Being inactive or immobile when travelling during long journeys. This can slow blood flow which increases the risk of clots developing
   
• Pregnancy – Blood clots more easily during pregnancy
   
• Woman on contraceptive pills and hormone replacement therapy. These can increase the likelihood of blood clotting.

Next: How is it diagnosed

DVT and venous insufficiency – Vascular Society

When a clot develops in a deep vein of the limb (leg or arm or pelvis) we call it a Deep Vein Thrombosis (DVT).  This causes the leg to swell and become painful. It is important to have this correctly diagnosed since treatment to stop the clot enlarging and moving through the circulation to the heart and lungs (pulmonary embolus) is usually needed. This involves thinning the blood with heparin injections and then an oral anticoagulant (warfarin, rivaroxaban, etc..).  The deep veins of the leg may be damaged by the thrombosis and fail to work normally after a DVT. The swelling and pain in the leg long term after a DVT is sometimes called Post Thrombotic Syndrome (PTS)

What Causes a DVT ?

There are many factors that can cause a DVT to occcur. In the deep veins of the leg, if the blood flow is slow, or the vein wall is damaged / diseased or the blood itself is more prone to clot (thicker blood) then a clot forming in the vein becomes more  likely. This triad of factors (VEIN, BLOOD, FLOW) is the model used to explain why a clot may have occurred. Often referred to as Virchows Triad.

Slower blood flow occurs when people are immobile due to illness or injury, when travelling in restriced positions for many hours, after surgery, with dehydration, increasing age and obesity. The vein wall may be more prone to a clot after injury, limb surgery, previous DVT, infusion with drugs and fluids that damage the vein lining. The blood can be more likely to clot due to medications, (hormones, the pill) in patients with cancer and in conditions where the blood count is raised (polycythaemia, leukaemia). Some patients have inherited conditions with abnormal clotting factors and are more prone to DVT as a result.

With thinning of the blood, the clotting process can usually be controlled. Over 3-6 months the clot in the vein is slowly resorbed and often the vein “recanalises” so that blood can flow through it again. 10-20% of veins may remain blocked. The valves in the veins are often damaged in this process, and the deep veins often do not work as efficiently as normal after a DVT.

There is growing interest in using clot dissolving drugs, and devices within the clotted veins to remove the clot when it first forms. This is called mechanico-lysis. For large extensive clots in the leg and pelvis, there is some evidence that this early removal of the clot can improve the function in the leg veins rather than leaving the clot to slowly be resorbed or leave the vein blocked. On going studies are evaluating this treamtent, to see which patients benefit most from this treatment.

Venous Insufficiency.

If the venous system in the leg fails to work normally the pressure in the leg veins rises. This damages the circulation in the lower leg particularly around the ankle leading to swelling, discomfort, skin changes and eventually it can cause ulceration. Varicose veins, a DVT, or primary failure of the valves in the veins can all contribute to this.  There are  some simple measures  to help the circulation in the leg veins, (elastic stockings, walking, avoiding standing, elevation, weight control) which are all very important in the management of this problem.   Occasionally procedures on the veins may help, particularly if the problem is mainly in the superficial veins.

Post Thrombotic Syndrome PTS 

PTS refers to the occurrenc of venous insufficiency with the above symptoms of pain, swelling, skin changes etc… in a leg after DVT. This often occurs in the first 1-2 years after the DVT.  Some evidence of symptoms and signs is present in 50% of cases after DVT, but it is only severe in 10-20% of cases. Good anticoagulation after the DVT, keeping mobile, avoiding being overweight, can all help reduce PTS. There is some debate about the effectivenes of wearing support stckings and for how long in order to reduce PTS. They probably help to some extent, especially early on after the DVT when the leg is swollen to improve symptoms. Some suggest wearing them for 2 years, but this may not always be necessary.

For more information go to Circulation Foundation

History, Physical Examination, Pulmonary Embolism

Deep Vein Thrombosis – Early Symptoms, Signs, Causes & Treatments

Blood returns to the heart through veins. When the blood clumps together and turns into solid material, it is called a blood clot. When the clot is in the deep vein it is called deep vein thrombosis (DVT). Deep vein thrombosis (DVT) usually occurs in the leg veins.

If the clot breaks off and travels to the lungs, it can cause a pulmonary embolism (PE) – a clot that blocks blood flow to the lungs, which can be deadly.

DVT causes symptoms in only about half the people who develop this condition. Symptoms may include:

• Swelling of the leg
• Pain or tenderness in the leg
• Increased warmth in the swollen or painful area
• Red or discolored skin in the swollen or painful area of the leg

Some people may not know they have a DVT until it breaks off and travels to the lungs, causing a pulmonary embolism. PE is an emergency situation requiring immediate medical help.
PE symptoms include:

• Sharp chest pain when taking a deep breath
• Shortness of breath
• Bloody cough
• A rapid or irregular heartbeat
• Feeling of anxiety
• Feeling faint or passing out

DVT causes symptoms in only about half the people who develop this condition

Causes

Blood normally flows continuously in arteries and veins. In certain situations the cells in blood may clump together to form a plug (blood clot) and fail to flow properly. This is triggered whenever flowing blood is exposed to certain substances after the vein’s inner lining is damaged as a result of surgery, serious injuries, inflammation or immune responses.
Inactivity is a major cause of DVTs. Extended periods of lying down can lead to sluggish, improper flow of blood in your legs. Some of the leading causes of DVT are surgery, injuries or illnesses requiring prolonged period of bedrest.
Other possible causes include cancer, hormone therapy and inherited conditions that make blood cells clump together and form clot more easily. Birth control pills can also increase the risk of clotting.

Risk Factors

• A previous episode of DVT
• Immobility, such bed rest during hospitalization
• Pregnancy and the first few weeks after giving birth
• A catheter (large IV tube) in the deep veins used for medical treatment
• Age – DVT can occur at any age, but risk increases with age
• Overweight or obesity
• Cancer and cancer treatment
• Smoking
• Hormone therapy or birth control pills
• Injury to blood vessels, broken bones or other trauma
• Some inherited blood disorders

Evaluation

To determine if DVT is present, your doctor will obtain your medical history and perform an examination. Your diagnostic tests may include:
​
Duplex ultrasound: Noninvasive test uses high-frequency sound waves to measure blood flows through your veins and evaluate the presence of clot.

D-dimer test: Measures a substance in the blood that when elevated may indicate underlying blood clot.

CT Venogram: Imaging test that uses IV contrast and specialized CT scan to create detailed pictures of the veins in your abdomen and legs.

Venography: Dye is injected into a vein in the affected leg. The dye makes the vein visible on an x-ray image. The x-ray shows whether blood flow is slow in the vein, which may suggest a blood clot.

Complications

Pulmonary embolism (PE): Most of the time with a DVT the clot is in the veins of the lower or upper extremities and attached to the vein wall. When the clot dislodges from the vein it will travel to another part of the body, this is called an embolus. With PE, the clot travels to the lungs and blocks blood flow. As a result, the lungs can be damaged by lack of blood flow, and other organs can be damaged by a lack of oxygen supplied by the lungs. PE is a dangerous, potentially fatal occurrence requiring immediate medical attention.
​
Post-thrombotic syndrome (PTS): Is a condition that may develop one to two years following an episode of DVT. Following a DVT the veins involved may be damaged and there be underlying blockage or reversal of blood flow. Both of these situations can lead to increased venous blood pressure in the legs. The symptoms associated with this condition, known as PTS, may include chronic leg pain and chronic swelling. Advanced stages of the condition include skin damage with discoloration and/or ulceration (wound) in the affected leg.

For Deep Vein Thrombosis treatment options and prevention visit our page:
https://www.advancedheartandvein.com/deep-vein-thrombosis

Are You at Risk for a Blood Clot?

Venous thromboembolism (VTE) is a condition used to describe two related conditions, which involve blood clots, most often called deep vein thrombosis (DVT) and pulmonary embolism (PE). It’s easy enough to understand, right? Let’s break down the words. “Venous” means “in the veins,” and “thrombus” is the word for a non-moving “blood clot”. An “embolus” is an abnormal particle such as a clot or air bubble that moves around the body via your blood stream. When an embolus blocks blood flow in a blood vessel it is called an “embolism”.

Simply speaking, DVT is when a blood clot forms in a deep vein usually in the thigh or lower leg, and a PE is when a part of the clot breaks off in the veins and travel to the lungs. It’s important to understand these conditions because DVT/PE can be a serious life-threatening condition that can happen to anyone.

What’s So Important about Blood Clots?

When blood clots that form in the leg or thigh become loose and travel to the lungs, they can block blood flow causing serious problems or even death.

DVT and PE affect many people in the U.S. and worldwide. In fact, there are over 900,000 VTE events in the U.S. every year. That’s more than the number of heart attacks or the number of strokes that occur each year. It is predicted the number of DVT and PE will continue to increase and by the year 2050, they are predicted to affect approximately 1.8 million Americans.

If you have a thrombus (or blood clot), your doctor will start treatment quickly to reduce the chances of it traveling in the blood stream and blocking blood flow to an artery in the lungs. Treatment may also reduce the chances of the blood clot happening again. DVTs are usually treated with medicines that are commonly called blood thinners. Less often, other treatments for DVTs including surgery or medicines called thrombolytics that break the clot up may be used. Treatment for PE requires either thrombolytics or surgery in addition to blood thinners.

Why Do Blood Clots Happen?

Three main categories of factors that lead to an increased risk for blood clots are known in the medical community as Virchow’s Triad, named after a Prussian doctor who worked in this area. The factors are:

• Blood stasis: This is when the blood flow slows down or pools. This can happen for a number of reasons including immobility for prolonged periods, certain types of surgery, or chronic heart disease.
• Hypercoagulability: This state occurs when the blood coagulates, or sticks together more easily than normal. It may happen because of specific genetic causes, cancer, smoking, oral contraceptive use, and pregnancy among others.
• Vascular injury: This is injury or trauma to the walls of the veins. Injuries may occur, from things like surgery, bone fractures, placement of a venous catheter,or injection drug use.

Risk Factors

As you might imagine, DVT and PE may occur in patients who may have a combination of the factors listed above in Virchow’s triad. Some conditions putting people at a higher risk for these blood clots are if they have:

• Had knee or hip surgery.
• Had trauma and/or bone fractures.
• An age older than 40 years.
• Been on prolonged bed rest.
• Suffered a serious medical illness, infection, heart attack, or stroke.
• Cancer.
• Cancer and are receiving chemotherapy.
• Had a previous DVT or PE.

Symptoms and Signs

DVT may have no symptoms at all or may include different combinations of pain, tenderness, discoloration, and leg swelling (that leaves an indentation when pressed). PE may include symptoms of shortness of breath, coughing (with or without blood in the phlegm), chest pain, a fast pulse (>100 beats per minute), and a low-grade fever. If blood clots in the lung cause the blood in the heart to back up it may cause low blood pressure and shock. If you experience any of these symptoms of DVT or PE, contact your health care professional right away.

Prompt treatment for DVT and PE can reduce the chance that another event will occur. It is important to discuss the treatment plan with your health care team and learn what to expect while on that treatment plan. It’s also important to stick with the plan you agreed upon and follow up with your health care team regularly.

Prevention

If you haven’t had a DVT or PE, but think you may be at an increased risk due to the factors described above, there are some ways to reduce the risk of DVT and PE from occurring. Talk with your health care professional about your risks and for help to:

• Stop smoking (if you smoke).
• Lose weight– obesity is risk factor for VTE and can also enhance the risk of other risk factors for VTE.
• Get active– to help keep your blood moving.

It is important to be aware of this condition for you and your loved ones to reduce the risk of blood clots, when possible. If you suspect a DVT or PE, seek medical attention quickly.

George H. Sands, M.D. is a Senior Medical Director at Pfizer.

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90,000 disease, symptoms, treatment, causes, diagnosis

Deep vein thrombosis of the lower extremities often develops in elderly patients suffering from cardiovascular diseases, diabetes mellitus, obesity, in the elderly and oncological patients. Thrombosis often occurs in severe trauma, traumatic and prolonged operations, in pregnant women before and after childbirth.

In the development of venous thrombosis, an important role is played by changes in the vascular endothelium on the affected limb, which acquires increased thrombogenicity and adhesiveness.These factors lead to the formation of blood clots.

In most cases (89%), the thrombus originates in the sural venous sinuses – relatively large, blindly ending cavities in the calf muscles that open into the deep veins of the lower leg. The sural sinuses are passively filled with blood when the calf muscles are relaxed and emptied when they contract (muscle-venous pump).

The clinical picture of deep vein thrombosis of the lower leg within 1-2 days is often erased.The general condition of the patients remains satisfactory, there are minor pains in the calf muscles, aggravated by movement, a slight swelling of the lower third of the leg, soreness of the calf muscles on palpation. One of the characteristic signs of deep vein thrombosis of the lower leg is pain in the calf muscles during dorsiflexion of the foot. Patients with deep vein thrombosis begin to experience sharp pain in the calf muscles even with a slight increase in pressure.

Diagnosis of acute thrombosis of the main veins of the lower extremities is based on the data of the clinical picture of the disease.The simplest and safest method for detecting phlebothrombosis is ultrasound duplex scanning. If you find symptoms, make an appointment with a phlebologist.

Treatment of thrombosis is usually conservative, much less often – operative. With inadequate treatment of deep vein thrombosis, almost 50% of patients may experience pulmonary embolism over a three-month period. Adequate treatment of acute deep vein thrombosis of the lower extremities with anticoagulants reduces the risk of thrombus spread and pulmonary embolism to 5% or less.

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Deep vein thrombosis of the lower extremities

Added: 07.03.2016

Life story: On the way home from work, a woman stumbled and fell. At the hospital, she was diagnosed with a fracture, put in a plaster cast, and a couple of days later sent home to recover. During the week everything went well … Sudden death made everyone who knew her shudder, and first of all her relatives and friends. An autopsy revealed that the cause was a detached blood clot that blocked the pulmonary artery. It was just that the woman had deep vein thrombosis in the legs, which did not cause her much inconvenience and therefore remained unattended.Very sorry. But a woman could still live and please her relatives and loved ones.

There are a million such stories. Very few people are serious about the health of veins and the first time they go to a phlebologist only when spider veins and “grape bunches” of unhealthy veins appear. Few pay attention to signs of thrombosis such as rare pain, stiffness, a feeling of heaviness and discomfort in the leg muscles. Such a frivolous attitude to one’s own health leads to bad consequences.

Unfortunately, it is often impossible to determine in time the initial symptoms of thrombosis of the vessels of the legs and many do not know that this type of thrombosis is almost asymptomatic, and therefore it is very dangerous , however, if the skin changes color, and where the blood clot is located, swelling occurs – these are signs of vascular disease. In a healthy person, venous blood moves from the bottom up: from the legs – to the organs located higher: lungs, heart, etc. If a blood clot blocks the lumen of a vein, then blood will hardly flow from the lower extremities, and edema appears.Since a blood clot can be located in different places, edema can also occur on the lower leg, ankle, and thigh. Sometimes the entire leg swells. When thrombosis of the lower extremities progresses, its symptoms are more pronounced. Sharp pain appears and heaviness in the legs increases. These symptoms are triggered by venous congestion below the site of thrombosis. As a result of the complete closure of the lumen of the vein, edema increases, metabolism in soft tissues is disrupted. This can lead to gangrene.Swelling and pain in the legs can be not only signs of vascular insufficiency, but also many other diseases. Sometimes acute thrombosis occurs. A person who moved normally today may not get out of bed tomorrow due to huge swelling. It is extremely serious if, due to the latent form of the course of thrombosis, a patient suddenly has pulmonary embolism. It occurs because a blood clot breaks off and migrates from the affected vessels of the legs into the artery of the lungs, where it is blocked.It only seems that the legs are far from the heart and lungs. But in fact, a vein is a direct road for a blood clot. If it breaks off, it literally flies up in seconds and enters the pulmonary artery, which is very dangerous. At the same time, it is not possible to save everyone … Therefore, do not risk it. For the successful treatment of deep vein thrombosis, its timely diagnosis is necessary. Today there is an accurate way to diagnose the condition of the veins – ultrasound. If you have something wrong with your legs, you have varicose veins, see a specialist.An experienced surgeon with a specialization in phlebology, Vladimir Sorokin, accepts at the Latgale Medical Center, who will diagnose the vessels of the legs and give valuable recommendations, and, if necessary, prescribe treatment. In order to prescribe the correct course of treatment, whether it is drug therapy or surgery, it is necessary to accurately diagnose the disease and comprehensively study the parameters of the thrombus (size, localization and the possibility of separation). If your doctor detects a deep vein clot during an ultrasound scan, he or she may refer you to a hospital for further treatment.Do not refuse hospitalization or postpone it for later: a blood clot can come off at any time. So, if you observe swelling of the extremities, a feeling of heaviness in the lower extremities, sharp pains, blue skin, fever and chills, then immediately consult a specialist.

It is also worth remembering that the risk of serious problems is exacerbated by:

• Smoking.
• Trauma contributes to the development of acute thrombosis. It leads to the fact that the vascular wall is affected and the process of hemostasis is activated.As a result, a blood clot forms.
• Overweight.
• Pregnancy contributes to the compression of the iliac veins, and sometimes the inferior vena cava. This leads to an increase in vascular pressure in the veins below.
• During childbirth, the fetus, which moves through the birth canal, has many opportunities for squeezing the iliac veins.
• Very high risk of clogged veins after caesarean section.
• Infection causes blockage of blood vessels in men.This is due to the activation of blood clotting factors in response to the vascular walls being affected.
• Long trips and flights.
• Advanced age.
• Taking medications that increase blood clotting.
• Joint operations, abdominal operations. The high prevalence of venous thrombosis is due to the fact that the number of operations using general anesthesia is increasing every year, as well as the increase in the number of operated elderly people with severe concomitant diseases.
• Complicated bone fractures.
• Cancer.
• The occurrence of vascular thrombosis is facilitated by bed rest (for a long time). The reason is the lack of muscle contraction, slowing blood flow and venous stasis.
• Healthy people also get sick if they sit or stand for a long time (traveling by car, working at a computer).

Recommendations of the surgeon Vladimir Sorokin:

• Periodic visits to a specialist will help you detect thrombosis in time and begin timely and effective treatment.
• Gels, creams, ointments available in pharmacies improve venous blood flow and relieve fatigue and heaviness in the legs. But such remedies are only good as an aid, they bring temporary relief, but do not solve the problem.
• Elastic compression methods that are prescribed for a long time are effective. Elastic stockings act on the superficial veins of the lower extremities, increasing blood flow in the deep veins.
• When sedentary work, you need to walk more often, walk at least within your office every 15–20 minutes.
• When you go to bed, place a pillow under your feet so that they have an elevated position and there would be no swelling.
• Do special exercises and diet. Do not be afraid to change your usual way of life! This will benefit not only the veins, but the entire body.

You can make an appointment with Vladimir Sorokin at the Latgale Medical Center (20 Rigas Street, Daugavpils) or by calling 25251010. The cost of a phlebologist consultation is 35EUR.

In Latgale Medical Center, phlebologist consultation includes:

– Doppler ultrasonography of the veins and arteries of the lower extremities;
– phlebologist consultation, drawing up a treatment plan and specialist recommendations;
– conclusion of a phlebologist;
– help in choosing compression products.

We will be glad to help you quickly, efficiently and confidentially!

90,000 External symptoms in patients with pulmonary embolism

Pulmonary embolism (PE) is an acute blockage of the trunk or branches of the arterial system of the lungs by a thrombus formed in the veins of the systemic circulation or in the right half of the heart [1, 2, 6].

In 95% of cases, PE is a consequence of deep vein thrombosis (DVT); therefore, in the modern literature, the term “pulmonary embolism” is most often replaced by the term “venous thromboembolism” [1, 4, 5, 8, 9].

PE is the third most common type of pathology of the cardiovascular system after coronary heart disease (CHD) and stroke. Annually causes death of 300-500 thousand people [1, 8, 9].

Thrombophlebitis is the most common source of thrombus formation [1, 2, 5, 6, 8, 9].

Distinguish between superficial thrombophlebitis (mainly varicose veins) and deep vein thrombophlebitis of the lower extremities. More rare forms of thrombophlebitis include Paget-Schrötter disease (thrombosis of the axillary and subclavian veins), Mondor’s disease (thrombophlebitis of the saphenous veins of the anterolateral surface of the chest) (Fig. 1) and Buerger’s migratory thrombophlebitis (thromboangiitis obliterans) [1, 4, 6].

Acute thrombophlebitis of the superficial veins of the lower extremities develops, as a rule, in a varicose vein.The greater saphenous vein is more often affected. In the course of the affected vein, skin hyperemia and a dense painful cord are determined (Fig. 2).

In some cases, ascending thrombophlebitis of the great saphenous vein develops with the spread of the process to the saphenofemoral anastomosis and the threat of pulmonary embolism.

Most often, embologenous thrombi are localized in the great veins of the lower extremities, the veins of the pelvis and the inferior vena cava.

The greatest danger of PE is thrombophlebitis of the deep veins of the leg.The disease usually begins acutely, with pain in the calf muscles, a feeling of fullness, an increase in body temperature. External signs of this disease: edema in the distal parts of the leg, cyanotic edema of the skin, after 2-3 days a network of dilated superficial veins appears on the legs, thighs, abdomen, then – if all veins are affected – diffuse cyanosis (Fig. 3).

Unilateral edema, unilateral pain in the lower extremities and tachycardia in the so-called revised Geneva account as signs of a possible PE have the most points in total (tab.1) [1, 2, 4, 5].

The clinical probability of pulmonary embolism is determined: with a total of 0–3 points – low; 4-10 points – intermediate; ³ 11 points – high.

A number of symptoms are characteristic of deep vein thrombophlebitis of the lower leg.

1. Homann’s symptom – with dorsiflexion of the foot, a sharp pain appears in the gastrocnemius muscle (Fig. 4).

2. Symptom Moses – pain when squeezing the leg in the anteroposterior direction in the absence of pain after compression from the sides (Fig.5).

3. Symptom Opitz – Ramines – sharp pain along the veins of the lower leg after increasing pressure to 40–45 mm Hg. in the sphygmomanometer cuff placed above the knee joint; after lowering the pressure, the pain disappears (Fig. 6).

4. Lovenberg’s symptom – a sharp pain in the calf muscles at a pressure of 60-150 mm Hg. in the cuff overlaid on the middle third of the lower leg (Fig. 7).

The development of thrombophlebitis in the femoral vein before the deep vein flows into it is characterized by pain in the adductor muscles of the thigh.On examination, slight edema and dilatation of the saphenous veins are found, on palpation – pain in the region of the Gunter’s canal.

Thrombophlebitis of the common femoral vein is accompanied by sharp pain in the limb, expressed by its edema and cyanosis. The increase in body temperature is accompanied by chills. In the upper third of the thigh, groin and pubic regions, dilated superficial veins appear.

In acute thrombosis of the main veins of the pelvis and thigh, white or blue phlegmas may develop.White phlegmasia is characterized by edema of the entire limb and milky-white color of the skin, blue phlegmosis is characterized by more common edema, cyanosis of the skin, and the formation of purple-cyanotic spots (Fig. 8).

Factors predisposing to PE are: operations on the pelvic organs and lower extremities, especially in old age, injuries of the lower extremities, malignant diseases, prolonged venous catheterization (including subclavian), varicose veins of the lower extremities, prolonged bed rest, cardiac insufficiency and disturbance of the rhythm of the heart, post-thrombophlebitic syndrome, etc.

When examining a patient with PE in the acute period, acrocyanosis, less often cyanosis, especially of the upper half of the body, can be detected.

The outcome of acute deep vein thrombosis in most patients is post-thrombophlebitic syndrome, the external signs of which are lymphostasis and trophic ulcers (Fig. 9).

Distinguish between acute, subacute and recurrent pulmonary embolism.

The most persistent clinical symptoms are shortness of breath, pleural pain, hemoptysis, tachycardia, fever.

For differential diagnosis of PE, the following methods are currently used: D-dimer determination, electrocardiography, echocardiography, multispiral computed tomography, ventilation perfusion scintigraphy, angiopulmonography, ultrasound examination of the veins of the lower extremities [1, 2, 4, 5].

An increase in the concentration of D-dimer in the blood> 0.5 μg / ml is one of the most reliable markers of DVT, the sensitivity of which reaches 100% [1, 2, 4, 5].

The X-ray picture of PE is diverse. A symptom of increased transparency of the pulmonary field, unilateral expansion of the lung root as a result of expansion of the main branch of the pulmonary artery, pulmonary infarction with perifocal pneumonia, areas of depletion of the pulmonary pattern, high standing of the dome of the diaphragm are distinguished. Subpleural localization of thrombosis determines a high frequency of reactive pleurisy, including interlobar. As the fluid resorbs, the appearance of multiple pleural adhesions, moorings is noted, obliteration of the pleural cavities develops.

With purulent thrombophlebitis, microbes multiply in the thrombotic masses and the vein wall, which leads to the development of a purulent process in the paravasal tissue. Septic thrombophlebitis can be a source of generalization of infection and the formation of abscesses in various organs, including the lungs. Septic thrombophlebitis often develops in injection drug users.

The most characteristic changes on the ECG are the appearance of Q waves and a negative T wave in the III chest lead.

The basis of therapy is made up of anticoagulant and fibrinolytic agents, as well as drugs aimed at preventing infection.Low molecular weight heparins are considered the most effective and safe.

Clinical examples

Patient J., 45 years old, was hit by a car – left leg injury with hematoma. The lower leg was swollen, severe pain, the patient could not walk. After 2 weeks, there was a sudden sharp pain in the left side of the chest, palpitations, body temperature rose to 40 ° C. I went to a doctor and was sent to a hospital.

On examination, the left shin is edematous, dense to the touch (Fig.ten).

Positive symptoms of Hohmann and Moses.

The plain chest X-ray (CT) shows an effusion in the left pleural cavity (Fig. 11).

A pleural puncture was performed, 450 ml of hemorrhagic fluid was aspirated. Analysis of pleural fluid: beats. weight – 1.023 kg / l, Rivalta reaction – positive, protein – 35 g / l, leukocytes (neutrophils – 60%, lymphocytes – 20%, eosinophils – 20%), erythrocytes – 1/2 of the field of view, mesothelium cells – a lot …

Two courses of treatment with antibacterial drugs of a broad spectrum of action for 5 days, repeated punctures were carried out.

Control X-ray of the chest organs – the level of fluid in the left external sinus continues to be determined (Fig. 12).

Computed tomography of the lungs – in S ₉ of the left lung focal shadow 75 ´ 25 ´ 45 mm of a heterogeneous structure with clear uneven contours: there is a small amount of fluid in the left pleural cavity (Fig.13).

Ultrasound of the vessels of the lower extremities – post-traumatic phlebitis and venous thrombosis of the left leg, hematoma.

Final diagnosis: PE: infarction pneumonia S ₉ left lung, left-sided pleural effusion; post-traumatic phlebitis and venous thrombosis of the left leg.

Patient G., 47 years old. About 15 years ago, I began to notice heaviness in the left leg, the leg seemed to “hang”, especially after physical exertion. Swelling of the left leg was periodically noted; used troxevasin.

During a walk in the park, suddenly there was a lack of air, a feeling of fear, a rapid heartbeat, then there was severe pain in the left side of the chest, the inability to take a deep breath. The next day, the body temperature increased to 38 ^{about 90 238 C, on the 4th day hemoptysis appeared.}

The patient was admitted to the therapeutic department.

On examination – on the left lower leg, in the popliteal fossa and partly on the thigh – the vascular mesh, the area of ​​skin hyperemia, varicose veins (Fig.fourteen).

Palpation showed pain along the deep veins of the left leg, especially in the popliteal fossa, positive symptoms of Hohmann, Moses, Opitz-Ramines and Lovenberg on the left leg (Fig. 15).

On the roentgenogram of the chest organs to the left of the IV rib downwards, an inhomogeneous darkening (Fig. 16).

In the clinical analysis of blood: leukocytes – 13 ´ 10 ⁹ / l, ESR – 47 mm / hour.

In the coagulogram, an increased level of fibrinogen.

A pleural puncture was performed, 350 ml of hemorrhagic fluid was aspirated.Analysis of pleural fluid: beats. weight – 1.026 kg / l, Rivalta reaction – positive, protein – 45 g / l, leukocytes (neutrophils – 70%, lymphocytes – 20%, eosinophils – 10%), erythrocytes – in the entire field of view, mesothelium cells – a lot.

Clinical diagnosis: PE: infarction, pneumonia of the lower lobe of the left lung, left-sided exudative pleurisy; deep vein thrombophlebitis of the left leg.

Treatment with enoxaparin, clopidogrel hydrogen sulfate, aspirin cardio, vazoket was carried out.

After the treatment, the plain chest X-ray shows positive dynamics in the form of resorption of infiltration in the lower left sections; the left costodiaphragmatic sinus is sealed (Fig. 17).

Patient M., 69 years old. Varicose veins of the superficial veins and deep vein thrombophlebitis of the left lower leg were detected at the age of 50 (Fig. 18).

Hohmann, Moses and cuff symptoms are positive.

History of infiltrative tuberculosis of the upper lobes of the lungs with disintegration and mycobacterial excretion with an outcome after effective treatment in fibrous focal changes in the upper lobes of the lungs.

Suffering from ischemic heart disease and hypertension, periodically exacerbated by deep vein thrombophlebitis of the legs.

At the age of 67, he suffered a minor stroke.

During the last five years – recurrent right-sided interlobar pleurisy (Fig. 19).

Pleural puncture was not performed.

Presumptive tuberculous and metastatic interlobar pleurisy were excluded.

Ultrasound examination of the vessels of the lower extremities: right leg – no signs of vascular lesions were detected; left leg – the popliteal vein partially collapses during compression tests, a recanalized organized thrombus is determined in it.

Clinical diagnosis: recurrent PE of small branches of the pulmonary artery with interlobar right-sided pleural effusion. Varicose veins and deep vein thrombophlebitis of the left lower leg.

About varicose veins

Chronic venous insufficiency is a disease that leads to long-term, sometimes lifelong, impairment of venous outflow from the lower extremities.

The most common causes of CVI are varicose veins and deep vein thrombosis.

The main cause of chronic venous insufficiency and varicose veins is disruption of the normal functioning of the valves of the veins.

The blood flow becomes chaotic, and in the veins, especially the subcutaneous ones, the pressure increases so much that the walls of the vessel cannot withstand and begin, like a balloon, to expand varicosely. In addition to varicose veins, other symptoms of the disease appear.

Risk factors for varicose veins and CVI

Female (women suffer from varicose veins 4-6 times more often than men)

Features of labor (varicose veins usually occur in persons whose work is associated with prolonged standing on their feet: sellers, hairdressers, surgeons).

Overweight

Multiple pregnancies

Hereditary predisposition The presence of varicose veins in close relatives increases the likelihood of its development

Heavy physical work (strength sports, chronic respiratory diseases)

Permanent leg injuries (among athletes, workers)

Constipation

Hormonal contraception

Symptoms of varicose veins and venous insufficiency

• Swelling of the leg and foot by the end of the day;
• Feeling of heaviness and fullness in the calves during prolonged sitting or standing;
• Bursting pains in calves, hot legs and night cramps in calves;
• Shoes, comfortable in the morning, begin to press in the evening; socks leave deep marks on the skin.These symptoms are ameliorated by walking and after a night’s rest;
• Vascular stars on thighs and calves, dark blue intradermal veins and convoluted varicose veins;
• The skin of the lower leg becomes dry, sensitive to various injuries, trophic ulcers may develop.

How dangerous are chronic venous insufficiency and varicose veins?

It is believed that chronic venous insufficiency and varicose veins are not very dangerous diseases that cause only cosmetic inconvenience.This is not true. Violation of venous outflow can provoke the formation of blood clots in deep (thrombosis) or varicose saphenous (thrombophlebitis) veins.

Deep vein thrombosis is manifested by a sharp dense swelling of the leg. In this case, the skin acquires a bluish tint, and any movement causes pain. With thrombophlebitis along the saphenous varicose veins, painful induration and redness appear.

Thrombosis and thrombophlebitis are extremely insidious diseases.Having torn off, a thrombus can cause a serious complication – pulmonary embolism, often resulting in the death of the patient.

Acute thrombosis and thrombophlebitis must be treated in a phlebological hospital, as in some cases an emergency operation may be required.

Drug treatment

Venotonic

The safest and most effective are produced from plants containing substances that strengthen the venous wall.These are the so-called bioflavonoids (diosmin, hesperidin, etc.). The effect of drugs, as a rule, begins immediately after the start of treatment and reaches a maximum after 1.5–2 months of daily administration. With non-started varicose veins, taking medications is necessary at least 2 times a year. In severe cases of varicose veins, they must be taken continuously.

Local treatment

One of the most proven and effective remedies is “Heparin-gel”, which is successfully used in cases of edema, pain, heaviness in the legs.

To keep your veins healthy

Be active

Avoid heavy physical activity

Do not abuse the sun and hot baths

Do not wear tight underwear, tight belts or waistbands

Watch your posture.Do not cross your legs while sitting

Do not abuse alcohol or smoke

Eat right

A large amount of raw vegetables and fruits should be present in the daily diet.