A deep vein thrombosis is when a blood clot forms within the deep veins of the leg. Deep veins are not visible on the outside of the leg. They sit deeper inside the muscles and are the main return pathway for blood back up the leg. Serious complications can occur when clots move from the deep veins to other parts of the body. The most common place for a DVT blood clot to travel to is the lungs. When this occurs, this is called a pulmonary embolism (PE). Below, we look at deep vein thrombosis causes, deep vein thrombosis symptoms, deep vein thrombosis treatment and deep vein thrombosis prevention.
Veins can be thought of as the ‘return’ side of the circulation pathway. Their job is to return blood flow from the organs and limbs back to the heart.
Within the venous system there are superficial veins (the ones that can be responsible for varicose veins) and deep veins. The deep veins are blood vessels that lie deeper within the muscles and account for about 90% of the drainage of blood from the legs. Deep vein thrombosis of the arm can occur too in rare cases.
When a blood clot forms inside the deep vein blood vessel it is called a deep vein thrombosis (DVT). While it can cause damage directly to the deep veins themselves, the bigger worry is if some of the blood clot dislodges and travels through the inferior vena cava to other parts of the body thereby restricting blood flow to the affected area.
The below are risk factors for developing a DVT/PE (venous thromboembolism)
A deep venous thrombosis may be entirely asymptomatic, or it may cause symptoms. Symptoms may include:
If a DVT blood clot travels up the inferior vena cava to the lungs it can cause a pulmonary embolism. This serious condition can also be asymptomatic, or it may cause any or all of the below: chest pain/tightness, a cough, coughing of blood and feeling short of breath. More severe cases may be fatal.
A blood test called a d-dimer can screen for the presence of a DVT. This blood test does not make a definitive diagnosis though, it just indicates a likelihood of the diagnosis. If the result is negative then you can be assured you don’t have a DVT, if the result is positive, then you need an ultrasound to confirm the diagnosis.
The diagnosis of DVT is made by doppler ultrasound at Palm Clinic in Auckland, NZ. Given that the symptoms and signs can be mild it is important to have a high index of suspicion and a low threshold to ultrasound to check for one. Given the risk of serious complications such as a pulmonary embolism, it is better to be safe than sorry.
The ultrasound can visualise the deep veins and see if there is any thrombus (clot) inside.
If a pulmonary embolism is in question, you will be referred to the hospital for a CT scan that specifically looks at the lungs called a CTPA (CT Pulmonary angiogram).
Treatment at Palm Clinic in Auckland, NZ is aimed at minimising the chance of the clot growing and/or moving to other parts of the body. Treatment can vary depending on the size and position of the clot.
Treatment options are:
Anticoagulants: These are blood thinners which affect the blood’s natural ability to clot. They can stop an existing clot from getting bigger and thereby reduce the risk of any breaking off and travelling to other parts of the body.
Thrombolytic drugs: Less commonly, thrombolytic drugs are used (in hospital) to help dissolve the DVT. These can have serious side effects, such as severe bleeding and so are only ever used when the benefits outweigh the risks and are only given in a hospital setting.
Compression stockings provide external support to the lower extremity which improves flow within the deep veins. The better the flow, the less the chance of a blood clot increasing in size and the less retention of fluid in the tissues. At Palm Clinic in Auckland, NZ we can fit you for the appropriate compression stockings. Wearing compression stockings for two years after the diagnosis of a DVT reduces the chance of developing post thrombotic syndrome (discussed below).
Prevention involves addressing any of the risk factors mentioned above. These include quitting smoking, attaining a healthy body weight and staying active and avoiding prolonged immobility. For those that are prone to DVT for medical reasons, a prophylactic dose of anticoagulant medicine may be indicated. Other factors that reduce the risk of DVT are wearing compression stockings on the lower extremity when you expect to be immobile or have had a procedure.
Treatment of varicose veins will reduce your risk of DVT in the long term as the presence of varicose veins carries a risk of DVT. After an initial DVT has resolved we will usually recommend having your varicose veins treated to lessen your long term risk of future DVT’s.
Potential complications of having a DVT are failure of either the surface veins (chronic venous insufficiency- or varicose veins) or deep veins (post thrombotic syndrome). Symptoms of either can include aching, swelling, and pigmentation of the lower legs.
If some of the DVT clot breaks off and travels it can block circulation to the organ that it arrives and stops at. The most likely organ to be affected is the lungs- this is known as a pulmonary embolism and can result in heart failure and/or be fatal.
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