Deep Vein Thrombosis (DVT)

These include the following conditions:

Deep Venous Thrombosis
Deep Venous Insufficiency
May Thurner’s Syndrome
Pelvic Congestion Syndrome
Varicocele
Nutcracker Syndrome

Overview

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg.

This is a serious condition if a piece of blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs (see below).

DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

Symptoms of DVT

One/both of your legs may show

Heaviness, tenderness, or throbbing of leg
Pain that feels like a cramp
Skin that’s warm to the touch
Swelling
Veins that look larger than usual
Changes in skin color (more red or purple than normal in fair individuals)

in severe cases- change in color of skin to blue/black indicating death of tissue due to blockage of blood supply(phlegmasia)

Pulmonary embolism

If left untreated, about 1 in 10 people with a DVT will develop a pulmonary embolism. A pulmonary embolism is a very serious condition that causes:

breathlessness – which may come on gradually or suddenly
chest pain – which may become worse when you breathe in
sudden collapse
coughing blood

What causes DVT?

Anyone can develop DVT, but it becomes more common over the age of 40.

Risk factors, including:

having a history of DVT or pulmonary embolism
having a family history of blood clots
being inactive for long periods – such as after an operation or during a long journey
blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot
having certain conditions or treatments that cause your blood to clot more easily than normal – such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Hughes syndrome
being pregnant – your blood also clots more easily during pregnancy
being overweight or obese

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen, which causes the blood to clot more easily. If you’re taking either of these, your risk of developing DVT is slightly increased.

Diagnosing DVT

D-dimer test

Detects pieces of blood clot that have been broken down

Larger the number of fragments found, the more likely it is that you have a blood clot in your vein.

However, the D-dimer test isn’t always reliable and additional tests maybe required

Ultrasound scan

It is standard baseline test for any patient suspected of having a DVT

Doppler ultrasound detects the presence of clot and its age, sites affected and also how fast the blood is flowing through a blood vessel.

CT Venogram

A CTvenogram may be used if the results of a D-dimer test and ultrasound scan can’t confirm a diagnosis of DVT or DVT is suspected in areas of the body where ultrasound cannot be done reliably.

Also sometimes helps to detect the cause of the DVT.

Treating DVT

Conservative

Most patients do not need any form of procedure to treat the clot and can be managed conservatively with medications.

Treatment for DVT usually involves taking anticoagulant medicines(blood thinners), which reduce the blood’s ability to clot and stop existing clots getting bigger.

Heparin and warfarin/coumarin are 2 types of anticoagulant often used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting.

New drugs called directly acting oral anticoagulants (DOACs), or NOACs (for Novel or Newer -) may also be used to treat conditions such as DVT. These medications are shown to be as effective as heparin. Stockings help to relieve the swelling in the leg and are generally recommended for a few months

THROMBOLYSIS

Strong clot dissolving medications(thrombolytics) given directly into the vein in patient with extensive DVT

CLOT ASPIRATION

Using negative pressure pumps to suck out the clot from the veins

Helps to avoid thrombolytics or reduce its dose used(thereby reducing its complications)

CHRONIC VENOUS INSUFFICIENCY/VENOUS ULCERS

Chronic venous insufficiency and leg ulcers affect approximately 1-2 people per 1000 of the general population.

Ulcer healing rates can be poor with up to 50% unhealed for 9 months.

Ulcer recurrence rates are worrying -one third of treated patients on their fourth or more episode.

Leg ulcer treatment affects the quality of life

WHAT IS CHRONIC VENOUS INSUFFICIENCY?

Chronic venous insufficiency is a term used to describe the changes that can take place in the tissues of the leg, due to longstanding high pressure in the veins.

This high pressure in the veins usually occurs because

Blood flow in the veins is abnormal, secondary to valvular incompetence, causing reflux (reverse flow) in the veins.

Veins in the legs become blocked

Varicose veins causing low level chronic inflammation in the surrounding tissues

Correctable risk factor

Overweight

2. physically inactivity

3. smoking

4. avoiding long standing

WHAT ARE THE CHANGES THAT OCCUR IN CHRONIC VENOUS INSUFFICIENCY?

Chronic venous insufficiency commonly involves the gaiter area of the leg (the lower half of the leg above the ankle and around the ankle). The classical changes are

Pigmentation
The brown discolouration occurs when blood cells leak out of the blood vessels and then permanently deposited in the tissues.

Ulceration
Severe damage causing loss of area of skin has been lost.

Long standing

Recurrent

Non healing

Multiple treatment options tried and failed

Lipodermatosclerosis (LDS or liposclerosis)
This refers to a thickening in the tissues underneath the skin.

They become hard and woody and lose all their normal suppleness.

Eczema
Skin becomes red, weeps watery fluid and scaly

Abnormal appearance to the shape of the leg (inverted champagne bottle)
The leg is very narrow at the ankle and just above, but then becomes much fatter in the upper part of the calf below the knee.

Swelling
Swelling around the ankle, foot and lower leg can be a sign of venous problems

HOW MUCH CHRONIC VENOUS INSUFFICIENCY TREATED?

Treatment will depend on many factors, including the reason for the condition and your health status and history. Other factors your doctor will consider are:

your specific symptoms
your age
the severity of your condition
how well you can tolerate medications or procedures

How to prevent venous insufficiency

Lifestyle changes that can be made in order to reduce your risk of developing this condition include:

Exercising regularly
Maintaining a healthy weight
Elevating the legs
Avoiding sitting or standing in one position for too long
Adequate skin care to maintain integrity of skin
Compliance with stockings use

MAY THURNER SYNDROME

What Is May-Thurner Syndrome?

In May-Thurner syndrome, the right iliac artery (which carries blood to your right leg) squeezes the left iliac vein (which brings blood out of your left leg toward your heart) when they cross each other in your pelvis. Because of that pressure, blood can’t flow as freely through the left iliac vein. It’s a bit like stepping part way down on a hose.

The result: You’re more likely to get a deep vein thrombosis (DVT) in your left leg. A DVT is a type of blood clot that can be very serious. It’s not just that it can block blood flow in your leg. It can also break off and cause a clot in your lung. That’s called a pulmonary embolism, and it’s life-threatening.

Symptoms

You likely won’t even know you have it unless you get a DVT. You might get pain or swelling in your leg, but usually, there aren’t any warning signs.

With a DVT, your left leg may show symptoms such as:

Heaviness, tenderness, or throbbing of leg
Pain that feels like a cramp
Skin that’s warm to the touch
Swelling
Veins that look larger than usual
Changes in skin color (more red or purple than normal in fair individuals)
in severe cases- change in color of skin to blue/black indicating death of tissue due to blockage of blood supply(phlegmasia)

If the DVT clot breaks off and moves to your lungs (Pulmonary Embolism), you’ll notice:

Chest pain that’s worse when you breathe in
Coughing up blood
Heartbeat that’s faster than normal
Passing out
Shortness of breath or other problems breathing