Deep Vein Thrombosis

When a blood clot forms in the deep veins of the leg, it is called Deep Vein Thrombosis (DVT). A thrombus is a blood clot, and the deep veins are the major veins inside the leg that carry oxygen-depleted blood back to the heart.

Blood clots are a normal step in the body’s healing process. They usually are reabsorbed once they are no longer needed. When venous disease is present, though, blood clots can form because the blood is pooling in the legs instead of being pumped back to the heart.

DVT can be very dangerous because a blood clot that breaks free and travels up to the lungs can cause a pulmonary embolism, which can lead to death.

Our doctors can perform minimally-invasive procedures called thrombolysis and thrombectomy that destroy or remove the blood clot before they break free and cause a potentially fatal pulmonary embolism. If this procedure is performed soon enough after the blood clot has formed, it can also prevent chronic venous insufficiency (CVI), a serious complication of DVT that can cause pain and disability.

If you think that you may have DVT, please contact us immediately.

DVT can mean that a blood clot is lodged in a vein, often blocking it partially or completely. This obstruction can cause visible symptoms such as swelling and redness or excessive warmth. It can also cause a pulling sensation or pain, such as aching in the calf or thigh, or tenderness when you touch or squeeze your leg, or even when you simply stand or move. The pain may get worse and eventually become constant.

DVT often affects only one leg, though it can affect both.

Small blood clots may not cause symptoms because they do not obstruct the flow of blood. In these cases, the first symptom of DVT may be pulmonary embolism as a result of the clot breaking free and traveling to the lungs.

In summary, the symptoms and signs of DVT are as follows.

SYMPTOMS

• Aching in the calf or thigh
• Pulling sensation in the leg
• Tenderness when your leg is touched or squeezed
• Discomfort when your foot is pulled upward (do not try this deliberately as it could dislodge the clot)
• Pain in your leg when you stand or move
• Pain in your legs that that gets worse and may become constant

SIGNS

• Swelling of the leg
• Redness of the leg
• Excessive warmth of the leg
• Superficial veins may become visible in the upper leg and lower abdomen

Symptoms are indicators of a disease that you experience, while signs are indicators of a disease that can be seen. Your doctor will ask you about the symptoms you experience and examine you for signs.

Our doctor will discuss your symptoms with you. If he suspects that DVT is causing your leg pain, an ultrasound test will be done to measure the blood flow through your veins and locate clots that could be obstructing the blood. If the ultrasound results are not sufficient, a venogram can be used. Venograms use X-rays to view the blood flow through the veins.

Ultrasound is considered to be best at locating blood clots above the knee, while venograms are generally best at identifying blood clots below the knee.

• Ultrasound: An ultrasound exam is a non-invasive exam that measures blood flow in the deep and surface veins to look for clots.
• Venography: A venogram is an exam that measures blood flow in the deep veins using X-ray technology. Blockages caused by clots can be detected with a venogram.
• Blood Clotting Analysis: A sample of your blood may be drawn to compare the clotting tendancies of your blood with the clotting tendencies of normal blood.
• D-dimer Test: You may also be given a blood test to detect D-dimer, a protein fragment that is present in the blood if any blood clots have been broken down in the blood.

Pulmonary Embolism

The most serious risk from DVT is pulmonary embolism. Pulmonary embolism happens when an artery in the lungs is blocked by a blood clot that has traveled from the leg.

SYMPTOMS

• Chest pain
• Shortness of breath
• Coughing up bloody phlegm

Pulmonary embolism can be fatal, so call 911 immediately if you have symptoms of pulmonary embolism, even if you have not been diagnosed with DVT.

Chronic Venous Insufficiency (CVI) and Post-Thrombotic Syndrome

The blood clots can block the veins, causing great pressure that can damage the valves that prevent blood from flowing backward into the legs. If enough valves are badly damaged enough, it will lead to chronic venous insufficiency. CVI is generally not life-threatening, but it can cause a reduction in quality of life due to leg pain and inability to stand or walk comfortable.

Highly symptomatic CVI is called post-thrombotic syndrome. It causes severe swelling and pain, and can also cause ulcers on the leg, which may have difficulty healing due to poor circulation. Post-thrombotic syndrome can occur and re-occur in people who have previously suffered DVT.

Initial Treatment

Initial treatment involves bed rest until symptoms are relieved. Compression stockings are used to help the blood return to the heart. The affected leg or legs may be raised to reduce swelling.

Blood thinners (anticoagulants) such as warfarin (Coumadin) or heparin are given to prevent new clots from forming, and can usually prevent existing clots from getting larger and breaking off to cause a pulmonary embolism. However, they do not dissolve existing clots. Your body will eventually break up any existing clots, but until then, they can cause irreparable damage to your veins. It is best to destroy or remove any blood clots as soon as possible.

Thrombolytic agents may be given to help to dissolve any blood clots. There is a risk of bleeding complications so thrombolytic agents require a hospital stay and monitoring by your physician.

Minimally Invasive Treatment

Our doctors can perform two different procedures, thrombolysis and thrombectomy, to either dissolve or remove the blood clot so that it doesn’t cause further damage or a pulmonary embolism. Both procedures are minimally invasive, meaning that there is no surgery performed. A small incision is made in your groin and a catheter is inserted into your vein. The catheter is guided to the clot itself, and then the clot is captured and removed (thrombectomy) or injected with a clot-busting agent (thrombolysis) so that it dissolves harmlessly.

Surgical Treatment

Surgery is used only for patients who cannot tolerate other therapies or who develop a pulmonary embolism while on medical therapy. Surgery may be used to remove the clot or to place a filter to catch any clots before they reach the lungs.

Blood can clot when the blood moves slowly for a long time. You may have heard that you should stand up and move around occasionally when you are on a long flight or car trip; this is to prevent DVT. If you are bedridden you are at a greater risk for DVT.

In addition to immobility, the following are considered to be risk factors for developing DVT:

• Over 60 years old
• Female
• Bedridden
• Smoking
• Diabetic
• Active cancer
• Recent major surgery requiring regional or general anesthetic
• Recent childbirth
• Estrogen use
• Obesity
• Hypercoagulability
• Use of oral contraceptives