Deep vein thrombosis

What is deep vein thrombosis (DVT)?

Deep vein thrombosis or DVT occurs when blood clots develop in the deep veins of the body. It occurs in the pelvis, lower legs, or thighs, but can occur in other parts of the body. If the deep vein inflames, it is called thrombophlebitis.

In rare cases, the blood clot breaks loose and travels to the lung. This condition is pulmonary embolism and sometimes is fatal. When DVT occurs with pulmonary embolism, the condition is called venous thromboembolism.

Deep vein thrombosis leaves long-term side effects. It damages the valves in the veins, causes swelling, pain, and leg sores.

Sometimes, DVT symptoms are hard to detect and occur. Only 50% of patients exhibit DVT symptoms. Doctors may suggest preventive care for patients susceptible to developing the disease.

Deep vein thrombosis causes and risk factors

The main cause of DVTs is blood clots. Other risk factors include:

• People over 60 are at risk of getting DVT.
• Sitting for a prolonged time. The calf muscles in the legs become stiff. Muscle contractions help blood circulation.
• Paralysis or long hospital stays. Prolonged bed rest stiffens the calf muscles in the legs and may lead to blood clots.
• The fetal weight puts pressure on the veins of the legs and the pelvis. Blood clots can occur up to 6 weeks after pregnancy.
• Body mass index (BMI) above 30 increases the risks for DVT.
• Certain blood disorders that run in the family make the blood thicker. It can cause blood clots.
• Damage to the vein due to a surgical procedure, trauma, or injury can lead to blood clots.
• Long-term smoking thickens the blood cells and makes them sticky. This damages the blood vessel lining and may cause blood clots.
• Certain infections in the veins or blood can lead to DVT.
• Health problems. Cancer, heart diseases, irritable bowel syndrome, high cholesterol, varicose veins, etc., raises the risks for deep vein thrombosis.
• Birth control pills and drugs used for hormone replacement therapy raises the risks of blood clots.
• Unprovoked DVT. Sometimes, DVT occurs for no known reason.

DVT diagnosis

The doctor will review your medical history and order some tests.

Duplex venous ultrasound

This is a widely used test for DVT. High-frequency ultrasound waves take clear images of the veins. It uses Doppler technology to generate colored images of the blood flow in the body.

Venography

The doctor injects a dye (contrast solution) into the vein. The dye flows through the blood. The x-rays show blockages of the veins in the legs and the thigh. It is generally done when duplex ultrasound gives inconclusive results.

MRI (magnetic resonance imaging) scan

The MRI scan takes pictures of the internal organs, veins, and blood vessels to detect blood clots. It is not done in patients with pacemakers or other implanted devices.

CT (computed tomography) scan

The CT scan shows x-ray images of the body’s internal organs. It detects DVT in the pelvis, abdomen, and also lungs.

Blood tests

The doctor orders other tests if the DVT is in an unusual location or due to some genetic blood disorder.

Treatment options

Treatment focuses on preventing blood clots from growing and reducing risks for other serious complications like pulmonary embolism.

Home remedies

• Take frequent walks to improve blood circulation.
• Keep your arms and legs elevated.
• Wear compression stockings. It improves blood circulation and relieves pain and swelling.
• Exercises like foot pumps, ankle circles, knee pull, etc., reduce blood clot formation.

Medications

Blood thinners like warfarin, heparin, enoxaparin, etc., prevent blood to clot. If blood thinners are not working, doctors prescribe thrombolytic drugs. It also helps patients with upper extremity deep vein thrombosis. Thrombolytic drugs are given intravenously.

Procedures

Doctors recommend surgery to remove large blood clots in the leg or the arm. It is generally recommended if the condition is severe and damages surrounding tissues and veins. Doctors also recommend IVC (Inferior Vena Cava) filter placement to prevent pulmonary embolism.

Preparation

Before a DVT procedure:

• Talk to your doctor about your prescribed medications.
• Inform about allergies, recent health conditions, or pregnancy.
• Complete your diagnostic tests.
• Talk about anesthesia problems.
• Consult the doctor regarding the discontinuation of certain medications like blood thinners, herbal supplements, vitamins, and over-the-counter medications.
• Stop drinking or eating after midnight the day before the surgery.

Procedures:

IVC filters

Filter placement in the IVC (large abdominal vein) prevents pulmonary embolism. It traps large blood clots and prevents them from entering the lungs and the heart.

The surgeon inserts a catheter through a small incision in the vein of the neck or the groin. The catheter helps insert the collapsed filter in the IVC and expands it to attach to the blood vessel’s wall. The filter can be placed permanently or removed after a period.

The procedure takes one hour and is done under intravenous sedation. The patient goes home after some rest.

Thrombectomy

The surgeon makes a cut above the clot in the artery or the vein. He/she then inserts the catheter to remove the clot. The procedure removes clots from the artery or vein of the arms, legs, or other organs in the body.

This procedure is normally done to remove large clots. Sometimes, the surgeon inserts a balloon with the catheter to inflate and remove the remaining clot. The surgeon may permanently leave a stent in the artery or blood vessel to keep it open.

Catheter-directed thrombolysis

It is a less invasive procedure than thrombectomy. The surgeon inserts an x-ray camera-guided catheter into the artery or the vein to reach the clot. The catheter injects a contrast solution to take x-rays of the clot. The catheter is left for 72 hours. It releases dissolving medications. The surgeon can also put a small device to remove the clot. It takes less time, about 30 minutes but requires a longer hospital stay.

When should you go for treatment?

Deep vein thrombosis symptoms:

• Swelling in the lower legs (usually one-sided).
• Cramping pain. The pain generally starts from the calf area.
• The affected area feels warm.
• Discoloration of skin. The skin turns reddish or blue.

Symptoms for DVT in the upper part of the body include:

• Neck or shoulder pain.
• Arm or hand inflammation.
• Darkish or bluish skin color.
• Hands become weak.

When to seek emergency care?

Pulmonary embolism (PE) is a life-threatening disease. Patients must seek immediate consultation if they develop:

• Chest pain.
• Discomfort while coughing.
• Shortness of breath.
• Feeling dizzy.
• Fainting.
• Rapid pulse rates.
• Rapid breathing.
• Coughing blood.

Surgery options

Deep vein thrombosis procedures are mostly done in an outpatient setting. Doctors recommend hospitalization if patients are at risk for pulmonary embolism, anticoagulant bleeding, comorbidity factors, etc. Patients may choose to have the surgery in an outpatient clinic or a hospital.

Small clinics

Pros

• Low fees.
• Quick service.
• Personalized care.

Cons

• Small setups.
• A small unit of medical staff.

Big hospitals

Pros

• Big setups.
• 24/7 emergency services.
• Multiple facilities.

Cons

• Expensive services.
• Long waiting time.

Cost of surgery

Surgery costs depend on:

• Type of procedure.
• Symptoms.
• Patient’s overall health.
• Surgeon’s fees.
• Fees for the surgical team.
• Hospital stays.
• Inpatient care charges.

Post-op care and things to keep in mind

Going home:

• Do simple movements to keep your blood flowing.
• Keep pillows under your feet. This improves blood circulation.
• Take blood thinner medications prescribed by your doctor.
• Wear compression stockings. This increases blood flow and decreases swelling in the legs.
• Take pain medications as directed.
• Do light exercises like ankle movements and leg lifts.
• Avoid smoking.
• Reduce coffee intake and avoid alcohol.
• If you are traveling for more than 4 hours, try moving around to increase blood flow. Walk and stretch your legs.
• Drink enough fluids.
• Avoid crossing your legs.

Complications

Potential risks for DVT procedures include:

• Excess bleeding.
• Blood vessel damage during surgery.
• Infection on the wound site.
• Anesthesia reactions.
• Blood clot fragments flow into the lungs and block blood flow.
• Improper positioning of IVC filters.
• In rare cases, the IVC filter may become loose and travel up to the lungs or heart and pierce blood vessels.
• IVC filter malfunction. It blocks the blood flow instead of blood clots.

Prevention

A healthy lifestyle can reduce the risks of DVT.

• Get regular health checkups.
• Take your prescribed medications regularly.
• Stop smoking.
• Remain active.
• Lose excess weight.
• Elevate legs.
• Avoid sitting for too long. Take frequent breaks.
• Ask your doctor about preventive care after a DVT surgery. Take blood thinners and wear compression stockings to prevent recurrence of the disease.
• Eat healthy foods.

Best option

Long-term DVT symptoms get worse without proper treatment. Once you have decided to get treatment, the next task is to find a suitable hospital and specialist to treat the disease. Goficure provides a team of experts who assist patients in getting complete medical care.

Goficure offers:

• Hassle-free treatment.
• Priority consultation and treatments.
• Confidentiality.
• Transparent pricing system.
• Insurance coverage.
• Specialist doctors and trustworthy diagnoses.

References