Deep Vein Thrombosis (DVT)
Deep vein thrombosis (DVT) is the formation of a blood clot, known as a thrombus, in the deep leg vein. It is a very serious condition that can cause permanent damage to the leg, known as post-thrombotic syndrome, or a life-threating pulmonary embolism. In the United States alone, 600,000 new cases are diagnosed each year. One in every 100 people who develops DVT dies. Recently, it has been referred to as “Economy Class Syndrome” due to the occurrence after sitting on long flights.
The deep veins that lie near the center of the leg are surrounded by powerful muscles that contract and force deoxygenated blood back to the lungs and heart. One-way valves prevent the back-flow of blood between the contractions. (Blood is squeezed up the leg against gravity and the valves prevent it from flowing back to our feet.) When the circulation of the blood slows down due to illness, injury, or inactivity, blood can accumulate or “pool” which provides an ideal setting for clot formation.
- Previous DVT or family history of DVT
- Immobility, such as bed rest or sitting for long periods of time
- Recent surgery
- Above the age of 40
- Hormone therapy or oral contraceptives
- Pregnancy or post-partum
- Previous or current cancer
- Limb trauma and/or orthopedic procedures
- Coagulation abnormalities
- Discoloration of the legs
- Calf or leg pain or tenderness
- Swelling of the leg or lower limb
- Warm skin
- Surface veins become more visible
- Leg fatigue
Left untreated, a DVT can break off and travel in the circulation, getting trapped in the lung, where it blocks the oxygen supply, causing heart failure. This is known as a pulmonary embolism, which can be fatal. With early treatment, people with DVT can reduce their chances of developing a life threatening pulmonary embolism to less than one percent. Blood thinners like Heparin and Coumadin are effective in preventing further clotting and can prevent a pulmonary embolism from occurring.
- It is estimated that each year more than 600,000 patients suffer a pulmonary embolism.
- PE causes or contributes to up to 200,000 deaths annually in the United States.
- One in every 100 patients who develop DVT die due to pulmonary embolism.
- Majorities of pulmonary embolism are caused by DVT.
- If pulmonary embolism can be diagnosed and appropriate therapy started, the mortality can be reduced from approximately 30 percent to less than ten percent.
Back To Top
Symptoms of Pulmonary Embolism
The symptoms are frequently nonspecific and can mimic many other cardiopulmonary events:
- Shortness of breath
- Rapid pulse
- Sharp chest pain
- Bloody sputum (coughing up blood)
Back To Top
Deep Vein Thrombosis Treatments
Early in treatment, blood thinners are given to keep the clot from growing or breaking off and traveling to the lung and causing a life-threatening pulmonary embolism by blocking the oxygen supply causing heart failure.
Inferior Vena Cava Filters
In patients in whom blood thinners are not medically appropriate, an interventional radiologist can place a device called a filter, which captures blood clots and prevents them from traveling to the lungs, but permits blood to pass. The filter is placed via a vein in the groin or neck and is done with local anesthesia. It can be performed with or without sedation. Some filters are designed so they can be removed when no longer needed. Like placement of the filter, this procedure is performed via a vein in the neck or groin.Back To Top
Patients with May-Thurner Syndome have a swollen left leg, which is often painful. This is caused by a stenosis, or narrowing, of the left common iliac vein, leading to left-sided deep vein thrombosis. The common iliac vein is the main vein in the pelvis draining blood from the leg. The stenosis is thought to develop in response to chronic irritation of the left common iliac vein by the crossing right common iliac artery. Thrombosis often ensues when an inciting factor is present, such as a hypercoagulable disorder, recent trauma, or the initiation of oral contraceptive therapy. Multiple case reports and small series attest to the ability of the administration of certain drugs, when delivered into the clot, to dissolve the clot, with subsequent stent placement, to provide effective treatment for these patients with low rates of early rethrombosis.
New Cause of Pain Identified in Patients With Chronic Deep Vein Thrombosis
Patients with deep vein thrombosis often develop pain at the time of onset of the thrombosis, which generally improves with blood thinners and leg elevation. Worsening of pain and swelling months or years after the initial thrombosis can be due to new thrombus formation, which may require retreatment with blood thinners. However, a new cause of pain and swelling has recently been identified.* Patients with deep vein thrombosis, with thrombus remaining in the vein after treatment with blood thinners, may develop a condition known as arteriovenous malformation. This condition causes increased blood flow from the artery into the vein, and increased pressure, leading to pain and swelling. If your pain and swelling has been evaluated for the more common recurrent thrombosis, generally done with ultrasound, and this has not been identified, you could have an arteriovenous malformation. This condition can be diagnosed with ultrasound or CT scan, and can be treated, but may be overlooked. Treatment is accomplished by closing off the arterial branch supplying the abnormal flow to the malformation in the vein, thereby decreasing blood flow and pressure in the vein. If you think you could have this condition, contact Atlanta Access Care for an evaluation.
*J Vasc Interv Radiol 2010;21:387-91.