Deep Vein Thrombosis (DVT)

Arteries bring oxygen-rich blood from the heart to the rest of your body, whereas the veins are the blood vessels that return oxygen-poor blood back to the heart. There are three kinds of veins. Superficial veins lie close to the skin, and the deep veins lie in groups of muscles. Perforating veins connect the superficial veins to the deep veins with one-way valves. Deep veins lead to the vena cava, the body’s largest vein, which runs directly to the heart.

What is deep vein thrombosis?

Deep vein thrombosis (DVT) is a blood clot in one of the deep veins. Usually, DVT occurs in the pelvis, thigh, or calf, but it can also occur less commonly in the arm, chest, or other locations. DVT can cause sudden swelling, pain or a sensation of warmth. DVT can be dangerous because it can cause a complication known as pulmonary embolism. In this condition, a blood clot breaks free from the deep veins, travels through the bloodstream, and lodges in the lungs. This clot can block blood flow, which can strain the heart and lungs. A pulmonary embolism is a medical emergency. A large embolism can be fatal in a short time.

Symptoms

Swelling, Tenderness, and Leg Pain

Swelling, tenderness, and leg pain that worsen when you walk or stand, create a sensation of warmth, or cause the skin to turn blue or red.

No Symptoms

About half of all deep vein thrombosis cases do not cause symptoms, as perceived symptoms often depend on the location and size of the clot.

Diagnosis

Examination

A complete physical examination and history.

Duplex Ultrasound

A duplex ultrasound can detect most cases of deep vein thrombosis and can be performed in the office.

Intravascular Ultrasound

An intravascular ultrasound can detect the location and extent of cases of deep vein thrombosis.

CT Scan

A CT scan can provide pictures of slices of your arteries, allowing for a more accurate diagnosis.

Venogram

A venogram is an x-ray that allows your physician to see the anatomy of your veins and, sometimes, the clots within them.

Treatments

A number of medications are used to treat deep vein thrombosis, including Heparin, Lovenox, and Coumadin. These medications are both intravenous and oral and occasionally require weekly monitoring of blood levels, called INR.

Several surgical options exist for treating DVT. Thrombolysis is a procedure used to dissolve and break the clot endovascularly. In this procedure, the vascular surgeon injects clot-dissolving drugs through a catheter directly into the clot. Thrombolysis has a higher risk for bleeding complications and stroke than anticoagulant therapy. However, thrombolysis can also dissolve very large clots.

Open thrombectomy is occasionally recommended to remove a deep vein clot. The procedure is called venous thrombectomy. You may need this surgery if you have a severe form of DVT which does not respond to adequate non-surgical treatment and thrombolysis.

Using the Penumbra System, a special metal filter can protect you from a pulmonary embolism if you are unable to take anticoagulants. This device is called a vena cava filter. The vena cava is a large vein in your abdomen. It carries blood back to your heart and lungs. The vascular surgeon may recommend a vena cava filter if you are not a candidate for drug therapy for DVT or if drugs didn’t reduce your clots. Vena cava filters trap the clots that break away from your leg veins before they can reach your lungs.

Risks of Operation

Risks of thrombolysis include high risk of bleeding, need for additional procedures, stroke, and very small risk of death. You may need to be monitored in ICU.