Deep Venous Thrombosis
What is Deep Venous Thrombosis?
Deep vein thrombosis (DVT) is a blood clot in a vein deep in the body. Veins are blood vessels with valves that help prevent backward blood flow. Blood is pushed through the veins in legs and arms when muscles contract. Deposits of red blood cells and clotting elements in the blood can build up in a vein. This build up leads to a blood clot. Clots usually occur in the legs, but can occur in other locations. As the clot grows, it blocks blood flow in the vein. Depending on where the clot is located, Conditions related to DVT include: central vein thrombosis (IVC/SVC); lower extremity; and upper extremity (Paget-Schroetter syndrome / axillo-subclavian vein thrombosis).
Deep Vein Thrombosis
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Several factors contribute to clot formation, including:
- Slow blood flow, often due to lying or sitting still for a long period of time
- Pooling of blood in a vein, often due to:
- Medical conditions
- Damage to valves in a vein or pressure on the valves, such as during pregnancy
- Injury to a blood vessel
- Clotting problems, which can occur due to aging or disease
- Catheters placed in a vein
Factors that may increase your chance of DVT include:
- Personal or family history of deep vein thrombosis
- Not moving your body, especially during travel
- Surgery, especially involving bones or joints
- Medical conditions, such as varicose veins, cancer, heart failure, heart attack, inflammatory bowel disease, blood disorders, sepsis and obesity
- Pregnancy, especially in women of increased age and those who are overweight, smoke, or have certain pregnancy-related conditions such as preeclampsia
- Inherited or natural genetic changes that can alter your protein levels
- Taking medications such as birth control pills, estrogen therapy, or antipsychotics
Symptoms occur when:
- The clot interferes with blood flow in the vein
- Local inflammation occurs
- A clot breaks free and travels to the lungs
Some may not have any symptoms until the clot moves to the lungs. This condition is called pulmonary embolism. Symptoms of DVT may include:
- Swelling of a limb
- Tenderness along the vein, especially near the thigh
- Redness, paleness, or blueness of the skin of the affected limb
Diagnosis & Treatment
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your blood and blood flow may be tested. This can be done with:
- Blood tests
- Impedance plethysmography
- Duplex venous ultrasound
Imaging tests can assess the veins. This can be done with venography.
The treatment goals are to:
- Prevent pulmonary embolism
- Stop the clot from growing
- Dissolve the clot, if possible
Treatment options include:
- Resting in bed when necessary
- Elevating the affected limb above the heart
- Wearing compression stockings as advised by your doctor
Other treatments include:
Blood thinners are used to prevent additional clots from forming. These may be given by injection or by mouth. This treatment may be continued long-term.
If needed, the following procedures are offered at St. Elizabeth's Interventional Peripheral Vascular Lab depending on a patient’s diagnosis:
Central vein thrombosis (IVC/SVC), lower extremity and upper extremity (Paget-Schroetter syndrome / axillo-subclavian vein thrombosis) treatments include:
- Catheter-based embolectomy/thrombectomy/thrombolysis. A series of terms used to describe the catheter-based removal of blood clots from vessels in either arteries or veins. The procedure(s) involve placing a catheter near or in the blood clot and actively removing it with suction/aspiration.
- Large bore catheter thrombectomy (Vortex). This procedure is used for large vessel (central vein) blockages from blood clots or clots en route to the lungs. A large catheter device (Vortex) is placed into the clot and when activated, it removes the clot through suction into the catheter.
Upper extremity (Paget-Schroetter syndrome / axillo-subclavian vein thrombosis) can also be treated with:
- Catheter-based Revascularization. These procedures involve a thin tube called a catheter, which is inserted into an artery. These procedures include:
- Balloon angioplasty. A balloon-tipped catheter is used to press plaque against the wall of the artery. This increases the amount of space for the blood to flow.
- Stenting. Usually done after angioplasty. A wire mesh tube is placed in a damaged artery. It will support the wall of the artery and keep it open.
- Atherectomy. Instruments are inserted via catheter. They are used to cut away and remove plaque so that blood can flow more easily.
To help reduce your chance of DVT:
- If you use them, monitor your use of blood thinners.
- Do not sit for long periods. If you are in a car or airplane or at a computer, get up often and move around.
- If you smoke, talk to your doctor about how you can successfully quit.
- If you are admitted to the hospital - get out of bed and walk as soon as possible during your recovery.
- If you are restricted to bed - do range of motion exercises in bed and change your position at least every two hours.
- Wear compression stockings to promote venous blood flow.
- Use a pneumatic compression device. This device uses air to compress your legs and help improve venous blood flow.
- If prescribed by your doctor, take medication to reduce blood clots. This medication can reduce your chance of death due to blood clots.