Deep Vein Thrombosis

What?

 

Deep Vein Thrombosis or DVT is when a blood clot forms in the deep veins - usually the leg or pelvis. As opposed to blood clots in the superficial veins, which is usually self limiting and benign, DVT is a serious condition. Sufferers experience pain, swelling and fullness in the leg. Over time the clot can harden and destroy the vein which can lead to long term skin changes, ulcers and difficulties walking - this is called the Post Thrombotic Syndrome or PTS.

Occasionally the clot can break off and travel to the lungs. This causes chest pain, shortness of breath and palpitations and is called a pulmonary embolism (PE). A PE is a medical emergency.

Why?

 

Blood clot form for a variety of different reasons. It is usually because the blood is pro-thrombotic (too sticky) or not moving through the veins fast enough.

Reasons for prothrombotic states:

  • Pregnancy

  • Oral contraceptive pill

  • Genetics

  • Inflammation - illness or surgery

  • Smoking

  • Cancer

Reasons for poor blood flow

  • Prolonged sitting during travel

  • Prolonged time in bed due to surgery

  • Obesity

  • Pregnancy

Rarely, a condition called May-Thurner syndrome may cause DVT. This is an anatomical condition where the vein draining the left leg is compressed in the pelvis. This condition increases the risk of DVT and recurrence.

What can be done?

 

DVT is usually diagnosed with a duplex ultrasound that can confirm the presence of clot.

The mainstay of DVT treatment has been blood thinning medication to prevent the clot worsening and reduce the risk of DVT. This medication is usually continued for at least 3-6 months, although possibly long depending on the cause.

Compression stockings and elevation improve the symptoms in the early period. Long term compression of the affected limb has been a mainstay of treatment and may improve long term results.

These simple measures are usually all that is required however in younger people, with extensive DVT who are very symptomatic, a new treatment called thrombolysis may improve the short terms symptoms and reduce the long term risk of PTS. Thrombolysis involves using clot busting medication and a mechanical device to break down the clot and open the vein. After this, the vein may need to be stented to remain open.

A detailed description of Deep Vein Thrombosis disease and treatment is available from the ANZ society of vascular surgery via the links below