Deep Vein Thrombosis & Pulmonary Embolism

Deep vein thrombosis, or DVT, is a serious condition in which a blood clot develops in a person’s veins, causing a partial or complete blockage of blood flow in an affected leg. DVT generally causes pain and swelling in the involved area, as well as skin discoloration. In more serious cases, the blood clot breaks loose and travels through the bloodstream to the lungs, blocking circulation to that organ. This condition, known as pulmonary embolism (PE), is life-threatening and requires immediate medical attention. A blood clot forms due to reduced blood flow in a vein, injury to blood vessels or clotting disorders. Although venous clots most often happen in deep veins in the legs, they can also occur in superficial veins.

The leading cause of deep vein thrombosis (DVT) is damage to a vein from surgery, inflammation, infection or injury. Nearly 40% of patients with DVT will develop PE, with the latter causing approximately 300,000 deaths in the United States each year. It’s important to realize that DVT can occur to anyone and that it can result in disability and even death. However, DVT can be prevented and treated if discovered early. DVT and pulmonary embolism that occur together is called venous thromboembolism (VTE).

SIGNS AND SYMPTOMS OF DEEP VEIN THROMBOSIS (DVT)

Some people have no signs of DVT, but the most common symptoms are:

• • Pain, swelling, and tenderness in the involved leg, often starting in the calf
  • Reddish or bluish discolored skin over the affected area
  • A feeling of warmth

DEEP VEIN THROMBOSIS (DVT) RISK FACTORS

DVT is most common in people over the age of 60, but it can affect almost anyone. Common risk factors include:

• A family history of DVT or pulmonary embolism (PE)
• Obesity
• Damaged blood vessels
• Having certain conditions that cause easier blood clotting, such as having chemotherapy or radiation therapy for cancer, heart and lung disease, thrombophilia and Hughes syndrome
• Being inactive when traveling during long journeys slows blood flow and increases the risk of blood clots developing
• Pregnancy increases the pressure in the veins in the pelvis and legs and puts a woman at risk for blood clot formation for up to six weeks following delivery
• Taking birth control pills and hormone replacement therapy can increase the likelihood of blood clots
• Heart failure
• Inflammatory bowel disease such as Crohn's disease or ulcerative colitis

Having one or more of the above risk factors also increases your chances of having DVT. It’s also worth noting that about half of DVT cases occur during or soon after a hospital stay or surgery. When your legs don't move for a long time on bed rest, the calf muscles don't contract, resulting in slow blood flow.

TIPS TO PREVENT DEEP VEIN THROMBOSIS

Take the following steps to reduce your risk and prevent DVT:

• Move around as soon as possible after surgery or injury
• Consider medical compression stockings or anticoagulants if you are at risk
• When sitting for long periods, get up and walk around, perform in-seat leg exercises and wear loose-fitting clothes
• Maintain a healthy weight

DIAGNOSIS AND TREATMENT

It is vital to do an ultrasound to diagnose and treat DVT promptly if the symptoms are concerning. At VIVAA, we will discuss the symptoms and schedule an ultrasound if we suspect DVT. Ultrasound allows Dr. Sidhu to watch and monitor your blood vessels and see the areas where the overall blood circulation may be constricted because of the thrombus. Once the diagnosis is made, treatment depends on the extent of the thrombus.

Treating DVT aggressively to prevent long-term disability is essential. Dr. Sidhu will discuss the latest medications and treatments to determine your best course. Depending on your symptoms, you may be a candidate for thrombolytic treatment to dissolve the blood clot. If your symptoms aren’t life-threatening, or if using a thrombolytic is too dangerous, you may receive anti-coagulant medications that interrupt the clotting process. These medications don’t break down blood clots but will keep them from getting bigger while your body dissolves them. Using compression stockings to prevent tissue damage and to help reduce swelling may also be part of your treatment, along with blood thinners to prevent blood clots from developing.

Sometimes, patients need surgery to place an inferior vena cava filter to prevent the blood clot from traveling to the lungs. This screen, placed in a big vein in the abdomen, is generally only used when anticoagulant medications are unsuitable or need to be stopped.

CHRONIC DVT AND POST PHLEBITIC SYNDROME

Chronic ilio-femoral DVT can lead to occlusion of the iliac veins. Also called post-phlebitis syndrome, this medical condition can occur as a long-term complication of DVT. This results in chronic swelling and pain, ultimately thickening and reddening skin and even wound development. The process to rid the body of blood clots can damage vein function, particularly the valves that regulate blood flow. If a patient has leg swelling after acute deep vein thrombosis (DVT), they should wear compression stockings to decrease the swelling. We may also recommend other lifestyle modifications such as elevating the extremity at night, weight loss and exercises to strengthen the extremity muscles.

PULMONARY EMBOLISM (PE)

The most serious complication of DVT occurs when a clot breaks free and travels to the lungs, where it can cause pulmonary embolism. Pulmonary embolism is diagnosed with a CT scan and, in the most severe cases, can require a procedure to dissolve the blood clot to prevent the long-term sequence of pulmonary hypertension. With early intervention, patients with DVT can reduce their risk of pulmonary embolism to about 1%.

Patients with a small blood clot with a pulmonary embolism diagnosed early can recover from PE. However, you could sustain damage to the lungs. If the blood clot is large, it can block blood flow to the lungs and can be fatal.

Signs of Pulmonary Embolism

The signs are not the same for each person, however, they can include:

• Shortness of breath
• Rapid breathing
• Sharp, stabbing chest pain that may worsen when you inhale
• Rapid heart rate
• Coughing, sometimes with blood
• Fainting
• Low blood pressure
• Fever