Diabetic Foot Ulcers Treatment & Management | How a Vascular Surgeon can help
January 13, 2021
Know your Vascular System & how to take care of your blood vessels health
August 19, 2021
How much do you know about (DVT) Deep Vein Thrombosis?
DVT Awareness Month
March is celebrated world-wide as blood clot awareness month.
Blood clots can happen to anyone, but they are preventable.
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling but can also occur with no symptoms.
You can get DVT if you have certain medical conditions that affect the blood clotting mechanism of your body. A grume in your legs also can happen if you do not move for an extended time, like after you've got surgery or an accident, when you're traveling a long distance, or when you're on bed rest.
Deep vein thrombosis is often very serious because blood clots in your veins can break loose, travel through your bloodstream and find stuck in your lungs, blocking blood flow (pulmonary embolism). However, embolism can occur with no evidence of DVT.
When DVT and embolism occur together, it's called venous thromboembolism (VTE).
Symptoms
DVT signs and symptoms can include:
- Swelling in the affected leg. Rarely, there's swelling in both legs.
- Pain in your leg. The pain often starts in your calf and may result in cramping or soreness.
- Red or discolored skin on the leg.
- A feeling of warmth in the affected leg.
- Deep vein thrombosis can occur without noticeable symptoms.
- Obesity
Causes
Anything that stops your blood from flowing or clotting normally can cause a blood clot. The main causes of DVT are damage to a vein from surgery or trauma and inflammation due to infection or injury.
Risk Factors
Many things can increase your risk of developing DVT. The more risk factors you have, the greater your risk of DVT.
- Age. Being older than 60 increases your risk of DVT, though it can occur at any age.
- Sitting for long periods of time(E-thrombosis), such as when driving or flying(Traveler’s thrombosis). When your legs remain still for hours, your calf muscles don't contract. Muscle contractions normally help blood circulate.
- Prolonged bed rest, such as during a long hospital stay, or paralysis. Blood clots can form in the calves of your legs if your calf muscles don't move for long periods.
- Fracture/Injury or surgery. Injury to your veins or surgery can increase the risk of blood clots.
- Pregnancy. Pregnancy increases the pressure in the veins in your pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after you have your baby.
- Birth control pills (oral contraceptives) or hormone replacement therapy. Both can increase your blood's ability to clot.
- Being overweight or obese. Being overweight increases the pressure in the veins in your pelvis and legs.
- Smoking. Smoking affects blood clotting and circulation, which can increase your risk of DVT.
- Cancer. Some forms of cancer increase substances in your blood that cause your blood to clot. Some forms of cancer treatment also increase the risk of blood clots.
- Heart failure. This increases your risk of DVT and pulmonary embolism. Because people with heart failure have limited heart and lung function, the symptoms caused by even a small pulmonary embolism are more noticeable.
- Inflammatory bowel disease. Bowel diseases, such as Crohn's disease or ulcerative colitis, increase the risk of DVT.
- A personal or family history of DVT or PE. If you or someone in your family has had one or both of these, you might be at greater risk of developing DVT.
- Genetics. Some people inherit genetic risk factors or disorders, such as factor V Leiden, that make their blood clot more easily. An inherited disorder on its own might not cause blood clots unless combined with one or more other risk factors.
- No known risk factor. Sometimes, a blood clot in a vein can occur with no apparent underlying risk factor. This is called an unprovoked VTE.
Complications
Complications of DVT can include:
- Pulmonary embolism (PE). PE is a potentially life-threatening complication associated with DVT. It occurs when a blood vessel in your lung becomes blocked by a blood clot (thrombus) that travels to your lung from another part of your body, usually your leg. It's important to get immediate medical help if you have signs and symptoms of PE. Sudden shortness of breath, chest pain while inhaling or coughing, rapid breathing, rapid pulse, feeling faint or fainting, and coughing up blood may occur with a PE.
- Postphlebitic syndrome. Damage to your veins from the blood clot reduces blood flow in the affected areas, causing leg pain and swelling, skin discoloration and skin sores.
- Treatment complications Complications may result from blood thinners used to treat DVTs. Bleeding (hemorrhage) is a worrisome side effect of blood thinners. It's important to have regular blood tests while taking such medications.
Diagnosis of DVT
- It is usually a clinical diagnosis based on the symptoms and signs.
- Your doctor may order a blood test (d-Dimer) to check the presence of blood clotting in the body, but it’s a less specific test.
- Venous duplex ultrasound scan is the best confirmatory test to diagnose DVT.
How Is DVT Treated?
Your doctor will want to stop the blood clot from getting bigger or breaking off and heading toward your lungs. They’ll also want to cut your chances of getting another DVT.
This can be done in one of three ways:
- Medicine. Blood thinners are the most common medications used to treat DVT. They cut your blood’s ability to clot. You may need to take them for 6 months. If your symptoms are severe or your clot is very large, your doctor may give you a strong medicine to dissolve it. These medications, called thrombolytics, have serious side effects like sudden bleeding. That’s why they’re not prescribed very often.
- Inferior vena cava (IVC) filter. If you can’t take a blood thinner or if one doesn’t help, your doctor may insert a small, cone-shaped filter inside your inferior vena cava. That’s the largest vein in your body. The filter can catch a large clot before it reaches your lungs.
- Thrombolysis procedure(clot removal from veins): Thrombolysis is used to remove a large burden of blood clots from veins in patients with DVT.Clot removal will clear the passage for return of impure blood from your legs. This procedure should be done within 7 to 10 days after diagnosis of DVT.
Advantages
- Minimal invasive latest technique, recommended as per recent guidelines
- Immediate reduction in leg swelling, pain
- Reduced late complications like-Recurrence, leg wounds development
Catheter-directed thrombolysis is done by doing a small puncture in vein behind the knee, guidewire along with the Angiojet (clot suctioning device) is introduced inside the vein. Clots are removed from vein & blood flow is again normalized in the limb.
- Avoid sitting still. If you have had surgery or have been on bed rest for other reasons, try to get moving as soon as possible. If you're sitting for a while, don't cross your legs, which can block blood flow. If you're traveling a long distance by car, stop every hour or so and walk around.
- If you're on a plane, stand or walk occasionally. If you can't do that, exercise your lower legs. Try raising and lowering your heels while keeping your toes on the floor, then raising your toes with your heels on the floor. Don't smoke. Smoking increases your risk of getting DVT.
- Exercise and manage your weight. Obesity is a risk factor for DVT. Regular exercise lowers your risk of blood clots, which is especially important for people who sit a lot or travel frequently.
- Compression stockings. These special socks are very tight at the ankle and get looser as they reach your knee. This pressure prevents blood from pooling in your veins. You can buy some types at the drugstore. But your doctor might prescribe a stronger version that can be fitted by an expert.
What to do next if I am suspecting DVT in my legs?
Consult a Vascular Surgeon immediately for assessment. Doctor will perform an Ultrasound Doppler test of your legs & will explain to you further the course of treatment.
Raise your voice to increase blood clot awareness,share life saving information with your dear ones.
Dr. Kushan Nanavati
Vascular & Endovascular Surgeon, Vadodara
