DEEP VEIN THROMBOSIS


What is deep vein thrombosis (DVT)?

The blood circulation system in our body has arteries and veins. The arteries carry pure blood and veins carry impure blood. The vein system in our legs has two groups of veins; superficial veins and deep veins. The superficial veins are ones which we can see under our skin on legs; while deep veins our hidden in the muscles. The thrombosis means blockage of veins by blood clots. So when deep veins forms clot inside it is called “deep vein thrombosis”. This usually happens in the legs. When that happens suddenly; patient develops pain, catch in the muscles and swelling of the leg; depending on the extent of blockage. If the extent of blockage is large you will have pain, swelling, stiffness. If the extent of block is less you may complain only of cramp or stiffness with pain.
In a few cases these pieces of blood clots in veins can break away and deposit into the blood vessels of lungs. When that happens; person may suffer from breathlessness, chest pain, heart failure and sometimes results in death.




Causes of deep vein thrombosis

There are various causes of deep vein thrombosis. It can be due to slowing of blood due to various reasons like prolonged bed rest, long hours of sitting, dehydration, trauma, recent surgery. The “economy class syndrome” is the formation of blood clots in veins deep within the legs occurring during or just after a long airplane flight, especially in economy class due to prolonged immbolisation and lack of space.
Some patients has increased tendency to form clots. It may due to certain deficiency of blood components. These patients tend to form blood clots more than others. Such individuals have repeated attacks of deep vein thrombosis. In certain diseases persons have more frequency of deep vein thrombosis like cancer, obesity and kidney diseases. Pregnancy is one state where chances of deep vein thrombosis are high due to pressure from uterus and hormonal changes. Women who are taking contraceptive pills are again more prone to DVT due to hormonal changes. Old age, persons with severe infections and patients on chemotherapy are also more prone to DVT.




Treatment of deep vein thrombosis

Deep vein thrombosis can be detected by blood test called “D-dimer”. To know the extent of disease sonography of veins (Color Doppler) is done. This Sonography test will confirm the diagnosis and also it will tell us the extent of disease. In some cases MRI scan will be required.
Once detected one should start treatment early to get best results. If your disease is mild, you can be treated as OPD patient. Doctor will give you blood thinning injections two times daily for 5-7 days and start blood thinning medications. You will also need blood tests to see the appropriate level of medication required for blood thinning. It is better to take rest from your work. If your disease is significant doctor will admit and treat you. This would include blockage of veins in pelvis, migration of blood clot into lungs, old age, and other medical diseases.
If there is considerable disease involving major veins in thigh and pelvis; the blood clots can be melted with blood thinning medicines injected directly into affected veins and clots can be aspirated out of the veins. This treatment is called “catheter directed thrombolysis”. This procedure has to be done within two weeks of start of disease. This is a new method of treatment which has significantly improved the results of treatment. If there is increased risk of blood clot migrating into lungs then doctor can put a filter in inferior vena cava (the large vein in lower trunk formed by joining of both leg veins).
Your blood thinning tablet will continue for six months. You will also be investigated to find out if you have certain deficiency of blood components. Besides this you will be required to wear compression stockings in affected leg. These stockings you will have to wear for two years or more.
Discussion will not be complete without long term effects of deep vein thrombosis. In medical term it is called ‘post thrombotic syndrome (PTS)’. Up to half of the patients who had DVT will suffer from PTS. The symptoms of PTS includes swelling of leg, pain, heaviness, itching, discoloration of skin, varicose veins and even ulcer on legs. It is to avoid these symptoms patients are advised to wear compression stockings for two years or more.
Deep vein thrombosis should be detected early and treated appropriately for early recovery, prevention of complications and decrease chances of long term effects.



Dr Sunil Bhargava MD, DNB, MNAMS
Consultant Interventional Radiology and Vascular Sciences
SevenHills Hospital, Andheri (E), Mumbai 400059
E mail drsunil.b@sevenhillshospital.com ,Mobile +919320182803

Dr Sunil Bhargava is an Interventional Radiologist with experience of over 17 years. He is an expert in endovascular treatment of vascular diseases. His areas of interest include venous ailments like varicose veins, deep vein thrombosis and congenital venous malformations.