Deep vein Thrombosis (dvt)
Deep vein thrombosis occurs when there is a thrombus or clot within the deep veins of the leg. This occurs as a result of injury to the vein, increased viscosity of the blood or stasis/slow blood flow. Deep vein thrombosis is potentially life threatening, particularly if the thrombus or clot breaks loose and dislodges in the lung causing a pulmonary embolism.
Risk factors for deep vein thrombosis (DVT) are:
- Age
- Obesity
- Malignancy
- Immobility
- Surgery of the hip/knee
- Inherited blood conditions
- Trauma
- Infection
- Varicose veins
- Pregnancy & post-partum period
- Hormone replacement therapy(HRT)
- Combined oral contraceptives
Symptoms of Deep vein thrombosis (DVT)
- Swelling of calf/lower leg
- Pain & tenderness of the calf
- Redness of the calf
- Difficulty walking
- Mild fever
Diagnosis of deep vein thrombosis
The diagnosis is made with a combination of clinical assessment, blood test and radiological imaging (Ultrasound, CT scan or MRA).
Treatment of Deep vein thrombosis
Anticoagulation
This is the standard method of treating deep vein thrombosis. Anticoagulation medication can be in oral or injection form. Essentially, these medications prevent further clots from forming and keep the blood thin.
In general, anticoagulation is required for a period of three to six months with follow up serial ultrasound scans. The duration of the anticoagulation is dependant on the initial cause of the deep vein thrombosis.
Thrombectomy/ thrombolysis
This procedure involves the administration of enzymes to dissolve the clots in the legs via catheters. Catheter directed thrombolysis can reduce the risk of future clot- related complications but has a significant bleeding risk due to the administration of the enzyme. This procedure can be performed together with a mechanical thrombectomy device that aspirates the venous clots. In general, this procedure is reserved for patients with acute deep vein thrombosis or clots that are less than 14 days old.
Other treatments
IVC filters are devices that are introduced into the inferior vena cava to prevent large venous clots from dislodging from the legs to the lung. This procedure is used for patients who are at high risk of this embolism.
Compression stockings are also used to encourage flow of fluid and blood upwards to the heart, thereby reducing venous pooling and improving clinical outcome.
