What is Deep Vein Thrombosis (DVT)?
It is a kind of thromboembolism in the veins. This means that a thrombus is formed deep in the vein, and it is found in the lower extremities, commonly on the leg or thigh. It also includes the popliteal vein, femoral vein, and iliac vein located in the pelvis, but it can also develop in other parts of the body. A thrombus is a blob of blood that has solidified. A blood clot obstructing the flow of blood in the vessel may cause a serious health condition. When the thrombus is detached from the leg vein and lodges itself in the arteries that supply blood in the lungs, which is the pulmonary artery, it can cause a pulmonary embolism. The most common long-term DVT problem is post-thrombotic syndrome.
Blood is composed of platelets and clotting agents, giving it the ability to thicken and coagulate, which is essential for one’s survival. When the blood vessel is damaged or cut, platelets pool at the area of injury, producing a mesh or a net creating a plug to stop the bleeding. The formation of a clot eventually decreases the blood flow rate at the site of injury, changes the blood vessel wall, and causes inflammation.
Here are the conditions that increase the risk of developing a Deep Vein Thrombosis:
- Inactivity or reduced movement, prolonged sitting or lying position due to illness.
- When blood vessels are damaged post-surgery or following a traumatic injury
- Obesity or being overweight
- Excessive usage of combined hormonal birth control pills
- May occur during pregnancy
- Family history or personal medical history of DVT
Signs and Symptoms:
Some patients who developed DVT may be asymptomatic, but here are the most common characteristic signs of a blood clot in the leg when left untreated: swelling pain; redness of the leg, ankles, and calf, which some describe as a “heavy ache” and worsen when foot flexes upward, most commonly occur on one side; tenderness and discoloration on the lower extremities; legs are warm to touch.
How is DVT Diagnosed?
Many medical conditions may also cause swelling of the lower extremities, which is common among the elderly above the age of 60. Symptoms of DVT may sometimes be confused with other disorders such as lymphoedema, but DVT is only diagnosed with a series of tests.
- Venous Ultrasound: it is an ultrasound for the leg. It uses a high-frequency sound wave that shows images of structures regardless of tissue density and determines the flow of blood using the doppler technology. It reflects waves from components that are in motion, like the red blood cells. It is a non-invasive procedure to investigate both the arterial and venous blood vessels.
- CT Scan Venography: A non-invasive technique to assess the anatomy and the patency of the vein. It is used to find the clot in the pelvis or the abdomen also including the blood clots in the lungs.
- Contrast Venography: It is a very reliable technique to confirm Deep Vein Thrombosis. It is a more invasive approach to assess DVT. The procedure uses a dose of contrast material and an x-ray to show the blood flow through the veins to find the clot. The patient may be instructed to wear a gown and fast for several hours before the exam.
- Wells Score: using a score to determine the risk of developing a DVT. The score is interpreted based on a ‘two-tier’ or a ‘three-tier’ model. If the score shows a higher risk for DVT, additional tests will be suggested to locate the clot.
- Compression Ultrasonography: This technique only focuses on the femoral and popliteal veins. It is done using a probe in a transverse position showing a cross-sectional view of the veins. A true sign of thrombosis is when a vein does not compress when the blood solidifies. However, when the probe is positioned parallel to the axis vein, it can move to the right or left, resulting in a false reading.
How to Treat DVT?
- Sclerotherapy: A treatment with a dose of Sclerosant. It is a solution injected into the blood or lymph vessel, causing it to shrink. It is widely used to treat ‘spider veins.’ It irritates the blood vessels causing them to swell up; when it swells, the blood flow decreases and shrinks the veins.
- Compression stockings: It looks like a pantyhose or socks or an elastic fiber that fits tightly around the legs and ankles. It is tighter in the ankles than in the calf. It shifts the fluid up the leg towards the heart. It boosts the blood flow and cuts down the pain and the swelling. It is recommended to stop the blood from pooling and clotting.
- Filters: If patients cannot take blood thinners, a filter is placed inside the vena cava to help prevent the risk of pulmonary embolism. But when these filters are left for too long, it could also cause DVT. This is only possible when anticoagulation medicines are not possible.
- DVT Surgery: It is the removal of a clot through surgery, also known as thrombectomy. An incision through the blood vessel is created to remove the clot then followed by the repair of the damaged tissue.
Immobility can significantly increase the risk of deep vein thrombosis. The best way to prevent DVT is to maintain mobility integrating leg exercises, and having an active lifestyle overall if possible. Walking can increase the flow of blood through the veins of the leg. Examples of exercises that help blood flow in the legs are knee pumps, foot pumps, and ankle rotation. Obesity is modifiable—following a proper diet will definitely help reduce the risk of DVT. Smoking is also one of the main risk factors that are modifiable, and avoiding it could largely help with DVT prevention.