Deep Vein Thrombosis

Swelling of the lower limbs in a person can be due to multiple reasons. One of the under diagnosed and dreaded causes of the same is DEEP vein thrombosis.
Veins are blood vessels that carry impure blood from any part of the body back to the heart. A person can develop a clot in the veins of his leg leading to swelling, heaviness and on occasion severe pain. This is called deep vein thrombosis.

Symptoms

In many cases of DVT there are no symptoms barring swelling. The most common symptoms are swelling, tenderness, pain in the leg, which gets worse with standing or walking, sensation of warmth and cyanosis (bluish colour) of the skin.

Causes

  • Bed ridden patient
  • Trauma
  • Cancer
  • Previous DVT
  • Vein Blockage
  • Prothromboticstate (state of blood to clot easily)
  • After operations
  • Pregnancy or in patient taking contraceptive pills

Diagnosis

DVT can be diagnosed by Ultrasound Doppler scan. Other blood tests like D dimer, LFT, CBC, KFT, Ultrasound, thrombotic testing may be done to assess you prior to starting medication and to look at possible causes of the reason you developed DVT.
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Treatment

The treatment of DVT is by starting blood thinning medications in the form of tablet on injections depending on the probable cause of DVT.
Depending on the medications there may be need for blood tests and dietary restrictions. Newer oral preparations offer good safety and are easy to use with no need for frequent blood tests or dietary restrictions. Most patients can be safely treated at home with no need for hospitalization.

IVC filter insertion

Patients in whom blood thinning medications cannot be used, benefit from insertion of a filter in the IVC which prevents a clot from the leg from accidentally lodging in the lung . This is also indicated who have a huge clot load in the leg vesseles and are at high risk of getting pulmonary embolism. This is a temporary device which is retrieved at a later date.
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Pharmacomechaniacal Thrombectomy / Thrombolysis

Selected patients with DVT can undergo a procedure called thrombolysis in which the clot is actively broken down with injection of clot breaking medication directly into the clot by minimally invasive technique and aspirated from the blood vesse ( thrombectomy). This is done under local anaesthesia under x ray guidance.
The advantages of the procedure is that it is minimally invasive and helps give early relief from swelling and pain and reduces long term complications post DVT. This is often combined with an IVC filter insertion to prevent clot from travelling to your lung during the procedure. The procedure can take from a few hours to 2 / 3 sessions depending on the amount of clot in your veins. Sometimes a tube with clot dissloving medications can be left in your vein overnight. Procedure is safe with significant improvement in pain and swelling in 48 to 72 hrs.
DVT Treatment in India

Complications of DVT

Pulmonary Embolism

Selected patients may require observation due to repeat attacks, severe symptoms or possibility of a pulmonary embolism i.e. a blood clot of the leg traveling to the lung and blocking the blood supply. This is a feared complication which can result in death of a person if not treated in time. Depending on the gravity of the problem, inpatient observation with blood thinning medications, direct clot dissolving medication use (catheter directed thrombolysis) or surgery may be required for the patient.

Post Thrombotic Syndrome

Symptoms include leg pain; sensations of leg heaviness, pulling, or fatigue and limb swelling. Symptoms can be present in various combinations, may be persistent or intermittent, and are usually aggravated by standing or walking and tend to improve with rest and leg elevation. Patients may develop perimalleolar or more extensive telangiectasiae, new varicose veins, stasis hyperpigmentation, thickening of the skin and subcutaneous tissues of the lower limb known as lipodermatosclerosis, and in severe cases, leg ulcers, which may be precipitated by minor trauma. These are characteristically chronic, painful, and slow to heal; require close medical attention; and often recur. The intensity of symptoms and signs of PTS tends to increase over the course of the day. Their severity ranges from minimal discomfort and cosmetic concerns to severe clinical manifestations such as chronic pain, intractable edema, and leg ulceration.
Management of post thrombotic syndrome would involve imaging of your deep venous system with a CT venogram or venogram in a cath lab followed by Angioplasty / Stenting as required along with compression stockings

How to reduce risk for DVT

  • Stay physically active – important following surgery and during long trips.
  • Move your feet up and down at the ankles.
  • Stand up to stretch the legs now and then. Stretching and moving your legs stops blood stagnating in the deep veins of the calf, and is the simplest and most effective thing you can do.
  • Maintain a normal weight.
  • Drink adequate water.
  • Medical problems such as infection, surgery  or cancer may be associated with DVT and accordingly DVT treatment should be tailored to the need of the patient.
  • If you have a blood clot now or ever had one, it is important to discuss the risks and benefits of staying on blood thinners and other treatment options such as IVC filter, thrombolysis (breaking the clot with medicines) or thrombectomy (removing the clot) with your treating doctor. The best doctor for DVT treatment is one who can offer all the available treatment options and guide you as to the best option for your particular condition.
  • Avoid excessive alcohol, which tends to cause dehydration