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Deep Vein Thrombosis

Deep Vein Thrombosis

Definition

Deep vein thrombosis (DVT) is a blood clot in a major vein, usually in the legs and/or pelvis.

Description

Deep vein thrombosis is a common but difficult to detect illness that can be fatal if not treated effectively. According to the American Heart Association, more than two million Americans develop deep vein thrombosis annually. An estimated 600,000 of these develop pulmonary embolism, a potentially fatal complication where the blood clots break off and form pulmonary emboli, plugs that block the lung arteries. Sixty thousand people die of pulmonary embolism each year. Deep vein thrombosis is also called venous thromboembolism, thrombophlebitis or phlebothrombosis.

Deep vein thrombosis is a major complication in patients who have had orthopedic surgery or pelvic, abdominal, or thoracic surgery. Patients with cancer and other chronic illnesses (including congestive heart failure ), as well as those who have suffered a recent myocardial infarction, are also at high risk for developing DVT. Deep vein thrombosis can be chronic, with recurrent episodes.

Causes and symptoms

Deep vein thrombosis is caused by blood clots in blood vessels that form in veins where blood flow is sluggish or has been disturbed, in pockets in the calf's deep veins, or in veins that have been traumatized. Symptoms include swelling and tenderness of the calf or thigh, and possibly warmth. Only 23-50% of patients experience symptoms, so it's often "silent." Some individuals and families have underlying clotting tendencies that can be tested for.

Diagnosis

Deep vein thrombosis can be detected through venography and radionuclide venography, Doppler ultrasonography, and impedance plethysmography. Venography is the most accurate test, but it is not used much, because it is often painful, expensive, exposes the patient to radiation, and can cause reactions and complications. Venography identifies the location, extent, and degree of attachment of the blood clots, and enables the condition of the deep leg veins to be assessed. A contrast solution is injected into a foot vein through a catheter. The physician observes the movement of the solution through the vein with a fluoroscope while a series of x rays are taken. Venography takes 30-45 minutes and can be done in a physician's office, a laboratory, or a hospital. Radionuclide venography, in which a radioactive isotope is injected, is occasionally used, especially if a patient has had reactions to contrast solutions.

Doppler ultrasonography is usually the preferred procedure for detecting deep vein thrombosis. This technique uses sound waves to measure blood flow through leg veins and arteries. A blood pressure cuff is wrapped around the patient's ankle and a transducer with gel on it is placed over pulse points of the foot and lower leg. High-frequency sounds bounce off the soft tissue, and the echoes are converted into images on a monitor. It is very accurate in detecting clots above the knee that can become pulmonary embolisms. Usually performed in a physician's office or hospital outpatient diagnostic center, Doppler ultrasound usually takes 30-45 minutes.

Impedance plethysmography records changes in blood volume and vessel resistance. A blood pressure cuff is wrapped around the leg above the knee, four electrodes are placed near the knee and the ankle, and the cuff is inflated. How efficiently the veins return to normal is measured. Performed in a physician's office, it takes about 15 minutes.

Treatment

Deep vein thrombosis can be treated with drug therapy, bed rest, and gradient elastic stockings. Medications include anticoagulants that "thin" blood to prevent further growth of blood clots, as well as clot-dissolving drugs. Heparin is a common injectable anticoagulant, and is usually followed by coumadin tablets for at least three months. Bed rest with the patient's legs elevated is necessary until the condition improves. Gradient elastic stockings should then be worn, and standing for long periods of time avoided. In some cases, a filter is placed in the major vein (the inferior vena cava) to trap emboli or clots before they get to the heart and lungs.

Alternative treatment

Deep vein thrombosis can be life-threatening and must be treated with conventional medical therapies. However, there are alternative therapies that can be used in conjunction with emergency treatments to dissolve the clot that help support the body and prevent recurrence. A trained alternative health care practitioner should be consulted due to the severity of this condition.

Prognosis

In many cases, deep vein thrombosis can be successfully treated if diagnosed early.

Prevention

Deep vein thrombosis can be prevented through prophylactic anticoagulant drugs and venous stasis prevention with gradient elastic stockings and intermittent pneumatic compression of the legs. High-risk patients often need to remain on anticoagulants like Coumadin indefinitely.

Resources

PERIODICALS

Davidson, Bruce L., and Eric J. Deppert. "Ultrasound for the Diagnosis of Deep Vein Thrombosis: Where to Now?" British Medical Journal 316 (January 3, 1998): 2.

KEY TERMS

Pulmonary embolism An obstruction of a blood vessel in the lungs, usually caused by a blood clot that blocks a coronary artery. Pulmonary embolism can be very serious and, in some cases, fatal.

Thrombosis The development of a blood clot inside a blood vessel.

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deep vein thrombosis

deep vein thrombosis (DVT) n. see phlebothrombosis.

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