Deep Venous Thrombosis (DVT) and complications

Extensive left leg DVT and Phlegmasia Caerulea Dolens

Deep Venous Thrombosis (DVT) or Venous Thromboembolism (VTE) is a serious problem caused by the formation of blood clots in the deep veins of the arms or legs occurring in up to 1 in 350 patients. Patients who develop a DVT may have one or several triggering factors for the condition. These risk factors are are age, previous DVT, a family history of DVT, immobility from abdominal, pelvic, hip or knee surgery, leg or pelvic fractures, being over weight, heart disease, pre-existing cancer, smoking, long distance travel (long haul flights of more than 4 hours duration) and "sticky blood disorders" such as Thrombophilia or Polycythaemia. In female patients, DVT can also occur in pregnancy and is associated with the use of either the oral contraceptive pill (OCP) or hormonal replacement therapy (HRT).

Patients affected by DVT commonly present with pain, tenderness, redness and swelling of the calf or thigh in the affected leg. Some patients with an extensive blood clot in their leg veins can be at risk of tissue damage from venous infarction (Phlegmasia Caerulea Dolens). This condition is serious and carries the risk of major amputation if left untreated in up to 1 in 3 patients with this complication. Longer term complications from DVT include a post-thrombotic syndrome (PTS). PTS comprises chronic limb swelling together with skin problems such as venous eczema, pigmentation, varicose veins and leg ulcers. DVT can also give rise to blood clots that travel from the legs to the lungs (pulmonary emboli or PE). PE are a serious complication of DVT. PE cause breathlessness and in some patients, sudden death from a circulatory arrest.

The diagnosis of DVT can be made rapidly with the help of blood tests and non-invasive duplex scanning. More extensive clot extending into the groin (iliac) and abdominal (caval) veins may require imaging with CT or MR venograms. Younger patients are also tested for the presence of "sticky blood disorders" (Thrombophilia).

The immediate treatment of DVT includes thinning the blood with heparin injections. Patients with severe symptoms are usually admitted to hospital for bed rest and elevation of the affected leg to ease the swelling. In selected patients, clot-busting drugs (thrombolysis) may be used to clear blood clot from the vein. Patients are usually discharged on warfarin tablets to prevent further DVT. The duration of warfarin treatment is usually directed by your vascular surgeon. Patients on warfarin require regular blood tests to ensure that the correct dose is given to achieve safe and effective levels for the prevention of DVT. Some patients develop a chronic leg swelling following DVT and will require treatment with long term graduated compression stockings.

The Surrey Vascular Clinic is also happy to advise patients regarding the prevention of DVT and the safety of air travel for patients with a history of DVT.

The information contained in this website is not a substitute for medical advice or treatment. The Surrey Vascular Clinic recommends consultation with your doctor or healthcare professional.