Deep Venous Thrombosis (DVT)
Jeannette K. Chang, M.D., F.A.C.S.
Michael N. Tameo, M.D.
Ronald L. Nath, M.D. , F.A.C.S.
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Deep Venous Thrombosis, or DVT, refers to the development of thrombus (blood
clot) within a deep vein. There can be several causes including surgery,
immobilization such as with hospitalization or prolonged travel without periodic
stopping to walk, history of previous DVT, trauma, malignancy, medications,
pregnancy, external compression of a vein, dehydration, central venous
catheters, and ‘hypercoaguable’ disorders of the blood that predispose a person
to form blood clots.
The most common locations for DVT include the extremities
(especially the legs), the pelvic (iliac) veins, the large vein in the
abdomen known as the inferior vena cava (IVC), intra-abdominal veins such as
the mesenteric, splenic, and portal, and the jugular veins. The symptoms of
a DVT often include pain, swelling, redness, and warmth at the affected
area. If located in the intra-abdominal veins then the symptoms are specific
to the affected organ(s).
Complications from DVT include pulmonary embolism (PE), post-thrombotic
syndrome, and severe limb-threatening swelling known as phlegmasia. PE is
when clot travels to the lungs causing injury and death to that portion of
the lung. This can cause severe chest pain and shortness of breath and can
be life-threatening. Post-thrombotic syndrome is when permanent damage to
the vein occurs leading to life-long swelling and often pain. Phlegmasia can
cause acute injury and even death to the affected limb and represents an
emergency that requires surgery to remove the clot.
Diagnosis of DVT and its complications requires a thorough history and
physical exam by a vascular surgeon. An ultrasound and/or computed
tomography (CT) scan is usually required. Occasionally, a venogram is
required, which involves injection of contrast dye into the vein for
Treatment of DVT requires medical therapy with blood-thinning medication and
surveillance with periodic ultrasounds, which we perform at our office in
our accredited non-invasive vascular lab. Patients can often receive the
required test and be seen by their vascular surgeon at the same visit.
Occasionally, a procedure to remove the clot is required. This may include a
minimally invasive (endovascular) treatment with thrombolysis (removal of
thrombus with medicine through a catheter), thrombectomy (mechanical
disruption and removal of thrombus through a catheter), and possibly also
balloon angioplasty and/or stenting. If the patient or circumstances do not
allow for this technique, then open surgical removal of the thrombus is
required. If the DVT is located in the arm as a result of external
compression from a condition known as thoracic outlet syndrome (TOS), then a
combination of endovascular and open surgery is needed. Please see the
specific link for thoracic outlet syndrome on the menu for more information
about this condition.