Deep Venous Thrombosis (DVT)

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 imaging.

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.