Venous thrombosis - Vascular diseases

Venous thromboembolism includes deep vein thrombosis and pulmonary embolism. Venous thrombosis can affect any vein in the body, with the most common location being the veins of the lower extremities. Early diagnosis and treatment prevents further complications. Each year approximately 900,000 new cases of thromboembolic disease are recorded in the United States and 1 million in Europe.

Causes of venous thrombosis

It is important to identify the causes that may lead to thrombosis.

  • Hospitalized patients
  • Recent surgery
  • Recent trip
  • Trauma
  • Malignancy
  • Prolonged bedrest (history of paralysis)
  • History of deep vein thrombosis, superficial thrombophlebitis
  • Thrombophilia (Factor V Leiden, Prothrombin, Lupus Anticoagulant)
  • Contraceptives
  • Pregnancy, postpartum

Symptoms and Diagnosis

The symptoms that can be experienced by someone with venous thrombosis are:

  • Pain in the calf or the leg
  • Swelling of the limb
  • Redness
  • In more advanced and severe stages, the leg may have cyanosis

Some of these symptoms are often difficult to distinguish venous thrombosis from other conditions such as heart failure, skin infection, edema from medication, or hematoma.

In addition to physical examination and special blood tests (d-dimers), diagnosis can be made with:

  • Venous duplex ultrasound is the fastest and one of the most reliable tests we use to diagnose venous thrombosis of the lower extremities pr upper extremities.
  • In case of more proximal extension, CT venography can detect thrombosis of the veins of the abdomen and pelvis.
  • Magnetic resonance venography can also accurately show thrombosis of the abdominal, pelvic and thigh veins.
  • Classic venography is an invasive method of diagnosis (usually used in combination with endovascular ultrasound) which is used when a therapeutic intervention has been decided.

Treatment

Deep venous thrombosis first line treatment is

  • Anticoagulation

Anticoagulants are blood thinners that prevent the progression of the clot. Depending on the patient, the physician decides the exact anticoagulation treatment and the duration. All benefits and potential complications are discussed in detail with the patient.

In case of extensive thrombosis, especially when the thrombosis is localized or extends to the iliac veins and inferior vena cava, we prefer to perform intervention with

  • minimally invasive endovascular approach, which involves removing the clot (thrombectomy) with special wires and catheters or injecting thrombolytic drugs, usually through a puncture in the groin or behind the knee.

Patient with iliofemoral thrombosis

Femoral and iliac vein thrombosis after successful endovascular mechanical thrombectomy

In some cases of deep venous thrombosis, it may be necessary to perform balloon venoplasty or to place a stent. More often with chronic thrombosis and in May-Thurner syndrome where a residual stenosis is found.

Placement of venous stents in chronic venous thrombosis

Protect your vessels

Georgios Tzavellas, MD uses the most modern invasive techniques to treat venous thrombosis to achieve the best possible results that will minimize immediate and future complications.