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Deep Vein Thrombosis (cont.)

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Does DVT require surgery?

Surgery is a rare option in treating large deep venous thrombosis of the leg in patients who cannot take blood thinners or who have developed recurrent blood clots while on anti-coagulant medications. The surgery is usually accompanied by placing an IVC (inferior vena cava) filter to prevent future clots from embolizing to the lung.

Phlegmasia Cerulea Dolens describes a situation in which a blood clot forms in the iliac vein of the pelvis and the femoral vein of the leg, obstructing almost all blood return and compromising blood supply to the leg. In this case surgery may be considered to remove the clot, but the patient will also require anti-coagulant medications. Stents may also be required to keep a vein open and prevent clotting. May Thurner Syndrome, also known as iliac vein compression syndrome, is a cause of phlegmasia, in which the iliac vein in the pelvis is compressed and a stent is also needed.

What are the complications?

Pulmonary embolism is the major complication of deep vein thrombosis. With signs and symptoms such as chest pain and shortness of breath, it is a life-threatening condition. Most often pulmonary emboli arise from the legs.

Post-phlebitic syndrome can occur after a deep vein thrombosis. The affected leg or arm can become chronically swollen and painful with skin color changes and ulcer formation around the foot and ankle.

How can blood clots in the legs be prevented?

  • Minimize risk factors for DVT, for example, quit smoking (especially if the person also is taking birth control pills or hormone therapy).
  • In the hospital setting, the staff works hard to provide DVT prophylaxis to minimize the potential for clot formation in immobilized patients. Surgery patients are out of bed walking (ambulatory) earlier and low dose heparin or enoxaparin is being used for deep vein thrombosis prophylaxis (measures taken to prevent DVT).
  • When traveling it is recommended that you get up and walk every couple of hours during a long trip.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

Kearon, C. et al. "Antithrombotic Therapy for VTE disease: CHEST Guideline and Expert Panel Report." Chest. February 2016, 149:2

Madhaven, A., et al. "May Thurner Syndrome as the Cause of Phlegmasia Cerulia Dolens." Am J Emerg Med: 2015: Dec ePub

Vieg, van Hylckama. et al. The Venous Thrombotic Risk of Oral Contraceptives, Effects of Oestrogen Dose and Progestogen Type: Results of the MEGA Case-control Study. BMJ. 2009; 339:b291.


Medically Reviewed by a Doctor on 7/3/2017

Source: MedicineNet.com
http://www.medicinenet.com/deep_vein_thrombosis/article.htm

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