thrombosis
Preventing and treating deep vein thrombosis
Sudden swelling of a limb accompanied by a feeling of tension and heaviness, newly visible superficial veins, or a bluish discoloration of the affected leg or arm—all of these can be symptoms of deep vein thrombosis. And it does not even have to cause severe pain at first. Nevertheless, if you suffer from the symptoms mentioned above, you should seek specialist medical treatment quickly, as initial thrombosis can develop into a dangerous pulmonary embolism.
Diagnosis & Therapy
Rapid diagnosis with ultrasound
Thrombosis is a blockage of a deep vein in the leg or arm caused by a blood clot. However, the pelvic veins or the inferior vena cava can also be affected by thrombosis. The lack of blood returning to the heart then causes noticeable swelling in the affected limb.
Ultrasound imaging is used for diagnosis, as it allows the blood vessels in the legs to be visualized. It is painless and completely safe. If the vein can be easily compressed with the transducer, there is no thrombosis. However, if the vein cannot be compressed because a clot inside it has caused hardening, thrombosis is almost always present.
How is fresh deep vein thrombosis treated?
Nowadays, deep vein thrombosis can usually be treated on an outpatient basis thanks to modern blood-thinning medication.
To prevent the thrombosis from spreading further and to counteract swelling of the limb, a compression bandage is applied in the acute stage and blood-thinning medication—usually in the form of a tablet—is prescribed. Once the swelling in the limb has subsided, the patient is given a compression stocking to wear for several months. In the area of the pelvic vein, special medication (known as lysis) may sometimes be used to dissolve the clot, or surgical removal with a catheter may be considered. However, this is decided on a case-by-case basis and depends on the individual patient.
Post-thrombotic syndrome
A possible long-term consequence of deep vein thrombosis is damage to other sections of the veins, which then leads to what is known as post-thrombotic syndrome. In this condition, the deep veins are no longer able to transport blood from the legs to the heart, and blood pools in the legs. This then leads to persistent leg swelling, new varicose veins, and lower leg ulcers. Treatment usually consists of wearing compression stockings for life. It is therefore crucial to remain under regular medical supervision after deep vein thrombosis in order to prevent post-thrombotic syndrome. A special, painless examination called venous occlusion plethysmography (VOP) can be used to check your vein function after a thrombosis.
Frequently asked questions about thrombosis
A thrombosis is a blood clot in a vein, usually in the leg or arm. A distinction must be made between superficial and deep vein thrombosis. In superficial vein thrombosis, which usually occurs in a visible varicose vein in the leg, there is a cord-like, hard thickening of the affected vein with redness and significant pain. Deep vein thrombosis causes a disruption in the flow of blood from the affected limb, resulting in significant swelling of the corresponding leg or arm and a feeling of tension. Exceptions to this are muscle vein thrombosis and isolated lower leg vein thrombosis, which usually only cause pain and not swelling. In any case, however, if thrombosis occurs, it must be thoroughly investigated with ultrasound to determine its true extent, as it may only be visible over a short distance from the outside, but may be significantly more extensive in the depths of the leg.
In my practice, I first perform a physical examination and then use ultrasound to determine the type of thrombosis (superficial, deep, muscle vein). Depending on the location and extent of the thrombosis, blood thinning is then carried out for between 6 weeks and 6 months or, if necessary, for life – depending on the severity of the thrombosis. Wearing a compression stocking on the leg or arm helps to reduce swelling and discomfort and appears to accelerate the breakdown of the blood clot. Inpatient treatment of thrombosis is no longer necessary today. I initiate the appropriate tests to determine the cause of the thrombosis, which are usually carried out by the patient's family doctor. An initial follow-up examination usually takes place after about 3 weeks.
If thrombosis is not detected in time and anticoagulation therapy is not initiated, this can lead to the growth of the thrombosis and, in some cases, to an additional pulmonary embolism, which can also be life-threatening.
Risk factors for thrombosis often include prolonged immobility (long journeys without getting up or lying down during infections) or a combination of taking the pill and smoking. Sometimes there is also a genetic predisposition to thrombosis, but this can only be determined by appropriate coagulation diagnostics. In rare cases, tumors can also lead to thrombosis, so a tumor must also be ruled out in cases of unexplained thrombosis.
The body often breaks down a thrombosis over the course of weeks to a few months. However, it is also possible that a thrombosis remains completely or partially intact. This does not necessarily mean that it will cause problems later in life. Rather, the prognosis (persistent swelling of the leg or arm) depends on whether the remaining or dissolved thrombosis has led to vein damage or a drainage disorder in the affected vein. This can also be determined over time using ultrasound.
Impressions from practice
