• Deep vein thrombosis, or DVT, refers to a condition in which blood clots ( solidifies ) in the deep veins of the leg. The veins are the blood vessels that return blood from peripheral areas of the body towards the heart.
A Blood Clot formation in one of the leg veins
  • Most deep vein clots form in the lower leg veins and extend in upward direction to involve all the deep veins of leg ( Popliteal and Tibial veins ) and thigh ( Femoral veins ). In severe cases, the clots may extend to the Waist ( Iliac Veins ) or even upto the Abdomen and Chest ( Inferior Vena Cava - IVC ).
  • Depending on the extent of DVT, it is named as Popliteal / Femoro-Popliteal / Ilio-Femoral DVT. Extension to the veins of waist and abdomen is a bad sign and needs immediate treatment.
  • DVT usually has a sudden onset, and develops within hours. This condition is extremely painful, and associated with swelling of the whole leg. Swelling occurs due to blockage of blood flow through the veins.
  • In advanced stages, the legs and thigh may become blue or white in colour, and Venous gangrene may develop.
A Patient with Left leg DVT - Note the swelling and Bluish discoloration
  • Certain conditions that lead to development of DVT are:
    • Recent Surgery or Hospitalisation with prolonged bedrest
    • Recent accident or injury / fracture on the leg
    • Road / Air travel of prolonged duration
    • Excessive smoking / Alcohol intake
    • Use of contraceptive pills or during pregnancy in females
    • Following Child Birth ( Post-Partum DVT )
    • Old, sick patients / Cancer patients
  • A Doppler ultrasound of the legs is the gold standard test for establishing a diagnosis of DVT. It confirms the nature as well as extent of the DVT.
  • Once DVT is diagnosed, the patient requires hospitalisation and treatment on an urgent basis, as the condition is dangerous and life threatening.
  • Treatment of DVT is done with a special class of drugs called as Anticoagulants (Blood thinners). Initially, these medicines are given in the form of injections, and then later converted to oral medicines.
  • Along with anticoagulation, immediate application of Compression Bandaging or GCS Stockings on the affected leg is mandatory for the prevention of Post Thrombotic Syndrome ( A late complication of DVT ).
  • Treatment for DVT has to be continued for a minimum period of 6 months to 1 year. As these medicines cause thinning of the blood, it is very important to monitor the effect by regular blood tests (Prothrombin Time and INR). Thinning of the blood more than desired limit may lead to bleeding from nose or mouth. 
  • In addition to medicines, treatment  includes compression therapy of the legs in the form of Compression bandage or Graded Compression Stockings (GCS) and elevation of the limb.
Compression Stockings for DVT
  • The acute phase usually settles and the and the chance of DVT related complications decreases within 48-72 hours of starting treatment. After 3-4 days of intensive care, patient may be discharged from the hospital with specific instructions. 
  • In selected patients with extensive Ilio-femoral DVT , Blue leg and venous gangrene, a procedure called as Catheter Guided Thrombolysis is initiated, in which medicines are injected directly into the clot with the help of catheter access to veins. This results in dissolving of the blood clot with restoration of blood flow.
Catheter directed Thrombolysis ( Dissolving the Clot )
  • Pulmonary Embolism (PE) is the life threatening complication of DVT, when pieces of clots break off from veins of the leg and travel towards the heart. They block the small vessels of the lungs, causing impaired breathing and oxygenation. Treatment for PE is the same as that for DVT. 
Pulmonary Embolism
  • To prevent leg vein clots from migrating to heart and lungs, a special device called as an IVC Filter is placed in the main truncal vein of the abdomen ( IVC ), with the help of catheters placed through a small needle hole in the neck or leg veins.
In IVC filter traps the clots and prevents them from reaching the heart and lungs
  • There are certain specific indications for placement of an IVC filter, and a Vascular Surgeon is the specialist for these procedures along with the above described treatment options for Deep Vein Thrombosis and Pulmonary Embolism.