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What is thrombosis and what causes it?
Venous thrombosis is the abnormal formation of a blood clot in the lumen of a vein, resulting in its blockage. Clotting factors play a major role in clot formation. In cases of abnormalities in the genes responsible for clotting factors, an increase in the number of clots in an organism occurs. These gene abnormalities constitute thrombophilic disorders. Other common causes of thrombosis include prolonged immobilization of the limb due to trauma or long travel, cancer, advanced age, surgery, venous catheters, pregnancy, and contraceptive treatment.
What is thrombophlebitis?
Thrombosis of the superficial veins is called thrombophlebitis. The clinical picture of thrombophlebitis is that of an inflammation in the course of the thrombosed vein with redness, increased heat, severe pain and swelling.
What are the causes of thrombophlebitis and how is it treated?
The main cause of thrombophlebitis in the upper limbs is puncture with a venipuncture catheter for intravenous therapy. In the lower limbs, thrombosis usually occurs with a corresponding clinical picture in the major saphenous vein (MSA) along the inner side of the lower limbs. A thrombophlebitis is also associated with a pre-existing problem of valvular insufficiency of the VSF (varicose veins).
Treatment for thrombophlebitis in the major saphenous vein (MSA) depends on its distance from the saphenous confluence. In cases of a distance of more than 3 cm, anticoagulation and anti-inflammatory treatment, as well as bandaging of the limb, is recommended. In cases with a distance of less than 3 cm, surgical treatment by means of a saphenectomy was recommended. However, the new guidelines recommend avoiding surgery and promote conservative management, as in the case of deep vein thrombosis.
Why is deep vein thrombosis dangerous?
In a deep vein thrombosis there is an increased risk of pulmonary embolism, with increased mortality.
The reason is the movement of part of the clots from the veins of the limbs to the pulmonary arteries, usually with acute symptoms of shortness of breath and heart failure.
What are the symptoms of a deep vein thrombosis?
In a deep vein thrombosis in the area of the gastrocnemius and/or the popliteal artery, patients experience swelling in the area below the knee and leg with redness, increased heat and pain in the calf, leg and/or popliteal area. Usually, such symptomatology is misinterpreted as a strain of the calf muscles.
When the thrombosis occurs in the femoral vein or in the iliac veins, there is swelling with redness, heat and pain in the entire lower limb. In cases of severe cyanotic painful inflammation (phlegmasia cerulea dolens), surgery is considered urgent because of the increased risk of gangrene and amputation of the limb.
In the upper limbs, deep vein thrombosis is mainly caused by catheters (e.g. Port, central venous catheter) in the subclavian vein, or by subclavian vein compression syndromes (thoracic inlet syndrome). The clinical picture is similar to that of the lower limbs with swelling, redness, heat and acute pain throughout the upper limb.
How is a thrombosis diagnosed?
The gold standard in the diagnosis of thrombosis is ultrasound (triplex). Ultrasound can be used to diagnose the extent and in many cases the age of the thrombosis. Phlebography as well as CT venography can help diagnostically.
Also, the hematological testing of the D-Dimer marker plays an important role in the diagnosis of thrombosis. The marker helps to exclude a thrombosis when it is negative. A positive D-Dimers index does not necessarily mean that there is a thrombosis.
The Vascular Surgeon - Phlebologist Athanasios Papaioannou has extensive experience in the diagnosis and treatment, both conservative and surgical (intra-arterial and non-surgical), of thrombosis of the superficial and deep veins of the limbs.
- Athanasios Papaioannou,
Vascular surgeon - Phlebologist
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