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Deep vein thrombosis (DVT)

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Η venous thrombosis is a pathological condition, in which a thrombus (blood clot) forms inside a vein. This condition prevents the normal flow of blood. The clot can form at any point in the venous system, but is usually located in the veins of the lower limbs. The two basictypes of venous thrombosis are:

Superficial venous thrombosis: It appears in the superficial veins, close to the surface of the skin, and is often less serious.
Deep vein thrombosis (DVT): It appears in deep veins, mainly of the legs, and is more dangerous, as it can lead to complications, such as pulmonary embolism, when a clot detaches and moves towards the lungs.

What is Deep vein thrombosis (phlebothrombosis)?

Deep vein thrombosis is a serious condition which occurs when a clot blocks a vein located deep inside our body. Blood clots are coagulations of blood -that is, formations of coagulated blood, which can form inside a vein and stop the flow of blood.

Venous clots typically appear in the leg but can also appear in other parts of the body. The most important thing however is that clots can travel towards the heart and specifically towards the pulmonary arteries and cause the very serious complication of pulmonary embolism.

Early symptoms of deep vein thrombosis?

The main symptoms of deep or superficial vein thrombosis on the foot can be summarized in the following:

Swelling of the affected leg
Cramps and intense pain in the calf
Unexplained pain in the leg and in the ankle
Warmth (burning) with intense pain and local redness in the lower extremity (mainly on the inner side of the leg or along the calf
Intense pain and redness of the skin locally in the lower extremity

The main symptoms of deep or superficial vein thrombosis on the arm can be summarized in the following:

Pain in the neck and/or the cervical spine
Pain in the shoulder and along the arm
Oedema (swelling) of the upper arm and hand
Blue discoloration of the skin
Inability to move the hand

Some patients may not realize that they have thrombosis and the diagnosis is made in the hospital with the symptoms of pulmonary embolism which can range from intense chest pain with rapid breathing and rapid heartbeat, to shortness of breath, loss of consciousness or even cardiac arrest.

Causes deep vein thrombosis?

The main causes that can lead to thrombosis are:

Trauma: Injury to a vessel can narrow its lumen or block the circulation of blood. This leads to the development of venous thrombosis.
Open surgery: During surgical procedures either due to injury of the vessels, or due to immobility a clot can form in the veins.
Immobility: The lack of movement (sedentary lifestyle) or complete immobility due to a fracture or surgery can lead to the development of deep vein thrombosis.
Cancer Patients suffering from cancer may develop deep vein thrombosis. This syndrome is called paraneoplastic syndrome.
Thrombophilia: Patients who have some form of thrombophilia can develop deep vein thrombosis much more easily. Young patients (under 50 years of age), patients with unexplained thromboses, patients with a family history of thrombophilia or women with multiple miscarriages should be examined for the presence of thrombophilia or not.
Specific medications: Some medications can also cause deep vein thrombosis (e.g. hormonal therapies in combination with smoking).

Standard treatment of venous thrombosis?

Venous thrombosis is a very serious condition, which if not treated properly and promptly can lead from the so-called post-thrombotic syndrome (swollen legs, brown discoloration and hardening of the skin at the level of the ankles, venous ulcers) to pulmonary embolism and death. For this reason you should immediately inform a vascular surgeon/angiologist if you have the slightest suspicion of venous thrombosis.

In the event that the doctor confirms that you have venous thrombosis then anticoagulant therapy must be administered. In cases of superficial vein thrombosis (thrombophlebitis) an anticoagulant in injectable form is typically administered for 30 to 45 days. In cases of deep vein thrombosis or pulmonary embolism anticoagulant therapy in pill form is administered for 3 to 6 months. It is important to emphasize that the clot is gradually dissolved by the body itself and not by the anticoagulant. The anticoagulant medication prevents the further development or recurrence of a clot during this period.

Do I need compression stockings after thrombosis?

In the event that the patient is at high risk for thrombosis, compression stockings can prevent its occurrence. If deep vein thrombosis has occurred, the use of stockings prevents the development of post-thrombotic syndrome, but the clinical evaluation of the leg or arm by the treating physician is important for the decision of whether to use them or not.

Do I need to have an inferior vena cava filter placed, if I have deep vein thrombosis?

The guidelines of scientific societies do not recommend do not recommend the use of inferior vena cava filters anymore, which function as an umbrella against pulmonary embolism. The only indication for a filter is in patients who cannot receive anticoagulants due to the risk of bleeding or who suffer pulmonary embolism despite the use of anticoagulant medications.

What is the role of endovascular techniques in the treatment of deep vein thrombosis and pulmonary embolism?

Deep vein thrombosis in the legs is treated conservatively as modern endovascular techniques do not offer a significant advantage compared to anticoagulant therapy. When however the thrombosis involves the veins of the abdomen, where the symptoms are also much more intense, then modern endovascular surgery offers the unique possibility of immediately removing the clot resulting not only in the immediate improvement of the patient's symptoms but also in the prevention of post-thrombotic syndrome as the function of the venous valves is preserved. Finally, in the case where pulmonary embolism occurs, which significantly burdens cardiac function with immediate risk to the patient's life, then endovascular surgery offers the possibility of aspiration and removal of the clot, which saves the patient's life.

Are the minimally invasive thrombectomy techniques available in Greece?

These special suction devices are available in Greece and specifically at the Athens Medical Center which is the only center with a specialized team (PERT team) for the treatment of deep vein thrombosis and pulmonary embolism. The specialization of our team in endovascular surgery as well as the state-of-the-art technical equipment with the presence of the most advanced hybrid operating room ensure the safety and success in the treatment of deep vein thrombosis as well as pulmonary embolism.