A thrombosis is defined as the formation of a blood clot in a blood vessel. When a blood vessel is damaged, the body tries to stop the flow of blood. With the help of platelets a clot is formed to block the injured area and to reduce blood loss. However, there are pathological conditions (for example, hypercoagulable state, stagnant blood or blood spinning, endothelial dysfunction) that can lead to blood clots without injury. In this case, the thrombosis is not normal and can cause serious problems such as disruption of the normal blood circulation in the vein or artery.
What is the difference between arterial and venous thrombosis?
The term venous thrombosis describes the formation of a clot in the venous vessels. It occurs frequently and impedes the circulation of blood from the organs to the tissues. In arterial thrombosis the clot is formed in an artery and blocks the flow of blood and nutrients to the organs. Its presence is more frequent when the arterial wall is damaged.
What does deep vein thrombosis mean?
Deep vein thrombosis refers to the formation of a clot (clotted blood) in one of the deep veins. It occurs most often in the pelvic area and thighs and can cause pain and swelling in the affected limb, but it can also have no symptoms at all. Deep vein thrombosis is a serious health problem because the clot can break loose and reach the lungs through the venous system (pulmonary embolism).
What is superficial venous thrombosis?
Superficial venous thrombosis occurs as a complication of chronic venous insufficiency and affects superficial veins located close to the skin. They usually occur after prolonged immobility for example after an operation, after long standing, etc. It is a less severe thrombosis with a lower risk of clot detachment compared to deep vein thrombosis.
How can thrombosis be diagnosed?
When there is evidence of thrombosis, a series of tests are performed to determine the extent of the problem.
- With the use of ultrasound (Doppler – Triplex) important information about the blood flow in veins and arteries is obtained, and the presence of any narrowing or obstruction is checked.
- CT angiography helps us determine the possibility of thrombosis of the iliac veins and the inferior vena cava.
- Through blood tests D-Dimers are determined. Depending on their level we can detect the presence of venous thrombosis.
- Although venography is rarely performed nowadays, it can help to detect an abnormality in the veins.
Which are the causes of thrombosis?
The most important causes of a blood clot are:
- hereditary factors associated with blood clotting disorder or venous insufficiency
- prolonged immobility or lying down leading to a reduction or absence of muscle contractions, and therefore difficulty in moving blood to the veins
- surgeries and injuries
- various forms of cancer
- pregnancy due to increased pressure on the veins of the lower limbs and pelvis
- hormone therapy and taking contraceptives
- various diseases such as heart failure or enteropathy
What is the treatment?
The treatment of thrombosis has three goals, to stop the increase of the clot size, to prevent its detachment-movement in the venous network and to limit the possibility of the formation of a new clot in the future.
- Anticoagulant treatment: is done subcutaneously for a few days and by taking pills for a period of 3-6 months. Anticoagulants cannot dissolve the clot, but they can stabilize it and prevent the formation of a new one. Blood tests are performed during treatment and the medicine dose is checked. A small dose can lead to clot formation while a large dose can cause bleeding.
- Thrombolytic medicine: if there is a clot the doctor will decide if it should be dissolved (thrombolysis). Thrombolytic medicine is administered by the doctor, intravenously through a special catheter.
- Filters: Filters are vascular devices that are placed in the inferior vena cava and prevent the clot from moving to the lungs.
- In more severe cases where the thrombosis is extensive, the vascular surgeon removes the thrombus with surgery.
What is thrombophlebitis?
Thrombophlebitis is defined as the development of a clot and inflammation in a vein. In most cases, clots appear in lower limbs due to the slow circulation of blood against gravity, from the legs towards the heart. Thrombophlebitis can be caused either by increased blood clotting, or by an injury to the walls of the vein, and is a thrombosis of the superficial network of veins.
Thrombophlebitis is divided into two types:
- Septic: which may be due to endothelial injury (ie by venous catheter placement) or to a complication following varicose vein injury.
- Aseptic: this occurs more often in women and is associated with increased blood clotting while often it is hereditary.
Who is most at risk of developing thrombophlebitis?
There are some groups of people that are more likely to develop thrombophlebitis:
- People with varicose veins
- People with a hereditary predisposition
- Pregnant women
- Women undergoing hormone therapy or taking contraceptives
- Patients in prolonged bed rest
- Overweight people
- Patients with autoimmune diseases
Which are the symptoms?
Patients feel pain and tenderness in the area. The skin is warmer and swelling and hardening can be found on the surface of the vein. The presence of edema may indicate the presence of deep vein thrombosis, which will differentiate treatment.
How is diagnosis made?
Clinical examination of the patient by the doctor may lead to the diagnosis of thrombophlebitis. By performing triplex ultrasound of the superficial and deep venous network, the diagnosis will be confirmed. When thrombophlebitis is located in the thigh, if the clot expands or moves from the superficial to the deep venous network, it could even lead to pulmonary embolism. That is why early diagnosis is considered particularly important.
How can thrombophlebitis be treated?
The treatment of thrombophlebitis depends on its location. When it occurs in the lower limbs, especially below the knee, it can be treated by lifting the leg, administering antibiotics or anti-inflammatory drugs, and bandaging the limb.
When it is located above the knee, the patient receives appropriate anticoagulant treatment and follows the treatment mentioned above. In the event that it extends near the sapheno-femoral junction in addition to anticoagulant therapy, the vascular surgeon may suggest surgical ligation to prevent the clot from moving into the deep venous system. If we are talking about septic thrombophlebitis, it is necessary to remove the part of the affected vein with surgery.