Deep vein thrombosis of the lower extremities

People suffering from varicose veins in the legs (varicose veins) face one extremely unpleasant complication – deep vein thrombosis (DVT). Although blood clots can form anywhere, they are much more common in the lower extremities. In this case, they speak of thrombosis of the veins of the lower extremities – this is a serious condition that occurs when a blood clot forms inside a vein located deep in the body, blocking the blood flow. A thrombus is a blood clot that has turned into a hard, poorly soluble plug that clogs a vein.

Blood clots inside deep veins usually form in the thigh or lower leg, but they can also develop in other areas of your body (including your arms, chest, brain, and heart). Other terms associated with this condition may include terms such as thromboembolism (usually due to damage to the pulmonary artery), post-thrombotic syndrome, and post-phlebotic syndrome.

Symptoms of thrombosis of the veins of the lower extremities

Symptoms of lower extremity vein thrombosis appear in about half of people with this disease. In the rest, blood clots, although they form, do not make themselves felt. Common symptoms and complaints in those who have experienced blood clots in the veins include:

• swelling in the leg, mainly in the ankle or lower leg area – usually it occurs only on one side;
• spasmodic or persistent pain inside the affected limb, which usually starts in the lower leg and spreads to the foot;
• severe, unexplained pain in the leg and ankle;
• an altered area of ​​the skin appears that feels warmer than the skin in the surrounding areas;
• the skin over the affected area becomes pale, cyanotic or, conversely, reddish or burgundy.

People may not feel any symptoms, or even know they have blood clots inside their deep veins, until they need emergency treatment for a pulmonary embolism (blood clot in the lungs).

A pulmonary embolism can form when a blood clot that forms in the veins in the legs has traveled from the leg to the vessels in the lung. This condition is life-threatening and requires emergency care.

Treatment of thrombosis of the veins of the lower extremities

Before starting the treatment of thrombosis of the veins of the lower extremities, it is necessary to determine the exact diagnosis and localization of blood clots. To do this, you need to perform a number of studies and analyzes.

Diagnostics

A phlebologist or vascular surgeon will evaluate your medical history to identify possible risk factors for thrombosis and then perform a thorough physical examination. This is not enough to make a diagnosis, so the specialist will prescribe one or more diagnostic tests to identify or rule out thrombosis inside the veins in the leg. These tests include:

• Ultrasonic scanning. This is the most commonly used test to diagnose DVT. An ultrasound will show how blood flows through the veins and arteries, where there is an obstacle. If a blood clot has formed, the doctor will be able to see the interruption in blood flow, helping to make a diagnosis.
• Phlebogram. If the ultrasound does not give accurate results, the doctor may prescribe a phlebogram for you. During this test, a dye is injected into a vein. Then an x-ray is taken of the area where the doctor suspects the presence of deep vein thrombosis of the lower extremities. The dye makes the vein more visible, so interrupted blood flow will be easy to identify.
• D-dimer test. The D-dimer blood test measures the presence of a substance that is released when a blood clot breaks down. If the levels are high and you have risk factors for DVT, you probably have blood clots in your blood vessels. If the levels are normal and the risk factors are low, there is most likely no blood clots.

Other tests may also be used to diagnose deep vein thrombosis in the lower extremities. Sometimes doctors prescribe a number of biochemical tests and CT, MRI to detect thrombosis.

Modern treatments

DVT is a very serious condition. Tell your doctor right away if you have symptoms of DVT or go to the nearest emergency room. A healthcare professional can evaluate your symptoms and determine if there is a problem.

Treatment of thrombosis of the veins of the lower extremities is aimed at preventing the growth of a blood clot. In addition, it can help prevent pulmonary embolism, significantly reducing the risk of even more blood clots. Possible medical and surgical treatment of the disease.

• Medicines. Your doctor may prescribe blood thinners such as Heparin, Warfarin, Enoxaparin¹. They make it harder for blood to clot, reduce the size of existing blood clots, and make it less likely that new clots will form. If blood thinners do not help, or if DVT is severe, your doctor may use thrombolytic drugs. They lead to the destruction (dissolution) of clots. The drugs are administered intravenously.
• Compression stockings. If you are at high risk of developing deep vein thrombosis in the lower extremities, wearing compression stockings eliminates pathological swelling of the legs, reducing the risk of blood clots.
• Cava filters. You may need to have a filter placed in a large abdominal vein called the vena cava if you cannot take blood-thinning medications². This form of treatment helps prevent pulmonary embolism by preventing clots from traveling to the lungs. But setting filters is also a risk. If left for too long, they can cause DVT. Filters should be used for a short period until the risk of thromboembolism has decreased and blood thinners can be used.
• Surgery for deep vein thrombosis of the lower extremities. Your doctor may suggest surgery to remove a blood clot in your leg. This is usually only recommended for very large blood clots or clots that cause serious problems such as tissue damage. During a surgical thrombectomy, or surgery to remove a blood clot, a surgeon will make an incision in a blood vessel. He will find and remove the clot, then restore the blood vessel and tissue. In some cases, doctors may use a small balloon to keep the blood vessel open while they remove the clot. When the thrombus is found and removed, the ball is removed along with it.

Surgery is not without risk, so many doctors will only use this method in severe cases. Risks include tissue infection, blood vessel damage, and excessive bleeding.

Prevention of thrombosis of the veins of the lower extremities at home

Exercises for deep vein thrombosis of the lower extremities

The longer you sit still, the higher your risk of developing blood clots in your veins. If you need to sit for long periods of time, there are exercises you can do while sitting to keep your legs moving and blood circulation going.

• Exercise #1. Bend your leg and lift your knee towards your chest. Grab your knee with your hands for more stretch. Hold this position for a few seconds, then do the same exercise on the other side. Repeat these steps several times.
• Exercise #2. Place your feet on the floor. Keeping your feet on the floor, lift your heels. Hold for a few seconds, then lower your heels. Raise your toes off the floor, keeping your heels in place. Hold for a few seconds, then lower your foot to the floor. Repeat these steps several times.
• Exercise #3. Raise both legs off the floor. Draw circles with your toes in one direction for a few seconds. Change direction and draw circles for a few seconds. Repeat this exercise several times.

Diet for deep vein thrombosis of the lower extremities

The diet should include lean meats, seafood, vegetables (cabbage, greens, tomatoes and cucumbers), grain bread (wheat or rye), low-fat dairy products, cereals, fruits and berries, including compotes and fruit drinks.

The diet for deep vein thrombosis of the lower extremities also provides for some restrictions. In particular, fatty meat, canned and smoked food, mayonnaise, and sausages will have to be removed from the menu. You will also have to reduce flour, especially products made from rich and puff pastry, as well as pasta, semolina, rice. It is better to give up carbonated drinks, alcohol, strong coffee and tea.

Folk remedies for thrombosis

Once a doctor has made a diagnosis of a thrombosis in the veins of the lower extremities, he will likely prescribe medication to help thin the blood or break up the clot. You can combine prescribed medications with the following home remedies to help prevent other complications and lower your risk of future blood clots.

• Walk daily to improve blood flow. Short, frequent walks are better than one long walk.
• Keep your legs elevated. Blood can pool in your veins if your feet are on the ground all day. Use a chair or footrests to keep your legs elevated periodically.
• Wear compression stockings. These specially designed stockings fit snugly around your legs and create a certain amount of pressure on the fabrics. Compression helps prevent blood flow slowdown and swelling, and increases microcirculation. Compression stockings can be useful when you travel by plane or car.

Popular questions and answers

We asked patients to answer popular questions surgeon Tigran Bokhyan.

Sources:

1. Lebedev A.K., Kuznetsova O.Yu. Deep vein thrombosis of the lower extremities // Russian family doctor. 2015. №3. https://cyberleninka.ru/article/n/tromboz-glubokih-ven-nizhnih-konechnostey
2. Shevchenko Yu. L., Stoyko Yum, Zamyatin M. N., Batrashov V. A., Gudymovich V. G., Lemaeva I. V., Vorobyov A. V. Diagnosis and treatment of deep vein thrombosis // Almanac of Clinical Medicine. 2006. No. 11. https://cyberleninka.ru/article/n/diagnostika-i-lechenie-tromboza-glubokih-ven