DEEP VEIN THROMBOSIS

Deep vein thrombosis (DVT) is the formation of a clot in the deep veins of the leg. It is thought that DVT develops in one out of 1000 people every year. DVT can occur in completely normal people for unknown reasons. However, most patients have one or more of the following risk factors:

 

1. Stagnation of blood flow: Leg vein blood flow may slow down in the event of prolonged immobilization (surgeries, prolonged aircraft and bus trips, etc.), in the presence of heart failure and varicose veins, and these can trigger clot formation.

2. Blood clotting tendency: Some people have inherited a tendency to clot (Factor V leiden, protein C and protein S deficiency, etc.). DVT is common in these patients.

3. Damage to the inner surface of the vein: In some vasculitis such as Behçet's disease, thrombosis frequently occurs due to damage to the inner layer of the vein. Thrombosis may also occur during some medical procedures, such as surgery and ablation of varicose veins.

 

If DVT develops in the leg, a blood thinning drug called heparin is usually given early and the body is expected to dissolve the clot by its own mechanism. In recent years, some attempts have been made  such as thrombolysis or thrombectomy, for the removal of the clot early and to a greater extent. After the administration of these drugs, the patient is given oral blood thinner for 6 months to prevent the recurrence of DVT. Some patients may require lifelong medication.

 

After DVT, the clot may dissolve completely and the patient may not have any problems. However, this is a rare condition. More often, the clot does not completely dissolve and some vessels remain blocked. Or, even if the thrombus dissolves, the clot-induced inflammation can destroy the valves in the veins and cause severe deep vein insufficiency. This can lead to lifelong swelling, pain, cramping and varicose veins (post-thrombotic syndrome).

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The most important period in DVT is the first 2 weeks. If an aggressive treatment is applied such as thrombolysis or thrombectomy during this period, the clot may dissolve early and completely, and the patient is less likely to have problems in the future. However, if treatment is late, DVT becomes chronic and adheres to the vessel wall. In this period, drug therapies such as thrombolysis are also less effective.

 

In the late period, DVT treatments are not successful. However, in some cases, chronic occlusion can be opened with stent. If the femoral and popliteal veins in the lower part of the groin are open, and the iliac vein on the groin is obstructed, the iliac occlusion can be opened with balloon and stent, and the patient can benefit considerably. Obstruction in the lower part of the groin can also be opened with a stent, but it has been shown that the stents in this location are occluded prematurely and the patient does not benefit from this procedure.

 

 

 

 

 

 

 

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Although doctors do not mention much, there is a risk of clot formation in the deep veins after varicose vein operations, or even clots migrating into the lung (pulmonary embolism). This risk is reported to be around 3-5% in classical surgery with general anesthesia. The reasons for this are: 1. Damage to the vein wall caused by venous intervention, 2. Long immobilization of the patient because of general or spinal anesthesia.

 

There is a risk of DVT in non-surgical varicose vein interventions also, although not as much as in conventional varicose vein surgery. Treatments such as laser, radiofrequency, MOCA and glue may also damage the deep veins, especially where the saphenous vein and perforating veins meet the deep veins. To prevent this, it is very important that the practitioner is experienced in such procedures and familiar with ultrasound-guided interventions. The second factor that will prevent DVT is the ability of the patient to accelerate circulation by moving his feet during and immediately after the procedure. For this reason, we do not recommend general anesthesia or spinal anesthesia during non-surgical varicose veins treatments. The ideal method is sedation and local anesthesia, and in some cases nerve blocks. In nerve blocks, the leg is anesthetized and the patient does not feel any pain, but is able to move legs during the procedure to accelerate the venous circulation and reduce the risk of DVT. In conclusion, albeit small, there is a risk of DVT in new varicose veins treatments, and this risk can be minimized with use of ultrasound skills of the operating physician and mobilizing the patient as early as possible.

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