One of the most common consultations that we as vascular surgeons receive is for deep vein thrombosis, otherwise known as blood clots. Deep veins refer to the location of the vein that has the problem. In the legs we have two main sets of veins: Deep and superficial. Deep veins are within the muscle and close to the bones whereas superficial veins are close to the skin; hence their names!
Thrombosis refers to the process of the blood turning from a liquid into a solid form. Normally, thrombosis occurs in response to an injury to stop bleeding from a wound. However, when thrombosis occurs in the deep veins, it stops blood from being transported from the foot back to the heart. The obstruction of flow results in swelling and pain below where the thrombus, or clot, has formed.
There are many causes of blood clots, but the most common causes include:
- Traveling for extended periods of time in a sitting or resting position.
- Trauma, including accidents which cause broken bones or bruises.
- Narrowing of the veins of the pelvis, and
- Specific genetic mutations that increase the likelihood of the blood forming clots.
- In older patients, another potential cause of blood clots without any other cause is cancer. Cancer, unfortunately, can result in the release of chemicals and hormones within the body that make clotting more likely.
For patients who develop a blood clot in the context of traveling, narrowed pelvic veins, or having a traumatic injury to the affected leg, treatment involves a 3-month course of blood thinning medication followed by ultrasound tests to determine the stability of the clot. If the symptoms improve and the clot remains stable, then the medication to thin the blood can be stopped at 3 months.
For travelers who are forced to sit for extended periods without being able to move, making an effort to walk around intermittently throughout the traveling can be helpful. For example, on the plane, every 30 minutes stand up and walk up and down the aisle 3-4 times. For patients who have a traumatic injury to their leg, the best choice would be to avoid, if possible, situations that led to the particular accident. Finally, in patients with narrowed pelvic veins, I as a vascular surgeon can help relieve the narrowing with a special minimally invasive procedure called a venogram. In the procedure, I place a self-expanding tube called a stent into the compressed vein via a small 2 mm puncture site in the groin to make sure the compressed vein remains open.
For those patients who did not have a traumatic accident, narrowed pelvic veins, recent travel, or a high suspicion of cancer, referral to a hematologist, or a doctor who specializes in disorders of the blood, can be helpful. The hematologist can help order special genetic tests to determine if there is a genetic predisposition to forming clots. In patients who do end up having genetic mutations, long-term placement on blood thinning medications can help prevent further events.
If you are anyone that you know is suffering from a blood clot, please do not hesitate to call our office on 408-376-3626 to schedule an appointment! The expertise that vascular surgeons have in this area of medicine is critical to ensure a good outcome!