Deep Vein Thrombosis

What is a deep vein thrombosis (DVT) and a pulmonary embolus (PE)?

The most common reason why a patient will suddenly develop a swollen leg is due to the development of a blood clot in the deep veins of the leg (deep vein thrombosis or DVT).  The development of DVT is associated with several factors.  These include long haul air travel, immobility, surgery, certain medications and several medical conditions.  Early diagnosis of the condition is critical in order to prevent the blood clots travelling to the lung and causing damage (pulmonary embolus). A pulmonary embolus is a serious medical emergency with a potentially fatal outcome.

What should I do if I develop a swollen leg?

Patients with a swollen leg should seek medical attention as soon as possible and have an ultrasound scan to confirm a DVT.  This will show any clots involving the deep veins of the leg (deep vein thrombosis) and appropriate treatment can be started in order to prevent clots spreading to the lungs, a condition known as a pulmonary embolism or a PE. Patients with a swollen leg who are thought to possibly have a DVT can have scans performed in Dr Freeman’s clinic on the same day that they are referred by a GP, and treatment can be started immediately.

What is the treatment for a DVT?

These days treatment can either be initially with injections or alternatively blood thinning medications (anticoagulants).  Recently tablets have become available that do not require regular blood tests in order to confirm that they are effective in thinning the blood and reducing the risk of the blood clot spreading to the lung. If this is the first diagnosed DVT patients will need to be on the tablets from anywhere between three and twelve months.  In some cases patients may require lifelong blood thinning treatment.  Patients are strongly advised to also wear compression stockings.

Is wearing compression stockings important?

A compression stocking is a device that uses graduated pressure (tighter around the ankle and less pressure as they move up the leg) to help prevent a recurrence of DVT by moving blood through the veins to the heart. Studies show that patients who wear stockings for two years after a significant blood clot are less likely to develop long term complications in the legs such as swelling and skin problems. The stockings need to be specially measured and worn each day in order to prevent the long-term complications related to having deep vein thrombosis.  Compression stockings or hosiery is available in several styles and colours, including socks, stockings, knee-highs, and thigh-highs for both men and women, Compression stockings should not be confused with support stockings. Ideally patients should be fitted a Class II stocking if they are able. In addition, patients are encouraged to walk regularly to promote blood flow and assist with helping the clot to dissolve.

Are there other treatments for deep vein thrombosis?

In some patients the blood clots will spread to involve the deep veins up in the pelvis or abdomen.  This is usually associated with an especially severe swollen leg.  Some patients that develop this may be appropriate for a procedure where a catheter is inserted to deliver direct clot-dissolving medication to the deep vein thrombosis (thrombolysis). A mechanical device can also assist in directly removing the clot from the deep veins. These procedures do have some risks, particularly bleeding, and not all patients are suitable for this treatment.

Are there other treatments to prevent pulmonary embolus?

Some patients require insertion of a filter between the blood clot and the lungs in order to stop the blood clot travelling to the lungs.  The filter is placed in the vena cava, the main vein in the abdomen. This is especially the case in patients who cannot have blood thinning medication or in whom the blood thinning medication is ineffective. Dr Freeman has had extensive experience in the management of deep vein thrombosis including clot dissolving treatments, patient suitability for a vena cava filter and filter insertion and removal.

Are there other causes of swollen legs?

Other causes of a swollen leg include problems with the lymphatic system such as lymphoedema, infections in the leg (cellulitis) and ruptured Baker’s cyst (swelling behind the knee).  Patients with heart, kidney, liver and thyroid problems can also develop fluid retention and swelling. Usually a careful assessment and appropriate tests can determine the cause of a patient’s swelling.

Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.