DVT and PE

Deep vein thrombosis is a dangerous condition where blood clots form in the deep veins of the legs, causing swelling and pain. If untreated, these clots can travel to the lungs and cause life-threatening pulmonary embolism. Early detection and appropriate treatment are critical to prevent complications and save lives.

DVT and PE
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Understanding Deep Vein Thrombosis, Superficial Venous Thrombosis, and Pulmonary Embolism

Blood clots in the veins can pose serious health risks, especially when they form deep inside the body and go unnoticed. While some clots may cause only mild symptoms, others can lead to permanent vein damage, non-healing ulcers or life-threatening events like pulmonary embolism.

What Is Deep Vein Thrombosis (DVT)?

Deep vein thrombosis (DVT) refers to a condition where blood clots form in the deep veins of the body, most commonly in the legs or pelvis. These veins are responsible for carrying “used” blood back to the heart. When a clot blocks a deep vein, the blood cannot return properly, leading to pain, swelling and heaviness in the limb.

If untreated, these clots may break free and travel through the bloodstream to the lungs, causing a pulmonary embolism — a medical emergency.

Deep Vein Thrombosis

What Causes DVT?

DVT usually occurs when three factors (known as Virchow’s Triad) come into play:

  • Stasis (slow blood flow)
  • Endothelial injury (damage to the blood vessel lining)
  • Hypercoagulability (increased clotting tendency)

These may be triggered by:

Risk Factors for DVT

  • Age: Risk increases with age, particularly over 60.
  • Smoking: Alters clotting mechanisms and damages vessel walls.
  • Genetics: Inherited clotting disorders (e.g., Factor V Leiden, Protein C or S deficiency).
  • Pregnancy: Increases pressure on pelvic veins and changes blood consistency.
  • Hormones: Use of oral contraceptives or hormone replacement therapy.
  • Obesity: Excess weight increases pressure in leg veins.
  • Prolonged immobility: Long flights, bed rest, post-surgery recovery.
  • Cancer: Certain malignancies cause a hypercoagulable state.
  • Idiopathic: Sometimes, no clear cause is found.

Symptoms of DVT

DVT can be silent, but common signs to watch for include:

  • Swelling in one leg (rarely both)
  • Pain or tenderness, especially in the calf or thigh
  • Warmth over the affected area
  • Red or discolored skin
  • Heaviness or fatigue in the limb

These symptoms can mimic other conditions, so timely medical evaluation is essential.

Pulmonary Embolism (PE)

What Is Pulmonary Embolism (PE)?

Pulmonary embolism occurs when a piece of the clot from a DVT breaks off and travels to the lungs, blocking the blood supply.

It is a life-threatening emergency.

Symptoms of Pulmonary Embolism:

  • Sudden shortness of breath
  • Sharp chest pain, especially while breathing in
  • Rapid heart rate
  • Coughing (sometimes with blood)
  • Feeling lightheaded or fainting

A large PE can cause sudden collapse or death if not treated immediately.

Superficial Venous Thrombosis (SVT)

While DVT involves deep veins, superficial venous thrombosis (SVT) affects veins close to the skin — usually the visible, tender varicose veins.

SVT causes pain, redness, and swelling along a superficial vein. Though less dangerous than DVT, it may extend into the deep system, especially at junctions, and therefore should not be ignored.

Differences in SVT and DVT

FeatureSVTDVT
LocationJust under the skinDeep within the limb
Risk of PELow, but possibleHigh
SymptomsRedness, cord-like veinSwelling, deep pain
TreatmentAnti-inflammatory, sometimes anticoagulantsAnticoagulants, imaging, intervention

Complications of Untreated DVT

  • Pulmonary Embolism – Can be fatal
  • Post-thrombotic syndrome (PTS) – Long-term leg swelling, skin changes, ulcers
  • Recurrent DVT
  • Chronic venous insufficiency – Damaged valves lead to backward blood flow, discoloration, and non-healing ulcers

Postphlebitic Syndrome

After a DVT, the valves in the veins may be damaged, leading to chronic leakage and backward flow of blood (venous reflux). This results in:

  • Persistent leg swelling
  • Skin pigmentation around the ankle
  • Hardening of skin (lipodermatosclerosis)
  • Development of ulcers that are difficult to heal
  • Bleeding from varicose or incompetent veins

This long-term complication emphasizes why early diagnosis and proper management of DVT are crucial.

Diagnosis of DVT and PE

  • Venous Doppler Ultrasound – First-line for detecting DVT
  • D-dimer blood test – Elevated levels may indicate clotting, but not specific
  • CT Pulmonary Angiogram – Gold standard to detect PE
  • MRI/MRV – For pelvic vein clots or difficult areas
  • Venography – Rarely used now but still helpful in certain cases

Treatment Options for DVT and PE

Treatment depends on the location, severity, duration, and presence of complications. The main goals are to:

  • Prevent clot extension
  • Reduce PE risk
  • Preserve venous function
  • Avoid recurrence
  • First-line therapy
  • Prevents further clot formation and allows natural breakdown
  • Includes: Heparin, Low Molecular Weight Heparin (LMWH) and Direct Oral Anticoagulants (DOACs) like Apixaban, Rivaroxaban
  • Duration: 3 to 6 months or lifelong depending on cause
  • For large, fresh clots with high PE risk
  • Involves injecting clot-dissolving drugs (e.g., alteplase) directly into the clot
  • Performed via catheter into the vein (Catheter-Directed Thrombolysis)
  • Mechanical removal of clot using devices or suction
  • Reserved for large clots causing severe symptoms
  • Used when veins are chronically narrowed or blocked
  • Helps restore long-term venous drainage
  • Particularly helpful in pelvic vein DVT (May-Thurner syndrome)
  • Inferior vena cava (IVC) filter prevents clots from reaching lungs
  • Used only in selected high-risk patients or when anticoagulation is contraindicated

Treatment of Superficial Thrombophlebitis (SVT)

  • NSAIDs (painkillers) for inflammation
  • Compression stockings
  • Warm compress
  • Anticoagulants in some cases, especially if the clot is near a deep vein junction or is extensive

Preventing DVT

  • Regular movement during long flights or after surgery
  • Compression stockings for high-risk patients
  • Hydration
  • Weight control
  • Avoid prolonged bed rest or sitting
  • Use of prophylactic anticoagulants during surgeries, after trauma, or in hospital admissions
  • Physical therapy to promote circulation
  • Early mobilization after delivery or orthopedic procedures

These are office-based procedures done under local anesthesia or sedation. The goal is to seal the faulty veins from inside, so blood flows through healthier veins.

Endovenous Laser Ablation (EVLA)

  • A thin fiber is inserted into the vein, and laser energy is used to seal it shut.
  • No cuts, stitches, or hospitalization required.
  • Quick recovery, minimal pain.

Radiofrequency Ablation (RFA)

  • Uses heat via radio waves to close off the vein.
  • Similar outcomes to laser, with low complication rates.

Endovenous Glue Therapy

  • A special medical glue is used to seal the vein.
  • No thermal energy or post-op stockings needed.
  • Ideal for needle-phobic or elderly patients.

Microwave Ablation

  • A newer modality that uses microwave energy.
  • Efficient in treating large-caliber veins with minimal heat spread.

Sclerotherapy

  • Suitable for smaller veins and cosmetic concerns (spider veins).
  • A medicine is injected into the vein, causing it to collapse and fade.
  • Performed alongside endovenous procedures.
  • Tiny incisions are made to hook out bulging veins.
  • Helps reduce symptoms and improves cosmetic appearance.
  • Removal of the entire saphenous vein via open surgery.
  • Rarely done today due to the success of endovenous techniques.
  • Reserved only for select cases where endovenous access isn’t possible.

When to Consult a Vascular Surgeon

You should consult a vascular specialist if you:

  • Experience leg pain or swelling without injury
  • Have a history of DVT or PE
  • Have visible veins with tenderness or redness
  • Are planning major surgery and have clotting risk factors
  • Need expert opinion on managing DVT complications (like non-healing ulcers or chronic swelling)

Early intervention can prevent long-term complications and significantly improve outcomes.

We aim to detect venous disease early.

Your Veins Deserve Attention

Many people ignore signs of leg pain or swelling until the condition becomes serious. DVT and PE are both preventable and treatable — when addressed early. As vascular specialists, we aim to detect venous disease early, treat appropriately, and provide long-term care to prevent recurrence and preserve vein health. If you’re at risk, or experiencing symptoms, don’t delay. Book a consultation today and take the first step toward healthy veins and a safer future.