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Venous Diseases

Venous Diseases

Veins are large diameter, thin walled blood vessels which return blood back into the heart. The blood flow is slow and presence of valves, especially in the lower limb veins play an important role in preventing back flow when the person in erect posture.

Pathologies of the Venous System.

Blood Clot: Venous Thrombosis

Vein Occlusion : Fibrosis of Vein

Incompetent Valves : Varicose Veins

Interventional Radiologist (IR) plays an important role in treating all the above conditions. Also, IR performs central venous catheterization.

Venous Thrombosis

A sudden episode of venous thrombosis leads to acute pain, swelling, redness of the limb, ulcer in the leg.

Causes of venous thrombosis:

  • Bed Ridden Patient
  • Injury
  • Dehydration
  • Tendency to Develop Blood Clots
  • Oral Contraceptives
  • Cancer etc.

There may be associated chest pain, shortness of breath due to blood clot travelling into the veins of the lung i.e. pulmonary embolism. This may cause sudden death.

IR punctures those veins under sonography control and under x-ray (IITV), directs long tube (catheter) and applies suctions to aspirate the blood clot. This is followed by injecting clot dissolving medicines (Thrombolytics). This combination of mechanical thrombo-aspiration and chemical thrombolysis helps to reduce the thrombus load in the veins, restoring blood flow in the veins. This is very helpful in reducing chronic painful condition called port-phlebotic (Thrombotic) syndrome.

To prevent pulmonary embolism, IR places a metallic umbrella like device called IVC filter, which helps trap large size blood clots as it travels into the vena cava. It is a life saving procedure.

What Is DVT ?

A deep venous thrombosis (DVT) is a blood clot (thrombus) that forms inside deep veins in your legs or pelvis. The clot blocks blood flow and causes pressure to build up in the vein. Part of the clot can break away and move through your bloodstream to your lungs. If the clot blocks one or more of the blood vessels in your lungs, it is called a pulmonary embolism.

DVT is a common problem. Most of these clots occur when blood flow in the veins of the legs is slowed. This is usually as a result of inactivity.

Ordinarily, as you walk around, your leg muscles squeeze your veins and keep blood flowing back to the heart. But if you are inactive for many hours, blood flow in the veins of your legs may slow so much that clots form. Long periods of inactivity can occur during a long airplane flight or while recovering from an operation or stroke, for example.

Certain people are more likely to get blood clots. These include:

  • People with some medical problems, including cancers and inherited abnormalities of the blood-clotting system
  • People on certain medications, such as birth control pills and hormone therapy
  • Pregnant women
  • People who are very overweight
  • People with heart failure

Who is likely to develop Pulmonary Embolism? How will I come to know if I develop Pulmonary Embolism?

Anyone who develops DVT is at risk of developing a pulmonary embolism.

A pulmonary embolism can lead to a sudden and sometimes very dramatic decrease in blood flow through the lungs. The decrease in blood flow can reduce the amount of blood flowing to your heart and the rest of your body. This can cause a drop in blood pressure and lead to fainting spells and even sudden death.

The blood flow decreases in part because the blood clot blocks blood flow. In addition, the blockage damages the walls of the lung's blood vessels. The damage releases chemicals that cause blood vessels to narrow.

What are the symptoms?

Some blood clots in the leg veins do not cause any symptoms. However, when the blood clots involve larger veins, they generally cause:

  • Redness
  • Warmth
  • Tenderness
  • Swelling (edema)
  • A sensation of heaviness in the leg, particularly when you've been standing

You can check for edema by pressing your finger into your lower leg. If you have edema, the pressure from your finger will create a small dent in your lower leg for several seconds.

A pulmonary embolism may cause no symptoms, mild symptoms, or serious symptoms that indicate a life-threatening emergency. Symptoms tend to be more severe when the blood clot is larger.

Symptoms with a larger clot include sudden shortness of breath and chest pain. The pain tends to be knife-like. It often is worse when you take deep breaths.

If the pulmonary embolism is very large, symptoms may be more dramatic. They may include fainting spells, severe shortness of breath, and coughing up blood. A large pulmonary embolus can cause sudden death.

How is it diagnosed?

To diagnose DVT, your doctor will examine your legs to check for swelling and tenderness. S/he will ask about your symptoms and risk factors.

For diagnosis, following tests are carried out

  • COLORDOPPLER
  • CT / MR VENOGRAPHY

Since pulmonary embolism (PE) and DVT are both aspects of Venous Thombo-Embolism, imaging the deep veins with CT immediately after imaging the thorax for suspected PE can demonstrates the presence or absence of DVT, as well as the overall burden and distribution of DVT. Combined CT Venography and Pulmonary angiography, aka CTVPA is a "one-stop examination", requiring only a few additional minutes.

Other possible tests include a computed tomography (CT) scan of the chest and a special type of lung scan (called a V/Q scan) to examine lung blood flow.

If your doctor is still unsure about the diagnosis after these tests, he or she may order a lower limb / pulmonary angiography. In this procedure, a small tube is threaded into the arteries of the lung. A dye helps identify blood clots.

Your doctor may order a D-dimer test. This blood test measures levels of a chemical called D-dimer. D-dimer increases when blood clots are being formed in the body.

How much is the expected duration of the disease?

If you have a DVT or pulmonary embolism, your symptoms should improve within a few days after starting treatment with blood-thinning medication. You will need to take medication for at least three to six months to prevent more blood clots from forming.

Most people recover completely. But some people who had a very large pulmonary embolism or who already had lung disease will continue to have lung problems.

Some people who have had a DVT develop a long-term problem with swelling of their legs. This is called post-phlebitic syndrome. These people often need to wear special stockings that help squeeze blood back toward the heart.

How is prevention done?

Most DVTs and pulmonary embolisms develop in people who are inactive because of an injury or surgery.

If you have had a DVT or pulmonary embolism, or you have a family history of blood-clotting problems, you can help prevent blood clots. Do the following:

  • Ask your doctor if you have any risk factors for blood clots that can be changed.
  • Avoid all medications that may cause blood clots. These include birth control pills and other medications that contain oestrogen.
  • Drink a lot of water and walk around frequently when on long plane flights or car trips.
  • Avoid prolonged periods of bed rest.
  • Discuss your history of DVT and pulmonary embolism with your physician before considering any surgical procedures.

How is it treated?

The main treatment for a DVT or pulmonary embolism is a medication called heparin. Heparin:

  • Thins your blood
  • Helps break up blood clots
  • Prevent new blood clots from forming

FOR ACUTE DVT:

Currently the Treatment of Choice:

  • Mechanical Thrombo-Aspiration
  • Catheter Directed Thrombolysis

"TO PROTECT THE VALVES AND PREVENT POST PHLEBOTIC SYNDROME…"

Chronic DVT - IR Procedure

ANGIOPLASTY & STENTING to increase venous flow & reduce venous pressure helping to heal chronic venous ulcer & reduce varicosity You also will start taking inj. heparin overlapped with tab. warfarin (Coumadin). Warfarin takes a few days to start working. Once a blood test shows that warfarin is effective, you will stop taking heparin. You will continue taking warfarin for several months or longer.

During the first few weeks that you take warfarin, you will continue to need frequent blood tests to make sure you are taking the right amount. Once your blood test results consistently show that you are taking the right amount of medication, blood can be drawn every two to four weeks.

Treatment with warfarin usually lasts three to six months. But more recent research indicates that the risk of recurrent blood clots is high. It may help for patients to continue to take warfarin at a lower dose, for more than six months.

How is the Prognosis?

Without treatment, a pulmonary embolism can be deadly. With appropriate and timely treatment, the outlook is very good.

Once you develop a DVT or pulmonary embolism, you are usually more likely to develop a second blood clot. This is because the original blood clot damaged some of your leg veins. Now, your blood does not move as quickly or smoothly through these veins. This increases your risk of a new blood clot.

However, if there is a clear reason that the blood clot formed, such as a long bed rest after surgery or an injury that damaged your blood vessels, your risk of developing more blood clots is relatively low unless you are forced to be inactive again or have another injury.

Chronic Deep Vein Thrombosis

If the clots in the veins are left unattended, these veins and the valves become clogged and hard. This increases pressure in the veins of the leg and foot causing swelling, discolouration, dilated veins, itching, and finally painful ulcers. This causes a nagging, painful state. IR can open up these chronically occluded veins by performing balloon dilatation – venoplasty and venous stenting to recanalize the vein and restore blood.

Varicose Veins

The valve in the veins of the leg directs blood to flow up into the heart. When these valves get dysfunctioned, the blood gets re-directed into the veins which are under the skin – (superficial veins). These veins dilate and become tortuous – worm like and look ugly. These are varicose veins. IR performs a minimally invasive procedure like RF ablation or laser ablation to block this abnormal vein in the leg and the thigh. A very effective method to clear these painful, ugly veins.With ablation, additional minor procedures like sclerotherapy and/or avulsion of small abnormal veins help to treat this condition.

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