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Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a serious condition in which a thrombus, or blood clot, develops within a deep vein, usually in a leg. These clots can travel through the bloodstream to the brain, heart or lungs, potentially causing a life-threatening event. DVT affects approximately 300,000 adults per year, approximately half of whom have no symptoms.

Causes of Deep Vein Thrombosis

  • Trauma to the vein's inner lining from surgery, serious injury, inflammation or an immune response
  • Slow or sluggish blood flow caused by lack of movement for long periods of time, such as sitting on an airplane or in a car for many hours, or after surgery
  • Having blood that is thicker than normal, the result of genetic conditions that increase blood's tendency to clot

Symptoms of Deep Vein Thrombosis

  • Swelling of the leg or along a vein in the leg
  • Pain or tenderness in the leg
  • Increased warmth or redness along with the swelling or tenderness in the leg
  • Shortness of breath or chest pain if the clot travels to the lungs

Risk Factors for Deep Vein Thrombosis

  • A history of a previous deep vein thrombosis
  • Inherited blood disorders
  • Use of birth control pills
  • Pregnancy and the first six weeks after giving birth
  • Recent or ongoing treatment for cancer
  • Older age
  • Trauma
  • Varicose veins

What to Expect at Your Medical Exam

Your vascular surgeon will try to determine if you are suffering from DVT, as well as to recommend the best method of treatment.

Your vascular surgeon will conduct a physical examination and ask you questions about your general health, medical history and symptoms. You will be asked to describe your symptoms, where they occur and how often. After your exam, if your vascular surgeon suspects you have DVT, one or more diagnostic tests may be ordered.

Diagnostic Tests

Several tests assist in the diagnosis of DVT. The most commonly performed is a duplex ultrasound, which is noninvasive and painless. Other tests may include:

  • Magnetic resonance imaging (MR)
  • Computed tomography (CT) scan
  • Venography

Treatment Options for Deep Vein Thrombosis (DVT)

Because of its life-threatening nature, it is imperative to quickly diagnose and treat acute deep vein thrombosis. The most common and effective treatment is anticoagulation (thinning of the blood).

The duration of anticoagulation depends on many factors. Treatment may last three to six months or longer. In advanced cases where a blood clot is blocking an artery, a doctor may inject a clot-dissolving drug into the artery at the point of the clot to break it up. Known as thrombolytic therapy, this treatment can actually dissolve the clot. Your vascular surgeon will decide which option is best for you.

Treatment of recent (acute) deep vein thrombosis (DVT) is initially accomplished with anticoagulants like heparin, which is administered through an IV, or enoxaparin, which is injected directly into the tissues under the skin of the abdomen or leg. Anticoagulants are often referred to as "blood thinners," although they don't actually thin the blood. While these drugs do not dissolve the clot, they can stabilize it by allowing the clot to stick to the vein wall, thereby avoiding pulmonary embolism and allowing the body to eliminate or partially dissolve the clot over time

Warfarin, a long-term anticoagulant, also known by its trade name, Coumadin, is taken orally and is started simultaneously with heparin or enoxaparin. Once the blood is adequately "thinned" with warfarin, heparin or enoxaparin is usually stopped. Warfarin treatment requires careful blood monitoring to ensure that the patient is taking the proper dose since serious bleeding from anticoagulants can occur. The treatment course often may continue for 3 to 6 months and in certain situations, for life.

Additional Treatment for DVT and Pulmonary Embolism (PE)

Rarely, the symptoms of deep vein thrombosis or pulmonary embolism are so severe that more aggressive treatment is needed. Medications that rapidly dissolve blood clots, called thrombolytics, are used selectively in individual patients in severe cases of DVT or PE. Thrombolytics are used to treat DVT when a severe blood clot causes painful leg swelling or compromises blood flow from the leg. They are also used in patients with severe cases of pulmonary embolism when extensive blood clots in the lung result in acute heart failure or acute lung failure. Thrombolytics are given by endovascular specialists in the hospital and require close observation throughout the time they are delivered due to an infrequent, but potentially serious risk of bleeding.

IVC Filters

Filters are mechanical devices that "catch" DVT clots that are released from the leg or pelvis and are traveling toward the lungs where they would cause pulmonary embolism. Filters are used in situations where a patient may need additional protection from clots that can result in pulmonary embolism. They may also be used when "blood thinners" are not effective or when a patient cannot receive anticoagulation. They are placed in the large vein of the abdomen, commonly called the IVC or inferior vena cava, that receives the blood from both legs returning to the heart and lungs. This filter is placed by an endovascular specialist.

The endovascular specialist advances a small tube containing the filter into a vein in the groin, neck or arm to the intended site in the IVC where the filter is released allowing it to open fully and attach to the walls of the IVC. From its position in the IVC, clots escaping from either leg or from the pelvis veins can be trapped. Some types of IVC filters are permanent while others can be removed when the risk of pulmonary embolism has passed.