Thrombosis is the blockage of a vein as a result of a blood clot. It is mostly seen in deep leg veins. This condition is called Deep Vein Thrombosis (DVT). Since the return of blood in the leg veins is blocked, it manifests itself with swelling, bruising and pain in the leg. If not treated at an early stage, the most feared consequence is pulmonary embolism (pulmonary embolism), which occurs when a blood clot travels to the right side of the heart and then to the pulmonary vessels.
Thrombosis of the arteries is a different situation. It is more common in the inguinal artery and at the points where the arteries divide into two. Sudden blockage of the leg artery leads to circulatory arrest and gangrene. DVT usually starts from the calf veins and progresses to the groin and then to the intra-abdominal veins. It usually occurs in the deep veins of the leg, but can also occur in the veins of the arm and other veins of the body.
Venous thromboembolism (VTE) occurs when a thrombus dislodges, progresses in the vascular circulation and blocks a smaller vein. Pulmonary embolism occurs as a result of VTE.

What are the Risk Factors?

Blood flow in the leg veins is caused by the contraction of the leg muscles and compression of the veins when we move. DVT can occur in cases such as surgery, intensive care hospitalisation, diseases such as hip fracture, and prolonged immobility during travelling. Patients who have had DVT before may have recurrence because the inner wall of the vein is damaged. In addition, intravenous injections and long-lasting vascular lines increase the risk of DVT for the same reason. Patients with genetic diseases that cause easy blood clotting are at risk. Chemotherapy drugs and birth control drugs containing estrogen also increase the risk of DVT because they cause easy clotting. Diseases such as cancer, heart failure and obesity are also risk factors for the same reason.

What are the symptoms of the disease

DVT is most common in the deep veins of the calf, below the knee. Typical symptoms include swelling, tension, severe pain, redness and temperature increase in the leg. If pulmonary embolism has developed; sudden onset of shortness of breath, chest pain while breathing, coughing blood is present.

What happens if left untreated?

Over time, the thrombus hardens and adheres to the vessel wall and the symptoms diminish. However, untreated DVT has two important complications: Pulmonary embolism (PE) and varicose veins (post-thrombotic syndrome) due to excessive increase in superficial vein circulation when the deep vein is blocked.
Pulmonary embolism occurs when a fragment of a clot breaks off from a leg vein and travels freely in the vascular circulation, passing into the heart and then into the thinning pulmonary vessels. The symptoms vary according to the diameter of the blocked vessel. Symptoms may range from shortness of breath, shock, blood pressure drop and heart failure to sudden death. One out of every 10 untreated DVT patients has PE to varying degrees.
Approximately half of DVT patients without appropriate treatment develop varicose veins within 2 years. Following the deterioration of the valves in the superficial vein, the vein dilates, the flow stops and back leakage occurs. With the internal varicose veins, intravascular pressure increases and is transmitted to the superficial capillaries. Thus, the capillaries under the skin swell, become visible and become varicose.

What are the treatment methods?

In the treatment of DVT, blood thinners (anticoagulants) are administered to prevent the clot from increasing and progressing. The aim is to prevent the formation of new clots and to harden the existing clot so that it can easily break off and cause pulmonary embolism.
Blood thinners are subcutaneous injections (heparin) given once or twice a day. Following early treatment, oral medication is started (Coumadin). Coumadin treatment requires periodic blood tests to check drug efficacy and dose adjustment. With the new generation of blood thinners, oral treatment is possible in single or double daily doses without the need for drug efficacy control. Current treatment continues for up to 6 months and is continued or discontinued depending on the presence or absence of reflow with repeated Doppler scans and the underlying cause. If DVT has progressed to the above-knee and intra-abdominal veins, thrombolytic treatment may be required. If thrombolytics are administered intravenously in such a way that the entire body is affected, there is a serious risk of bleeding (gastrointestinal, brain haemorrhage). For this reason, the side effects are minimised by administering a lower dose through an angiographically inserted catheter into the blocked vessel.
With a new method, which has become widespread in recent years with good results, it is possible to mechanically remove the clot and open the blocked vessel. In this method, the blocked vessel is visualised using angiography. The clot is broken up and removed with a ‘motorised aspiration catheter’. Thrombolytic medication is then administered through the catheter and complete vascular patency is achieved. The earlier this procedure is performed before the clot hardens, the more effective and successful it is. Complete and permanent treatment of this disease is possible if you consult a cardiovascular surgery clinic as soon as the complaints of leg swelling, pain and discolouration begin. 

What are your suggestions for prevention?

Since DVT is common in patients with high blood coagulability, they should receive preventive blood thinners under the supervision of a haematologist. In medical conditions such as intensive care hospitalisation, especially orthopaedic and major surgeries, blood thinners are given during hospitalisation. Prolonged immobilisation increases the risk of DVT. Also, advanced age, heart failure and smoking are risk factors. In situations where we cannot move, such as long journeys; consuming plenty of fluids, getting up every 2 hours and walking in the corridor or during breaks, if you cannot walk, stretching the feet in the sitting position and pulling the foot to the accelerator position and then back exercises the calf muscles. Thus, it provides flow in the veins and reduces the risks. In such cases, wearing compression stockings up to the knee is also strongly recommended, especially in patients with varicose veins, as it compresses the calf muscles. Patients of advanced age and patients with cardiac arrhythmias (atrial fibrillation) are at serious risk of arterial and cerebral embolism. Such patients should receive lifelong blood thinning treatment.

What to do in the summer months?

In the summer months, the amount of fluid in the blood decreases as a large amount of water is excreted from the body by sweating. This causes a decrease in the fluidity of the blood. DVT is much more common in summer months. Especially people in the risk group should pay attention to fluid intake. Approximately 2 litres of fluid leaves our body through urine and sweating. This amount is higher in summer months. Therefore, it is necessary to consume 2.5-3 litres of fluid per day. Especially during the holiday periods when we are more exposed to the sun, you should definitely have a bottle of water with you while sunbathing.