Deep Vein Thrombosis (DVT)

What is Deep Vein Thrombosis (DVT)?

Deep vein thrombosis (DVT) happens when a blood clot forms in a deep vein. It usually forms in the large veins in the lower leg or thigh, but it can also develop in veins in the arms or pelvis. DVT typically affects only one side of the body. It can cause leg pain, swelling, or warmth, but sometimes it has no noticeable symptoms at all. In some cases, DVT can be serious, as the clot might break loose and travel to the lungs, causing a life-threatening condition called pulmonary embolism.

Causes of DVT

Blood clots form when blood flow slows or is blocked, allowing clots to develop. Key risk factors include:

• Long periods of immobility (such as long flights or bed rest)
• Medical conditions that increase blood clotting
• Surgery
• Smoking
• Obesity
• Certain medications

Symptoms of DVT

Common symptoms include:

• Swelling in the affected leg
• Pain, especially in the calf
• Warmth and redness in the area of the clot
• However, some people with DVT have no symptoms

Complications of DVT

The most serious complication of DVT is a pulmonary embolism (PE), where part of the clot breaks off and travels to the lungs, causing potentially life-threatening complications. DVT and PE together are known as venous blood clots, or venous thromboembolism (VTE).

Diagnosis and Treatment of DVT

• Diagnosis: DVT is typically confirmed with imaging tests like an ultrasound.
• Treatment: Treatment usually involves blood-thinning medications (anticoagulants) to prevent the clot from growing or new clots from forming. In some cases, procedures to remove or break up the clot are necessary.

Prevention and Management Tips

• Move regularly, especially during long periods of sitting or inactivity.

• Wear compression stockings if you have a high risk of blood clots
• Maintain a healthy lifestyle—stay hydrated, manage weight, and avoid smoking.

How to Use Point Of Care Ultrasound (POCUS) to Find DVT

Patient Positioning

1. Start with the patient lying on their back (supine) with the leg extended and rotated outward.
2. For assessments behind the knee (popliteal area), position the leg in a bent position (flexion).

Scanning Process

1. Place a linear transducer at the inguinal crease.
2. Scan slowly, checking if the vein compresses every 1-2 cm along the femoral and popliteal veins.

Key Locations for Detecting Clots

Focus on these common sites for clots:

• Common femoral vein (CFV)
• Where the common femoral vein (CFV) splits from the saphenous vein
• Popliteal vein

Confirming DVT

A main sign of DVT is when the vein doesn’t compress. Normally, pressing on the vein with the ultrasound probe should make it collapse. If it stays open, this likely means there is a clot.

Ultrasound Findings in DVT

In this case, the ultrasound showed that the femoral vein could not be compressed at the point where it branches off to the lateral perforator vein, which confirmed the presence of a blood clot (DVT). The clot was partially blocking the vein, which is common in DVT.

Management of DVT

Once DVT is diagnosed, treatment begins right away:
                 

• Blood thinners (anticoagulants): Initially, intravenous heparin is given, followed by long-term oral blood thinners like warfarin or a DOAC.                 
• Pulmonary embolism (PE) monitoring: The patient was checked for PE (using tests like a CT scan) because of symptoms like shortness of breath and chest pain.                 
• Compression stockings: These were prescribed to improve blood flow and prevent more complications.                 
• Lifestyle changes: Advice included quitting smoking, staying at a healthy weight, and exercising regularly to lower the risk of future DVT.

Conclusion

DVT is a serious condition that can cause life-threatening complications if not treated quickly. In this case, early detection with ultrasound and quick treatment with blood thinners helped stop the clot from getting worse and reduced the risk of pulmonary embolism. Recognizing the symptoms, understanding the risk factors, and following proper treatment can greatly improve outcomes and lower the chance of future problems.