Thrombosis is caused by a blood clot, or thrombus clinging to the wall of the vein. The clot irritates the vein wall causing inflammation and pain. When blood clots inside of a vein or artery, at least two things take place; partial or complete obstruction to the flow of blood within the vessel, and inflammation. The veins of the lower legs are the usual site of abnormal blood clots, but they can also occur in the arm or other areas of the body. The reaction is commonly referred to as phlebitis or inflammation of a vein.

There are two types of thrombophlebitis. The first is called superficial because it occurs in the veins, which are close to the skin surface. The other type is deep venous thrombosis (DVT) and it occurs within a vein deep in the muscles. Several factors may be responsible for triggering the clotting mechanism. Treatment and cause of the two conditions are different.

Causes for Superficial Thrombophlebitis often include irritants to the vein such as:

• Injury to the affected part of the body
• Infection
• Prolonged use of intravenous (IV) medications
  

• Congestive heart failure
• Recent surgery
• Prolonged inactivity, such as sitting for long periods or bed rest
• Smokers who take oral contraceptives
• Pre-existing conditions such as cancer or varicose veins

• A hard, cord-like feeling of the vein
• Tenderness or pain over the vein
• Redness and/or a feeling of warmth over the vein
• Swelling of the affected area, possibly extending to the arm or leg

• Warm, moist compresses applied to the area as recommended by the doctor
• Elevation of the affected arm or leg on pillows or such
• Support stockings, or elastic bandage such as ACE wrap
• Anti-inflammatory medication such as ibuprofen
• Pain medication as needed

Deep Venous Thrombosis (DVT) is a serious condition that occurs when a deep vein is partially or completely blocked by a blood clot. The treatment goal is to prevent the clot from getting bigger or breaking off and floating in the blood stream to another part of the body such as the heart and lung.

Risk factors for Developing DVT are conditions that cause sluggish blood flow in the veins, or an increased tendency of some to form clots such as in the following circumstances:

• Prolonged bed rest or paralysis
• Decreased activity for a long period of time, such as a long airplane flight, can slow blood flow
• Recent major surgery or the presence of a major illness, such as cancer or heart disease, can cause a greater tendency to clot
• Injury to the veins
• Injury to the arms or legs
• Obesity
• Pregnancy
• Oral contraceptives in women who smoke

Signs and symptoms of DVT

• Unusual sudden swelling of an arm or leg
• Pain, cramping or an aching feeling in the legs
• Fever
• Skin that is warm to touch
• A bluish color of the skin in severe cases
• No symptoms at all

Diagnosis is made through a combination of physical examination, an in-depth history of the signs, symptoms, risk factors, general health and past episodes of DVT and often diagnostic tests. It will be important to tell the doctor the medicines you have been taking, as well as about recent activities and travels.

Non-Invasive Testing : Non-Invasive Testing is done in the vascular laboratory either at the Beachwood office or downtown at the hospital. This is performed to check the blood flow in your veins. Non-Invasive tests are painless and have no risks or side effects. They do not involve the use of needles, x-rays, or dye and no special preparation is required before the test and no observation afterwards. This allows the tests to often be done the same day as the office visit, depending on the schedule of the laboratory. All non-invasive tests take less than one hour to perform and the results are given to Dr. King for evaluation. Most often, you will discuss the results by telephone. There are several types of Non-Invasive tests that the doctor may order:

• Venous Doppler Exam uses ultrasound to send high frequency sound waves, which are reflected from moving red blood cells. This test is used to diagnose blood clots or weak valves in the legs. During the test, you will be asked to lie down and slightly bend your knees into a frog-legged position. The examiner places the probe over veins at various locations on your legs and listens with a device that looks like a stethoscope. You may be asked to take a deep breath and hold it, then to release it quickly at times during the test.
• Duplex Imaging is used to diagnose many different problems in the legs including blood clots and weak valves. This ultrasound examination changes the sound waves into a picture of your veins on a video-imaging screen. The examiner will place a cool, wet-feeling gel on various parts of your legs and then run a probe over the veins to view them while you change positions from standing, lying on your back and occasionally on your stomach.

Invasive Testing

• Venograms are special x-ray pictures of veins used to diagnose blood clots and to obtain more specific information about the venous system. Usually performed in the x-ray department as an outpatient, since this examination requires the puncture of an artery and the injection of dye, you will be asked to sign a consent form. You will remain awake, although you may be given medication to help you relax. When the dye is injected into a vein in the foot, there is often a brief, hot burning sensation experienced by the patient. In most cases, if a clot is present it will be shown on the x-ray.
• Venous Pressure Measurements are used to evaluate chronic venous insufficiency through measurements of venous pressure and the function of venous valves. A small needle is placed in a surface vein of the foot and connected to a machine that will measure pressure. The pressure readings are usually compared while lying, sitting, and pumping the foot so that the function of your valves can be evaluated.

Treatment of DVT nearly always requires a hospital admission for initial treatment. If left untreated, DVT may cause serious health problems. A clot can grow in size and block other veins. In addition, portions of the clot may break away and travel through the veins to the heart and lungs, sometimes lodging in the pulmonary artery. This condition is called pulmonary embolism and can be life-threatening. While the symptoms of swelling and discomfort may go away within the first week of developing a DVT, it takes the body about six months to recover. Treatment is very specific to the patient and case, but the following list is frequent treatment options. Each case will vary and Dr. King's recommendations will be tailored to you.

• Bed rest with the affected extremity elevated for a day or two to reduce swelling.
• Blood thinners, or anticoagulants, such as heparin or warfarin are often used. Heparin, a blood thinning medication is frequently delivered intravenously during hospitalization. This medication helps to prevent the blood clot from enlarging while the body works on dissolving the clot and forming new routes for the blood to bypass the clot. Frequent blood tests are needed while taking Heparin to be sure the correct level is maintained in the body. Blood thinners, such as warfarin, taken in pill form may be needed.
• Pain medication as needed.
• Compression with an elastic bandage like ACE wrap or a custom fitted stocking or sleeve is often needed for months.
• Filtering devices may be surgically inserted in the vena cava for patients who cannot take blood thinners or who have serious clots despite using them. The filtering devices do not prevent the formation of clots, but will usually prevent any clots from reaching the heart and lungs and causing a potentially life-threatening pulmonary embolus.
• Thrombolysis, or dissolving the blood clot. This is often done in conjunction with balloon angioplasty. Either a vascular surgeon or interventional radiologist uses a catheter inserted in the leg and threaded into the segment of vein containing the clot. With the tip of the catheter in the clot, the clot-dissolving drug is infused, or placed directly into the clot. It usually takes several days for the clot to completely dissolve and venograms and or duplex scans monitor the progress.
• Balloon Angioplasty. Once the clot has been dissolved, widening the narrowed segment with balloon angioplasty decreases chances that future clots will form. If there appears to be a tendency for the vein to collapse after widening and improving the blood flow, a stent, or small mesh tube may be inserted and left in place to support the vein walls.

Decreasing Risk Factors for Development of DVT involves improving the blood flow in the lower extremities.

• Elevating the legs above the level of the heart
• Maintaining a regular exercise program such as walking
• Taking stretch breaks, short walks, and or flexing feet up and down while sitting during long trips or at a desk
• No smoking, especially while taking oral contraceptives