Deep vein thrombosis
Updates to Article Attributes
Body
was changed:
The term deep vein thrombosis (DVT) is practically a synonym for those that occur in the lower limbs. However, it can also be used for those that occur in the upper limbs and neck veins. Other types of venous thrombosis, such as intra-abdominal and intracranial, are discussed in specific sections.
Epidemiology
- 1.6 new cases per 1000 per year
- 2.5-5% of population is affected
- >
; 50;50% have long terms symptoms ofPostpost thrombotic syndrome - 6% of DVT patients report eventual venous ulcers (0.1%
ingeneral population)
Risk factors
- Age
(Relative(relative risk increase ~2 per 10 year increase) - Surgery
(Orthopaedic(orthopaedic patientsbeingat highest risk: hip 48%, knee 61%) - Trauma
- History of venous thromboembolism (2-9% increase)
- Primary hypercoagulable states
- Protein A, C, and S deficiency 10x increased risk
- Factor V Leiden
(Heterozygous(heterozygous 8x increased risk,Homozygous 80Xhomozygous 80x)
- Oestrogen replacement (2-4x increased risk)
- Immobilisation (2x increased risk)
- Pregnancy (0.075% of pregnancies)
Radiographic features
Ultrasound
The majority of deep venous thrombi occursthromboses occur in the lower extremities and begin in the soleal veins of the calf. Doppler sonovenography studycompression sonography is the imaging modality of choice. Features include:
- non-compressible venous segment
- increased venous diameter: acute thrombus
- decreased venous diameter: chronic thrombus
- loss of phasic flow on Valsalva manoeuvre
- absent colour flow: if completely occlusive
- increased flow in superficial veins
- lack of flow augmentation of calf squeeze
- anechoic thrombus: acute thrombus
- echogenic thrombus: chronic thrombus
Complications
-<li>> 50% have long terms symptoms of Post thrombotic syndrome</li>-<li>6% of DVT patients report eventual venous ulcers (0.1% in general population </li>- +<li>>50% have long terms symptoms of post thrombotic syndrome</li>
- +<li>6% of DVT patients report eventual venous ulcers (0.1% general population)</li>
-<li>Age (Relative risk increase ~2 per 10 year increase)</li>-<li>Surgery (Orthopaedic patients being highest risk: hip 48%, knee 61%)</li>- +<li>Age (relative risk increase ~2 per 10 year increase)</li>
- +<li>Surgery (orthopaedic patients at highest risk: hip 48%, knee 61%)</li>
-<li>Protein A, C and S deficiency 10x increased risk</li>-<li>Factor V Leiden (Heterozygous 8x increased risk, Homozygous 80X)</li>- +<li>Protein A, C, and S deficiency 10x increased risk</li>
- +<li>Factor V Leiden (heterozygous 8x increased risk, homozygous 80x)</li>
-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The majority of deep venous thrombi occurs in the lower extremities and begin in the soleal veins of the calf. Doppler sonovenography study is the imaging modality of choice. Features include:</p><ul>- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>The majority of deep venous thromboses occur in the lower extremities and begin in the soleal veins of the calf. Doppler compression sonography is the imaging modality of choice. Features include:</p><ul>
- +<li>anechoic thrombus: acute thrombus</li>
- +<li>echogenic thrombus: chronic thrombus</li>
References changed:
- 2. Watson L, Broderick C, Armon M. Thrombolysis for Acute Deep Vein Thrombosis. Cochrane Database Syst Rev. 2014;(1):CD002783. <a href="https://doi.org/10.1002/14651858.CD002783.pub3">doi:10.1002/14651858.CD002783.pub3</a>
- 3. Meissner M, Wakefield T, Ascher E et al. Acute Venous Disease: Venous Thrombosis and Venous Trauma. J Vasc Surg. 2007;46(6):S25-S53. <a href="https://doi.org/10.1016/j.jvs.2007.08.037">doi:10.1016/j.jvs.2007.08.037</a>
- Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database of Systematic Reviews 2016, Issue 11
- Meissner MH et al. Acute venous disease: Venous thrombosis and venous trauma Journal of Vascular Surgery, 2007-12-01, Volume 46, Issue 6, Pages S25-S53
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