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DR FAROOQ AHMAD RANA
ASSISTANT PROFESSOR SURGERY
DEEP VEIN THROMBOSIS
Definition
 Deep vein thrombosis is the
formation of a blood clot in one of
the deep veins of the body,
usually in the leg
VIRCHOW’ TRIAD
ENDOTHELIAL DAMAGE
STASIS
HYPERCOAGULABILITY
Endothelial Injury
 Trauma,
 surgery, and
 invasive procedure may disrupt venous
integrity
 Iatrogenic causes of venous thrombosis are
increasing due to the widespread use of
central venous catheters, particularly
subclavian and internal jugular lines. These
lines are an important cause of upper
extremity DVT, particularly in children.
Hypercoagulability
 SURGERY AND TRAUMA RESPONSIBLE FOR UP






TO 40% OF ALL THROMBOEMBOLIC DISEASE
MALIGNANCY
INCREASED ESTROGEN (DUE TO A FALL IN
PROTEIN ‘S) INCREASED ESTROGEN OCCURS
DURING
ALL STAGES OF PREGNANCY—
THE FIRST THREE MONTHS POSTPARTUM,
AFTER ELECTIVE ABORTION, AND
DURING TREATMENT WITH ORAL
CONTRACEPTIVE PILLS
Venous stasis
 prolonged bed rest (4 days or more)
 A cast on the leg
 Limb paralysis from stroke or spinal cord
injury
 extended travel in a vehicle
HISTORY
 PAIN IN CALF AND THIGH
 SWELLING
 BILATERAL 30%
 SYMPTOMS AND SIGNS OF PULMONARY
EMBOLISM
 PLEURITIC CHEST PAIN, HEMOPTYSIS,
SHORTNESS OF BREATH
CLINICAL EXAMINATION
 PALPATE DISTAL PULSES AND EVALUATE
CAPILLARY REFILL TO ASSESS LIMB
PERFUSION.
 MOVE AND PALPATE ALL JOINTS TO DETECT
ACUTE ARTHRITIS OR OTHER JOINT
PATHOLOGY.
 NEUROLOGIC EVALUATION MAY DETECT
NERVE ROOT IRRITATION; SENSORY, MOTOR,
AND REFLEX DEFICITS SHOULD BE NOTED
 HOMANS'’ SIGN: PAIN IN THE POSTERIOR
CALF OR KNEE WITH FORCED DORSIFLEXION
OF THE FOOT
CLINICAL EXAMINATION CON.
 COLOUR CHANGES
 CELLULITIC
 WHITE :PHALAGMESIA ALBA DOLENS





CYANOSED : PHLEGMASIA CERULIA DOLENS
SIGNS MAY BE PRESENT
MINIMAL PITTING OEDEMA
DILATED SURFACE VEINS
STIFF CALF HOMAN’ SIGN RESISTANCE TO FORCED
DORSIFLEXION
 FEVER
 CYANOSIS, SIGNS OF RIGHT HEART FAILURE
Phlegmasia cerulea dolens
Venous gangrene
D/D
 RUPTURED BAKER CYST
 CALF MUSCLE HEMATOMA
 RUPTURED PLANTERIS MUSCLE
 THROMBOSED POPLITEAL ANEURYSM
 ACUTE ARTERIAL ISCHEMIA
 LYMPHOEDEMA
Diagnostic Studies
 CLINICAL EXAMINATION ALONE IS ABLE TO
CONFIRM ONLY 20-30% OF CASES OF DVT
 D-DIMER
 DUPLEX ULTRASOUND
 ASCENDING VENOGRAPHY(PREVIOUS GOLD
STANDARD)
Color duplex scan of
DVT
PROPHYLAXIS
 MACHANICAL:
 GRADUATED ELASTIC COMPRESSION
 EXTERNAL PNEUMATIC COMPRESSION
 PHARMACOLOGICAL
 LOW DOSE UNFRACTIONATED HEPARIN
 LOW MOLECULAR WEIGHT HEPARIN
THROMBOPHILIA SCREENING
FACTOR V LEIDEN, PROT C&S DEFICIENCY
ANTITHROMBIN III DEFICIENCY
 IDIOPATHIC DVT < 50 YEARS
 FAMILY HISTORY OF DVT
 THROMBOSIS IN AN UNUSUAL SITE
 RECURRENT DVT
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