Deep vein thrombosis

Generality

Deep vein thrombosis is a serious disease and much more frequent than one can imagine (estimated incidence around 1.6 - 1.8 per thousand).

Also known as "economy class syndrome" or "traveler's thrombosis", it is typical of aging but does not spare young women and children; the risks are greater even for those who remain motionless or simply sit for a long time, perhaps behind a desk, at the theater, by train, by car or by plane.

Causes

Physiologically speaking, venous thrombosis is the consequence of an abnormal blood coagulation process that flows inside a vein, often located in the legs, but which can also be found in other parts of the body. In these locations, inside the vessel a blood clot (thrombus) is formed which slows down, in some cases it blocks the blood circulation, with consequent suffering of the anatomical structures upstream of the obstruction.

Phlebitis, or thrombophlebitis, is the old term used to identify deep vein thrombosis of the arms or legs. Today this term has become somewhat out of use and is used to a limited extent to identify thrombotic processes affecting the superficial veins of the lower or upper limbs.

As we said, deep vein thrombosis is a problem that mainly affects people who remain in a sitting position for a long time, as happens during an intercontinental flight. The sloping position of the legs, in fact, can give symptoms of overload of the deep venous circulation, as the return of blood to the heart is hindered by the force of gravity and the propulsive action of the muscles, which occurs, however, is lost when Very often, moreover, one makes the mistake of traveling with pants or socks that are too tight and this certainly does not help the circulation, because it further slows down the return of blood from the veins to the heart. By plane, there is also the problem of dehydration induced by the particular climate that is created inside it. We therefore speak of "economy class syndrome" because business travelers, having more space to relax and take a comfortable position, are, at least theoretically, less subject to this problem.

Complications

The consequences of deep vein thrombosis depend on the fate of the blood clot. In fact, it can melt, as happens in the vast majority of cases, or increase in size or, worse still, break, with dramatic consequences for health. The small fragments generated by its rupture, called emboli, can in fact be carried by the blood to the heart, which pushes them into the arteries of the lungs, causing the so-called pulmonary embolism, a disease

Another possible complication that occurs months later, especially when the thrombosis is not adequately treated and the thrombus does not dissolve, is the so-called post-thrombotic (or post-phlebitic) syndrome. This complication of deep vein thrombosis is characterized by a complex of symptoms and disorders, which manifest themselves with edema, pain, tissue changes (eczema, skin pigmentation, ulceration, lipodermatosclerosis) and dilation of the superficial veins.

As mentioned, the thrombus tends to form at the points furthest from the heart, where the blood flow is slower (therefore and especially in the deep veins, such as those of the calf, hence the term venous thrombosis - deep -).

Venous Thrombosis Symptoms

For further information: Venous Thrombosis Symptoms

Nonspecific symptoms related to suffering from the venous circulation of the lower limbs are very common and are mostly limited to the appearance of a sense of heaviness and swelling in the legs. If their onset is sporadic, they should not cause excessive concern, especially if we have given the legs a good reason to swell (air flight and all the other conditions seen above). On the other hand, all those who in the past have already had problems with the venous circulation of the legs, overweight or obese people, smokers, women who are taking the contraceptive pill and above all people with familiarity for the pathology (i.e. those individuals with relatives who have already suffered from the same problem).

From a symptomatic point of view, deep vein thrombosis is a subtle disease, in the sense that the symptoms can be different and, in some ways, opposite. The leg, for example, can be very swollen or not at all swollen, be hot or not. not at all, you can feel a pain inside it or not. C "it must be said, in fact, that the classic symptoms of deep vein thrombosis (edema, redness, tension and pain) occur only when the blood occlusion is extensive and affects very important veins located deep.

To further complicate the situation, contributes the fact that the clinical signs of this disease are common to numerous other pathologies, such as those of muscle tendon origin (trauma, strains, strains, hematomas, tendinitis), neurological (sciatica), osteoarticular ( fractures, osteomyelitis, synovitis) or lymphatic.

The suspicion that it may actually be deep vein thrombosis is well founded when the symptoms predominantly affect only one leg. Conversely, if the legs swell at the same time it is quite unlikely that it is a thrombosis problem. In any case, in the presence of one or more risk factors, it is important, fundamental, to always and promptly contact your doctor, that is, when the phase is still acute. An early intervention makes it possible to avoid potentially serious consequences, such as pulmonary embolism, which generally do not develop immediately but only after a few days.

Pulmonary embolism can cause severe symptoms, such as severe pain in the chest, an oppressive cough, and the release of phlegm mixed with blood.

Chronic venous insufficiency, on the other hand, manifests itself with persistent edema of the affected limb, more or less associated with the appearance of dark spots on the skin, dilation of superficial veins and, in the most serious cases, with skin ulcers.

Risk factors

Particular attention should be paid to people with past episodes of thrombosis, in whom the risk of still encountering this problem is higher, because it means that a certain basic predisposition is present. All the more reason, therefore, the control of modifiable risk factors is fundamental, obtainable by abolishing smoking, reaching and maintaining one's ideal weight, as well as avoiding clothes that are very tight to the groin.

The family predisposition, confirmed by several studies, has led to the coining of a new term, "hereditary thrombophilia". Venous thrombosis can in fact be favored by small genetic mutations in the coagulation factors, which can be transmitted by inheritance and predispose the subject to the development of thrombosis and embolisms even at a young age (under 45 - 50 years).

Hormone-based therapies, such as "oral replacement" treatments undertaken in menopause, slightly increase the risk of developing deep thrombosis. However, this is a moderate increase, but one that must still be taken into consideration by particularly predisposed people.

On the other hand, there is no important correlation between arterial hypertension and venous thrombosis. Those with high blood pressure, on the other hand, run a greater risk of blood clots forming and breaking in the arteries, with different and in some respects more fearful consequences.