Phlebitis, deep venous thrombosis and pulmonary embolism are the most serious acute manifestations of venous disease. These acute disorders usually occur suddenly without pre-existing conditions, or after triggering events like hip surgery, but can also be triggered by chronic venous disease.
The superficial venous thrombophlebitis is a blood clot (thrombus) that grows inside a varicose vein of the superficial venous network (just under the skin), and is often associated with an inflammation of the vein (phlebitis). A section of the varicose vein suddenly becomes red, warm, painful and hard. The inflammation can spread upward or downward following the vein. The risk of pulmonary embolism is limited but existing. A visit to the doctor is necessary. The superficial thrombosis may grow into the deep veins or can even be associated with deep venous thrombosis or other localizations. There a no specific reasons that will trigger a thrombophlebitis, sometimes it is caused by a small injury of the veins, more likely to happen when varicose veins are present.
Most of the treatment will consist in wearing 20 to 30 mmHg SIGVARIS medical compression stockings, walking and applying local anti-inflammatory medication. A surgical drainage or elimination of the varicose vein may also be considered.
Deep vein thrombosis
The phlebothrombosis or deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein of the lower limbs. The blood clot inside the vein can hold onto the vein wall, or it can be floating inside the vein. The following elements may be involved in DVT formation:
- blood flow alteration
- alteration of the blood constituents
- defect within the vessels inner layer
The blood flow alteration may follow immobilisation (prolonged bed rests, plaster casting, long distance travel on airplanes, cars, trains). The alteration of the blood constituents can be due to hormonal treatments, smoking, cancers. The defect of the vessel walls can occur after all kind of injuries (trauma, inflammatory diseases, cancer). Elderly people are at higher risk to develop DVT. However, a person without any previous venous condition can develop a deep vein thrombosis too.
The most frequent symptoms of DVT are:
- acute pain in the calf
- hardening of the calf
- painful swelling of the ankle that can reach up to the knee, even the thigh
- skin that is warm to the touch
The calf’s pain may cause walking to be difficult. A feeling of heat, a slightly blue or red aspect of the skin may also be observed. However, nearly 50% of all DVT cases have no recognized symptoms.
When symptoms described above occur, you must go see a doctor quickly in order to confirm the diagnosis which can be made with a simple ultrasound scan that is painless and riskfree. A specific blood test may be performed to measure “D-dimer” which is a sign of recent clotting. Early diagnosis and treatment greatly reduces the risk of serious complications.
The treatment of a deep venous thrombosis will consist of taking anticoagulant drugs, and wearing 30 to 40 mmHg SIGVARIS medical compression stockings that will eliminate the symptoms rapidly and durably and allow to stay mobile and pursue every day activities.
Both components of the treatment will last for several weeks or months. The major risk in a DVT is to develop pulmonary embolism. This risk however, is minimal if treatment has been initiated. Therefore, treatment can be given on a outpatient basis in most cases.
Pulmonary embolism (PE) – occurs when the blood clot, or part of it (emboli), detaches itself and migrates to the pulmonary arteries in the lungs. Most patients with a DVT have an unrecognized pulmonary embolism. Pulmonary embolism is the most serious consequence of DVT because it may be fatal.
The signs of embolism are acute chest pain (respiration depending pain), anxiety, shortness of breath, blood expectorations (spitting), a significant decrease of blood pressure, fast heartbeat. Because those symptoms are also common with other medical conditions, it may not be recognized right away. Only specific tests will enable a correct diagnosis such as lung scan (Computer Tomography (CT) in most cases).
In case of such symptoms, emergency medical assistance must be sought at once. Treatment include anticoagulant medication.
The majority of people recover from pulmonary embolism. However, over 200 000 persons die each year in the USA, over 15 000 in France, as a result of those conditions.
One-third of patients with DVT, develop a long-term complication known as post-thrombotic syndrome (PTS). This condition can show up as chronic pain, swelling and discoloration of the leg, as well as the development of open ulcers, caused by the damage that is done by the clot to valves in the veins. The likelihood of another clot forming is hign once you have had a DVT. The effects of PTS are long lasting and can lessen one’s quality of life.
The basis of prevention and treatment of PTS is wearing compression stockings. Half of the patients with a DVT will not recover completely. The valves in the deep veins are irreversibly damaged. This may lead to heaviness, pain, edema and skin changes of the leg. The incidence and severity of this clinical outcome are greatly reduced when compression stockings are worn.
Spontaneous or accidental bleeding from varicose veins may induce profuse bloodloss. It occurs in most of the cases in superficial vein or intradermal varicose veins or in venous ulcers. It is a serious complication of varicose veins if it is not treated right away. If the patient remains in a standing position, he may get a serious hemorrhage. To stop the bleeding, raise and maintain the leg above heart level and exert with the fingers a constant pressure on the wound. Do not place any tourniquet. The bleeding will stop after a few minutes. Then apply a firm bandage on the bleeding area and go see your doctor to get the appropriate treament of the affected vein.