Deep Venous Thrombosis and its Complications

1. DeepVenousThrombosisanditsComplications M.A.Kubtan M.D-F.R.C.S.(U.K) Dept of General Surgery Al Mouasat University Hospital Damascus MAK

2. TheRoleofClotting In the blood vascular system the clotting mechanism guards against the danger of haemorrhage MAK

3. Thrombosis Is the formation of a solid mass ( Thrombus) in the circulation from the constituents of streaming blood MAK

4. CausesofPhlebothrombosis • Changes in the vessel Wall . • Changes in the Blood flow . • Changes in the composition of the Blood . MAK

5. Changes in the Vessel Wall • Pressure on the veins by the heavy calf tissues when the patient is immobilised in bed . • Local hypoxia due to pressure on the vessles associated with immobility . • Direct trauma by a fracture edges . • Ill applied tourniquets and plaster of Paris . MAK

6. TheBloodFlow • Stasis (The usual cause of venous thrombosis) • Increased viscosity of blood • In polycythaemia Vera • Dehydration • Eddy Current MAK

7. TheCompositionofBlood • Platelets( Thrombocytosis ). • Clotting Factors. MAK

8. Platelets Thrombocytosis Transient ( after Parturition, Trauma, Sever Haemorrhage, and after Splenectomy ). Persistent ( Polycythaemia Vera ). MAK

9. PlateletsFunction • PlateletAggregation. • PlateletAdhesiveness. MAK

10. TheRoleofClottingMechanism The Clotting Time Is shortened after • Sever Haemorrhage . • Trauma . • Sever Infections ( Typhoid Fever ). • Administration of Corticosteroids . • Oral Contraceptive . • Lipaemia shortens the clotting time and inhibits fibrinolysis . MAK

11. VenousThrombosis • Thrombophlebitis . • Phlebothrombosis . MAK

12. Thrombophlebitis is a condition in which there is both inflammation and a blood clot in a vein. Thrombophlebitis can occur in either superficial or deep veins. MAK

13. Phlebothrombosis • It is essentially due toStasis . • It may be caused bylocal injuryto the venous endothelium . • There is no obviouslocal infective element. • It is commonpostoperative compliction • Frequently encountered inHeart disease . MAK

14. A DVT is a condition where ina blood ,clot (thrombus) forms in a vein of the deep system. MAK

15. PathogenesisofPhlebothrombosis • Primary platelet Thrombus . • The Coralline Thrombus . • Occluding Thrombus . • Consecutive Clot . • Propagated Clot . MAK

16. PrimaryPlateletThrombosisخثرةالصفيحاتالبدئيةالشاحبةPrimaryPlateletThrombosisخثرةالصفيحاتالبدئيةالشاحبة • Platelet adhere to the vein wall and aggregate to form apale thrombus . • This allows clotting factors to accumulate in the area . • Promote an increase in thefibrin element . MAK

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18. CorallineThrombusالخثرةالمرجانيةاللونAmixedthrombusCorallineThrombusالخثرةالمرجانيةاللونAmixedthrombus • Due to fibrin deposition on the primary platelet thrombus . • Leads to further platelet deposition • Consist of alternate layers of fused platelets and fibrin with entrapped blood cells . • They are bent in the direction of blood flow . • Ripple appearance (Line of Zahn ) . MAK

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20. OccludingThrombsالخثرةالسادة • The growth of coralline thrombus progressively occludes the vein . • Composed of blood clot with smaller platelet element. • It is red. MAK

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22. ConsecutiveClotالخثرةالمتعاقبة • Once the vein is occluded • The stationary column of blood undergoes coagulation forming aConsecutive clot . • When consecutive clot extend to the next venous tributary it may become endothelialised , or there is the development of more thrombus or clot. MAK

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24. PropagatedClotالخثرةالمتمادية • When clot reaches to the entrance of venous tributary , it may lead to formation of another consecutive clot . • Stagnation of column of blood above the consecutive clot may produce propagated clot en mass . MAK

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30. A thrombosis in a deep vein is a much more serious problem than one in a superficial vein. The reason for this is that a piece of the clot in DVT may break off and travel through the deep veins back to the heart, and eventually be pumped by the heart into the arteries of the lung. MAK

31. DVTs can occur anywhere in the body but are most frequently found in the deep veins of the legs, thighs, and pelvis. MAK

32. DVT is a common condition that affects almost 2 million Americans each year. Among patients with DVT, pulmonary embolism will occur in 30%. Pulmonary embolism causes 600,000 deaths each year. MAK

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34. What Are The Symptoms of a DVT In the affected leg • swelling • Pain • no symptoms at all unless the clot dislodges MAK

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36. CommonSitesAffectedbyThrombosis • Deep Veins of the Calf . • It may extend to PTV or the POPV. • At the beginning of Femoral Vein . • Commonly in Lt CIV due to pressure from the Rt CIA . • Following Pelvic Operation . MAK

37. PlsmaticD-dimers • Fibrin is the main constituent of a thrombus. • Its formation is rapidly followed by activation of fibrionlytic system leading to lysis of fibrin clot. • Dissolution of stabilized fibrin releases specific breakdown products D-dimers (DD). MAK

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39. DDassayasauseful first stage diagnostic tool • Negative result can rule out thromboembolic event. • False positive ( Specificity 40% ). • Test used 1. ELISA (Enzyme-linked immunosorbant assays ). 2. Latex tests less sensitive . MAK

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41. Venography MAK

42. MR MAK

43. SpecialClinicalTypes • Phlegmasia alba dolens. • Phlegmasia Coerulea dolens. • Trousseu,s Syndrome. • Pregnancy-related thrombosis. MAK

44. IliacFemoralVeinThrombosis MAK

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48. Isotope Scan MAK

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50. Local Causes i ) lack of Muscular Activity . ii ) Incompetent Valves . iii ) Pressure from outside ( Tumours, Ascites , Plasters and Bandages .) MAK