Sudden appearance of a leg swelling may prove fatal

Dr KK Pandey *

A deep vein thrombosis of the right leg. Note the swelling and redness. :: Pix - wikipedia/James Heilman, MD

If one of your legs and thighs has sudden appearance of swelling, redness and raised temperature and you feel difficulty while walking, this may be an indication of a very serious condition called Deep Vein Thrombosis (D.V.T.). The lack of exercise, avoidance of long walk, sitting long hours in front of computers and use of contraceptives or hormones by ladies, do play a significant role in the recent rapid rise in incidences of Deep Vein Thrombosis. Besides, use of fashionable high-heeled sandals and shoes do increase the risk of Deep Vein Thrombosis especially among modern, educated and young ladies.

D.V.T. is mostly misdiagnosed in Indian subcontinent

People quite often due to ignorance, mistake DVT either for any hidden injury in the leg or fatigue, or muscle pull, or infection or filariasis. Some people especially in developing countries suffering from deep vein thrombosis, unknowingly get their legs massaged by some local quacks in order to get some relief.

The condition of Deep Vein Thrombosis in many patients are misdiagnosed as Filariasis, or Sciatica or simple swelling due to over-stretched muscle or nerve. Some patients get treatment of filariasis for weeks. Some get the treatment of leg traction with hanging weight over their feet. Because of these wrong treatments the precious time is lost, and Deep Vein Thrombosis gets worse and worse and finally may cost a patient’s life.

Why D.V.T. is more commonly seen these days?

The significant risk factors for development of Deep Vein Thrombosis include lack of exercise especially of legs and feet, prolonged bed rest due to some operation or chronic disease, and continued use of contraceptives or hormone without a physician’s advice. The patients suffering form lung and pancreatic cancers are more prone to develop Deep Vein Thrombosis. Any disorder or any disease, which accelerate the process of clotting of blood, will have a definite role in the development of Deep Vein Thrombosis. Pregnant ladies during their pregnancy or immediately after delivery are likely to suffer from this disease. Patients who are paralyzed due to brain strokes are more susceptible to risk of Deep Vein Thrombosis because of prolonged bed-rest and lack of exercise.

How does a Deep Vein Thrombosis develop?

For understanding Deep Vein Thrombosis, it is very essential to have some basic knowledge of blood supply and drainage system of legs and arms. The veins collect oxygen-deficient impure blood from legs and arms and carry it back to heart. From heart impure blood goes to lungs for purification where blood is replenished with oxygen. At times, when blood clots inside these veins are collected due to any reason, they will impede the blood flow in the leg veins. This results into total obstruction of veins. That jeopardizes the drainage system of lower limb and this will lead to pooling of impure blood and therefore swelling of leg and thigh or arm. This stage is the beginning of deep veins thrombosis. If at this stage a proper treatment is not instituted, risk of losing legs or hands or even life is increased.

Why is Deep Vein Thrombosis dangerous?

In deep vein thrombosis, besides collection of impure blood in the leg and feet due to blockade of vein, accumulation of water, electrolytes and minerals too occurs as well. This leads to gross disturbance of internal body system thus resulting into a life - threatening condition called Phlegmasia Caerulea Dolens (PCD).

The accumulation and stagnation of a large quantity of impure deoxygenated blood, water and essential elements into the leg and foot cause significant increase in tissue pressure. This enhanced tissue pressure in the limbs compresses significantly the blood pipes called arteries that supply pure oxygen - rich blood to limbs. This compression of blood pipe results into reduced or complete stoppage of flow of pure blood. This ultimately leads to blackening of foot, toes or hands that heralds the beginning of a dangerous stage of gangrene.

Pulmonary Embolism is the most dreaded complication of D.V.T.

If a patient of Deep Vein Thrombosis is not treated properly in time or mistreated due to wrong diagnosis, the blood clots accumulated in veins may slip upwards and go back to heart, from where these clots finally land up in lungs. This condition is called Pulmonary Embolism (P.E.), and it is very dangerous and life threatening. In such a situation, patient develops breathlessness and blood pressure drops significantly. The patients who develop pulmonary embolism must be immediately admitted in a large multi specialty hospital equipped with modern investigatory facilities and intensive care units, otherwise such patients may lose their lives.

Treatment options available for Deep Vein Thrombosis

In general, patients of Deep Vein Thrombosis are administered intravenous drugs, which keep the blood thin and diluted. When there is a strong possibility of a coexistence of pulmonary embolism too, thrombolytic therapy is initiated. For such therapy, ultramodern intensive care units with facility of artificial breathing support system like ventilators are essential, otherwise such patients may die, if not treated promptly.

In patients of Deep Vein Thrombosis, when stage of P.C.D. (Phlegmasia Cerulea Dolens) gets further complicated, the possibility of losing the limb increases. In such an emergency situation, an operation called venous thrombectomy has to be performed. In this operation, blood clots are removed surgically from the large sized veins, which are then surgically connected to an artery in the thigh to get some pure blood supply so that vein does not collapse and drainage system of the affected limb does not come to a standstill.

Use of IVC Filter to save a life

In some special conditions, of Deep Vein Thrombosis, I.V.C. filters are put through angiography inside the large common vein situated in the abdomen. These I.V.C. filters act as a sieve and do not allow clots of thigh and leg vein from slipping upwards towards heart and lung, but at the sometime allow blood to continue to flow. That is why; patients of Deep Vein Thrombosis must be shifted to and treated at a large modern hospital equipped with angiography, Doppler study and nuclear medicine facilities.

A mild chronic leg swelling is an usual fall-out of DVT

In majority of the patients of Deep Vein Thrombosis, even after treatment, there always exists a possibility of developing later, varicose veins and venous ulcers over the legs. In this condition, venous valves get permanently damaged due to previous clotting; this leads to permanent mild swelling and discoloration in the leg and foot. These patients, who had DVT before, are therefore required to do some regular special exercises to prevent the development of non-healing ulcer over the leg.

How to prevent Deep Vein Thrombosis in first place ?

One should do regular exercise to prevent the attack of deep veins thrombosis. If you do daily morning walk for 4-5 kilometers and regular exercise of legs and feet, possibility of pooling of deoxygenated impure blood in leg vein becomes very less because of strengthened muscular pump of leg. The persons on prolonged bed - rest due to cancer, paralyzed patients, young mothers with recent deliveries, ladies on contraceptives or hormone therapy, are at high risk of developing Deep Vein Thrombosis, therefore they need special precaution and care.

What to do if you have a suspicion of Clotting in leg veins

In the event of developing leg pain or discomfort during walking or mild leg swelling, people must immediately consult a Vascular Surgeon instead of a General Surgeon or a Bone Specialist, so that Deep Vein Thrombosis can be controlled effectively in the early stage with less damage to venous valves. Such patient should go for treatment to a hospital equipped with all modern investigatory facilities like Doppler Study, Echocardiography, and angiography and ventilation perfusion study of lung.

How to prevent recurrent DVT

If you had had an attack of DVT in past, you should be extra careful to prevent recurrence of deep vein thrombosis. One must walk daily for at least two hours a day. During day time, one must wear scientifically made graduated compression stockings only to be taken off in the night time while on bed. One should avoid prolonged sitting as well as prolonged standing. While sleeping, one should put pillows underneath the legs to raise them about 10 inches above the chest level.