The following information does not replace a physician’s diagnosis and advice under any circumstances whatsoever.

Leg vein thrombosis

Leg vein thrombosis: what’s that?

Thrombosis is described as the blockage of a blood vessel by a clot (thrombus) which forms in a healthy or previously damaged blood vessel. Veins (venous thrombosis) and arteries (arterial thrombosis) can be affected. If a thrombus fully closes a vessel, this may result in acute danger to life, depending on the location of the thrombus (heart, lung, brain).
Thromboses arise most frequently in veins, primarily in veins in the lower half of the body, such as the deep leg veins or also the pelvic veins. Thromboses are incurred considerably more frequently in the veins than in the arteries as the venous blood flow speed is lower there and the inner vein membrane has a different anatomical structure than the arteries. Blood clots accumulate more easily on the venous valves located there.

Symptoms of leg vein thrombosis

Thromboses are often formed in the deeply located leg veins. A suddenly occurring complete occlusion of a vein is accompanied by considerably more acute symptoms than a slowly developing clot which may develop over several days or weeks and only gradually leads to occlusion.

It is important to distinguish between a superficial “ ” and a “deep leg vein thrombosis”. Deep leg vein thromboses often have an impact when you get up: Those affected feel sudden pain in the calf, the leg is swollen and the pressure on the calf hurts. During its initial phase, the thrombosis causes fewer complaints in many cases. That makes it particularly dangerous.

The initial signs of a deep leg vein thrombosis include:

  • A feeling of tension or also pain in the leg similar to aching muscles (pain is reduced by propping your legs up).
  • Compared to the other leg, swelling and stronger pronouncement of the veins which run directly under the surface of the skin (“warning veins”).
  • Slight bluish-red discolouration, possibly also hyperthermia of the leg concerned, shiny skin.

If these indications exist, you should consult a physician immediately, danger to life exists!

If you also incur chest pain and shortness of breath, this may signalise a pulmonary embolism. A pulmonary embolism is the occlusion of one or more lung vessels and caused by washed in blood clots. This is an acute emergency – alarm the emergency doctor immediately!

If a thrombosis is not treated adequately, the so-called postthrombotic syndrome (PTS),  long-lasting damages to the veins, may develop. This results in chronic blood stasis which is triggered by scar tissue in the vessels. The venous valves in whose lower region the blood flows back, may be affected by this. The blood stasis can damage the vessels in the long-term and severely. Moreover, as a consequence of leg vein thrombosis, a chronic venous insufficiency  (CVI) may arise, including the swelling status (oedemata) and changes to the skin up to an open leg.

Causes of vein thromboses

Three major causes exist for the emergence of a thrombosis, they are described as “Virchow’s triad”:

  • Blood clotting disorder
  • Slowdown of the blood circulation
  • Injury to the inner vessel wall

Numerous risk factors promote the emergence of a leg vein thrombosis, including:

  • Blood clotting disorders (hereditary and acquired)
  • Operations, injuries
  • Internal diseases (heart attack, infections, malignant tumours)
  • Immobility, for example arising from long bedriddenness
  • Pregnancy
  • Taking hormone compounds containing oestrogen, such as the pill
  • Hormone replacement therapy during the menopause

Generally, an increased risk of thrombosis exists if blood congests in the legs over a longer period (bedridden patients, pressure or plaster cast bandages, paralyses with failure of the so-called calf muscle pump). Also, sitting for long periods and a general lack of exercise (e.g. flights of longer than three hours) increase the risk of thrombosis.

Diagnosis of leg vein thrombosis

Precise questioning of the patient (case history), visual assessment and palpating the leg affected are the initial diagnostic steps. If these result in the suspicion of leg vein thrombosis, imaging procedures are then used in order to confirm the diagnosis. Primarily, ultrasound (duplex sonography) is used here. Within its scope, a compression sonography is made, during which the vein where thrombosis is suspected is compressed using the ultrasonic probe. If this examination does not enable safe diagnosis, further measures are taken. In cases of suspected deep vein thrombosis, these also include taking a blood sample for the so-called D-dimer valuation.

How can vein thromboses be prevented?

In particular, people who exhibit several risk factors should observe rigorous thrombosis prophylaxis and live “aware of their veins”. This includes:

  • Vein gymnastics
  • Contrast showering the legs (Kneipp)
  • Frequent elevation of the legs
  • Regular exercise and endurance sports (swimming, Nordic walking and cycling)
  • Reduction of overweightness
  • Healthy and varied nutrition
  • Sufficient liquid intake
  • Repeated leg movement on long journeys
  • Use of medical compression stockings

What therapy options are available for leg vein thromboses?

A deep vein thrombosis is always an emergency, where after securing the diagnosis treatment must immediately be started. The earlier a thrombosis is treated, the better the treatment perspectives.

The target of treatment is to stop the thrombosis process, prevent pulmonary embolism and, if possible, to recover the blocked blood circulation. Clots can be dissolved by medication (thrombolysis) or removed via an operation (thrombectomy). However, an operation can only be considered in case of early phase occlusion of a large thigh or pelvis vein. Nowadays - except in rare cases - the treatment of a thrombosis with modern medication (thrombolysis) is first choice.
Independent of whether a surface thrombophlebitis or a deep vein thrombosis is diagnosed, compression therapy is the initial step. For this, initially a sturdy compression bandage is applied, which can be replaced during the later course or after the leg is no longer swollen (after approx. 10 days) with a medical compression stocking such as the BORT AktiVen®.

The administration of anticoagulant substances, for example heparin, is an important constituent of the basic therapy. In the meantime, modern medication is available which need not be injected. Some of these DOACs (direct oral anticoagulant substances) can be administered immediately after the diagnosis has been established, whilst other preparations can only be applied following initial administration of heparin. “Haemodilution” with DOACs should be of longer duration in order to support the reduction of the clots and prevent new clot formation. Here, the duration of therapy depends on the cause and extent of the thrombosis, but also existing additional diseases as well as the clot development and possibly additionally necessary medication.

Status: August 16, 2022