Surgery

2. INTRODUCTION
• A venous thrombus is the formation of a semi
solid coagulum within flowing blood in the
venous system.
• Venous thrombosis of deep veins of the leg is
complicated by immediate risk of pulmonary
embolus and sudden death.
• Risk of developing a post-thrombotic limb and
venous ulceration.

3. AETIOLOGY
• Changes in the vessel wall(endothelial
damage)
• Stasis ,diminished blood flow
• Coagulability of blood (thrombophilia)
Predisposing factors:
Injury ,esp fractures of the lower limb and pelvis
pregnancy and the oral contraceptive pills.

4. PATHOLOGY
• A thrombus often develop in he soleal veins
of the calf.
• Fibrin and red cells form a mesh until the
lumen of the vein wall occludes.
• Thrombus extend as a propagated loose red
clot.
• Extend up to the large venous branch ,break
off and embolise to the lung.

5. • Embolus arising from the lower leg veins
becomes detached passes through the large
veins of the limb and venacava.
• Lodges in the pulmonary arteries
• Occlude the pefusion to all or part of one or
both lungs.
• Sudden collapse and death.

7. DIAGNOSIS
• The most common presentation in DVT is pain
and swelling esp in the calf.
• Many patients have no symptoms of
thrombosis and present with pulmonary
embolism.
• Sometimes leg appears cellulitic.
• Presenting with venous gangrene have
underlying neoplasm.

8. • Mild pitting edemaof the ankle ,dialated
veins,stiff calf and tenderness over the course
of the deep veins.
• Low grade pyrexia in patients with pulmonary
embolism.
• Signs-cyanosis, dyspnoea, raised neck veins,
split second heart sound, pleural rub if there is
right heart strain.

9. INVESTIGATION
• Patients with idiopathic thrombosis ususally
have a D-dimer measurement.
• If d-dimer is raised ,a Duplex ultrasound
examination of the deep veins should be
performed.
• Ascending venography
• CTscan

10. DIFFERENTIAL DIAGNOSIS
• Ruptured baker’s cyst
• calf muscle haematoma
• Ruptured plantaris muscle
• Thrombosed popliteal aneurysm
• Arterial ischaemia

11. PROPHYLAXIS
Prophylactical methods include:
• Mechanical
• Pharmacological
Mechanical :graduated elastic compression
stocking,external pneumatic compression.
These reduces the incidence of thrombosis.
Pharmacological:low molecular weight heparin
given sc .

12. TREATMENT
• Patients confirmed to have DVT on duplex
imaging should be started on sc low
molecular weight heparin&rapidly
anticagulated with warfarin.
 Warfarin started at a dose of 10mgon day 1
 10mg on day 2
 5mg on day 3.
• Prothrombin time is taken on day 3.

13. • Thrombolysis :Tissue plasminogen activator
in most patients is administered directly into
the thrombus ,via the popliteal vein or by
direct puncture in the groin.
• Thrombi can be compressed by stent
grafting,this technique is very good in
patients with ‘iliac vein compression
syndrome’.