1. DR FAROOQ AHMAD RANA ASSISTANT PROFESSOR SURGERY
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DEEP VEIN THROMBOSIS

2. Definition
Deep vein thrombosis is the formation of a blood clot in one of the deep veins of the body, usually in the leg

3. VIRCHOW’ TRIAD
ENDOTHELIAL DAMAGE
STASIS
HYPERCOAGULABILITY

4. Endothelial Injury Trauma, surgery, and
invasive procedure may disrupt venous integrity
Iatrogenic causes of venous thrombosis are increasing due to the widespread use of central venous catheters, particularly subclavian and internal jugular lines. These lines are an important cause of upper extremity DVT, particularly in children.

5. Hypercoagulability
SURGERY AND TRAUMA RESPONSIBLE FOR UP TO 40% OF ALL THROMBOEMBOLIC DISEASE
MALIGNANCY
INCREASED ESTROGEN (DUE TO A FALL IN PROTEIN ‘S) INCREASED ESTROGEN OCCURS DURING
ALL STAGES OF PREGNANCY—
THE FIRST THREE MONTHS POSTPARTUM,
AFTER ELECTIVE ABORTION, AND
DURING TREATMENT WITH ORAL CONTRACEPTIVE PILLS

6. Venous stasis prolonged bed rest (4 days or more) A cast on the leg
Limb paralysis from stroke or spinal cord injury
extended travel in a vehicle

7. HISTORY PAIN IN CALF AND THIGH SWELLING BILATERAL 30%
SYMPTOMS AND SIGNS OF PULMONARY EMBOLISM
PLEURITIC CHEST PAIN, HEMOPTYSIS, SHORTNESS OF BREATH

8. CLINICAL EXAMINATION
PALPATE DISTAL PULSES AND EVALUATE CAPILLARY REFILL TO ASSESS LIMB PERFUSION.
MOVE AND PALPATE ALL JOINTS TO DETECT ACUTE ARTHRITIS OR OTHER JOINT PATHOLOGY.
NEUROLOGIC EVALUATION MAY DETECT NERVE ROOT IRRITATION; SENSORY, MOTOR, AND REFLEX DEFICITS SHOULD BE NOTED
HOMANS'’ SIGN: PAIN IN THE POSTERIOR CALF OR KNEE WITH FORCED DORSIFLEXION OF THE FOOT

9. CLINICAL EXAMINATION CON.
COLOUR CHANGES
CELLULITIC
WHITE :PHALAGMESIA ALBA DOLENS
CYANOSED : PHLEGMASIA CERULIA DOLENS
SIGNS MAY BE PRESENT
MINIMAL PITTING OEDEMA
DILATED SURFACE VEINS
STIFF CALF HOMAN’ SIGN RESISTANCE TO FORCED DORSIFLEXION
FEVER
CYANOSIS, SIGNS OF RIGHT HEART FAILURE

10. Phlegmasia cerulea dolens Venous gangrene

11. D/D RUPTURED BAKER CYST CALF MUSCLE HEMATOMA RUPTURED PLANTERIS MUSCLE
THROMBOSED POPLITEAL ANEURYSM
ACUTE ARTERIAL ISCHEMIA
LYMPHOEDEMA

12. Diagnostic Studies DUPLEX ULTRASOUND
CLINICAL EXAMINATION ALONE IS ABLE TO CONFIRM ONLY 20-30% OF CASES OF DVT
D-DIMER
DUPLEX ULTRASOUND
ASCENDING VENOGRAPHY(PREVIOUS GOLD STANDARD)

13. Color duplex scan of DVT

14. PROPHYLAXIS MACHANICAL: GRADUATED ELASTIC COMPRESSION
EXTERNAL PNEUMATIC COMPRESSION
PHARMACOLOGICAL
LOW DOSE UNFRACTIONATED HEPARIN
LOW MOLECULAR WEIGHT HEPARIN

15. THROMBOPHILIA SCREENING FACTOR V LEIDEN, PROT C&S DEFICIENCY ANTITHROMBIN III DEFICIENCY
IDIOPATHIC DVT < 50 YEARS
FAMILY HISTORY OF DVT
THROMBOSIS IN AN UNUSUAL SITE
RECURRENT DVT

16. THANK YOU
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