1) Deep vein thrombosis (DVT) can be caused by Virchow's triad of factors that increase the likelihood of blood clots: damage to vessel walls, slowed blood flow, and increased coagulability. 2) DVT presents as either phlebothrombosis, a clot in a healthy vein, or thrombophlebitis, a clot after vein inflammation. Complications include pulmonary embolism and infection. 3) Diagnosis involves tests like Doppler ultrasound, CT scans, and blood tests. Treatment focuses on prevention with stockings and blood thinners, or surgery to remove clots.

1. DVT
Prepared by: Dr. Dounia Mammar Kebbab

2. Predisposing factors:
Virchow's triad
1. Change in vessel wall with damage of endothelial lining.
2. Venous stasis (  velocity)
3. Hypercoagulability of blood (  viscosity)

4. Pathology
 Thrombosis in a healthy vein  phlebothrombosis
 Calf venous sinuses
 Red thrombosis ( RBCs + fibrin)
 PE
Phlebothrombosis:

5.  Thrombosis after inflammation of
the vein  thrombophlebitis
 Ileofemoral veins (endothelial
damage)
 White thrombus ( Platelets+ fibrin +
WBCs)
 Non adherent Jelly like propagated
thrombus
 Red tail  PE
Thrombophlebitis:

7. Sequelae:
 Locally:
• Organization of thrombus by fibrous tissue.
• Recanalization.
• Calcification  phlebolith.
• Infection  abscess.

8.  Distally:
• Oedema and 2ry V.V
 Proximally:
• Aseptic embolism (Phlebothrombosis)  pulmonary embolism
• Septic embolism (thrombophlebitis)  pyaemia and lung abscess

9. C/P:
Silent cases to classic pictures
1. Asymptomatic group:
Unexplained fever and TC. Later: pulmonary
embolism or post phlebitis limb may manifest.
2. Symptomatic group: classic triad:
 Pain:  muscle exercise.
 Tenderness: Homan’s sign.
 Swellin:

11. Complications:
Phlegmasia cerulea dolens Phlegmasia alba dolens

12.  Venous gangrene

13.  Pulmonary embolism
 Late cpc:
 2ry V.V
 CVI.

14. Investigations
 Doppler U/S
 Dupplex U/S
 Ascending venography
 Enhanced helical CT
 I 125 fibrinogen uptake
 Plethysmography
 Venous manometry
 laboratory

15. DDx:
Swollen paiful calf:
1. Contusion of calf muscle.
2. Calf hematoma.
3. Ruptured plantaris tendon.
4. Reuptured packer’s cyst.
Swollen lower limb.

16. TTT
 Prophylaxis = prevention of postoperative DVT
Graduated elastic stocking Intermittent pneumatic compression

17. Curative TTT:
1.Bed rest with leg elevation and elastic stocking.
2.Anticoagulant therapy : Heparin, warfarin.
3.Fibrinolytic therapy.
4.Surgical TTT:
Venous thrombectomy.
IVC interruption.

18. Merci!