This document provides tips and instructions for using a PowerPoint presentation on deep vein thrombosis (DVT). It recommends showing blank slides with the title and asking students what they know about each topic before providing the content. This active learning approach should be repeated for revisions. The presentation covers DVT etiology, pathophysiology, clinical features, investigations, management, prevention, and other key areas. Students can also use it for self-study. Bibliographic references are included in the notes.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Learning Objectives

3. Learning Objectives
1. Introduction & History
2. Relevant Anatomy, Physiology
3. Aetiology
4. Pathophysiology
5. Pathology
6. Classification
7. Clinical Features
8. Investigations
9. Management
10. Prevention
11. Guidelines
12. Take home messages

4. Introduction & History.
•

5. Introduction
What is DVT ?

6. Introduction
• Deep vein thrombosis is the
formation of a blood clot in
one of the deep veins of the
body, usually in the leg.

7. • What is clot / thrombus/ embolus

8. Introduction
• Thrombus is a clot that
forms inside blood vessel or
heart.
• A thrombus that breaks
loose and travels from one
location in the body to
another is called an embolus.

9. Aetiology

10. Aetiology
• Idiopathic
• Congenital/ Genetic
• Nutritional Deficiency/excess
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative / lifestyle
• Iatrogenic
• Psychosomatic
• Poisoning/ Toxins/ Drug induced

11. Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative

12. Etiology
Virchows Triad
1. Venous Stasis
2. Hypercoaguability of blood
3. Endothelial damage

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

14. Hypercoagulability
 Surgery and trauma -
 Malignancy
 increased estrogen
 Inherited disorders of coagulation -
 Acquired disorders of coagulation- Nephrotic
syndrome, Anti-phospholipid antibodies


15. Endothelial Injury
 Trauma
 Surgery
 Invasive procedure
 Iatrogenic causes –
central venous catheters
 Subclavian
 Internal jugular lines
These lines cause of upper extremity DVT.

16. Aetiology of Aetiology
•

17. Aetiology of Aetiology
• Idiopathic
• Congenital/ Genetic
• Nutritional Deficiency/excess
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative / lifestyle
• Iatrogenic
• Psychosomatic
• Poisoning/ Toxins/ Drug induced

18. Pathophysiology

19. Pathophysiology
• Vessel trauma stimulates the clotting
cascade.
• Platelets aggregate at the site
particularly when venous stasis present
• Platelets and fibrin form the initial clot
• RBC are trapped in the fibrin meshwork

20. Pathophysiology
• The thrombus propagates in the direction of
the blood flow.
• Inflammation is triggered, causing
tenderness, swelling, and erythema.
• Pieces of thrombus may break loose and
travel through circulation- emboli.
• Fibroblasts eventually invade the thrombus,
scarring vein wall and destroying valves.
Patency may be restored valve damage is
permanent, affecting directional flow.

21. Clinical Features
•

22. Clinical features
Phlegmasia cerulea
dolens
 leg is cyanotic from
massive ileofemoral
venous obstruction.
 The leg is usually
markedly edematous,
painful, and cyanotic.
Petechiae are often
present.
Phlegmasia alba dolens
 Painful white
inflammation was
originally used to describe
massive ileofemoral
venous thrombosis and
associated arterial spasm.
The affected extremity is
often pale with poor or
even absent distal pulses

23. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

24. Demography

25. Demography
• DVTs occur in about 1 per 1000 persons per
year.
• 300,000 deaths may be directly or indirectly
related to these diseases in us.
• In pregnant women, it has an incidence of
0.5 to 7 per 1,000 pregnancies, and is the
second most common cause of maternal
death in developed countries after bleeding
• Less common in asians
• Slightly more in males

26. Symptoms

27. Symptoms
• Asymptomatic
• Edema - Most specific symptom
• Leg pain - Occurs in 50% of patients but is
nonspecific
• Tenderness - Occurs in 75% of patients
• Warmth or erythema of the skin over the
area of thrombosis
• Clinical symptoms of pulmonary embolism
(PE) as the primary manifestation

28. Signs

29. Signs
• Calf pain on dorsiflexion of the foot
(Homans sign)
• A palpable, indurated, cordlike, tender
subcutaneous venous segment
• Variable discoloration of the lower
extremity
• Blanched appearance of the leg because of
edema (relatively rare)

30. Complications

31. Complications
• As many as 40% of patients have silent PE
when symptomatic DVT is diagnosed .
• Paradoxic emboli (rare)
• Recurrent DVT
• Postthrombotic syndrome (PTS)

32. Investigations

33. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology
– Germ line Testing and Molecular Analysis
• Diagnostic Laparotomy.

34. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histlogy

35. Laboratory Studies
• D-dimer testing
• Coagulation studies (eg, prothrombin time
and activated partial thromboplastin time) to
evaluate for a hypercoagulable state

36. Diagnostic Studies
Imaging Studies

37. Diagnostic Studies
Imaging Studies
• X-Ray – Venography
• USG Duplex
• CT/ CT venogram
• Angiography
• MRI
• Endoscopy Venoscopy
• Nuclear scan Radiolabeled fibrinogen

38. Differential Diagnosis

39. Differential Diagnosis
• Cellulitis, lymphangitis
• Lymphedema
• Postphlebitic syndrome
• Ruptured Baker cyst
• Varicose veins
• Superfical thrombophlibitis
• CCF

40. Management

41. Management
• Anticoagulation (mainstay of therapy) -
Heparins, warfarin, factor Xa inhibitors, and
various emerging anticoagulants
• Pharmacologic thrombolysis
• Endovascular and surgical interventions
• Physical measures (eg, elastic compression
stockings and ambulation)

42. Minimally invasive Therapy

43. Minimally invasive Therapy
Endovascular therapy
• Thrombus removal with catheter-directed
thrombolysis
• Mechanical thrombectomy
• Stenting of venous obstructions

44. Prevention

45. Prevention
• Screening
• Risk reduction

46. Prevention
Prophylaxis
Mechanical / Pharmacological
• Mechanical
• Graded compression stockings
• Intermittent pneumatic leg compression
• Early mobilisation
• Pharmacological
• Heparin

47. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

48. Get this ppt in mobile

49. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
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