This document discusses deep vein thrombosis (DVT), including its causes, risk factors, diagnosis, and treatment. It notes that DVT occurs when blood clots form in the deep veins, most commonly in the legs. It describes Virchow's triad, the three factors that contribute to DVT risk: venous stasis, hypercoagulability, and endothelial injury. Common signs of DVT include calf pain and swelling; diagnosis involves tests like ultrasound, MRI, or blood tests. Treatment aims to prevent clots from growing (prophylaxis) such as with blood thinners, compression stockings, or devices, as well as definitive treatments like continued anticoagulation or thrombolysis for severe cases.

1. Mr. Adeel Abbas

2. Anatomy
Superficial Venous System.
Deep Venous System.
Perforating Venous System.

3. Deep Venous System

4. Venous Insufficiency
Congenital.
Primary/Familial.
Secondary.

5. Varicose Veins
Abnormally Dilated, Tortuous, Prominent veins.
Common in Female Adults.
Duplex Ultrasound is Investigation of Choice.
Treatment help relieve symptoms, prevent or manage
complications & improve cosmetic appearance.
Treatment Conservative & Surgical.

6. Deep Venous Thrombosis

7. DEEP VENOUS THROMBOSIS
Blood in the Deep Veins Clots.
Affects Deep Veins of Legs & Pelvis.
Can Occur in Upper Limbs.
Major Cause of Morbidity & Mortality in
Hospitalized Patients.
Embolization of Thrombus Results Pulmonary
Embolus.
Local Venous Damage Leads to Chronic Venous
Insufficiency/Post-Phlebitic Syndrome.

11. Risk Factors;
Age > 65.
Malignancy.
Increased BMI.
Pregnancy.
Prolonged Immobilization.
Tobacco Use,
Prior DVT.

12. Virchow‘s Triad

13. Venous Stasis:
Site of Initiation Soleal Sinuses.
Endothelial Cellular Layer Contacting Activated
Platelates & Procoagulants(Tissue Factors)  DVT.

14. Venous Stasis occurs in;
Immobility.
Long Operation.
Obesity.
Heart Failure.
Trauma.

15. Hyper-Coagulable State:
Protien C & S Deficiency.
Factor V Mutation.
Prothrombin Gene Mutation.
AntiThrombin III Deficiency.
AntiPhospholipid Syndrome.
Homocysteinemia.
Lupus Antibody.
Anticardiolipin Antibody.

16. Hypercoagulable State occurs in;
Polycythaemia.
Thrombocythaemia.
Leukemia.
Sepsis.
Major Trauma.
Diabetes.
Pregnancy.
Smoking.
Malignancy.

17. Venous Injury:
Venous Thrombosis Occurs at Distant Site From
Operation.
Microtears Develop within Valve Cusps  Exposure of
Subendothelial Matrix.
Mechanism NOT KNOWN.

18. Venous Injury occurs in;
Trauma.
I/v Cannula.
Inflammation.
Infection.

19. Diagnosis
Under-Diagnosed Threat.
Asymptomatic (50%).
Calf Tenderness/Ache.
Pedal Edema.
Mild Pyrexia/Red.

20. Varicose Veins.
Venous Ulceration.
Diagnosis (cont)

21. Homan’s Sign

22. Investigations
D-Dimer (Byproduct of Fibrinolysis);
95% Sensitive.
Duplex Ultrasound;
Gold Standard.
Excellent for Femoral/Popliteal DVT.
MRI  Accurate for Calf & Iliac DVT.
Venography / Phlethysmography.
CT Venography  IF Ilio-Femoral DVT.

23. Management
Prophylaxis Against DVT.
Definitive Treatment.

24. Prophylaxis Against DVT;
Mechanical Compression:
 TED Stockings.
 Intermittent Pneumatic Compression Devices.

25. Prophylaxis Against DVT; (cont)
Pharmacological:
 LMWH.
 Unfractioned Heparin.
 Warfarin.

26. Definitive Treatment;
AntiCoagulation:
 For 12 weeks.
 Start with LMWH.
 Maintain with Warfarin  Pregnancy??
TED Stockings:
 For 2 years.
Thrombolysis:
 for Ilio-Femoral DVT.

27. Outcome of DVT:
Resolution.
Recurrent DVT.
P.E.
Chronic Venous Insufficiency.

28. Pulmonary Embolism Features;
Dyspnoea ± Pleuritic Chest Pain.
Tachycardia & Tachypnoea.
Cough ± Haemoptysis / Fever.
Massive P.E  Circulatory Colapse.

29. Investigation for Pulmonary Embolism;
Pulmonary Angiography  Gold Standard.
CTA or V/Q Scanning  Diagnostic.
ECG.
D-dimer.
CXR.
ABGs (HyperVent).

30. Treatment for Pulmonary Embolism;
Emergency Treatment:
 O2 Therapy.
 Fibrinolysis.
 Heparin.
 Pulmonary Embolectomy.
Later Management:
 Anticoagulation for 6 months.
 TED Stockings.
 IVC Filters.

31. SEQ
71 yrs old female comes with H/o sore ulcerated area
above her medial ankle in her left leg, local eczema,
and discomfort. Maintaining regular exercise. She has
past H/o DVT in her right leg following long flight 10
yrs ago. She is not on any medication.
What is the Diangnosis?
Define Virchow’s Triad?
What treatment option are available?

32. Tricky Q & A
Where does DVT originate?
Is DVT more common in the Right or Left Iliac Vein?
On Which Day Post-Operatively DVT/PE causes
Fever?
What is the usual source of a
Pulmonary Embolus?
Whats Saddle Embolus?

33. Thank You…!