Tests, Investigations and Treatments for DVT, Superficial Thrombophlebitis and post-phlebitic limb

A painful, swollen leg is the commonest presentation of a deep vein thrombosis (DVT). However, many other things can cause painful swollen legs and also some DVTs can be present without pain, or without swelling.

Therefore, before we think about the treatment of DVT, we have to make sure that we are treating a deep vein thrombosis and nothing else instead.

TESTS and INVESTIGATIONS

Blood tests for DVT

There are some blood tests that are used in accident and emergency departments for screening for deep vein thrombosis (DVT). These rely on picking up the biochemical markers of clotting somewhere inside the circulatory system.

An argument can (and has) been made for these tests as a screening test to put people into a ‘high risk’ or ‘low risk’ category of having a DVT. This is useful in a public service that has a lot of people to see and where costs have to be contained.

However, these are not highly accurate and so for an individual who wants to have the optimal treatment, there is really no place for them.

Infrared or Thermal imaging cameras or devices

In the past, some people used heat imaging cameras or techniques. Very few units now use these as they are not highly accurate or useful.

Duplex Ultrasound scan

The best test currently available for diagnosing deep vein thrombosis (DVT) is using a colour flow duplex ultrasound performed by an experienced expert. There are several different sorts of colour flow duplex ultrasound and, to be able to diagnose small deep vein thromboses in the calf, a very high resolution machine is required to be operated by someone who is expert in scanning veins.

At The Whiteley Clinic we insist on the very best equipment and train our own vascular technologists to make sure that they reach the exacting standards that we insist upon.

TREATMENT

Deep Vein Thrombosis - DVT

The usual treatment for deep vein thrombosis is to thin the blood using anticoagulants.

This usually entails injections of heparin which act immediately, whilst oral warfarin is started and stabilised. Warfarin combats the vitamin K in the body which is used for blood clotting. It is usually started by giving a loading dose for three days and then using blood tests to stabilise the right dose over the next few days to weeks.

The correct level is obtained by measuring the clotting time by a regular blood test - the "INR" (International Normalised Ratio). For DVT this should be kept about 2.0 - 3.5 x normal clotting - in other words, the time for the blood to clot should be 2.0 - 3.5 times longer than it would normally clot in that person.

The body is able to break down most clots by itself and so the heparin followed by the warfarin is merely there to stop any more clot forming whilst the body breaks down the deep vein thrombosis (DVT) that is already there.

Traditionally, doctors have kept the warfarin going for three to six months. However, we now rescan the leg to make sure the blood is flowing, before deciding whether the warfarin can be stopped or not.

Very rarely, if there is a massive deep vein thrombosis which is a risk of either blocking the veins completely or breaking off and going up through the system to the lungs (a pulmonary embolism), then either a clot busting injection called thrombolysis can be used to break down the clot, or a filter can be put into the veins to catch the clot if it breaks off.

Superficial Thrombophlebitis (Phlebitis)

Clots in the superficial veins are painful and will be locally inflamed and lumpy. Once the diagnosis has been confirmed, treatment is usually non-steriodal anti-inflammatory drugs, such as Aspirin, for those who can tolerate them.

Antibiotics are NOT needed as the inflammation is due to the clot in the vein and NOT infection.

In severe cases, the clot can be removed under local anaesthetic, reducing the pain, speeding up the recovery and improving the end cosmetic result. In the longer term, the underlying cause needs to be treated - usually varicose veins.

Post-Phlebitic Limb

Treatment of the post-phlebitic limb can be a very complex and demanding process - often requiring considerable time and expense.

Fortunately, most people who consult us having been told elsewhere that they have "complex veins" or a "post-phlebitic limb" actually turn out to have less severe and more easily treatable conditions once we have performed our specialised scans.

Those rare people who do have complex post-phlebitic limb are given a full diagnosis and explanation, and a full option of possible treatments are discussed. As these are many and varied, they cannot be easily summarised here.