In April I had a blood clot in my thigh, behind my knee and in my calf. I had another really bad calf cramp, so my doctor sent me for another doppler, which showed I had developed another clot in my calf. He said that I would have swelling for life. Is he right?
He may be right - IF you are not a candidate for valve repair surgery. Compression stockings can help control the swelling,
Published on Jul 11, 2012
Are you taking any blood thinners? Normally blood clots can be treated with medications and other treatments if necessary. But clots in the legs will cause swelling and as long as there is clot, there will be swelling.
Published on Jul 11, 2012
Not necessarily. Post-thrombotic syndrome (PTS) develops in 20-50% of patients who have a deep vein thrombosis in the leg. It takes months to years to develop after the initial clotting episode and manifests as swelling, discomfort, and a brown pigmentation of the skin especially near the ankle or lower calf. PTS rarely develops after an isolated clotting of the veins of the calf. It usually develops after extensive clotting in the iliac veins in the pelvis that drain the venous blood from the leg or in the larger veins of the thigh or at the knee (femoral or popliteal veins). The most important predictor of development of PTS is residual clot or obstruction from the clot in the ilaic vein in the pelvis after the first several months of anticoagulation treatment.
In my view, all patients who have had clotting in the veins of the thigh or knee in the remote past who have leg swelling, pain, or abnormal skin changes should have a thorough duplex ultrasound of the veins of the leg AND of the pelvic and abdominal veins to determine whether there is residual obstruction in these veins or if the patient also has venous insufficiency due to failure of valves in the veins of the leg. The ultrasound studies need to be performed by a laboratory or vein center which is serious about high quality evaluation of venous disorders and usually should not be done outside of a vein center.
Routine daily use of elastic compression stockings and weight loss (if overweight) are very important components of managing this problem. Most patients who have had two episodes of DVT should be on lifelong anticoagulation to reduce the likelihood of recurrent DVT. If a significant obstructive change is found in the iliac vein or in the femoral vein in the upper thigh, balloon venoplasty and stenting often will dramatically improve the leg symptoms. If substantial venous insufficiency is found in the superfical veins of the leg such a the saphenous vein, some pateints will benefit from treating the venous insufficiency. It is important to be sure that any treatment for venous insufficiency does not block venous outflow around the obstructed veins often found deep within the thigh.
The discussion above should make it obvious that you need to be sure you are seeing a physician with considerable sophistication in managing complicated venous disease.
Published on Jul 11, 2012
You seem to have had an extensive DVT. The more involved the DVT, the greater the chance of long term swelling. However, over time, and it could take 12 to 18 months, the clotted veins can recanalize or even have the clots resolve, which could lead to a relatively normal appearing leg. Fewer clots tend to revert to normal, whereas extensive ones lead to long term problems called chronic venous insufficiency.
Published on Jul 11, 2012
Unfortunately, you may indeed have swelling in the affected leg for most of your remaining life. DVT and deep vein insufficiency after DVT is difficult to treat with anything other than elevation, compression hose and
ambulation (exercise). Make sure they also perform a full venous insufficiency study of your legs to make sure you do not have any component of superficial and thus, treatable venous insufficiency.
Published on Jul 11, 2012
Your doctor maybe right. However, exercise and use of compression hose can help. Over time the clots dissolve. Swelling can persist after this if there is significant damage to the valves in the veins.
Published on Jul 11, 2012
Deep vein clots require each of the following:
1) An accurate diagnosis regarding why you developed a clot;
2) Anti-coagulation for a minimum of 3 months of uncomplicated;
3) Therapeutic compression therapy. In this instance 30-40 mmHg thigh, panty, or capri/calf high combination.
4) Walking 10,000 steps per day.
Understanding why you developed the clot is how you may learn to prevent another clot. There are clotting disorders that leave you predisposed and each carries individual risk. Anticoagulation guidelines for uncomplicated deep vein clots are well established. The anticoagulation should be therapeutic, and it is my belief that before your anticoagulation is discontinued, a D-Dimer should be ordered to assess for any ongoing clotting activity. Starting anticoagulation is easy, but stopping in my opinion requires finesse. If there is ongoing clotting activity, another three months of anticoagulation is indicated. If the d-Dimer is negative, anticoagulation may be discontinued and the blood test repeated in one month.Compression is critical in reducing your risk of having a swollen leg for the remainder of your life. In addition to reducing swelling, it has been shown to lessen the risk for the condition known as post-thrombotic syndrome (painful, swollen, and often ulcerated limb).Walking is simply a healthy thing to do and helps to lessen vein pressure that leads to swelling. Connecting with an experienced vein specialist is indicated to help guide you through your recovery and to help you should additional problems develop. In summary, compression and walking are your friends. Each is imperative in your healing and to prevent the concern about 'swelling for life.' I am hopeful this helps provide you some direction.
Published on Jul 11, 2012