What is a DVT?
A blood clot in a deep vein, typically in the lower extremity
DVT is life-threatening due to the risk of pulmonary embolism (PE) if the clot travels to the lungs.
What are the classic causes of DVT according to Virchow’s Triad?
- Hypercoagulability (e.g., cancer, medications, genetics)
- Venous stasis (immobility, bed rest, long flights)
- Vein injury (trauma, surgery)
What populations are at high risk for developing DVT?
- Age > 40
- Cancer patients
- History of DVT
- Orthopedic surgery (hip/knee)
- Stroke, CHF, pregnancy, oral contraceptives
Why is a DVT considered life-threatening?
It can result in a pulmonary embolism (PE)
How does a DVT form?
Stagnant blood in immobile patients forms small clots that can grow
What are acute DVT symptoms?
- Warm, swollen leg
- Superficial venous dilation
- Positive Homan’s Sign (pain with dorsiflexion of foot)
What are the ultrasound findings for acute DVT?
- Intraluminal echoes
- Non-compressible vein
- Increased diameter
- Absent Doppler flow
What is a specific ultrasound finding that indicates an acute DVT?
Absence of Doppler flow and increased vein diameter
What is the standard treatment for DVT?
Anticoagulants for at least 3 months
What is a Free-Floating Venous Thrombus (FFVT)?
An unattached thrombus that poses a high risk for pulmonary embolism
Why is a free-floating venous thrombus (FFVT) especially dangerous?
It can easily dislodge and lead to a pulmonary embolism
What is the timeline for chronic DVT resolution?
Can take 3–6 months to resolve
What are common ultrasound findings in chronic DVT?
- Non-compressible veins
- Recanalized flow through adhesions
What is a common ultrasound finding in chronic DVT?
Recanalization with blood flow through small channels
What technique helps achieve full vein compression during ultrasound?
Placing a hand under the leg to compress from both sides
When should you avoid the compression technique during a venous ultrasound?
When a free-floating thrombus is seen in the vein
What percentage of pulmonary embolisms (PEs) come from DVTs in lower extremities or pelvis?
90%
What should be done if a PE is strongly suspected but the LE duplex is negative?
Perform a pulmonary arteriogram
What defines chronic venous insufficiency?
Weakened vein walls and damaged valves leading to blood pooling in the legs
What are the symptoms of chronic venous insufficiency?
- Hyperpigmentation
- Edema
- Ulceration
Which symptom is most commonly associated with chronic venous insufficiency?
Hyperpigmentation, edema, and ulceration
What are varicose veins?
Dilated superficial veins due to congenital wall weakness
What are the risk factors for varicose veins?
- Pregnancy
- Older age
- Female sex
- Prolonged standing
What causes reflux into the GSV?
Incompetent valves at the saphenofemoral junction
