Vascular Medicine 2014, Vol. 19(2) 148–150 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1358863X14529007 vmj.sagepub.com What is venous thromboembolism? There are three types of blood vessels: arteries, veins, and lymphatics. Veins are the blood vessels that return blood from the arms, legs, and organs to the heart. Deep vein thrombosis (often called ‘DVT’) and pulmonary embolism (often called ‘PE’) are the most common types of venous thromboembolism. A thrombus is a blood clot and an embo- lism is a clot that has traveled through the bloodstream and has become stuck in another blood vessel. DVT occurs when blood clots form in the veins. Blood may form clots when blood flow is sluggish, when the walls of the veins are injured or damaged, or when the blood itself is more prone to clot due to inherited or other factors (known as ‘hypercoagulable states’). PE occurs when blood clots that form in the legs travel through the circulation and lodge in the blood vessels of the lungs. When this happens, the lungs are less effective at getting oxygen from the air into the bloodstream, which can lead to symptoms such as shortness of breath and, in severe cases, loss of consciousness or collapse. Who is at risk? Venous thromboembolism is the third leading cause of car- diovascular death, behind heart attack and stroke, occur- ring in about one to two per 1000 people. Venous thromboembolism occurs most frequently in patients who have had recent surgery – especially orthopedic surgery such as hip or knee replacement – trauma, or medical ill- ness that leads to hospitalization for more than 3 days. Other risk factors for venous thromboembolism include smoking, cancer, pregnancy, oral contraceptive or hor- mone replacement use, being overweight, and older age. Venous thromboembolism is uncommon in people younger than age 40 years, and it is much more frequent among people older than age 70. Among younger people, it is more common in women; among older people, it is more common in men. Some cases may be caused by acquired or inherited conditions that predispose people to blood clot formation (hypercoagulable states). In some patients, no cause is ever identified, and these patients tend to be at much higher risk for having another venous thromboem- bolism if left untreated. What are the signs and symptoms? The most common signs and symptoms of venous throm- boembolism are shown in Table 1. In DVT, patients may notice that one leg becomes swollen, tight, and painful. The affected leg may be red and warm. DVT seldom occurs in the arm unless the patient has a central intravenous line such as those used for chemotherapy or antibiotics. In PE, most patients complain of shortness of breath, and they may have chest pain that is typically described as worse while taking a deep breath. Patients may have a rapid heart- beat and breathing rate, and in severe cases the blood pressure might be quite low. In the most severe cases, patients may lose consciousness and collapse. Occasionally, patients with DVT or PE have no symptoms, and the blood clot is identi- fied when an imaging test is performed for another reason. How is it diagnosed? DVT is usually diagnosed using vascular ultrasound, a non- invasive test that uses sound waves to look at the blood vessels in the leg. During the examination, an ultrasound technologist presses on the deep veins of the legs with the ultrasound probe to collapse or compress the veins, which Vascular Disease Patient Information Page: Venous Thromboembolism (deep vein thrombosis and pulmonary embolism) Natalie S Evans 1 and Elizabeth V Ratchford 2 Keywords deep vein thrombosis, pulmonary embolism, venous thromboembolism 1 Section of Vascular Medicine, Cleveland Clinic, Cleveland, OH, USA 2 Johns Hopkins Center for Vascular Medicine, Baltimore, MD, USA Corresponding author: Natalie S Evans Section of Vascular Medicine Cleveland Clinic 9500 Euclid Ave. J3-5 Cleveland, OH 44195 USA Email: [email protected] 529007 VMJ 0010.1177/1358863X14529007Vascular MedicineEvans and Ratchford research-article 2014 Vascular Disease Patient Information Page
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