Deep Vein Thrombosis and Pulmonary Embolism

Deep vein thrombosis (DVT) refers to the development of blood clots in the deep leg veins, which is where most venous (of the vein) clots occur. Pulmonary embolism (PE) occurs when clots break off from vein walls and travel through the heart to the pulmonary arteries. An estimated 250,000 to 2 million cases of DVT and/or PE are diagnosed in the United States each year, and PE accounts for up to 18,000 deaths each year. These deaths, however, are largely preventable.

Cardiovascular specialists from the Brigham and Women’s Hospital (BWH) Division of Cardiovascular Medicine and the Division of Vascular Surgeryoffer collaborative and comprehensive clinical services to adults with DVT or PE. Part of the Brigham and Women’s Hospital (BWH) Heart & Vascular Center, their services include a broad range of innovative diagnostics and leading-edge medical, interventional and surgical therapies such as magnetic resonance venography (MRV), pulmonary angiography, inferior vena cava (IVC) filterimplantation, and thrombectomy. Our physicians also focus on educating patients about what they can do to help prevent DVT and PE.

Read this article in BWH’s HealthHub Blog, Deep Vein Thrombosis: A Silent and Life-Threatening Condition

Deep Vein Thrombosis and Pulmonary Embolism Topics

Risk Factors for Deep Vein Thrombosis and Pulmonary Embolism

Risk factors for developing deep vein thrombosis and pulmonary embolism may include one or more of the following:

  • Genetic conditions associated with an increased risk of blood clot formation
  • Surgery or other trauma, particularly to the legs
  • Long periods of limited mobility, including extended bed rest or long plane (or other vehicle) trips
  • History of clots
  • Aging
  • Cancer and cancer therapy
  • Certain medical conditions, including heart failure, chronic obstructive pulmonary disease, high blood pressure, stroke, and inflammatory bowel disease  
  • Certain medications, such as birth control pills and hormone replacement therapy
  • Pregnancy (during and after)
  • Obesity
  • Varicose veins
  • Smoking tobacco
Symptoms of Deep Vein Thrombosis and Pulmonary Embolism

Deep vein thrombosis occurs without any symptoms in about 50 percent of cases. When they do occur, they may include one or more of the following:

  • Leg swelling
  • Red or white skin
  • Rapid heartbeat (tachycardia)
  • Mild fever
  • Warm skin
  • Visible surface veins
  • Pain, tenderness, or tightness in leg, particularly while walking or standing

Common symptoms of pulmonary embolism include:

  • Sudden shortness of breath (most common)
  • Chest pain, particularly while breathing
  • Anxiety
  • Dizziness, lightheadedness, or fainting
  • Palpitations (feeling that heart is beating too hard or too fast)
  • Coughing up blood
  • Sweating
  • Low blood pressure
  • Symptoms associated with DVT (above)

Symptoms of DVT or PE may resemble other medical conditions and problems. Always consult a doctor for a diagnosis.

Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism

Our deep vein thrombosis and pulmonary embolism specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. In order to diagnose and determine treatment for DVT, a complete medical history, a thorough physical exam, and one or more of the following specialized diagnostic tests will be provided.

Deep Vein Thrombosis and Pulmonary Embolism Treatment

Our cardiovascular specialists develop individualized treatment plans for patients based on:

  • Age
  • Overall health
  • Medical history
  • Severity and form of the disease
  • Tolerance for specific medications or procedures
  • Expectations for course of the disease
  • Presence of other conditions

DVT and PE can be treated with medications or removed via a minimally-invasive catheter procedure or surgery, including:

Medication

Procedures and Surgery

  • Inferior vena cava (IVC) filter To prevent blood clots from traveling from the legs to the heart or lungs, doctors will occasionally recommend that a filter be positioned in the vein that returns blood to the heart from the lower body. This vein is the inferior vena cava (IVC). During the procedure, a small plastic tube (catheter) is positioned into the IVC via the blood vessels of the groin or neck. The filter is a metal basket that is positioned in the IVC and can remain in place permanently or, if necessary, removed at a later date.
  • Thrombectomy For cases of a recent pulmonary embolism that is causing problems for the pumping of the heart, the blood clot in the pulmonary artery can be removed with special devices that break up the clot and extract it through the catheter. Occasionally, heart surgery is needed to treat very large clots.

Other Treatments

  • Compression stockings provide pressure to the legs which helps prevent swelling.
  • We also focus on educating patients about what they can do help prevent DVT and PE, including: losing weight, quitting smoking, avoiding long periods of immobility, controlling high blood pressure, and wearing compression devices.
What You Can Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of surgery, you care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with DVT or a pulmonary embolism. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Multidisciplinary Care

Patients benefit from the teamwork of medical cardiologists, interventional cardiologists, vascular and endovascular surgeons, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in DVT and PE. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about deep vein thrombosis and pulmonary embolism in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.

Visit the Brigham and Women’s Hospital HealthHub Blog, which features information on a variety of topics, including heart disease.

Learn more about the North American Thrombosis Forum

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