Blood Vessel Clots

The legs contain two major groups of veins: superficial veins which lie in the fatty layer under the skin, and deep veins which lie within the calf muscles. Short veins connect these two venous groups. Thrombi in the superficial veins are harmless, but thrombi in the deep veins can break loose and lodge in small arteries in the lung (emboli) obstructing blood flow (Berkow, Beers and Fletcher, 1997, p. 141). Most of the blood from the legs returns to the lungs, so large emboli can be fatal if they obstruct all or most of the blood flowing from the right side of the heart to the lungs.

DVT causes a fatal pulmonary embolism in about two in every 1000 postoperative patients each year, and most die within 30 minutes of the acute event (Verstraete, 1997, p. 123). Approximately 50 percent to 60 percent of patients with asymptomatic proximal vein thrombosis and 30 percent of those with symptomatic calf vein thrombosis develop post-phlebitic syndrome from five to seven years later. DVT leads to the hospitalization of approximately 250,000 Americans each year (A Revolution, 1996, p. 4).

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y also be needed to diagnose DVT (Deep Vein Thrombosis, 1999, p, 406). The most effective treatment for DVT is to prevent it happening (Verstraete, 1997, p. 123). There are several things which can be done to prevent DVT: wearing elastic stockings; intermittent pneumatic compression devices which repeatedly squeeze the legs, helping the veins to empty; keeping the legs elevated when sitting or lying down; leg exercises and leg massage; walking as soon as possible after surgery; and taking anticoagulants. When anticoagulants are contraindicated in a patient with DVT, i.e. in patients with bleeding disorders, prophylaxis is limited to the non-medical methods listed above (Verstraete, 1997, p. 125). Elastic stockings reduce the risk of clotting by making the veins thinner and making the blood flow more rapidly. However, they provide only minimal protection and must be worn correctly or they may potentiate the problem (Berkow, Beers and Fletcher, 1997, p. 143). Elastic stockings should not be used in patients with severe leg ischemia (Verstraete, 1997, p. 123). Pneumatic stockings may also be used in patients who cannot take anticoagulants. They are usually made of plastic, and are inflated by an electric pump. Pneumatic
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