cardiovascular disorders
Deep Venous Thrombosis (DVT)
Pathophysiology of Deep Venous Thrombosis
Lower extremity DVTmost often results from Impaired venous return (eg, in immobilized patients) Endothelial injury or dysfunction (eg, after leg fractures) Hypercoagulability Upper extremity DVTmost often results from Endothelial injury due to central venous catheters, pacemakers, or injection drug use Upper extremity DVT occasionally occurs as part of superior vena cava (SVC) syndrome (compression or invasion of the superior vena cava by a tumor and causing symptoms such as facial swelling, dilated neck veins, and facial flushing) or results from a hypercoagulable state or subclavian vein compression at the thoracic outlet ( Pathophysiology reference ). The compression may be due to a normal or an accessory first rib or fibrous band ( Deep venous thrombosis usually begins in venous valve cusps. Thrombi consist ofthrombin, fibrin, and red blood cells with relatively few platelets (red thrombi); without treatment, thrombi may propagate proximally or travel to the lungs. Common complications of DVT include Chronic Venous Insufficiency and Post-Thrombotic Syndrome None Chronic Venous Insufficiency and Post-Thrombotic Syndrome None Pulmonary Embolism (PE) None Much less commonly, acute massive DVT lead to phlegmasia alba dolens or phlegmasia cerulea dolens, both of which, unless promptly diagnosed and treated, can result in venous gangrene. Inphlegmasia alba dolens,a rare complication of DVT during pregnancy, the leg turns milky white. Pathophysiology is unclear, but edema may increase soft-tissue pressure beyond capillary perfusion pressures, resulting in tissue ischemia and venous gangrene. Phlegmasia alba dolens may progress to phlegmasia cerulea dolens. Inphlegmasia cerulea dolens,massive iliofemoral venous thrombosis causes near-total venous occlusion; the leg becomes ischemic, extremely painful, and cyanotic. Pathophysiology may involve complete stasis of venous and arterial blood flow in the lower extremity because venous return is occluded or massive edema cuts off arterial blood flow. Venous gangrene may result. Infectionrarely develops in venous clots. Jugular vein suppurative thrombophlebitis (Lemierre syndrome), a bacterial (usually anaerobic) infection of the internal jugular vein and surrounding soft tissues, may follow tonsillopharyngitis and is often complicated by bacteremia and sepsis. In septic pelvic thrombophlebitis, pelvic thromboses develop postpartum and become infected, causing intermittent fever. Suppurative (septic) thrombophlebitis, a bacterial infection of a superficial peripheral vein, comprises infection and clotting and usually is caused by venous catheterization. 1.Bosch FTM, Nisio MD, Büller HR, van Es N. Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis.J Clin Med2020;9(7):2069. doi:10.3390/jcm9072069 