Venous Thrombosis
Overview of Venous Thrombosis
What is deep vein thrombosis?
Signs and symptoms
What causes DVT?
DVT Risk Factors
How to reduce the risk of DVT
At a Glance
Frequently Asked Questions about Vein Treatment at the Sydney Skin and Vein Clinic
You do not need to take any time off work as all the procedures are walk-in walk-out. In general, no medical certificates can be issued for you to take time off work. For interstate patients, a certificate of attendance may be issued.
After treatment of varicose veins you may need to go for a 30 minute walk. After that you can go back to work.
The number of treatments needed to clear or improve the condition differs from patient to patient. One to six or more treatments may be necessary. The average is four treatments. After your ultrasound maps, a follow-up consultation will be organised during which the doctor will give you an estimate of the number of treatments you may need.
The degree of pain varies from person to person, depending on the person's general tolerance to pain. The injected solution stings but generally does not cause severe pain.
Each Sclerotherapy treatment session lasts up to 30 minutes, with EVLA lasting from 60-90 minutes. It is a walk-in and walk-out procedure. The treatment does not disrupt your daily routine. Weight bearing exercises are to be avoided during this period.
Most patients do not need to wear bandages but compression stockings need to be worn.
Varicose veins are unhealthy superficial (surface) veins and do not function correctly. That means that they are not doing what they are meant to do, which is to take the blood back to the heart. Once these veins are removed, your blood circulation will improve. So, in summary you do not need these veins. The blood mostly returns to the heart via the deep veins. Most people with varicose veins have healthy deep veins that function correctly. In the presence of varicose veins, deep veins have to work harder to drain the leg. By removing the varicose veins, there is less pressure on the deep vein to perform. With the duplex ultrasound we check both the superficial and deep veins.
Once treated, the veins should not come back as they are dissolved and absorbed by the body. New abnormal veins, however, may appear in time due to hormonal, hereditary and environmental factors. If new veins appear, they can be treated. We recommend a yearly ultrasound check.
In experienced hands, sclerotherapy has a very high success rate, and EVLA achieves a 96% success rate. Outcomes depend on the physician's expertise, the type and concentration of solution used, post-procedure compression and the severity of the condition, which is why it is important to be treated by a appropriately trained and experienced specialist.
Done correctly, Sclerotherapy is a very successful treatment. In our clinic more than 90% of patients are cleared or at least see a very impressive improvement. The success of the treatment depends on your age, severity of the disease, your speed of healing, your other concurrent medical conditions, and how well you follow the doctor's instructions. It is important to remember that due to genetic and hormonal factors you may develop new veins in future. These can be treated as they appear.
After treatment, small tender lumps may develop along the treated vein due to trapped blood. This is a normal part of the healing process and is not a cause for concern. Your doctor may release these at your next visit, which will relieve any associated discomfort. If you experience any pain in the meantime, please contact the clinic to arrange an appointment.
The answer is No. Only one leg gets treated at a time. We are limited by how much we can inject per session to avoid complications.
Sclerotherapy is a gradual process. While injected veins begin to break down quickly, the body takes time to absorb the dead tissue, meaning treated veins may initially look worse before they improve. It can take several months to a year for the veins to disappear completely. Any residual skin staining will also fade over time, so patience is important.
The answer is no. In most cases, varicose and larger blue reticular veins feed the spider veins. Treating spider veins without addressing these underlying feeding veins is largely ineffective and can lead to complications. For this reason, we always treat the larger veins first, which often results in the spontaneous improvement of many smaller veins. Please note that we do not treat cosmetic spider veins, only those arising from varicose veins.
The answer is No. Most people need a few sessions of micro-Sclerotherapy dedicated to treating the spider veins AFTER the treatment of varicose veins. Varicose and larger blue (reticular) veins feed spider veins, but only the spider veins which are in direct communication with them.
For example, if you have spider veins on the inside of the foot, treating your Great Saphenous vein (inner aspect of the leg) will help a lot of those go away but that will not remove spider veins on the outer aspect of the leg.
Depending on the size of the veins, either sclerotherapy or vascular laser treatment may be appropriate. The doctor will assess your individual case and discuss treatment options during your consultation.
Operations requiring general anaesthesia are likely to increase your risk of clotting in the deep veins. We recommend you postpone your vein treatment for at least a month after any major operation booked. You should discuss any operations you have had or are intending to have with your doctor.
Yes. However, if the treatment involves the legs, please ask your practitioner to contact us first.
If you are only having small blue veins treated, there are no travel restrictions. However, if you are having larger varicose veins treated, you must avoid long-distance travel, defined as any journey exceeding five hours by car, coach or plane, for four weeks before and after treatment.
For shorter trips, break your journey into one-hour segments and wear your compression stockings throughout. If travelling by car, take regular breaks to walk and stimulate blood flow. These precautions are important in preventing deep vein thrombosis. Please refer to our travel guidelines or discuss any upcoming trips with your doctor.
Walking is highly beneficial for vein health, helping the calf muscles pump blood back to the heart. We recommend 30 minutes of walking per day. Running and leg weight lifting should be avoided during treatment, though upper body stretching is fine. Please allow at least one month after completing all treatments before resuming heavy exercise such as running or weight lifting. For guidance on specific activities, speak with your doctor at your consultation.
The Oral Contraceptive Pill must be stopped before treatment. Ideally it should be stopped one month before. Female hormones have been reported to increase the possibility of complications such as thrombosis and matting. Oestrogen containing foods such as tofu, soy, flaxseed oil and chickpeas should be avoided in high quantities throughout your treatment. You can resume the oral contraceptive pill one month after the completion of the treatment. Meanwhile, you need to make sure that you do not get pregnant before the completion of treatments.
The hormone replacement therapy must be stopped before treatment. Ideally it should be stopped one month before. Female hormones have been reported to increase the possibility of complications such as thrombosis and matting. You can resume the HRT one month after the completion of the treatment. If you develop severe flushing while off hormones, discuss the issue with your GP or Gynecologist. There are alternative medications that can be used in these situations.
If you only occasionally take aspirin or anti-inflammatories (such as Nurofen, Naprosyn, Voltaren, Brufen etc) for one week prior to treatment. Also, it is advisable not to take vitamin E or use creams containing vitamin E during the treatments. This is to prevent excessive bruising. Panadol and other paracetamol are OK. If you have arthritis or other conditions for which you must take these drugs, do not stop but inform the doctor at your initial consultation.
Iron tablets and Vitamin E supplements should be stopped at least one month prior to your treatment. The excess iron stores are associated with staining of the skin in form of haemosiderin pigmentation. Even though the staining will fade in time, it is better avoided. Vitamin E and Fish Oil may cause excessive bleeding and bruising. You also should not be using creams containing Vitamin E on your legs. All Chinese herbs and supplements need to be stopped one month before your treatments. If you wish to, you can re-commence taking these one month after all your treatments are finished.
Please do not apply any creams to your legs on the day of the treatment. You can moisturize your legs on other days. Shaving is OK. Avoid using anti-bruising creams and creams containing vitamin E.
Shaving is ok but waxing should be avoided during treatments.
We strongly recommend that you do not get pregnant while having treatments. No-one has studied the effects of injections on babies so we do not know if it is safe to have treatment while pregnant. In general, it is better to treat your veins BEFORE pregnancy but if you are pregnant, you should wait till you have stopped breastfeeding and then come for another assessment of your veins.
Smoking should be avoided right throughout your treatment. Hot saunas and very hot showers should be avoided. In general, heat dilates (opens) up the veins.
Our doctors do not perform phone consultations. If you are still not clear about any aspect of your treatment, another consultation with the doctor will be organised to discuss your queries and concerns.
Diagnosing Venous Thrombosis
Duplex Ultrasound
Venography
Venography involves the injection of a dye into a large vein in the foot or ankle. An X-ray image is then taken to reveal the location of possible blood clots. Venography is one of the most accurate ways to identify deep vein thrombosis, but it may be uncomfortable. Occasionally it may cause phlebitis, an inflammation of the superficial veins. For these reasons,venography is no longer used routinely for DVT diagnosis.
Magnetic Resonance Imaging (MRI)
MRI uses a strong magnet to create a clear, high quality image of the body’s internal structures. It can be very effective in diagnosing DVT, especially in the thigh and pelvic areas. However, it is an expensive procedure and is only used in special circumstances.
Diagnosing Pulmonary Embolism
The symptoms of pulmonary embolism (PE) are not very specific, and can be present with many other conditions. Up to 75 per cent of patients suspected of having PE do not actually have this condition.
Special diagnostic tests, therefore, need to be performed. The three tests currently used to diagnose PE are pulmonary angiography, nuclear medicine lung scans and spiral CT scans.
Blood Tests
Occasionally certain blood tests, such as D-dimer, are performed to confirm the diagnosis of DVT. Once the diagnosis is established, other blood tests, such as a thrombophilia screen, may be done to look for underlying tendencies to clotting. Certain other advanced tests such as Factor Xa Clotting Time (XACT), Rotational Thromboelastometry (ROTEM) and platelet function studies (MULTIPLATE) can be done in-house at the Phlebology Research Lab.
Testing For Clotting Tendencies (Thrombophilias)
If blood clots occur in more than one family member, an inherited clotting disorder may be present. Genetic mutations such as Factor V Leiden and the prothrombin gene mutation are among the most common, and can cause defective blood clotting. Individuals who inherit a mutation from one parent (heterozygous) may experience recurrent DVT, with the risk being highest when both parents are affected (homozygous).
Other inherited causes include deficiencies in antithrombin, protein C and protein S components that ordinarily help dissolve clots. Certain genetic mutations can also elevate homocysteine levels in the blood, increasing the tendency to clot as well as the risk of stroke and heart attack.
Blood tests are available to identify these abnormalities. Medicare Australia does not cover the cost of these tests unless there is a personal history of DVT, and only covers certain tests in the case of a family history of clotting. It is worth noting that the presence of thrombophilic abnormalities does not generally change the management of DVT or significantly increase the risk of recurrence.
Specialised tests including Factor Xa Clotting Time (XACT), Rotational Thromboelastometry (ROTEM) and platelet function studies (MULTIPLATE) can be performed in-house at our Phlebology Research Lab to further assess underlying clotting tendencies.
Treating Deep Vein Thrombosis (DVT)
Once a DVT is diagnosed, treatment begins immediately to prevent the clot from extending or breaking off, and to reduce the risk of post-thrombotic syndrome. Depending on the location of the clot and the likelihood of complications, treatment may be administered at home or in hospital. Early treatment significantly reduces the risk of pulmonary embolism and improves long-term outcomes.
Heparin & Warfarin
To treat blood clots, doctors use various drugs, including anticoagulants. Standard anticoagulant medications includeheparin and warfarin. Heparin is given either through a vein (intravenously) or as an injection under the skin. Warfarin is given orally as a tablet. Heparin acts immediately, while warfarin takes several days to become effective. Both are usually started at the same time, but heparin is discontinued after warfarin becomes effective. Regular blood tests are required to monitor the effectiveness of warfarin. It is important to take warfarin as directed and to record all dosages.
Two types of heparin are available for treatment of DVT. Unfractionated heparin (UH) is given in hospital, whereas low molecular-weight heparin (LMWH) can be self-injected at home, which usually is more convenient and less expensive. LMWH has the added benefit of not usually requiring periodic blood tests to monitor its effects. An example of low-molecular-weight heparin is enoxaparine.
Contrary to popular belief, anticoagulants do not actively dissolve the clot; they prevent new clots from forming and reduce the risk of PE. In rare cases, clot dissolving (thrombolytic) agents are administered. For patients who are unable to tolerate medications, surgical removal of the clot (thrombectomy) may be performed, as well as insertion of a filter in a major vein that acts like a clot sieve. To minimise any pain, discomfort or complications associated with the treatment of a DVT, you should:
- Elevate the affected leg whenever possible
- Wear graduated compression stockings
- Avoid long periods of immobility.
How long do patients need to be treated for a DVT?
Depending on the underlying condition that caused the DVT, treatment may be needed for as little as four weeks, or for the rest of the patient’s life.
In patients with an obviously reversible cause of a DVT (for example, trauma, after orthopaedic surgery or prolonged bed rest), four to six weeks of therapy are usually adequate. The risk of a recurrent DVT in these patients is very low.
In patients with an identified cause of DVT that cannot be reversed (for example, cancer, inflammatory bowel disease or inherited conditions), therapy should continue for at least six to 12 months, and may need to be continued indefinitely.
Patients with no identifiable cause of their DVT have been shown to experience a high incidence of recurrent blood clots if they are treated for three months or less. Most physicians, therefore, recommend at least six months of anticoagulant therapy for these patients.
With treatment, the clot stabilises and attaches firmly to the wall of the vein. The risk of the clot breaking off and travelling to the lungs, therefore, decreases over time.