About Dr Paresh Pai
Dr Paresh Pai is a Senior Consultant Vascular and Endovascular Surgeon at the Breach Candy, PD Hinduja, Lilavati, Bhatia and Raheja Hospitals in Mumbai. With more than two decades of experience in the management of cerebrovascular disease, distal small vessel reconstruction in atherosclerotic and diabetic limbs, venous thromboembolic disease and endoluminal treatment of aortic aneurysms, Dr Pai is a former Treasurer and Secretary of the Vascular Society of India. He is a past Consultant Vascular Surgeon at the Westmead Hospital inSydney, Australia.
Thrombosis means blood clot. Clotting of blood is a normal process which occurs such as in times when a blood vessel gets injured. But sometimes, these blood clots occur in places where you do not want them to take place. These sites could include:
- Clot in the arteries of the heart which results in a myocardial infarction or a heart attack
- Clot in the vessels of the brain can lead to a stroke
- Clots in the lungs is called a pulmonary embolism
- Clots in the peripheral arteries in the legs, reduced blood supply in the limbs can lead to gangrene
- Clots in the veins of the abdomen
Venous thromboembolism includes a blood clot in the deep veins such as a blood clot in the vein in the leg or a clot in the arteries of the lung.
The veins carry blood back to the right side of the heart, from the right side of the heart it goes to the lungs. And the lung then acts as a filter, which is why it is called venous thromboembolism, because it groups deep vein thrombosis and pulmonary embolism together.
Deep veins thrombosis is the formation of a clot in the deep veins of the legs. The veins are in the muscles and that is why they are called deep veins, since they are situated deep inside the veins.
It commonly occurs in the leg, however, it cal occur at other places in the body as well.
Deep Vein Thrombosis is an underrated disorder in India. There used to be misnomer that DVT is not common in the Indian population, it is more common in the Caucasians, thats not really true. However, we do not have the exact numbers for the incidence of the disease in India.
Indians and Asians are just as affected as Westerners and Caucasians.
Pulmonary Thromboembolism (PTE) is a preventable cause for mortality and and morbidity.
Many times, pulmonary embolism (PE) and deep vein thrombosis is silent and can therefore be missed.
Medical patients are at as much risk as surgical patients
Prevention of DVT and PE is more important than treatment.
Unfortunately, the prophylaxis and prevention of Deep Vein Thrombosis is not adequately followed.
The treatment of DVT is inadequate, unfortunately.
Patients and surgeons perceive that cases of post operative bleeding is a surgical complication and cases of DVT/ PE is a medical problem, which is not true.
Venous thrombosis often goes undetected until it is too late.
Less than half of all cases of fatal PE are detected prior to death.
Approximated 80% of DVT is clinically silent. It is the proverbial iceberg.
Universally, a study shows, approximately 52% of people, globally are at a risk for developing PTE, of which 65% are patients in the surgical ward, about 41.5% are in the medical ward.
Patients who needed up with DVT, 45% were patients who had undergone surgery add 55% of the patients in the medical ward had ended up with DVT. The lowest use of prophylaxis was used in Bangladesh, Thailand, India and Pakistan.
PE affected also the younger patients (approximately 20%)
Deep Vein Thrombosis patients typically present with:
- Pain and swelling of the leg
- Local rise in the temperature of the foot
- Discolouration of the leg
Patients with Pulmonary Embolism can present with:
- Shortness of breath
- Chest pain
- Cough
- Blood in sputum
- Sweating
- Palpitations
- Wheezing
Pulmonary embolism occurs when a clot from the leg breaks reaches the heart, for example on movement; and lodges there blocking the blood supply, causing shortness of breath.
Approximately 50% of patients with DVT have asymptomatic Pulmonary embolism.
Risk factors include:
- Past history of blood clots
- Family history
- Clotting disorders- can be inherited or acquired
- Obesity
- Tobacco and cigarette use
- Varicose veins
- Prolonged immobility
- Surgery/ trauma
- Increased age
- Pregnancy
- Poor cardiac/ respiratory function
- Patients undergoing surgery lasting duration longer than 1 hour
The diagnosis for DVT is made by a combination of:
- Blood tests
- Clinical examination.
- A negative D dimer test exclusively rules out Depp vein thrombosis, however a positive D dimer may mislead you into a diagnosis of DVT, where it might not be there.
- Doppler ultrasound
- Venogram
Preventative measures:
- Lifestyle modifications
- Maintain a healthy body weight
- Avoid prolonged durations of inactivity
- Regular exercise
- Avoid smoking
- Maintain and control your blood pressures
- Wearing compression stockings
Goals of treatment include:
- Preventing an existing clot to get triggered
- Prevent formation of new clots
- Provide symptomatic relief
- Give cosmetic solutions
- Prevent clots from breaking and travelling into the parts
- Prevent long term complications
