Venous thromboembolic complications (VTE) is a term that encompasses three acute vascular pathologies characterized by the formation of blood clots. These conditions include acute thrombophlebitis or varicothrombophlebitis (TP or VTP), deep vein thrombosis or acute venous thrombosis (DVT), and pulmonary embolism (PE). These diseases, which affect the venous system, are highly dangerous and are distinguished by a wide range of manifestations and severe malignant progression. Their social and economic significance is due to fatal complications, the development of severe chronic post-thrombotic disease after thrombosis, frequent disability, and high mortality, including hospital mortality.
Historical Background
The study of deep vein thrombosis spans over 400 years. The first mention of phlebothrombosis appeared in medical literature 300 years ago. Special interest in DVT emerged after the development of the theory of venous thromboembolism, when the classic triad of causes for thrombus formation was formulated: increased blood clotting, damage to the inner vessel wall, and slowed blood flow. These components remain relevant today.
Subsequent research focused on understanding the body’s response to thrombosis, the factors influencing thrombus spread, and systemic changes caused by the thrombotic process, particularly in the coagulation system and affected vessels. In recent years, global progress has been achieved in diagnostics (modern ultrasound and spiral CT), the development of new, more effective, safer, and patient-friendly drugs for treatment and prevention, the creation of clear treatment standards, and radically improved approaches to management and therapy.
Main Risk Factor
The primary risk factor for VTE is varicose veins of the lower extremities (VVLE). In this disease, dilated veins in the legs accumulate excess blood. Blood flow slows significantly, leading to thrombus formation in superficial veins. Severe varicose changes create abnormal connections between superficial and deep veins, allowing clots to migrate first into perforating veins, then into deep veins. DVT is more dangerous, and upward migration of thrombi toward the heart may cause the most life-threatening complication—pulmonary embolism.
Thrombophlebitis
Thrombophlebitis is a disease where clots form in superficial veins. It usually develops after trauma, hypothermia or overheating, as well as due to certain blood diseases (thrombophilia), infections (erysipelas), hormonal disorders, or abrupt coagulation abnormalities (medications). Most often, clots form in varicose veins—this condition is called varicothrombophlebitis.
Symptoms: sudden appearance of a dense cord along normal or varicose veins, painful and warm to touch, with bright red skin above it. Thrombophlebitis always involves strong inflammation of surrounding tissues. The most common symptom is leg swelling, sometimes accompanied by fever. Clots usually appear in the lower leg but can spread upward to the thigh, causing ascending thrombophlebitis—an aggressive process with high risk of migration into deep veins and the heart. This requires urgent surgery.
Local thrombophlebitis (small area involvement) may be treated conservatively with elastic compression, medication, and local therapy. However, any thrombotic process remains unpredictable and dangerous, with risks of new clots in the heart or brain. Even after improvement, the process may recur.
Therefore, thrombophlebitis is an indication for surgical removal of affected veins with thrombi. These operations are technically complex and traumatic, with long rehabilitation. Specialists emphasize timely removal of varicose veins at early stages, when modern minimally invasive outpatient surgical methods can be applied.
Diagnosis: usually clinical, supported by ultrasound to determine thrombus location, its spread to deep veins, and to plan surgery.
Our Advantages
- Extensive experience in vascular surgery and venous pathology at all stages
- Full cycle of vascular care: from diagnostics to supportive treatment
- Personalized selection of surgical techniques
- Reconstructive artery operations with preservation of natural flow
- Minimally invasive procedures with short hospital stay
- Ambulatory treatment of varicose veins in elderly patients with fast recovery
- “All-in-one” surgical interventions for varicose disease
- Comprehensive care programs for arterial pathology and lymphedema
- Comfortable hospital conditions and highly professional, attentive staff
Phlebothrombosis (Deep Vein Thrombosis)
When thrombi form in deep veins, acute phlebothrombosis develops—a severe, life-threatening condition requiring urgent treatment. It carries the highest risk of thrombus detachment, migration into the heart, and death.
Causes: spontaneous (long flights, immobility) in elderly, underlying diseases (cardiac, hematologic, cancer, connective tissue, congenital coagulation disorders), leg trauma with immobilization, overheating, dehydration, certain medications, hormonal imbalance, obesity, surgery, pregnancy, and childbirth.
Symptoms: sudden calf pain (tightness, pressure, worsening with movement), pronounced swelling of leg or thigh, skin discoloration (bluish). Sometimes symptoms are “blurred” or absent (“silent DVT”), leading to sudden complications.
Diagnosis: ultrasound imaging—determines thrombus location, type (occlusive, mural, floating), extent, and blood flow disturbance. Additional lab tests (coagulation, D-dimer). Sometimes CT or contrast venography is used.
Treatment:
- Early treatment crucial (“golden 6–12 hours”). Thrombolytics (clot-dissolving drugs) administered systemically or locally (catheter-directed thrombolysis).
- If late, intensive conservative therapy with anticoagulants (stepwise: injections of fast-acting drugs, then oral long-term therapy).
- Elastic compression (bandages, compression stockings) and phlebotropic drugs are mandatory.
- In severe cases (large pelvic or femoral thrombi, high embolism risk): surgery to remove thrombi, or implantation of vena cava filters (temporary preferred).
With timely treatment, pulmonary embolism develops in only 5% of cases, fatal in 1%.
Patients require long-term specialist monitoring for post-thrombotic syndrome and therapy adjustment.
Pulmonary Embolism (PE)
If the thrombotic process progresses untreated, thrombi migrate upward into the heart and lungs, causing pulmonary embolism (PE). This leads to acute overload of the heart and lungs, often fatal. Mortality reaches 30%. Massive PE is the second leading cause of sudden death after cardiac arrest, and the third leading cause of death overall.
Symptoms: sudden onset, rapid progression, severe cardiopulmonary failure: fainting, hemoptysis, bluish face, shortness of breath, cough, arrhythmia, chest pain, hypotension, possible lung infarction. Classical presentation is rare; often masked as other diseases.
Risk factors: advanced age, obesity, surgery, pregnancy, rheumatism, atrial fibrillation, severe infections, bed rest, varicose veins, cancer, prior thrombosis, postpartum state, chronic heart failure, hormonal therapy, trauma with immobilization, connective tissue diseases, venous catheterization, congenital coagulation disorders.
Diagnosis: based on suspicion in presence of symptoms and risk factors. Main methods: angiopulmonography, spiral CT, contrast MRI. Supportive: ECG, echocardiography, chest X-ray, lung scintigraphy, leg vein ultrasound. Lab: D-dimer, troponins, coagulation parameters.
Treatment:
- Immediate stabilization and initiation of therapy are crucial.
- Thrombolysis (clot dissolution) most effective in first 6–12 hours. After 48 hours, effect decreases, bleeding risk rises.
- Anticoagulation therapy (stepwise, various groups) is the mainstay.
- Surgery (embolectomy, mechanical thrombolysis, cava filter implantation) possible but limited due to risks.
- Intensive and symptomatic care (respiratory support, hemodynamic stabilization) essential.
Modern international guidelines, based on evidence-based medicine, form the basis of PE management.
At Dobrobut Medical Center, as a multidisciplinary clinic, we apply these principles in practice, offering all modern options for timely and effective treatment of venous thromboembolic complications, including urgent and emergency care.
