Deep Vein Thrombosis (DVT) Through the Ages

I have addressed Deep Vein Thrombosis (DVT), its causes, how it can be recognized, and treatments many times. I thought we might review the history of treatment of DVT.

The first documented case of DVT occurred more than 700 years ago in the middle ages. A 20 year old Norman cobbler, Raoul, developed unilateral edema in the ankle and calf which the moved up to the thigh. His physician advised him to “wait and see”. Raoul’s symptoms worsened and he developed a leg ulcer. He visited St Eloi’s shrine, without any improvement. Then he visited the tomb of King Saint Louis. He spent some time in prayer to no avail. He then decided to collect the dust he found below the stone that covered tomb. He applied the dust direct to the ulcer. The story reports he was miraculously healed and was still alive 11 years later. After this story of Raoul, there was increased mention of DVT especially in pregnant and postpartum women.

During the Renaissance physicians thought that pregnancy-related DVT (leading or only cause of DVT) was the result of “evil humors”. It was thought that postpartum DVT was caused by retention of unconsumed milk in the legs (‘milk leg’). Therefore in the late 1700’s breast-feeding was encouraged to prevent DVT.

From 1784 – 1920’s treatment was evidence based. In 1676 Wiseman suggested DVT was a consequence of alteration of blood. In 1793 Hunter hypothesized it was a occlusion of a vein by blood clots. In 1784 Hunter performed ligations (ties) above the blood clot to prevent extension of the clot. Because there was no other treatment for Pulmonary Embolism (PE) this became widely used at the end of the 19th century. This could be done at the femoral, common femoral, iliac or inferior vena cava. Used until mid 20th century along with anticoagulants after they became available.

Iron Splints

Since there was great fear of the blood clot migrating and becoming a PE, strict bed rest was prescribed and was the
cornerstone of DVT treatment from the end of the 19th century. Patient’s limbs were set in iron splints to prevent movement and special inclining beds were used to increase venous return.

Inclining Bed

During the 19th century it was thought that DVT was caused by inflammation of the vein wall, fever, postpartum and after septic surgical procedure. Treatment included anti-inflammatory medication and treatment for infection. Blood letting was popular (especially with leeches) as well as cupping, purging, applying ice or prescribed cold bath. These treatments started becoming obsolete in early 1900’s. Prior to 1930’s (before anticoagulant therapy) treatment was bed rest to fix thrombus, elevation and now application of heat with warm compresses to increase collateral circulation and reduce venous spasm. In hospitals Wright describes the preventative measures such as early ambulation, elastic compression, avoidance of dehydration and tightly applied adhesive strapping.

Next week we will continue with the last 100 years. In the meantime, keep wearing your support stockings and support socks!


Possibility of a New Treatment for Venous Insuffiency

We have talked so many times about venous insufficiency…its causes and management. From one of previous newsletters “Most leg problems are caused by age, obesity, sedate lifestyle, standing or sitting for long periods of time, past surgeries, pregnancy, or heredity. You must remember the heart is a one-way pump. The heart pumps blood from the heart through the arteries to the various parts of the body. The veins have the arduous task to return the blood to the heart along with waste and metabolic residue. The movement of the blood toward the heart can be a challenge. Gravity forces the veins to work harder to return the blood to the heart. The veins have little one way valves that work with the leg muscles to pump the blood back to the heart. In a normal vein, one way valves are located ever 2 – 5 cm to aid in the proximal flow toward the heart. When calf muscles relax, the valves close to prevent blood from flowing backward into the lower part of the veins. These valves are fragile and can be easily damaged. The contraction and relaxation of the calf muscles work as a “secondary pump” to move the blood. Many things can happen that interrupts this blood flow. The valves in the veins may be injured and do not close completely and allow the blood to remain in the lower leg. “

Mini Heart

Now we have the possibility of a new treatment. Narine Sarvazyan, a professor of pharmacology and physiology and a researcher at the George Washington University has made a startling discovery that could improve the treatment for people with impaired blood flow. Stem cells (muscle cells) from the patient’s own heart are harvested and modified so they become programmable stem cells. Using a patient’s own tissue has many different advantages, the most important being the elimination of any risk of rejection. Unlike the controversial embryonic stem cell, adult stem cells can generally only form cell tissue associated with the organ that it was extracted from. In the laboratory these harvested stem cells are grown into “mini hearts”. They are one millimeter in diameter that behave “surprisingly similarly” to a real full-sized heart. These tiny hearts can be implanted to encourage blood flow in veins that have compromised valves. The “mini heart” is a rhythmically contracting “cuff” of heart muscle cells that encircle the problem vein and pumps blood as it beats. 

Research is continuing. Perhaps we can look forward to one day when we no longer suffer from venous insufficiency. In the mean time keep wearing your support socks and hose to keep your legs healthy.


Venous Disease of the Legs

Varicose veins are the result of venous insufficiency. There are many things that influence the health of the veins in our legs. Among these are hereditary, obesity, sedate life styles, and of course, age. The population of the United States is getting older, the Baby Boomers are now in their 60’s, and, unfortunately many of us are over-weight (including me). The Heart is responsible for the blood flow in our bodies. The circulatory system is made up of the heart, arteries which carry blood from the heart to our legs and arms, arterioles and capillaries (where oxygen is exchanged), and veins which carry blood back to the heart. The heart is an excellent pump, but it needs assistance in getting blood flow from our legs and back to the heart. This is where the valves in our veins come in. The tiny valves in the veins open and close to allow blood to flow only one-way back to the heart. The problem occurs when the valves get damaged form age or from physical injuries to the leg and do not close properly. When the valves get damaged they cannot close properly and the blood can then back-flow and create pooling. This can cause stasis, edema, and in severe cases blood clots or even lymphedema.

Now let’s discuss a few vein diseases

Spider VeinSpider Vein

Spider veins are created by small dilations in the veins just below the skin. Yes, they are a little unsightly. They don’t seem to cause any problems other than a slightly ache, but they are giving you a warning to wear compression stockings to keep them under control so that varicose veins do not develop.

Varicose VeinsVaricose Vein

Varicose veins are created by poor circulation in the venous system. They are generally ropy looking and should be evaluated by your physician. If left untreated, they can lead to much more serious problems. With varicose veins the valves in the veins become incompetent and the function of returning blood to the heart has been compromised. This condition is called venous insufficiency and can have very serious consequences. Wearing your support hose can assist in maintaining control of the varicosities so your venous disease does not progress. There are also many physicians who can advise you of various medical treatments including oblation surgery.

Stasis Dermatitis

Stasis Dermatitis

<Stasis Dermatitis is a red looking inflammatory skin disease that is common with people with chronic venous insufficiency. If your leg looks like this, you should definitely have seen your physician about it. Again, wearing compression stockings will help maintain control of this disease, if left untreated it can lead to venous ulceration, or worse.

Venous Ulcer

Venous Ulcer

Venous ulcers are wounds that occur when the veins of the leg do not return the blood back to the heart. The blood may leak out of the vein into the tissue. This causes the tissue to break down and an ulcer to form. They are found on the sides of the lower leg above the ankle and below the calf and are slow to heal and often reoccur.

As you can tell venous diseases of the leg can become progressively worst. When you are experiencing leg problems always consult with your physician. They can direct you to wearing the correct compression stockings and can assist you in maintaining control of the disease.

Lets strive to keep our legs healthy,