Diagnosis of a pelvic vein thrombosis | Pelvic vein thrombosis

Diagnosis of a pelvic vein thrombosis

If the typical symptoms of a pelvic vein thrombosis such as a feeling of heaviness and tension, pain, swelling and blue discoloration of the leg occur, a specific thrombosis diagnosis should be carried out. Here, the so-called colour duplex compression sonography is the diagnostic standard. This is a special ultrasound examination of the leg veins, which can show the blood clot and the reduced flow rate of the blood.

This examination is painless and has no radiation exposure. Furthermore, elevated D-dimers can be found in the blood, a laboratory parameter which is typical for blood clots, but which can also be elevated in other diseases (such as cancer) and therefore has only limited significance. If the blood clot cannot be clearly detected by ultrasound, an imaging examination with contrast medium can also be used.

Treatment of pelvic vein thrombosis

If pelvic vein thrombosis has been diagnosed, a quick start of therapy is necessary to keep the risk of pulmonary embolism as low as possible. The usual therapy consists of so-called anticoagulation. This refers to the administration of drugs that inhibit blood clotting and thus prevent the formation of further clots.

Several drugs, also known as blood thinners in everyday life, can be used for this purpose. Heparin is often used, which, depending on the preparation, can be administered once or twice a day with an injection under the skin (subcutaneously). Alternatively, so-called direct oral anticoagulants can be used, which are given in tablet form (e.g. Xarelto).

The duration of the blood thinning depends strongly on the cause of the pelvic vein thrombosis and is carried out for at least six months. This is mainly considered as a preventive measure to prevent the formation of a new clot. If there are increased risk factors, the duration of blood thinning can be extended.

If the symptoms are very pronounced and especially in young patients, the blood clot can also be removed surgically. Blood thinning to prevent further clots should also be performed in this case. This should be accompanied by pressure treatment with compression stockings for at least three months.

It is also important that bed rest is not observed, but rather that moderate physical activity is observed. – Medications for thrombosis prophylaxis

  • Compression stockings
  • Measures for thrombosis prophylaxis

Surgery is not necessary in many cases of pelvic vein thrombosis. It is especially recommended for very pronounced symptoms such as severe leg swelling and severe pain.

This is especially true for younger patients, who are also most likely to meet the necessary requirements for surgery (e.g. healthy cardiovascular system). Another indication for surgery is the highly dramatic form of venous thrombosis, known as “Phlegmasia coerulea dolens”. Here, all venous vessels of a leg are blocked and blood flow can no longer be guaranteed.

This is where maximum pain and swelling of the affected leg occurs. Only emergency surgery can prevent amputation of the leg. Fortunately, this maximum picture of a pelvic vein thrombosis is very rare.

Recanalisation is a surgical procedure in which the pelvic vein is freed from the thrombus and the venous canal is reopened, so to speak. A catheter (a thin tube) is usually inserted into the affected vein. At the end of the catheter there is a small balloon which can be inflated as soon as it is behind the clot.

This allows the clot to be pulled out of the vein. Alternatively, a highly concentrated amount of blood thinner can be applied locally to the clot via the catheter and the resulting fragments of the clot can be collected. Whether recanalization is indicated should be determined by an expert physician in consultation with the patient.