Thrombosis (synonyms: iliac vein thrombosis; leg pelvic thrombosis; phlebothrombosis; TBVT; TVT; thrombosis; deep vein thrombosis (TBVT); deep venous thrombosis (DVT); venous thrombosis; ICD-10 I80.-: Thrombosis, Phlebitis, and Thrombophlebitis) refers to the complete or partial occlusion of a vessel or cardiac cavity. This occlusion is caused by a thrombus (blood clot). Normally, when we injure ourselves, our blood clots and forms a blood clot that closes the wound. This prevents further blood loss and protects the wound against the penetration of germs or bacteria from the outside. If such a thrombus already develops in the vessel without external influence, it is called a thrombosis. Such a thrombus then blocks the vessel and sometimes causes severe pain. Thromboses can be differentiated into:
- Venous thromboses
- Arterial thromboses (rare)
Depending on the localization, thromboses can be divided into:
- superficial thrombosis (thrombophlebitis) or superficial venous thrombosis (OVT) – obstruction of the superficial venous system (main stem veins and/or their side branches) by a thrombus (blood clot).
- Thrombophlebitis (= OVT of a non-varicose vein).
- Varicophlebitis (= OVT of a varicose vein)
- Deep vein thrombosis (DVT) – partial or complete obstruction in the deep venous system (conducting veins and/or muscle veins) by a thrombos (blood clot).
- Deep vein thrombosis of the upper extremities (DVT-OE): shoulder and arm vein thrombosis (1-4%).
- Deep vein thrombosis of the leg (TBVT; phlebothrombosis).
Course forms of deep vein thrombosis (DVT):
- Descending iliac vein thrombosis (“ascending”): origin is the iliac vein (anatomically mostly left iliac vein). From this, there is appositional growth of the thrombus (blood clot) distally (“away from the center of the body”), occasionally proximally (“closer to the center of the body”) into the vena cava (vena cava).
- Ascending DVT (“descending”): origin are mostly the veins of the lower leg, starting from this, it comes to the appositional progression of the thrombus proximally. (most common form of progression)
- Transfascial venous thrombosis: Starting from a superficial vein thrombosis (OVT), it comes to the ingrowth of the thrombus into the deep venous system.
- Phlegmasia coerulea dolens: special form in which there is acute occlusion of all veins of the affected limb.
Deep vein thrombosis of the extremities are divided into:
- Distal thromboses (type 1) – grow proximally (“closer to the center of the body”); most common; low risk of embolism.
- Proximal thromboses (type 2) – grow distally (“further from the center of the body”); high risk of embolism
- Thromboses that grow into the depth (from the surface via the venae perforantes) (type 3); low risk of embolism.
Sex ratio: arm vein thrombosis is more common in men than in women. Regardless of the type of thrombosis, healthy young women have a threefold increased risk than young men; at older ages, a balanced sex ratio is present
Frequency peak: the higher the age, the higher the risk: 70% of all thromboses occur after the age of 60! The prevalence (disease frequency) is 0.1 % (in Germany). The incidence (frequency of new cases) is about 90-130 cases per 100,000 inhabitants per year (in Germany). Course and prognosis: Thromboses can occur in all vessels of the human body. Phlebothrombosis (thrombosis of the deep veins) is particularly common, and here especially deep vein thrombosis (TBVT). The most dangerous complication of thrombosis is embolism (partial or complete occlusion of a vessel by entrained material (embolus)). DVT can have significant consequences: approximately 2.6-9.4% lead to pulmonary embolism with a lethal (fatal) outcome. In cases of extensive DVT, chronic post-thrombotic syndrome (PTS) occurs in approximately 20% of patients. Patients with deep vein thrombosis (DVT) or with pulmonary emboli (pulmonary embolism) have an increased risk of myocardial infarction (heart attack). In the first year after deep vein thrombosis, the rate of myocardial infarction is 1.6-fold higher, and in the first year after pulmonary embolism, the rate is 2.6-fold higher. Note
- After first idiopathic venous thromboembolism (VTE), i.e., without a trigger factor such as immobilization, surgery, or thrombophilia (tendency to thrombosis), the risk of developing a recurrence (recurrence of the disease) after discontinuation of anticoagulation (anticoagulation) is 10%-a good one-third after 10 years. The 10-year cumulative risk for men was 41.2% and for women 28, 8%.
- According to a meta-analysis, one in 20 patients with idiopathic venous thromboembolism (VTE) receives a cancer diagnosis in the following 12 months. In such cases, tumor screening should therefore be performed. This applies esp. to older patients because of their higher cancer prevalence (cancer incidence).
Arterial thrombosis leads to organ infarcts such as myocardial infarction or apoplexy (cerebral infarction) due to the obstruction of the supplying arteries.
