A 58-year-old woman had a blood clot in her leg that had been ulcerating and blackening for 7 years. How important is it to discover the blood clot and treat it promptly?

"I'm afraid I will never be able to walk again." Yesterday afternoon, in the vascular surgery ward of Zhejiang Provincial People's Hospital, 58-year-old Sister Peng lay on the hospital bed with red eyes, raising her hand to wipe away tears from time to time.

Deputy Chief Physician Chen Legao, assistant to the director of vascular surgery, said that Ms. Peng was admitted because of the sequelae of deep vein thrombosis in her left lower limb. She had just undergone a balloon dilatation surgery on the left iliac vein in the morning, and she still had a series of treatments to do, including ulcer repair.

"Sister, don't worry. Your main veins are now unblocked. As long as you cooperate with our treatment, you will gradually get better. You will definitely not be unable to walk." Chen Legao comforted her, "But you still have to pay more attention in the future. Thrombosis treatment is a long process, and daily maintenance and prevention are also very important."

I have a blood clot and no regular treatment

Possible progression to post-thrombotic sequelae

Sister Peng has had blood clots in her lower limbs for seven years. She had gone to the hospital in her hometown for a check-up because of leg swelling and pain. The doctor recommended surgery, but Sister Peng was reluctant to pay for the surgery, so she just took some medicine to take at home.

My eldest sister's hometown is close to the mountains, and she has to go up the mountain to do farm work every day. Although she has been taking medicine, her condition has not improved due to long-term heavy labor.

"At that time I thought it would pass if I just endured it, I didn't expect it to be so serious." The eldest sister said that some time ago when she went up the mountain to work, she accidentally got a small hole in her leg by a branch. She applied some medicine after returning home, but the wound not only did not heal, but gradually turned black and festered, and slowly spread to the surrounding area.

When she really couldn't walk, the elder sister became scared and, following the recommendation of her fellow villagers, went to Zhejiang Provincial People's Hospital for treatment.

After a "one-stop" ultrasound screening, Ms. Peng was found to have deep vein thrombosis in her left lower limb, as well as varicose veins with ulcers.

"If thrombosis is treated earlier, the effect will be better and you can suffer less." Chen Legao said that in clinical cases, the most regrettable thing for doctors is that the condition of patients like Ms. Peng became more and more serious and even developed sequelae because they did not receive regular treatment in time. The manifestations of sequelae of thrombosis include persistent swelling of the lower limbs, ulceration and blackening, repeated inflammation, etc., which will bring great pain and inconvenience to patients.

In addition to Aunt Peng, there is also a 73-year-old uncle who was admitted due to the sequelae of thrombosis.

The attending physician, Deputy Chief Physician Lai Jifu, said that when the uncle first came to the hospital, his legs were swollen twice as thick as a normal person's, and his skin was torn. Examination revealed that he had a filter placed in his inferior vena cava, and there were blood clots below the filter, which had spread to both legs.

"Uncle, you've had this filter in place for a long time, right? Why haven't you removed it?" Lai Jifu said that although the filter can prevent blood clots from falling, there are strict indications for how to place it, and it must be professionally evaluated, and it should usually be removed after 2 weeks. If it is left in the body, it will make the blood clot worse.

My uncle was a little surprised and said that this filter was placed in the hospital in his hometown five or six years ago and no one told him that he had to remove it.

It turned out that my uncle had been traveling back and forth between his two sons over the years and rarely went to the hospital. He thought that there would be no major problems after the surgery and the placement of the filter, so he had never had a follow-up check-up and only took the medicine intermittently when he remembered to.

Because the treatment was delayed for too long, my uncle's blood vessels were damaged. The doctor first gave him temporary vascular clearing treatment, and will carry out a series of improvement treatments later.

Lai Jifu said that the treatment of thrombosis is actually a race against time. Regular treatment should be received promptly after discovery, especially in the first 3 to 5 days after formation, when the treatment effect is best. If the time is delayed too long, the thrombus will fibrosis and form phleboliths, which will cause irreversible damage to the blood vessels. At this time, only improvement treatment can be carried out, and the probability of recurrence will be higher.

These people are all at high risk of thrombosis

Things to keep in mind when dealing with blood clots

Jiang Jinsong, chief physician and director of the Department of Vascular Surgery at Zhejiang Provincial People's Hospital, said that thrombosis refers to abnormal coagulation of blood in blood vessels, most of which occurs in the deep veins of the lower extremities. If thrombosis is not treated in time, it is very risky - after the thrombosis breaks off, it will travel along the blood vessels throughout the body. Once it falls into the lungs, it may cause acute pulmonary embolism, which may even be life-threatening in severe cases.

There are many reasons for thrombosis, such as high blood viscosity, endothelial damage, coagulation disorder, etc. From a clinical point of view, the following types of people belong to the "high-risk group" prone to thrombosis:

1. Tumor patients. Tumors secrete procoagulant factors, which, combined with the effects of anti-cancer drugs, make it easier for blood clots to form.

2. Business people who often travel long distances. When traveling long distances by car, high-speed rail, airplane, etc., due to space limitations, the range of movement is often small and the sitting time is long. There is a term called "economy class syndrome", which is caused by long-term inactivity.

3. Elderly people. Elderly people are the largest group of patients with thrombosis. Some elderly people like to play mahjong and cards, sitting for hours at a time, which is very bad for their health.

4. Young people who don’t like to exercise. Blood clots are not an “old age disease”. Some young people watch football games, play games, and lie in bed for two or three days. Lack of exercise, lack of water intake, increased blood viscosity, can also cause blood clots.

"When there is a blood clot, drug treatment is the basis. You must follow the doctor's orders and take the medicine on time and in sufficient amounts." Director Jiang Jinsong said that anticoagulant treatment takes a relatively long time, generally lasting 3 to 6 months. Clinically, at least one-third of patients do not persist, resulting in incomplete treatment and easy recurrence of the disease.

In addition to drug treatment, the latest mechanical thrombus removal is also widely used in clinical practice. It is an interventional method that removes thrombi from blood vessels without any incision, immediately clearing blocked blood vessels. The use of this method can greatly reduce the risk of sequelae for patients with thrombosis like Ms. Peng.

October 13 is World Thrombosis Day. Director Jiang Jinsong reminds us to pay special attention to the following points in preventing and treating thrombosis :

1. If you have varicose veins, go to the hospital in time, exercise more, drink more water, and avoid standing or sitting for long periods of time.

2. Receive regular treatment, take medication on time, have regular checkups and follow-ups, and deal with any problems immediately.

3. Maintain hygiene, especially foot hygiene, to prevent athlete's foot and tinea pedis. In winter, you can apply moisturizer appropriately to keep the skin of your legs and feet moisturized.

4. If you experience sudden leg swelling, don't take it lightly. Go to the hospital for examination in time to rule out blood clots.

Finally, even if you suffer from sequelae of thrombosis, you don’t need to worry too much. It is recommended that you go to a vascular surgery specialist clinic for treatment. After targeted evaluation and treatment, there are still ways to improve the situation.

Lin Lin, reporter of Orange Persimmon Interactive