Venous occlusive disease is most frequently a result of a DVT (deep venous thrombosis). DVT can involve the upper or the lower limb or vessels of the abdomen. Orthodox management of an acute DVT at any site usually involves the administration of a drug to stop the blood from clotting. Common drugs that are used to achieve this result are called Heparin, usually given intravenously, Clexane, usually given by subcutaneous injection, and Warfarin, usually given orally. The administration of all these drugs may require some blood tests to determine the effect that they are having on the clotting mechanism on the body.
While these drugs prevent the development of new clots, clots that have already been formed can only be dissolved by the administration of “clot busting” drugs. Some of these drugs are Streptokinase, Urokinase and tissue plasminogen activators. These drugs are administered either systemically or by regional infusion. systemic infusions means that the drug will work in all parts of the body with equal effect, whereas, regional infusion means that the drug is administered in such a way that its effect occurs in a local area and other parts of the body are less effected.
The administration of one or a combination of these drugs either by systemic or regional techniques is used to overcome the effects of an acute venous obstruction or occlusion.
If a venous becomes chronic, that is lasts for longer than a week, side effects may occur that are the direct result of this venous obstruction. Chronic venous obstruction can result in venous hypertension. The manifestations of venous hypertension depend on the site of which it occurs.
Chronic venous hypertension of the lower limb is a common occurrence associated with DVT and varicose veins. Its characteristics are swelling, hyper-pigmentation, ulceration, lipodermatosclerosis, pruritus and venous intermittent claudication. Claudication means to limp as a result of leg pain after walking a certain distance. Traditionally, venous hypertensive disease has been controlled by surgical elastic stockings. However, with the advent of percutaneous, radiologically and ultrasonically based procedures, often these venous obstructions can be overcome. The best example of this in the lower limb is the presence of an iliac vein occlusion in the abdomen (See the treatment of arterial and venous occlusive disease video for further information).
Venous occlusive disease of the upper limb is termed Paget-schroders syndrome. This is caused by compression of the vein as it passes over the first rib at the base of the neck. The venous compression often causes thrombosis of the vein. The thrombosis is most frequently related to an episode of physical exertion such as swimming. The effected arm becomes swollen, heavy and painful. In the chronic situation, large venous collaterals can be seem over the shoulder and chest wall. Often, this syndrome is associated with pain and heaviness in the arm in association with use. This syndrome can be treated by dissolution of the clot with “clot busters” and placement of a stent and sometimes surgical removal through the axilla of the first rib.
Occasionally veins of the abdomen become blocked with clot. Thrombosis of the portal vein in the acute situation can result in abdominal pain and this is often diagnosed by the performance of CT scanning during the investigation of this abdominal pain. Acute treatment consists of the administration of anticoagulant drugs with or without the use of clot busters. Chronic occlusion of the portal vein can present as portal hypertension.Vein Disorders