SUPERFICIAL AND DEEP VENOUS THROMBOSIS

SUPERFICIAL AND DEEP VENOUS THROMBOSIS

SUPERFICIAL VENOUS THROMBOSIS (SVT):
It is the formation of a thrombus (blood clot) in the superficial veins, usually associated with inflammation (thrombophlebitis). Commonly affects great and small saphenous veins.

DEEP VENOUS THROMBOSIS (DVT):
It is the formation of thrombus in the deep veins of the lower extremities, pelvis, or less commonly in the upper limbs. It poses a risk for pulmonary embolism if the clot dislodges.

AYURVEDIC CORRELATION:
Can be correlated with Siragata Vata or Sira Granthi as mentioned in classics.

"सिराः स्नेहादिभिः शुद्धाः सम्प्राप्ताः स्वास्थ्यमाश्रयः।
विबद्धाः स्यात्तु यत्र स्यात्तदा दोषैः सिराग्रहः॥"
— Sushruta Samhita, Chikitsa Sthana 18/17

ETIOPATHOGENESIS

MODERN VIEW (VIRCHOW’S TRIAD):

1. Endothelial injury: Trauma, surgery, inflammation

2. Stasis of blood flow: Immobilization, varicose veins

3. Hypercoagulability: Genetic factors (Factor V Leiden), malignancy, pregnancy, oral contraceptives

RISK FACTORS:

• Prolonged immobility

• Recent surgery or trauma

• Malignancy

• Pregnancy and postpartum

• Oral contraceptive pills

• Obesity

• Smoking

• Previous history of DVT

• Varicose veins (more in SVT)

AYURVEDIC ETIOLOGY (NIDANA):

• Abhighata (trauma)

• Ati-sthiraasana (prolonged sitting)

• Avara vyayama (lack of exercise)

• Snigdha guru bhojana leading to Srotorodha

• Kapha and Vata vitiation causing obstruction in siras

"आसिनः शयमानश्च यः स्यादल्पविचेष्टितः।
स रक्तगमने दोषान् संप्राप्नोति न संशयः॥"
— Charaka Samhita, Chikitsa Sthana 28/202

CLINICAL FEATURES

SUPERFICIAL VENOUS THROMBOSIS (SVT):

• Localized pain, tenderness along the superficial vein

• Redness and warmth over the vein

• Palpable cord-like vein

• Swelling may be mild

• Fever (if infective component present)

DEEP VENOUS THROMBOSIS (DVT):

• Swelling of the entire limb or part of limb

• Deep aching pain, heaviness in leg

• Warmth over affected area

• Pitting oedema

• Positive Homans’ sign (pain on dorsiflexion of foot)

• Dilated superficial veins (collaterals)

AYURVEDIC LAKSHANA:

• Shotha (Swelling)

• Toda (Pricking pain)

• Snayugata shula (Ligament pain)

• Raga (Redness)

• Shopha with Stambha (Stiffness)

INVESTIGATIONS

BLOOD TESTS:

• D-dimer test: Elevated in DVT (not specific)

• CBC to rule out infection

• Coagulation profile (PT, aPTT, INR)

IMAGING:

• Doppler Ultrasound: Investigation of choice

• Venography: Gold standard (rarely used now)

• MRI/CT Venography: For pelvic vein thrombosis

• ECG and Chest X-ray: If PE is suspected

DIFFERENTIAL DIAGNOSIS

FOR DVT:

• Cellulitis

• Baker’s cyst

• Ruptured popliteal cyst

• Lymphoedema

• Muscle tear or hematoma

• Compartment syndrome

FOR SVT:

• Insect bite with phlebitis

• Cellulitis

• Thrombosed varicose vein

• Lymphangitis

COMPLICATIONS

DVT:

• Pulmonary embolism (life-threatening)

• Post-thrombotic syndrome

• Chronic venous insufficiency

• Recurrent DVT

SVT:

• Extension into deep venous system

• Skin pigmentation and ulceration

• Varicosities

MANAGEMENT

MODERN MANAGEMENT

ACUTE MANAGEMENT (DVT):

• Anticoagulants: Heparin followed by Warfarin or DOACs (e.g., Apixaban, Rivaroxaban)

• Compression stockings

• Leg elevation and mobilization

• Inferior vena cava (IVC) filter (in high-risk patients with contraindications for anticoagulants)

SVT MANAGEMENT:

• NSAIDs for pain and inflammation

• Warm compresses

• Local heparin gel

• Anticoagulants if SVT is extensive or near sapheno-femoral junction

SURGICAL OPTIONS:

• Thrombectomy (rare)

• Ligation of affected veins (in recurrent SVT)

• Sclerotherapy or laser for varicosities

AYURVEDIC MANAGEMENT

SHODHANA CHIKITSA:

• Virechana with Trivrit, Eranda taila for Kapha-Vata shaman

• Raktamokshana (Siravyadha) in localised dushta rakta dushti

"सिरामोक्षणमुत्तमं रक्तदुष्ट्यां विनिर्णयेत्।"
— Sushruta Samhita, Sutra Sthana 14/36

SHAMANA CHIKITSA:

• Dashamoola kwatha, Punarnavadi kwatha

• Guggulu preparations: Kaishora Guggulu, Yogaraja Guggulu

• Rakta shodhaka dravyas: Manjistha, Sariva

• Local application:

  • Sikta taila

  • Jatyadi taila

  • Lepa of Haridra, Daruharidra, Shigru, Arjuna churna in case of inflammation

PATHYA-AHARAVIHARA:

• Avoid heavy, unctuous, and kapha-aggravating foods

• Encourage light diet, barley, horse gram

• Regular mild exercise (after acute phase)

• Avoid prolonged sitting or standing

PROPHYLAXIS AND PREVENTION

• Early mobilization after surgery or long travel

• Use of compression stockings

• Adequate hydration

• Prophylactic anticoagulants in high-risk individuals

• Lifestyle modifications like weight reduction, avoiding smoking and sedentary habits

INTEGRATED APPROACH (AYURVEDA + MODERN)

• Ayurveda can aid in long-term prevention and recovery by improving Agni, clearing Srotorodha, and enhancing Rakta shuddhi

• Modern interventions are necessary in acute phase and life-threatening complications like PE

• A holistic plan combining Shamana, Shodhana, Ahara-Vihara along with modern pharmacological and diagnostic protocols ensures better patient outcomes