Think you may have a blood clot right now? Call 911 for sudden shortness of breath, chest pain, a fast or irregular heartbeat, coughing up blood or fainting. Do not drive yourself. Sudden swelling, pain, warmth or redness in one leg needs a same-day check at an urgent care or emergency room.
Deep vein thrombosis (DVT) is a blood clot in one of the deep veins, most often in the leg. The clot can block blood flow, causing swelling and pain. It can also break loose and travel to the lungs, which is called a pulmonary embolism. DVT is common, and it is treatable. Most people are treated with blood thinners and do not need to stay in the hospital.
The vascular surgeons of Vascular & Vein Institute of the South (VVIS) diagnose DVT with ultrasound in our offices. We treat it and follow you afterward to watch for and treat long-term problems in the leg. For some people with large clots that reach up into the groin or pelvis, we also offer procedures that remove the clot, at Memphis-area hospitals including Baptist, Methodist and Saint Francis and in our office-based labs and surgery center. We see patients at our offices across Tennessee, Mississippi and Arkansas. Call 901-390-2930 or schedule online.
What is deep vein thrombosis?
Your legs have two sets of veins. The veins you can see near the skin are surface veins. The deep veins run inside the muscles and carry most of the blood back to the heart. A clot in a deep vein is a DVT.
Most DVTs form in the calf. Clots in the vein behind the knee or higher, in the thigh or pelvis, are larger and more likely to cause lasting problems or travel to the lungs. A clot can also form in the deep veins of the arm, most often around an IV line, port or pacemaker wire.
A clot in a surface vein is called superficial vein thrombosis. It feels like a tender, firm cord under the skin, and it often forms in a varicose vein. It is less dangerous than DVT, but it can spread into the deep veins or hide a DVT, so get it checked with an ultrasound today.
DVT symptoms: signs of a blood clot in the leg
About half of people with a DVT have no symptoms at all. When symptoms occur, they usually affect one leg:
- Swelling of the calf, ankle or whole leg
- Pain or cramping, often in the calf, that may feel like a pulled muscle
- Skin that feels warm to the touch
- Skin that looks red, purple or darker than usual
- Veins near the skin that look larger than normal
In the arm, a DVT can cause swelling of the hand and arm, aching in the shoulder or neck, and a bluish color.
Call 911 if you have sudden shortness of breath, chest pain, a fast or irregular heartbeat, coughing up blood, or fainting. Do not drive yourself. These can be signs of a pulmonary embolism. Also call 911 if your leg becomes severely swollen, painful and pale or blue, which can mean a clot is cutting off all blood flow.
Get checked the same day at an urgent care or emergency room if one leg or arm suddenly swells or hurts. Do not wait for an office visit.
DVT causes and risk factors
Clots form when blood slows down, when the lining of a vein is injured, or when the blood clots more easily than normal. Common triggers include:
- Being still for a long time: a hospital stay, bed rest, a long flight or car trip, or a cast on the leg
- Surgery or injury, especially hip, knee or belly surgery and broken bones
- Cancer and some cancer treatments
- Pregnancy and the first weeks after giving birth
- Estrogen in birth control pills or hormone therapy
- A past DVT or pulmonary embolism, or a family history of clots
- Inherited clotting conditions, such as factor V Leiden
- Age over 60, obesity and smoking
- A central IV line, port or pacemaker wire, for clots in the arm
Some people have a narrowed vein that makes clots more likely. The most common example is May-Thurner syndrome, in which a large vein in the pelvis is squeezed by the artery that crosses over it. We look for it when a DVT involves the whole left leg or the veins in the groin or pelvis, or when clots keep coming back.
How DVT is diagnosed
- Duplex ultrasound. A painless scan that shows the veins and the blood flowing through them. It is the main test for DVT, and we perform it in our offices. If your leg has suddenly become swollen or painful, do not wait for a scan in our office. Get checked the same day at an urgent care or emergency room.
- D-dimer blood test. A normal result helps rule out a clot in people at low risk. A high result does not prove a clot, so an ultrasound follows.
- CT or MR venography. Scans that show the large veins in the pelvis and belly, which ultrasound cannot see well. They are used when a pelvic clot or May-Thurner syndrome is suspected.
If a clot is found, we also ask what caused it. A clot with a clear short-term cause, such as surgery, is treated differently from one with no obvious cause. Learn more about venous duplex ultrasound and our other vascular tests.
Deep vein thrombosis treatment options
Blood thinners (anticoagulants) are the main treatment. They stop the clot from growing and prevent new clots while your body slowly dissolves the clot over weeks to months. Most people take a pill, such as apixaban or rivaroxaban, and are treated at home. Treatment usually lasts at least three months. If the clot had no clear cause, or your risk continues, treatment may go on longer. Some small clots in the calf are watched with a repeat ultrasound instead. If you are pregnant, you will usually get blood thinner shots instead, because these pills are not used in pregnancy.
Walking. Once you are on a blood thinner, walking is encouraged. Studies have not found that walking makes the clot more likely to travel to the lungs, and it can help the swelling. If your leg is very swollen and painful, start slowly.
Compression stockings can ease swelling and aching while the leg recovers. They are a comfort measure, not a cure, and not everyone needs them. If you have poor circulation in your legs (peripheral artery disease) or heart failure, ask us before you wear compression stockings.
Clot removal procedures. For a large clot that reaches up into the groin or pelvis, especially in a younger or active person with a very swollen, painful leg, removing the clot can relieve symptoms faster and may lower the chance of long-term leg damage. Clot removal works best when the clot is new, usually less than two weeks old, and when your risk of bleeding is low. If you have a large new clot in the groin or pelvis, call us right away. Two approaches are used:
- Catheter-directed thrombectomy. Through a small puncture behind the knee or in the thigh, a thin tube is guided into the clot and the clot is broken up and suctioned out.
- Catheter-directed thrombolysis. A low dose of clot-dissolving medicine is delivered through a catheter directly into the clot, usually overnight, and sometimes for a day or two, with close watch in the hospital.
These procedures are not right for everyone. Large studies have had mixed results. Clot removal can ease pain and swelling sooner, and in some people with clots that reach the groin or pelvis it may lower the chance of long-term leg problems. It also raises the risk of serious bleeding compared with blood thinners alone. Blood thinners are still needed afterward.
Venous stenting. If a narrowed pelvic vein caused the clot, a stent can be placed to hold the vein open after the clot is removed. Read about May-Thurner syndrome and venous stenting.
IVC filter. If you cannot take blood thinners, a small filter can be placed in the large vein in the belly to catch clots before they reach the lungs. Most filters should be removed once blood thinners are safe again. Read about IVC filter placement and removal.
| Treatment | Who it is for | Where |
|---|---|---|
| Blood thinners | Almost everyone with a DVT | At home, with office follow-up |
| Compression stockings | Swelling or aching while the leg recovers | At home |
| Catheter clot removal | Selected patients with a large, new clot that reaches the groin or pelvis | Hospital, or our office-based labs and surgery center (clot-dissolving medicine is given only in the hospital) |
| Venous stent | A narrowed pelvic vein, such as May-Thurner syndrome | Hospital, or our office-based labs and surgery center |
| IVC filter | People with a new clot at or above the knee who cannot take blood thinners | Hospital, or our office-based labs and surgery center for planned placement and removal |
If you were just diagnosed with a large clot in your thigh or pelvis, call 901-390-2930 instead of booking online, so our team can decide how soon you need to be seen.
After a procedure, call 911 if you have chest pain or sudden shortness of breath. If the puncture site bleeds, lie down and press firmly on it, and call 911 if the bleeding does not stop. Call us right away, or go to the emergency room, if you have a growing lump at the puncture site or new or worsening leg swelling or pain.
Recovery and follow-up after a DVT
Swelling and pain usually improve over a few weeks. Take your blood thinner exactly as prescribed, and tell every doctor and dentist you see that you take one. Avoid new medicines and supplements until you have asked, because some raise the risk of bleeding. Call 911 for a severe headache, vomiting blood, or bleeding that will not stop. Call your doctor for black or bloody stools, pink or red urine, or a lot of new bruising.
Some people develop post-thrombotic syndrome. It causes long-term swelling, aching, heaviness, darker skin and sometimes sores on the lower leg. It happens when the clot damages the valves in the vein or leaves it scarred or narrowed. It is more common after large clots in the thigh and pelvis. Staying active, controlling weight and wearing compression stockings when the leg is swollen can help. Tell us if your leg is still swollen months after the clot.
We check the veins again with ultrasound when your treatment plan calls for it. We also work with your primary care doctor or blood specialist (hematologist) to decide how long you take blood thinners.
When to see a vascular surgeon for DVT
See us if:
- You have had a DVT and want follow-up of the leg veins
- Your leg is still swollen or painful months after a clot
- You have had more than one clot, or a clot without a clear cause
- Your DVT involves the whole left leg, or the veins in the groin or pelvis, where May-Thurner syndrome is possible
- You have an IVC filter and no plan for its removal
- You were told you may need a clot-removal procedure and want another view. Call us right away, because timing matters.
We also offer second-opinion consultations. For a new, sudden swollen leg, go to urgent care or the emergency room first, then let us follow you afterward.
Diagnosed with a DVT in the emergency room or by your doctor? Call 901-390-2930 or schedule online for follow-up.
What to bring: your ultrasound or CT reports, your discharge papers, the name and dose of your blood thinner, and a list of all your medicines and supplements.
Referring a patient? Use our provider referral page or call 901-390-2930.
Frequently asked questions
Is a DVT an emergency?
A suspected DVT needs a same-day check, so go to an urgent care or emergency room if one leg suddenly swells or hurts. It becomes a 911 emergency if you have sudden shortness of breath, chest pain, a fast or irregular heartbeat, coughing up blood or fainting, or if the leg becomes very swollen, very painful, and pale or blue. Do not drive yourself.
What does a blood clot in the leg feel like?
Often like a cramp or pulled muscle in the calf that does not go away. The leg may also be swollen, warm or red, or feel heavy or tight. Many people feel nothing at all. If one leg suddenly swells or hurts, get checked the same day at an urgent care or emergency room.
Can a DVT go away on its own?
Your body breaks down a clot slowly, over weeks to months. But without treatment a DVT can grow or travel to the lungs, so do not wait to see if it goes away. A blood thinner stops the clot from growing while your body clears it. Pain and swelling usually improve over a few weeks.
How long will I need blood thinners?
Usually at least three months. If the clot was caused by a short-term risk, such as surgery or a long trip, you may be able to stop then. If there was no clear cause, or your risk continues, you may need blood thinners longer, sometimes for years. Your doctors will review this with you at about three months.
Can I walk with a DVT?
Yes. Once you have started a blood thinner, walking is encouraged. Studies have not found that walking makes the clot more likely to travel to the lungs, and it helps the swelling go down. If your leg is very swollen and painful, start slowly, and ask your doctor about heavy exercise and sports.
Do I need compression stockings?
Not always. Stockings can ease swelling and aching while the leg recovers, and many people find them helpful. They have not been shown to prevent long-term leg damage in everyone, so we recommend them based on your symptoms.
Can the clot be removed?
Sometimes. For a large clot that reaches up into the groin or pelvis, a catheter procedure can break up and remove the clot or deliver clot-dissolving medicine directly into it. It is used for selected patients with a large, new clot that reaches the groin or pelvis, and it raises the risk of serious bleeding compared with blood thinners alone. Most people do well with blood thinners alone.
What is post-thrombotic syndrome?
Long-term swelling, aching, heaviness, skin changes and sometimes sores in a leg that had a DVT. It happens when the clot damages the valves inside the vein or leaves the vein scarred or narrowed. It is more common after large clots above the knee. Staying active and controlling weight help, compression stockings can ease the symptoms, and a stent helps some people with a blocked pelvic vein.
Will my DVT come back?
It can. The risk is higher if the first clot had no clear cause, if you have a clotting condition, or if you have cancer. Taking your blood thinner as prescribed lowers the chance. Treating a narrowed vein, when one is found, may lower it too. If leg symptoms come back, get checked the same day. Call 911 for chest pain or sudden shortness of breath.
Can I fly after a DVT?
Ask your doctor. Many people can fly once they are stable on a blood thinner. On a long flight, walk the aisle every hour or two, drink water, and consider compression stockings.
What is the difference between a DVT and a superficial clot?
A superficial clot is in a vein just under the skin. It feels like a tender, firm, red cord. A DVT is in a deep vein and can travel to the lungs. Up to 1 in 4 people with a superficial clot in the leg also have a DVT or a clot in the lungs, and some superficial clots need a blood thinner. Get any painful, hard, red vein checked with an ultrasound today.
Do I need an IVC filter?
Most people do not. A filter is used when you have a clot and cannot take blood thinners, for example because of active bleeding, a recent bleed in the brain, or a major surgery that cannot wait soon after a new clot. When a filter is placed, a plan to remove it should be made at the same time.
Can a DVT happen in the arm?
Yes. Arm DVTs are less common and often form around an IV line, port or pacemaker wire. Treatment is similar, with blood thinners and, in some cases, removal of the line. In young, active people, an arm clot can also come from a vein squeezed under the collarbone (venous thoracic outlet syndrome). That needs a prompt visit with a vascular surgeon, because treatment works best early.
What should I avoid if I have a DVT?
Do not stop or skip your blood thinner unless your doctor tells you to. Do not rub or massage the sore leg. Ask before taking pain relievers such as ibuprofen, naproxen or aspirin, or any new supplement, because they can raise the risk of bleeding. Avoid long periods of sitting; get up and walk when you can.
How can I lower my risk of a DVT?
Move often on long trips: walk the aisle or stop the car every hour or two. After surgery or a hospital stay, get up and walk as soon as your care team allows, and ask whether you need clot-prevention medicine. Stay active, keep a healthy weight and do not smoke. If you have had a clot before, ask your doctor what to do before a long trip or surgery.
What kind of doctor treats DVT?
Emergency doctors, primary care doctors and hematologists (blood specialists) often start treatment with a blood thinner. A vascular surgeon treats the veins themselves: large clots that may need removal, a narrowed pelvic vein, IVC filters, and swelling that lasts after a clot. We see patients at our offices across Tennessee, Mississippi and Arkansas.
Do I need a referral?
It depends on your insurance. Some plans need a referral from your primary care doctor. Call 901-390-2930 and we will tell you what your plan needs.
If you have had a DVT, or you have leg swelling that will not go away, let us check your veins and make a plan for your leg. Call 901-390-2930 or schedule online. For a sudden swollen, painful leg, get checked the same day. For chest pain or trouble breathing, call 911.