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Vascular Surgery/Blood clot behind knee

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QUESTION: Hi Lauri. I have what they finally concluded is a calcified blood clot behind my knee. I was treated with warfarin for a dvt, but I obviously walked around for several years with a blood clot which calcified over time, This was determine by a sonogram twice. I remember when my lower leg swelled up prior to me going to the doctor, but I ignored the symptoms.
I'm not on blood thinners, or any other treatment since it was determined by a hematologist it was one time event, and I have no history.
I am 58yo and healthy and a long time runner. They don't know why I got a blood clot, but obviously I'm clear to do anything I want.
Even though I'm Ok, I still have a little swelling around my ankle, and my calf is a little bigger than the other one. My leg don't hurt, and I'm getting blood flow, but there is still a tightness feeling in that leg, also the veins stick out in my ankle.
They said the blood vessels have rerouted around the blood clot, but I'm obviously not getting the same blood flow I once had since my ankle stays a little swollen.
My question is even though I'm able to do anything, and it don't hurt, there is still tightness that makes me uncomfortable. Is there anything that a vascular surgeon could do to improve return blood flow?, or, since I'm able to function normally they would advise leaving it alone. Thanks

ANSWER: Kenny
you dont say if it was a deep or superficial vein clot, and it makes a difference, with your symptoms, i suspect it is superficial, but not sure.
generally, we dont fix things that are not causing a problem, so if you have some swelling and you are uncomfortable, insurance wont cover treatment and most docs wont treat. the visible veins are usually considered cosmetic unless you are having pain or impairment. you may have superficial venous incompetence or valve damage from the clot, this is called post phlebitic syndrome and while it can be really ugly, it sounds like you are doing OK. in order to see if you have superficial incompetence you would need another ultrasound to determine the extent of damage, and to be sure you would want a scan of the deep system as well as when we treat the superficial system, the blood is re-routed, as you describe - to the deep system so it has to be working properly or we cause more problems. if it were me, i would live with the tightness and mild swelling. ask your doc about adding compression hose to prevent the swelling. hope this helps lauri

---------- FOLLOW-UP ----------

QUESTION: Thanks Lauri for you response. Yes indeed it was a DVT of the popliteal vein behind my knee. If I would have gone to the doctor when it happened the blood thinners might have worked.
Even though I have blood return, it's not near what it used to be, and the blood obviously pools around my ankle causing tightness.
I was just curious to see if anything else could be done to increase blood return. My doctor did tell me I could wear a compression sock to help, but that doesn't really cure the problem.   Thanks again

Answer
Hi You are right sox wont fix anything, just prevent swelling and distention of veins near the skin. if you want to actually fix the problem, yo would have to ultrasound for venous insufficiency of superficial and deep veins, if there are incompetent veins, they need to be measured (diameter) and the 'reflux' measured for speed. these are then interpreted by vascular surgeon who can tell if there is a problem in the deep or superficial system, if deep sox is only answer. if greater or lesser saphenous veins are incompetent and of a certain diameter with reflux of specified speed, she can treat with a closure (clotting) of the greater or lesser saphenous  or ligation (tying off of the veins) thus shunting the blood to the deep system to return to your heart. if greater or lesser saphenous are not incompetent you would need sclerotherapy (injections) or phlebectomies (removal) of the skin veins. all of these procedures work well and all carry a small risk of postop problems and unless it is painful or causes problems with your skin i would try the sox. if you do try the sox put them on before you swing your feet out of bed as the minute you get up gravity starts filling the veins and increasing swelling so the sox are of no use- they cant fix just prevent.
heres a link
http://emedicine.medscape.com/article/1085412-overview
hope this helps lauri

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Lauri Ordway

Expertise

I can answer your questions related to your circulation, your peripheral vascular system. This includes all arteries and veins except those inside the head and inside the heart. For example, neck (carotid), arms (carotid subclavian bypasses to Thoracic Outlet) belly (aortic aneurysm & occlusive disorders, renal artery stenosis), legs (iliac, femoral, popliteal, peroneal, dorasalis pedis, posterior and anterior tibial) arteries. Aneurysm & occlusive disease, atherosclerosis, leg pain, arterial wounds and gangrene, amputation prevention. Arterial Bypass, Reynaud’s, Buerger's disease (thromboangiitis obliterans), Thoracic Outlet and other circulation disorders. Vein disorders: Blood Clots (DVT), post-phlebetic syndrome, varicose veins, venous stasis ulcers. I can help with vascular wounds from diagnosis to treatments. I have worked extensively with VNUS Closure and EVLT (Laser) for varicose veins and can describe pre and post procedure expectations and describe the procedures themselves. I can't help with spider veins or cosmetic vein treatment, we don't do it. I have 15 years of wound care experience, arterial, venous, trauma and diabetic wounds for example. **I CANNOT answer questions about STENTS or STENTING, heart disease, blood pressure, brain aneurysm although I can help with questions about the arteries that go to and from those organs.

Experience

I am a nurse, I worked for 15 years with two terrific peripheral vascular surgeons, and one of them is also the inventor of very innovative wound care products and surgical instruments to make vascular surgery procedures better and faster. I wrote and manage the clinic website and field questions from patients all over the world. I am now working with another vascular surgeon and wound care expert, which has given me an opportunity to widen my horizons as I learn another excellent physician's preferences and benefit from his experiences in this amazing specialty.

Education/Credentials
I am an LPN, licensed in Minnesota

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