Vascular Disease Foundation - Fighting Vascular Disease... Improving Vascular Health.

Interactive Learning : Ask the Doctor


Ask the Doctor Live Chat Transcript - Tuesday, March 3


Michael A. VasquezMD, FACS, RVT

The Venous Institute of Buffalo

Venous Disease Coalition Steering Committee Member




Moderator- VDF: Thank you for joining us today!  I would like to introduce Dr. Vasquez who is now ready to take your questions.

Betty: Hi Dr. Vasquez, how long can a person have a DVT before it shows any symptoms or causes a pulmonary embolism?

Speaker- Dr. Vasquez: DVT is most frequently symptomatic - pain and swelling, HOWEVER DVT can be silent. If there is a concern, you should seek attention from your doctor.

Elizabeth: Hello, I am a 55 year old woman and 8 yrs ago I had a PE. But I didn't have any risk factors. About 5 months ago I injured my ankle and a clot formed in my lower leg. I was hospitalized given lovenox and put on coumadin. Because this is my 2nd incident should I be on coumadin for the rest of my life?

Speaker- Dr. Vasquez: DVT secondary to a known inciting event does not usually require lifelong warfarin. However, a history of PE complicates things. You may consider asking your physician for a clotting profile workup to make sure you do not have any hereditary risk.

Moderator- VDF: This next question was also e-mailed to us ahead of time: I was born (in 1957) with a condition on my right hand. The latest diagnosis was “arterial venous malformation”. I had surgeries in 1957, 1966, and 1975. I currently have a large mass at the base of my 3rd finger, a smaller mass at the base of my thumb, and a small mass on top of my hand. Any references to my condition never seem to be for the hand. Where can I look for the latest info? The last doctor I saw said that surgery could result in the loss of my finger if blood flow was cut off to the veins.

Speaker- Dr. Vasquez: There are few physicians who specialize in vascular malformations. The most widely known one is at Georgetown University. His name of BB Lee, MD. I recommend looking him up.

Carol: My legs ache after standing and walking. What should I do?

Speaker- Dr. Vasquez: The question is why do they ache? There may be many answers to this. First, I recommend you see your doctor as nothing replaces a good history and physical. If your doctor feels that you have venous reflux, you may benefit from compression hose or consultation with a specialist in venous disease.

Carol: I have small varicose veins - would that be the cause?

Speaker- Dr. Vasquez: The usual cause is venous reflux disease. In this, the vein valves do not work properly and pressure builds in your legs when you are standing. A physician specializing in venous disease may be able to help if your own doctor cannot.

Moderator- VDF: My wife's family was in a study for factor viii in Maastricht several years ago. This next question was also e-mailed to us ahead of time: Three siblings had DVT; one brother, who had a more serious episode, remains on warfarin. In 2003 my wife had an episode of DVT and was eventually put on warfarin. She is 65 and otherwise healthy. Our Question is how can we determine if she could be taken off warfarin after being on it for 5 years already? Her INR hovers just above 2.

Speaker- Dr. Vasquez: There is no simple answer to this question. I believe that a consultation with a Hematologist is in order here. That physician would be able to put all the variables together and offer his/her best judgment as to the course of action.

Moderator- VDF: This next question was also e-mailed to us ahead of time: I was diagnosed with a DVT on the 24th of December. I was in the hospital and have been put on 10mg of warfarin a day, it’s been over 2 weeks and my dosage has not gone down. I go for regular blood work and my Doctor has not let me know anything different. I often still get sharp pains in the calf of my leg and the odd time a burning sensation, what does all this mean?

Speaker- Dr. Vasquez: You need to speak with your doctor. First make sure your warfarin dosage is properly adjusted to your latest blood testing. If the pain persists, revisit your doctor. If you are not pleased with the response you receive, get a new doctor.

Robert, PA-C: Since there may be a slight increased risk or DVT with a patient who has CVI, How should patients be tested for Chronic Venous Insufficiency Pre-Orthopedic total hip/total knee procedure? CEAP + venous clinical severity score / PPG venous refill / full duplex ultrasound? Is there a preventative DVT pre-surgical work up?

Speaker- Dr. Vasquez: There are many questions here. However, the American College of Chest Physicians has recently issued Thrombosis Guidelines in 2008. I recommend that you visit the under "Resources" and Health Professional for access to this information.

Carol: There are some varicose veins showing in my calf. Although small or thin, I have heard about DVT. Should I see a doctor about this? Is it urgent? What kind of doctor? 

Speaker- Dr. Vasquez: Small veins in the legs do not appreciably increase your risk of DVT. Legs that develop sudden pain or swelling or hard spots where a soft vein once was maybe at risk of DVT, however you can always ask your doctor at your next appointment. I would recommend a physician that has a special interest in venous disease. I am a vascular surgeon, however other specialist take care of these problems very well.

Thanks to everyone for logging in today and thanks to Dr. Vasquez for his time today! We wish you all a healthy day!      


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