In medicine, they differentiate between "acute" and "chronic." "Acute" refers to things that are new and/or short-lived. You could have an acute DVT if you've just been diagnosed. You could have an acute cough if you've just got a cold.

"Chronic" means something that has been there a while and may/may not improve. You can have a chronic DVT that has been in your leg for years. You can have a chronic cough if you're a smoker or have asthma.

Neither word means that something is unchanged or hasn't improved. It's more just dating the condition ... is it new or pre-existing?

From my perspective, three months is a little early to tell if a DVT is going to be truly chronic. Many people take longer than that for their clots to resolve. My first DVT was diagnosed in 2005--almost ten years ago now! When my second DVT was diagnosed in 2009, the first one was still there... it was definitely chronic at that point. Some doctors thought it might never go away ... I thought it would probably be in my leg forever too. It isn't a danger at that point, of course, since it has pretty much turned into a "scar" in the leg and the blood flow has worked around it, but it is still visible via ultrasound.

There were two surprising things with my "chronic" DVT though. First was that it didn't really cause any issues. The leg was bigger than the other one, but I didn't have any issues with pain or discoloration or increases in swelling. The second surprising thing was that it DID go away eventually. I had some leg pain last year which lead to an ultrasound ("just to be sure" since I'm still on warfarin). At that time, the clot was gone. A little tiny bit of residual scarring, but otherwise it was gone. I was really shocked by that ... it had finished dissolving somewhere between four and nine years after diagnosis.

So, basically, all "chronic" means is that it isn't a brand new clot ... that would be cause for concern!

Yes, agreed with everything Toss said. Since you asked whether it being chronic means it's still totally occluded, I just wanted to add a response to that. The classification of chronic doesn't describe what level of occlusion, so until you have the results of the report, you just wont know for certain. Most likely your clot has opened back up, or recanalized, which would mean it does allow blood flow, despite there being some "old" clot still there.

I agree that 3 months is still early for DVT recovery, so even these results, take them as just knowing where you are now, because you'll continue healing for at least the next several months and things will continue improving.

Thanks Tossnturn...
I see. Yes, no new ones! My leg does hurt and is still swollen, although it's minimal, as it was 3 months ago. But it def hurts!!! So, I guess I will see what that means. The other parts of the clot must have some blood flow, they have improved somewhat which is good so early, I agree. Yea, it is soon indeed, so the chronic thing doesn't really mean anything. ok. They told me 3 months ago they thought the dvt had been there a long time. Again, who knows. I have had swelling for 7 years.

I think after so many years I would have been surprised that yours had resolved as well. That is good that eventually they can clear up. Luckily you have no symptoms! This pain is really an issue.

I dont really get the part that it isn't a danger after a while, or that it is stable, considering the blood flow is totally altered. I am glad you are ok and still anti-coagulated. It's a lot of work for those little veins to make up the work, isn't it?

But thank you for your answer. I was reading about CVI.. chronic venous insufficiency. I stumbled upon it actually. I wonder with my blood pooling disorder if this is related. :

"The damaged veins allow blood to leak backward; this prevents the proper flow of blood to the lower extremities. CVI can cause long-term pain, swelling, and cellulitis or ulcers in your legs. It can also create pain with prolonged sitting or standing and make walking difficult."

I know I have more pain after walking and every position hurts, but like you said, it could be too soon to really know how this will play out. I just wonder if the years of blood pooling hasn't caused the issues to begin with. Who knows! lol. Sometimes we never find out.....

I just wish I knew right now. I hate waiting. I've been sick for too long! lol. I'm such a whiner ;)

Thank you Shilosmom... RIght, I dont know if it's occluded from the term, ok, got it. I will hopefully get the details soon then.. I can't wait to get the reports. Luckily the records are online and should be available to me around Wednesday. I am lucky my lungs are resolved now, according the what the nurse told me briefly. I wasn't expecting that! I guess I didn't expect any of it to be better yet. lol. I feel like garbage! lol.

You guys are sooooo smart and informative. I love how patients have all the info you are looking for. I trust you guys more than the docs!!! lol. This is all still new to me, and I really need to change the hema. I just didn't have the energy to deal with the change right now, but I will do it soon. he tells me nothing and then just kicks me out. I see him on the 6th, but I am not looking forward to it at all!

Thanks again :)))

In my own personal experience, three months is way, WAY too soon to know how things will play out in the long run. With my first DVT (the most serious one), I saw improvements and recovery all the way up to two years, so you still have tons of time for improvement.

If you have other issues going on, it might be a good time to talk with your doc and see if you can unravel everything and figure out what the best path to recovery is. You might need a specialist also, although I don't know much (anything) about CVI, so I probably shouldn't be speculating.

Chipsanddip, I could easily believe that if you have already had CVI for some time that it's a contributing factor to having gotten DVT. It's at least an additional risk factor because blood isn't flowing as well as it should, and we often here talk about the circumstances which cause blood clots as being more of a "perfect storm" of combined risk rather than one single cause. Here people usually say they have post thrombotic syndrome (PTS), but I think that in reality that's physically the same as CVI, it's just that it's usually called PTS when it happens as a result of a DVT. At least, it is in my case. My surgeon diagnosed me with CVI because the clots I had destroyed my valves.

Your hematologist might have some input as to whether he thinks the CVI was a contributing factor or not, and that will likely depend mostly on whether he finds a blood disorder or not. In all honesty, you may not really need to bother changing hematologists, because you really might not need one at all. Many of us have seen a hematologist for a short time after getting clots, mostly for evaluation of genetic clotting factors, but not many people continue with one over the long term, because it usually isn't necessary. Usually you can get your GP or a Coumadin clinic to oversee your anticoagulation for whatever time you need to take it.

One suggestion I might make to ask your hematologist in case he doesn't find a genetic clotting factor (which is, I think, still the most common result), is that considering you have CVI what his opinion is on long-term anticoagulation. Because this being the first time you've clotted, normally you'd do your six months or whatever and be done. But since you have CVI, and perhaps depending on the extent of it, it might lean the doctors toward a different recommendation if they think it significantly increases your risk of another clot. I hope you don't mind me sticking my nose in there, but I know sometimes when we're new to a problem, and especially with a dismissive doctor, we don't always know what we should ask.

I'll also echo what Toss said about recovery. My leg continued improving for about two years after I was diagnosed with the DVT, so although you still have pain and problems now, it doesn't mean you'll be stuck at this point over the long term. Personally I found walking to be extremely helpful for my leg. It wasn't easy to walk much on it in the beginning, and you have to listen to your body and be reasonable, but I always felt general improvement as I walked.

Oh, and you said you didn't quite understand about saying the clot is stable and not a danger. We don't mean by that to say you don't feel the physical effects of the clot still, it just means that the clot has hardened and adhered to the vein wall, and it's not a danger in that it won't embolize and cause PE, because clots in your lungs are way more dangerous than clots in your leg.

Glad to hear that you're healing so well overall, and that your lungs are already doing so well. That's all great!

Just few clarifications (apologies if I repeat what others have said)

Following clotting (generally for the first days) , the clot is initially quite loose in structure (is composed of lumps of platelets and fibrin proteins (D-dimer measure activity of the lysis of fibrin)). In the first days the clots is broken down by various ensymes (same or similar as in thrombolysis) which are controlled by various proteins (e.g. Protein S, C, but inactivity in these retard lysis of blood clots). This is where the clotting is in the "acute" stage. Gradually the clot hardens and adheres to the vein wall and is very slowly broken down. After a while the clot becomes so hard that the body is either very slow or cannot break it down, i.e. it becomes "chronic" or "residual" clot. There is no sharp transition from "acute" to "chronic" clots, but it is a gradual change. Also, it is debatable when "chronic" clot becomes "chronic clot", is it after 1 year?, 2 years? Overall, "chronic" clots refers to clots that are not going to decrease, or decrease very little.

"Chronic" clot does not necessarily mean that the vein is occluded.

Venous insufficiency is a manifestation of DVT, but generally PTS. If you have post-thrombotic syndrome or DVT, the flow up the leg becomes more sluggish, and if the venous valves are damaged, some of the blood is pused down with the gravity. Chronic venous insufficiency means thus the chronic state. So with a patients with PTS, chronic venous insufficiency is there one manifestation of it.

Just a little background of how blood is transported up the leg. In contrast to arteries which can compress and pump the blood themselves, then to transporting the blood in the veins is carried out with muscole contraction. Veins are extremely flexible and each time you press the calf muscle, the muscle presses the veins, and squeezes the blood upwards while the valve veins make sure that the blood does not go down again. In addition, in the vein there are valves to make sure that the blood does not flow down again. If the valves are very damaged, this means that each time calf is pressed, the blood is squeezed upwards but as the valves are damaged, flows down again and this causes pooling of blood, i.e. venous insufficiency, which causes PTS symptoms (swelling, redness etc..). Incidentally, ultrasound analysis have shown that if a clot is lying on a vein valve fore a month or longer it will get damaged and contribute to a PTS. Vein valve damage is the strongest predictor of PTS. However, a clot in a vein does not mean that the valve is damaged, as generally the clots are very patchy and these have to lie directly on the valve vein.

As others have said, 3 months is very short time in DVT/PE recovery. Clots can dissolve for a year or so, and possibly longer time. I would not despair now and think about potential future outcomes, as these are extremly difficult to predict. I would thus not even think about this. Many poeple get PTS, but in most cases these do not have a large influence on people lifes.

This reply was much longer than I intended...sorry about that..

Hi.. I dont know about the CVI either, and finding specialists, especially here, is seeming impossible. That is the problem with having complicated chronic issues. I have been left in the lurch for many years. Which is why I wonder what they meant when they said the clot had likely been there a long time. I am tired of not having real answers. I have to spend $$ that I don't have, literally, lol, to send my records to a neuro in NY who did a study with Prof. Hughes about the link between POTS (My blood pooling, tachy disorder) and APS. I am praying to speak to her soon and get her opinion. I also had a genius internist in NY who could figure all this out, but I need a small fortune to pay for a consult. Although, I may have to do it. No one down here is all that familiar with POTS, if at all. I have been sick since I was a kid, and it's infuriating to me that no one gets it.

I would like to skip this hema and find someone versed in MY conditions but I dont have many options on my health care plan. I am very limited, which is why I have to reach out, and out of network, to hopefully get somewhere.

I guess it is not bad at all, what I am experiencing .. considering what others have gone through. I feel very lucky and I dont have the extreme anxiety, but I think if I had the massive lung pain, I would likely be living in sheer terror right now. But I feel like I got off pretty easy in that department. I do have to go for a stress test to check my heart, but still my chest symptoms are not awful. They are there but not something I can't handle, it must be pretty mild. But my leg, does bother me. But like you have said, you both needed a couple years with your dvt's, so that is good to know:)

I had 2 PE's but one was small, so I think the other was not that much bigger considering I had no pain breathing. I would get chest pains, and still do and a deep fluttering in my chest, hence the stress test. But that is all. The pain was a little intense Friday which is why I went to the ER, but still, once it passes, I'm fine.

The whole thing is so bizarre to me. lol. But the worst is that I am used to not get correct diagnoses for many many years, and I am in no mood to wait another decade!! lol. THe docs down here are 50/50. Some have been real beasts. I am very disillusioned. I have met a few kind and smart ones, but they are in diff specialties or not on my plan. But the bad ones have been really bad, and I am very frustrated. Sorry if I keep repeating myself :( I just don't trust the hands that I am in to a degree. It's scary because now things have amped up to a more serious level with the clots.

Shilos... How did they dx your CVI? Was it a special test? Or does it show on ultrasound? These were my first leg dopplers, I'm still waiting for the reports. Again, I've had the swelling for 7 years but it was never checked. ugh.

Anyhow, I appreciate the time you all have taken to write to me about your experiences. It's all invaluable info and I find it very helpful talking to you all!!! I know nothing, so it's great to hear actual info from those of you who have lived it.

Thank you !!!!!!!
xoxo

Just a thought... but if you've had a doctor, ANY type of doctor that you really liked and felt like they really understood you, ask for recommendations from them for other doctors to see. A lot of times you can even call and just talk to the front desk and see if they have regular recommendations they make on other types of specialists. I know that my primary doc does this and I've had good recommendations from other specialists that I've gotten along with. Sometimes you just have to find one or two good ones and you can "grow" your doctor network from there.

Thanks Toss... the problem is that I am new to the area:( I am in Florida now, from NY. Which is why I will have to go into overdraft to call those old docs. lol. They do phone consults which is good. But very expensive. But if they know of anyone down here, they will for sure tell me. At least I know they are good and will be very very helpful... I wish I was still home, I would feel more secure with my old team! It takes a village!!! lol
Thank you:)))

My CVI was diagnosed with a combination of the ultrasound and my reported symptoms. Well, the continued swelling was obvious, and my leg felt very heavy, like it was made of lead, and my surgeon said that was a classic CVI symptom. Honestly in my case it didn't surprise anyone because the clots were so severe and the treatment itself tends to destroy valves also.

I'm sorry I must have misunderstood what you first wrote, because I thought you had been diagnosed with CVI prior to the DVT. I don't know that POTS is considered any sort of risk factor for DVT, but if you happen to have APS as well, that is a clotting risk.

Do you mind me asking what part of Florida you're in? It's just that I also am a northern transplant to Florida, if by chance you're near my area I may be able to give some suggestions on doctors. I completely understand how hard it is when you don't really trust your medical team. That same thing happened to me in Cincinnati when everyone kept telling me nothing was wrong with me, only to end up having had PE the whole time. Fortunately for me, I have gotten good doctors where I live who have helped me with continuing problems more than what the doctors up north would do.

Got my report:

There is absence of flow, compression and augmentation in the left
mid superficial femoral vein which is diffusely small, decreased in
diameter compared to the exam from 11/29/2014, likely chronic. There is slow flow in the distal superficial femoral vein.The common
femoral and popliteal veins are patent with normal compression and
color Doppler flow. No new DVT is seen.

I am annoyed they didn't scan my ankle. I don't know why she stopped mid calf:( grrr

Hi Shilosmom... I am in Broward, near Pompano. Most of the docs are in Coral Springs or Margate that I see.
yes, I dont know about the CVI at all, I just happened upon it and do have some symptoms... the POTS has been shown to be linked to APS in some patients. So, I I just wonder what decades of pooling had to do with it, and if that is why there is a connection. Or what decades of pooling would do in general.

Where are you? How long have you been down here?
xoxo

Based on your report, you have a occlusive clot in the middle part of the left deep vein (superfiical) femoral vein, that would be around mid thigh. Because they say, in the left superficial femoral (SF) vein, do you have two SF veins, or are they referring to the left leg? (I have two SF veins). The vein has also undergone some structural changes that I do not understand fully. There is however some slow flow in the distal part of the (superficial) femoral vein, that would be somewhere above the knee. The common femoral vein (which is above mid thigh, but the SF veins splits into the femoral and deep femoral vein) and the popliteal vein (which is behind the knee) are not clotted. The fact that your Popliteal vein was clear of clots, then it is extremely unlikely that your calf veins are clotted. You further have no new clots.

Based on this, this occlusive clot in the superficial femoral vein is really slowing down the blood flow up the leg. However, your occlusive clot seems to be quite localised. You can actually have this clot removed, but Mark Garcia at Christiana care have been very successful at removing such old and hardened clots

http://www.christianacare.org/bodymod.cfm?id=169&action=detail&ref=3068

EKOS can also be used to remove old clots, and as the clots are only 3 month old, it could work as well. http://www.ekoscorp.com/

Because your clot is occlusive, but it is so localised (from around 1/3 to mid thigh) it should be possible to remove. Mark Garcia has removed lots of such clots. By doing this the blood flow is restored and when that happens you should feel much better. This clot slows down the flow and thus contributes to the CVI.

Considering that the clot is only 3 months old, then you can also wait and see if the body breaks down the clot over time. The problem with that approach as longer time you have such occlusive clot, you may over time impose more damage to your veins and your valves. Furthermore, whether the clot stays occluded forever or not is also really difficult to say. It may partially or completely dissolve after 6 months or a year, thus permitting flow through the vein, or it may not do it at all. Whether it is better to waith with operation now and see how the situation is after 6 months, or remove it now, is something you need to discuss with your doctors. Both approaches have pros and cons.

Stefan I can't thank you enough!!! You are a wealth of info!!! yes, I think they mean the left leg... and where you say it is, (I knew it was the thigh) but the mid inner thigh is where a lot of pain and pinching is. But I also have a lot pain all around my knee (still hard to bend) and at my shin. But I see what you mean about the calf. Maybe that is why the girl didn't scan my ankle.

I did check your link to the doctor, I am in Florida with a very limited health insurance policy unfortunately, but I am saving the info just incase. Have you had any removed? I would be a little scared of the pain following that procedure. I see the hematologist on the 6th and I will see what he says about the new report. But I need to change that doc anyhow, but I will be asking the question. I do not know when or if they re-scan the leg anytime soon. I would assume it could be in another 3-6 months.

I really need to save your comment and review several times... I will forget many things. I will email it to myself to try to remember! You have such great information. It makes sense that the longer it sits there the more trouble it can cause if it does not begin to dissolve on it's own. So, that is food for thought. This is all new to me and I am only beginning to absorb some info about it all.

Thank you so much for posting :)
I hope you are well!