Veins are blood vessels in our body which conduct blood from peripheral tissues in the body to heart. These vessels, unlike the arteries, lack a muscular wall and depend on the surrounding muscles to pump blood to heart in an antigravity direction. When there is immobilisation for a long duration, there can be stasis of blood in the veins due to inactivity of muscles. This results in clotting of blood, which forms a thrombus. This mainly occurs in deep veins of leg.
Economy Class Syndrome or Traveler’s thrombosis is occurrence of thrombosis of deep veins of legs. It is most commonly reported in people who travel long distances by aircraft. Economy class offers little leg space and consequently immobilization. With added risk factors, such as antiphospholipid syndrome, cancer, pregnancy, obesity, age over 40 years, orthopedic surgery to lower limbs and dehydration it can lead to deep vein thrombosis.
Additional environmental factors during air travel may also play a role. Although the problem has been specifically related to air travel, it would appear that the problem is linked to immobility and that all travellers, including travellers by bus, train and car, are equally at risk. It has been reported that the risk of venous thromboembolism approximately doubles after a long–haul flight (greater than 4 hours) and also with other forms of travel where travellers are exposed to prolonged seated immobility. Risk increases with the duration of the travel and also in passengers having other known risk factors.
Pain and swelling of calf or the entire leg are the main symptoms, with a sudden onset. Sometimes it may be sever enough to make walking difficult. Pulmonary embolism is a fatal complication when the thrombus dislodges from the veins and gets impacted in the blood vessels of lung. Pulmonary embolism manifests as breathing difficulty, blood in sputum and chest pain.
It is always better to prevent than treat the condition. Prevention involves proper hydration, abstaining from alcohol and smoking cigarettes, wearing of compression stockings. In cases of passengers with known risk factors Low molecular weight heparin prophylaxis can be given as injections. In established cases of travellers thrombosis, anticoagulant therapy with warfarin and low molecular weight heparin can be initiated.
