CHAPTER 1Economy Class Syndrome1.1DefinitionThe economy class syndrome
is the occurrence of deep vein thrombosisin air travelers.The term was first coined in the late 1980s when it turned out that people who hadtraveled long distances byairplanewere at an increased risk for thrombosis, especially
deep venous thrombosisand its main complication, pulmonary embolism. Although all
these diseases had been recognized for a long time, the possibility of litigationagainstairline companies brought them into the limelight when this "syndrome" was reported.
1.2Deep Venous Thrombosis (DVT)
Deep Vein Thrombosis (DVT) is a thrombus formation in a deep vein of the body. Theycommonly inhabit the femoral vein. Patients presenting with symptoms of a DVT areconsidered high-risk patients because of the sequelae that may follow.
Venous clots most often occur in the deep veins of the leg which is called deepvein thrombosis (DVT), or deep vein clot. Venous thrombosis in the lower limbs can beconfined to the superficial leg veins, or may extend to involve the deep veins of the calf,or the more proximal veins such as the superficial femoral, common femoral, or even theiliac veins. Thrombosis is significantly more common in the left leg, probably due to thefact that the femoral artery on that side passes anterior to the vein and may compress it.Thrombosis in the superficial veins of the legs often occurs in varicosities, but is usuallyself-limiting. By contrast, the risk of pulmonary embolism is much higher when proximalveins are involved.
Three predisposing factors are always present in the development of DVT, knownas Virchowâ€™s Triad: vessel wall injury, blood stasis, and hypercoagulability.Damaged endothelium may be caused by direct trauma, infections of surroundingsoft tissue, intravenous catheters or prolonged use of them. The trauma revealssubendothelial tissue which releases platelet activating factors, initiating coagulationcascade, results in platelet adhesion to the wall and the beginning of thrombus formation.2