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Thrombi may develop anywhere within the venous system but most commonly arise in the deep veins of the leg through an interplay among 3 factors that include vessel wall damage, venous stasis, and hypercoagulability. Direct damage to the veins helps explain the propensity to deep vein thrombosis (DVT) after major orthopedic surgery. Thrombi often originate in the calf, either in the muscular sinuses or valve cusps of deep veins. Immobility delays emptying of muscular veins and retards clearance of activated clotting factors. With stasis, endothelial cells lining the avascular valve cusps are activated by hypoxemia, a process exacerbated by inflammatory cytokines generated postoperatively or in medical illness...
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