Long distance travel, whether by automobile, train, or airline can be associated with leg discomforts and risks. Lack of leg movement gives way to swelling of the feet and legs. The swelling contributes to leg fatigue, discomfort and the sensation of leg heaviness.

Activity restriction in the confined seated position results in diminished flow of venous blood from the legs back to the heart. This combined with pre-existing risk factors may lead to a more serious danger - travel-related thrombus. You may have heard this reported in the media as economy class syndrome (ECS). A travel-related thrombus is a venous thrombosis (blood clot in a vein) associated with greater than 5 hours of travel in a seated position. The venous thrombosis may be limited to a deep vein (DVT) or a fragment could flow to the lungs and lodge causing a pulmonary embolism (PE).

The likelihood of a thrombus occurring can be reduced with appropriate preventive measures suited to an individual’s risk. Risk factors for long-distance travel related venous thrombosis include: age >40, malignancy, heart failure, severe varicose veins, chronic venous insufficiency (CVI), obesity, hormonal medication, previous DVT, family history of DVT, and recent surgery.

Consult with your physician to determine your risk category and seek advice on appropriate prophylactic measures, including the amount of compression to wear.

Recommendations for any extended travel:

• Drink plenty of non-alcoholic fluids, especially water
• Perform ankle movements often
• Stretch and exercise your legs at least once every hour
• Elevate legs when possible
• Avoid high-heeled footwear and restrictive clothing
• Wear gradient compression hosiery
• Seek medical advice if you have or are concerned about any risk factors

At The Vein Institute of Toronto we recommend Class 1 20-30 mm Hg medical compression stockings of the knee high form.
Facts About Economy Class Syndrome (ECS) and Deep Vein Thrombosis (DVT)

• "Economy Class Syndrome" (ECS) is the term associated with a serious condition called deep vein thrombosis (DVT). Crowded, cramped conditions and limited physical activity during extended air travel may increase the risks for DVT.
• ECS got its name from the inactivity associated with air travel, particularly in cramped coach seating.
• During prolonged periods of inactivity, the effects of gravity make it difficult for the blood in the veins of the legs to return to the heart. Activity of the calf muscles is needed to contract and pump blood up the legs. Without this activity, blood can pool in the legs, causing swelling and discomfort and may develop into a blood clot in a deep vein – deep vein thrombosis.
• When normal activity resumes, the blood clot can break off and form an embolism that can pass to the heart or lungs, obstruct the pulmonary arteries, and lead to death.
• Development of thrombi during extended air travel has been documented throughout the past 40 years.
• Although DVT can strike individuals who are in good health with relatively little warning, there are people who are at greater risk for developing the condition. Obesity, pregnancy, chronic heart disease, use of hormone medications, malignancies, history of blood clots, varicose veins, and recent trauma or surgery may increase a person's risk for DVT. ¹ Travelers should ask a physician if they are predisposed to any risk factors for DVT.
• DVT is not only associated with long flights. This condition may also be linked with activities or occupations that involve long periods of passive sitting.¹
• To reduce the risk for DVT while traveling, physicians recommend wearing gradient compression hosiery to improve blood circulation in the legs in conjunction with foot/ankle exercises and walking.