Venous Resource Center

Travelers Risk Assessment

If you are planning to fly or drive for longer than eight hours on two occasions within a six-week period, we invite you to fill in this form and submit it through this web site. All information is strictly confidential. Your email address will not be revealed to the Surgical Research Department at Evanston Northwestern Healthcare.

Check the box next to the questions that apply to you.

Have you ever had a blood clot in your legs or lungs?
Do you have a family history of blood clots?
Do you have or have you ever had swollen legs?
Do you have visible varicose veins?
Do you have ileitis or colitis (inflammatory bowel disease)?
Do you have serious lung disease or difficulty breathing?
Within the last month, have you had more than three days of continuous bed rest due to injury or illness?
Within the last month have you had a pelvic fracture or plaster leg cast?
Have you had a stroke, heart attack, or heart failure?
Within the last month, have you had major surgery lasting over one hour?
Do you have or have you had a malignant disease (cancer)?

The Following Questions Are For Women Only

Do you take oral contraceptives or hormone replacement therapy?
Are you pregnant or postpartum within the last month?

*Age over 40=1 risk factor; age over 60=2 risk factors; age over 75=3 risk factors.

**Basal metabolic index based on height and weight of 25 is a risk factor.

One risk factor for every "Yes" response.

---The travel counts as one factor---

Total Risk Factors:

Scroll down to submit the form

General measures for all travelers:

It is important to do the following:
Drink plenty of fluids.
Stretch legs and change position frequently.
Breathe deeply frequently.
Be careful about leg rests that compress the calf or behind the knee.
Avoid excessive alcohol intake.

If you have more than two risk factors, it is important to consult your physician or a physician familiar with travel-related thrombosis and the methods to prevent thrombosis during extended travel by road or air.

If you have checked off two or more of these factors, you should wear an appropriate support stocking on both legs before you fly or drive long distances.

Samples of these products will be available through this website soon.

These products may also be purchased from your local surgical supply store.

Beware of inferior products, which may not only be less expensive but also less effective.

If you have any further questions, please fill out the boxes below.

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