Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a serous and possibly dangerous condition in which a blood clot forms in a deep vein of the leg, pelvis or occasionally, the arm. If the DVT is left untreated, the blood clot can migrate to the heart and lungs which is called a Pulmonary Embolism (PE), which can be fatal.

DVT is categorized as being acute or chronic. Acute DVT is often first treated with blood thinning medications (anticoagulation such as heparin or warfarin/coumadin). Blood thinning medications help reduce the chance of PE and rely on the body’s natural defenses to dissolve the clot which may take several weeks or months to work, and by that time, the vein may be permanently blocked.  A permanently blocked deep vein can eventually lead to a condition called Post Thrombotic Syndrome (PTS). The morbidity associated with PTS may be significant and patients can present with edema, chronic pain, swelling, skin changes, and heaviness of the affected limb.

Deep Vein Thrombosis (DVT) Treatment

For patients with symptomatic acute DVT, a minimally-invasive procedure called DVT thrombectomy and thrombolysis is commonly performed to rapidly remove and dissolve the clot. The procedure involves placing a small catheter in the leg to mechanical remove the clot by suction and dissolve the clot through the administration of clot-dissolving medications (tPA). Oftentimes, there is an underlying anatomical problem which causes the clot to form in the first place, such as a segment of narrowing in the vein. This can be treated by angioplasty (ballooning the vein open) and/or by placing a stent to keep the vein open. DVT thrombectomy and thrombolysis can significantly speed the recovery from a DVT and help to minimize future adverse outcomes such as pulmonary embolism (PE) and post thrombotic syndrome (PTS).

IVC Filter

If blood-thinning medications are contraindicated, a small filter may be placed within the inferior vena cava (IVC), which is the large vein within the abdomen that returns blood back to the heart from the lower extremities. The filter, called an IVC filter, prevents blood clots from traveling to the heart and lungs. When placing an IVC filter,  the interventional radiologist will use imaging technologies such as ultrasound and real-time fluoroscopy to accurately place a filter into the inferior vena cava. The filter is deployed through a catheter into a safe location from which it can trap free-floating clots. Most IVC filters currently used can be easily removed by the interventional radiologist after the threat of blood clots is gone. Alternatively, the IVC filter can be left in place permanently depending on the patient’s history. An IVC filter placement or removal can be performed as an outpatient or inpatient procedure and are typically performed under local anesthetic.