Deep Venous Thrombosis

What is it?

DVT is a serious medical condition when a blood clot forms in the large veins of the body. This can be instigated by certain medical conditions, medicines, or even prolonged inactivity, i.e. a long car or plane ride. Most DVTs are not life or limb threatening, but can be extremely painful and limit ones activity. The larger and more extensive DVTs can result in extreme pain and immobility because of swelling.

Most often, the treatment for DVTs is anticoagulation (blood thinner), typically for 3-6 months. However, when the DVT burden is very large and involves the upper leg or when symptoms are severe, more aggressive treatment may be necessary to expedite and facilitate a rapid and complete recovery. These treatments include catheter directed thrombolysis (medicine that dissolves the clot), angioplasty (balloon stretching of the vein) and occasionally stenting. Many of these therapies can be done as outpatient procedures, with infrequent circumstances requiring patients to spend the night in the hospital.

What if only anticoagulation is used for large/upper leg DVTs?

Everyone is different, but typically, the larger the blood clot burden, the harder it is for your body to dissolve the clot completely, despite being on anticoagulation. Residual blood clot or scarring can damage the vein walls and valves, which decrease their ability to function correctly.

What if I can not be on anticoagulation?

If a patient can not tolerate anticoagulation due to a variety of reasons, one may consider placement of an IVC filter to help prevent the migration of the lower exteremity DVT to the lungs, a more serious condition called pulmonary embolism. More information regarding this procedure can be found here.

Who is eligible for more aggressive treatment of DVTs?

Patients with large lower extremity DVTs involving the upper leg (common femoral vein, iliac vein) IVC or patients with severe lifestyle limiting swelling and pain.

What is CDT (catheter directed thrombolysis)?

CDT is a minimally invasive technique where a catheter (small long tube) is inserted into the vein that contains the blood clot. There are a variety of types and designs of catheters used, but many of them have small holes along the entire length of the catheter. Low doses of a medicine called tPA is pushed through the catheter and actively dissolves the clot. After the medicine dissolves the clot, any remaining thrombus is usually aspirated (sucked out of the vein), clearing the vein and allowing the swelling and symptoms to quickly resolve. If there is residual narrowing of the vein, this can be treated with balloon dilation (angioplasty) and/or stent.

When should intervention for DVT occur?

For a new DVT, the ideal time frame to dissolve the blood clot is within two weeks of onset of symptoms. However, there are procedures that help counteract the damage of an old DVT. If the iliac vein or IVC is occluded, these vessels can typically be reopened to facilitate blood draining from the leg.

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