VASCULAR & IR
Venous Disease: Deep Vein Thrombosis
IR Clot-Busting Treatment Prevents Permanent Leg Damage
The formation of a blood clot, know as a thrombus, in a deep leg vein can be a very serious condition that can cause permanent damage to the leg, known as post-thrombotic syndrome, irreversible damage in the affected leg veins and their valves. Early treatment with blood thinners is important to prevent a life-threatening pulmonary embolism, but does not treat the existing clot.
Long-term studies show that 73-82 percent of people treated with blood thinners alone developed post-thrombotic syndrome. In many cases, people with continuing leg pain after seven days should seek a second opinion from an interventional radiologist because the clot may need to be removed to avoid permanent leg damage. Contrary to popular belief, anticoagulants do not actively dissolve the clot, they just prevent new clots from forming. The body normally dissolves a clot over time, but often the vein becomes damaged in the meantime.
Catheter-directed thrombolysis is performed under imaging guidance by interventional radiologists. This procedure, performed in a hospital's interventional radiology suite, is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserve valve function to minimize the risk of post-thrombotic syndrome. The interventional radiologist inserts a catheter into a leg vein, such as the Popliteal, and threads it into the vein containing the clot using imaging guidance. The catheter tip is placed into the clot and a "clot-busting" drug is infused directly into the thrombus (clot). The fresher the clot, the faster it dissolves one to two days. Any narrowing in the vein that might lead to future clot formation can be identified by venography, an imaging study of the veins, and treated by the interventional radiologist with balloon angioplasty or stent placement.
In patients in whom this is not appropriate and blood thinners are contraindicated, an interventional radiologist can insert a vena cava filter, a small device that functions like a catcher's mitt to capture blood clots, but allows normal liquid blood to pass. People with symptoms of DVT should first go to an emergency room to seek help, to receive initial treatment with blood thinners to prevent a pulmonary embolism. After treatment with blood thinners, if symptoms such as leg pain and swelling continue, patients should obtain a consult with an interventional radiologist for further evaluation.
Some of the symptoms include:
Discoloration of the legs
Calf or leg pain or tenderness
Swelling of the leg or lower limb
Increased visibility of surface veins
Clinical resolution of pain and swelling and restoration of blood flow in the vein is greater than 85 percent with the catheter-directed technique.