Deep Vein Thrombosis (DVT) Treatment
Deep vein thrombosis (DVT) is a condition in which a blood clot develops in one of the primary veins of the pelvis, thigh, or calf, or less frequently the arms, abdomen, and chest. When a clot forms, it can extend to adjacent areas of the vein, triggering a localized inflammation that may encourage additional blood clot growth. A clot in a deep vein can also increase the potential for a dangerous complication, pulmonary embolism, in which a clot breaks free, travels through the bloodstream, and lodges in the lungs, where it can cause heart and lung collapse. Interventional radiologists use treatments called thrombolysis and thrombectomy to break up and dissolve acute (new) blood clots. People who have had DVT in the past may have older clots and scars, and we use a variety of techniques to re-open veins that have longstanding blockages.
What is thrombolysis/thrombectomy?
Thrombolysis is a minimally invasive procedure in which we administer clot-dissolving drugs directly into the clot to break it up. During thrombectomy we use a catheter tipped with a tool that mechanically breaks up the clot. These two procedures are sometimes used together, and are useful for very large clots or in people who are at high risk of developing a pulmonary embolism. Thrombolysis is usually reserved for emergencies because of its high complication rate, though most complications are manageable.
How do I get ready for the procedure?
On the night before the procedure eat a light meal, then do not eat or drink anything after midnight. We will provide you with more detailed information about which medications you may take in days before and on the morning of the procedure. Plan to have someone drive you home after the procedure.
What will happen during the procedure?
After you arrive at the interventional radiology suite and change into a gown, you will lie on the procedure table. To relax you and block any pain we will intravenously give you a combination of medicines called “conscious sedation.” Using X-ray and/or ultrasound image guidance, we will insert a long, very thin tube called a catheter into a small incision in a vein either below your knee or in your groin and thread it through the vein to the clot. Using a catheter equipped with holes along the sides we will release a clot-dissolving (thrombolytic) drug directly into the clot to dissolve it, and in some cases will also mechanically break up the clot using a catheter tipped with a tiny metal coil. Once the clot is removed we will withdraw the catheter and close the incisions. This procedure takes about one to three hours.
Are there any risks?
The most common complications of thrombolysis and thrombectomy include bleeding from the needle puncture. Other complications include low blood pressure, an allergic reaction to the clot-busting medication, post-thrombotic syndrome (swelling, pain, and ulcers (sores), or, very rarely, Intracranial hemorrhage (bleeding in the brain tissue).
After the procedure
After the procedure we will have you rest in the recovery area, and we will give you intravenous fluids, antibiotics to prevent infection, and painkillers to relieve discomfort at the catheter insertion site. We may discharge you once any bleeding from the insertion site has stopped and your vital signs are normal.