Deep Vein Thrombosis (DVT) Treatment
Using image guidance and minimally-invasive tools, Columbia's interventional radiologists perform thousands of procedures each year to treat deep vein thrombosis (DVT) and many other conditions that would otherwise require open surgery.
DVT is a condition in which a blood clot develops deep in one of your primary veins, usually in the leg. DVT often causes the leg to swell, although a clot can exist with no symptoms. DVT is potentially life-threatening because the clot can break free and travel through the bloodstream to your lungs, where it can cause heart and lung collapse.
DVT is most often treated with blood thinners and other medications. For patients with more serious clots, or when medications aren't working or can't be taken, interventional radiologists use a variety of techniques to break up and dissolve new clots, or re-open veins that have longstanding blockages:
- Thrombolysis and thrombectomy are procedures used to break up and dissolve acute (new) blood clots.
- Inferior vena cava (IVC) filters can be placed in a major vein called the inferior vena cava to catch blood clots, usually temporarily.
Thrombolysis and Thrombectomy for DVT
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.