Deep Vein Thrombosis (DVT) Treatment with Thrombolysis: Catheter-based Clot Removal

At Vascular and Interventional Physicians, our specialty-trained interventional radiologists perform a minimally invasive, non-surgical procedure that removes blood clots, as known as deep vein thrombosis (DVT), from patients’ legs. The procedure, called DVT thrombolysis, can be done on an outpatient basis. In the days following the procedure, the pain and swelling related to the deep-vein blood clots generally resolves. Once the clot is removed from the veins of the leg, patients are able to resume their normal activities within a week.

What is Deep Vein Thrombosis (DVT)?

Thrombosis means the formation of clot. So deep vein thrombosis means formation of clot in the deep veins. There are two systems of veins in the legs: the superficial veins, which are close under the skin, and the deep veins, which are not visible. The deep veins are very important because they carry the majority of the blood back to the heart.

Traditional Treatment for DVT

For many decades, the traditional treatment for DVT has been “anticoagulation”: drugs that thin the blood. Some examples are lovenox, which is a shot in the skin, and coumadin, which is a pill. Another name for coumadin is warfarin.

Anticoagulation does not directly treat the clot; it prevents new clot from forming in the hope that the body will dissolve the clot that’s already there. Anticoagulation tries to the tip the balance in favor of the body dissolving the clot.

The biggest problem with treatment with anticoagulation alone is that, depending on which studies you look at, despite taking blood thinners, 33-50% of people develop something called “post-thrombotic syndrome” which is lifelong pain and swelling of the legs.

Why does post-thrombotic syndrome develop?

Blood in the arteries is propelled forward by the heart. After this blood makes its way through the tiny capillaries of the organs and limbs, it no longer has the strong impetus to move forward on its own. So within the deep veins of the arms and legs, there are one-way valves which prevent blood from going the wrong way. As you move your limbs, contract your muscles, and walk, blood is propelled back to the heart, and the one-way valves prevent blood from going the wrong way.

When clot forms in the deep veins, it heals by scarring and thinning over many months. This process can damage these very important one-way valves. Once damaged, blood can flow the wrong way—away from the heart, down toward the feet—and pool within the leg veins. You can imagine the result: swelling and pain.

Post-thrombotic syndrome literally translates into “after clot syndrome”.

Thrombolysis: A Safer Alternative to Traditional Treatment for DVT

In DVT thrombolysis, we place a catheter into the vein to actively remove the clot. It’s a complementary treatment to anticoagulation, so the patient still needs to take the blood thinner medication after the procedure. But the goal is to get rid of the clot as soon as possible in order to minimize damage to those important one-way valves, thereby preventing post-thrombotic syndrome.

How Our Treatment Works

The procedure is minimally invasive, is done with the patient sedated, and takes about 2 hours. A small needle is placed into the vein at the back of the knee and a flexible wire is extended into the vein through the clot. A specialized catheter is run along this wire to the site of the clot to dissolve, break apart, and remove the clot.

The physicians at VIP use cutting edge catheters for DVT removal, including the Angiojet, which uses highly pressurized jets of saline to fragment and remove clot, the Trellis, which uses a clot-dissolving medicine called tPA to break up the clot and suction it out.

Inferior Vena Cava (IVC) Filter

The various branches of veins in the each leg come together into the common iliac vein, one on each side. The right and left common iliac veins join together to form the inferior vena cava, which is the main channel through which blood drains into the heart. When we perform the DVT thrombolysis procedure, there’s a chance some of the clot can break off and travel toward the heart and lungs.

Therefore, sometimes the physician performing the procedure places a little basket into the IVC called an IVC filter to trap any clot that breaks away. This filter is temporary and is usually removed within 2-3 months.

Iliac Vein Stent

Occasionally, the root problem is a narrowing of the iliac vein. In this situation, a mechanical stent is placed to open up the vein and prevent future clot development at the site.

Conclusion

As a minimally invasive treatment, DVT thrombolysis improves quality of life compared to those patients who are on blood thinners alone. Compared with traditional treatment for DVT, hospital stays can be shortened or eliminated. Patients return to their normal activities in a shorter time. The risk of having lifelong leg pain or swelling, known as post-thrombotic syndrome, is thought to be lessened. No incisions or invasive surgeries are required.