Deep vein thrombosis (DVT) is the formation of a blood clot, known as a thrombus, in the deep leg vein. It is a very serious condition that can cause permanent damage to the leg, known as post-thrombotic syndrome, or a life-threatening pulmonary embolism. In the United States alone, 600,000 new cases are diagnosed each year. One in every 100 people who develops DVT dies. Recently, it has been referred to as "Economy Class Syndrome" due to the occurrence after sitting on long flights.
Who is at risk for DVT?
Certain individuals may be at risk for developing DVT, although DVT can occur in almost anyone. Some risk factors or triggering events to discuss with your doctor include, but are not limited to:
- Cancer
- Certain heart or respiratory diseases
- Prior DVT
- Oral Contraceptives/Smoking
- Acute medical illness with restricted mobility
- Inherited or acquired predisposition to clotting
- Obesity
- Hospitalization
- Pregnancy
What are the symptoms?
Symptoms of DVT may include pain, swelling, tenderness, discoloration or redness of the affected area, and skin that is warm to the touch. However, as many as half of all DVT episodes produce minimal symptoms or are completely “silent."
Because a number of other conditions – including muscle strains, skin infections, and phlebitis (inflammation of veins) – display symptoms similar to those of DVT, the condition may be difficult to diagnose without specific tests.
How is DVT diagnosed?
The tests used most often to diagnose DVT do not involve any needles and are relatively painless. Your doctor may listen to blood flowing through the veins in your calf and thigh and behind your knee, using a special stethoscope placed on your leg. The most reliable method of diagnosing DVT is called a duplex scan. An ultrasound microphone is placed on the leg over the affected area, and sound waves measure the veins and blood flow on a screen that is similar to a television.
What are the treatment options?
In the past, DVT patients were given anticoagulant medication to prevent further clotting and the risk of Pulmonary Embolism.
Blood Thinners
Early in treatment, blood thinners are given to keep the clot from growing or breaking off and traveling to the lung and causing a life-threatening pulmonary embolism by blocking the oxygen supply causing heart failure. Contrary to popular belief, blood thinners (anticoagulants) do not actively dissolve the clot, but instead prevents new clots from forming. Over time, the body will dissolve the clot, but often the vein becomes damaged in the meantime. To prevent permanent leg damage, patients can get catheter-directed thrombolysis treatment.
Catheter-Directed Thrombolysis
Catheter-directed thrombolysis is performed under imaging guidance by at the Interventional Institute at Holy Name Hospital by interventional radiologists. This procedure 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 DVT is dissolved while you are wide awake and resting comfortably on your stomach. There are no incisions or anesthesia involved. This is accomplished by making a small puncture in the vein behind your knee and placing a thin catheter into the clot. Then a "clot busting" drug is infused directly to 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 a balloon angioplasty or stent placement.
In patients in whom this is not appropriate and blood thinners are not medically appropriate, an interventional radiologist can insert a vena cava filter, a small device that functions like a catcher's mitt to capture blood clots but allow normal liquid blood to pass.
Contact Information and Scheduling
The Interventional Institute
Holy Name Hospital
201-833-3310