DEEP VENOUS THROMBOSIS (DVT)

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   Deep vein thrombosis is a blood clot or thrombus in a deep vein. They are most common in the leg. But they may develop any part of the body. Part of the clot, called an embolus, can break off and travel to the lungs (PE). This can cut off the flow of blood to all or part of the lung. PE is an emergency and may cause death.

There are several risk factors such as obesity, surgery, immobility, birth control pills, a family history of blood clots, varicose veins and cancer.

May-Thurner syndrome (MTS),also known as the iliac vein compression syndrome, is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or blood clots (deep venous thrombosis) in the iliofemoral veins.

Most people with DVT develop symptoms of pain, swelling, and redness . Sometime DVT is symptomless. The two most common complications of a blood clot are chronic venous insufficiency and post-thrombotic syndrome(PTS).

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Treatment May Includes:

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• Blood thinners (anticoagulant medicines).

• Walking. Getting up and moving as soon as possible after diagnosis.

• Elastic or compression stockings, if required.

• Clot busters (fibrinolytics or thrombolytics). These medicines are used to break up clots and can be given directly into the clot by your Interventional Radiology specialist using a minimally invasive endovascular therapy called Catheter Directed Thrombolysis (CDT). This is typically a day case, and has been shown to help symptoms and complications of DVT in carefully evaluated patients.

• Mechanical Clot suction. These devices are small (less than width of a pen) devices that can be placed directly into the vein but an IR specialist where the clot is and then the clot removed, allowing normal blood flow to pass again.

• Inferior vena cava filter. In some cases, a filter is placed in the vena cava (the large vein which returns blood from the body to the heart). This filter prevents clots from reaching the heart and lungs.

• Above procedures /treatments are always better than surgical thrombectomy .

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How Is Deep Vein Thrombosis Diagnosed ?

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•  Duplex ultrasound. This painless procedure ,observe blood flow in veins. Duplex ultrasound is the most    common test for     DVT.

•  Lab work. Blood work may be done to look for blood clotting and other problems.

 

What Is The Treatment For Deep Vein Thrombosis?

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Specific treatment will be determined by Vascular Interventional Radiologist(IR) :

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•  How old you are

•  Your overall health and medical history

•  How sick you are

•  The location of the clot

•  How well you can handle specific medicines, procedures, or therapies.

•  How long the condition is expected to last

•  Your opinion or preference

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The goal of treatments is are to prevent the clot from getting larger, to prevent a blood clot from travelling to the lungs (PE), to decrease the chance of another blood clot forming and to prevent development of PTS.

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Acute DVT - Mechanical Throbectomy and Thrombosis :
 

Who requires this procedure ?

  This procedure is indicated for patients who develop a clot in the vessels of lower limbs and extending into lower abdomen carrying blood towards the heart.

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What is the underlying problem?

  The underlying disease is a block in the vessels of the lower limb, thereby reducing the blood return to heart, pooling in lower limbs and painful swelling of lower limbs.

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What are the consequences of postponing / worst complication if left untreated?

  Unless treated at the right time the patients may eventually land up in sudden death if the clot extends towards heart , failing kidneys and post thrombotic syndrome.

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How is it diagnosed?

Diagnosis requires a Doppler scan followed by Angiogram, which is also used to plan the procedure and prognosticate the outcome.

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What are the steps of procedure?

  The block is cleared using wire and special catheters, lumen is opened using a special vaccum like device and clot resolving drugs and sometimes stents are used to preserve the lumen .

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Why endovascular approach?

  As most of the patients are unfit for the surgical options and interventional radiology offers solution through a 3mm hole under local anaesthesia as a day care procedure.