Deep Venous Thrombosis, or DVT, is a condition is which blood clots form within the deeper and larger veins of the body. DVT is much more serious than clots forming in smaller more superficial veins. Larger vein are not only critical to the function of our circulation, but they are also direct pathways to our heart and lungs. So if a DVT blood clot forms, than it may also float and move to the heart and lungs. If this occurs it can be lethal, causing sudden cardiac arrest and death. If this occurs, it is referred to as a pulmonary embolism.
Symptoms than can occur when a blood clot forms in the body include pain and swelling. But many blood clots can be asymptomatic and go undetected until they float to the heart and lungs. They can therefore be silent killers, not giving any warning signs until a sudden embolism leads to acute collapse and death. Since most blood clots originate in the legs and pelvis, many patient can exhibit signs of sudden swelling or pain in a leg. Discoloration of the skin of the legs or feet can also occur. If the DVT forms in the arms or chest, then symptoms could begin in an arm or hand.
There are several ways in which Deep Venous Thrombosis can be detected and diagnosed. All of these methods require a diagnostic study by a health care professional. So if you suspect that you may have symptoms of a DVT, seek immediate medical attention. One common way that DVT is diagnosed is with an ultrasound of the veins. Ultrasounds can only detect DVT in certain areas of the body such as the legs or arms. Ultrasound usually cannot detect DVT in the abdomen, pelvis, or chest. If DVT is suspected in these locations, then a CT scan or MRI or even catheter venogram may be required. If a patient presents with chest pain or shortness of breath and a pulmonary embolism (blood clot traveling to the lungs) is suspected, then a stat CT of the chest is performed.
This study is typically performed after the administration of IV dye to help visualized the blood flow. This study is often referred to as a CTV or CTA. It has a very high accuracy in detecting DVT movement to the lungs.
Another test that is useful in detecting DVT throughout the body is a blood test referred to as a D-dimer test. If this test is positive, then it is hightly suggestive of a blood clot being present somewhere within the body. If the test comes back positive, then additional imaging studies are performed to determine the exact location and extent of the DVT to help guide the treatment plan.
Medications for Deep Venous Thrombosis
There are many many different medications available for the managment of deep venous thrombosis. The most traditional medication utilized for the treatment of DVT is an oral anticoagulant called coumadin, also known as warfarin. It has been used for the treatment of blood clots since 1954. It is a very effective medication and is inexpensive since it is a generic medication. It is typically administered as a once a day pill orally. One of the benefits of coumadin is that the effects of coumadin can be fairly quickly reversed with the use of blood transfusions of plasma and and adminstration of Vitamin K. So if you are on coumadin and exhibit bleeding problems then the effects can be fairly quickly reversed.
Another very common medication for the use of DVT is low molecular weight heparin anticoagulant known as Lovenox. This is quicker acting and shorter acting than coumadin. One of the other big differences between coumadin and warfarin is that Lovenox can only be given as an injection but coumadin is given as a oral pill. Lovenox can be given as a once a day or a twice a day injection.
A common blood thinner that is utilized in the hospital for treatment of DVT is heparin. Heparin is the shortest acting blood thinner utilized in DVT treatment. It is usually administered as a constant IV infusion. The benefit of heparin is that is is quickly out of your system after the IV infusion is discontinued. So it is a very useful medication to use for DVT if you need to quickly stop the anticoagulant effects of the blood thinners, such as for upcoming surgeries or procedures that need to be performed.
Newer classes of anticoagulant drugs are referred to as direct thrombin inhibitors or direct factor Xa inhibitors. They go by the brand names of Xarelto, Pradaxa, and Eliquis. These medications are fast acting but do not have effective medications to allow the reversal of their anticoagulant effect. But they are frequently used due to their easy oral administation, consistent absorption, quick effects, and the fact that they do not need regularly blood testing to confirm their effectiveness.
Endovenous Interventions For DVT
A very common treatment utilized for treatment of extensive DVT is catheter thrombolysis. This procedure involves the insertion of a intravenous catheter into the veins where the blood clots are located. A liquid medicine is then slowly dripped into the DVT to cause the clot to slowly dissolve. The most common IV drug utilized is called tPA, i.e. tissue Plasmingoen Activator.
Catheter thrombolysis is the most aggressive way to quickly dissolve large blood clots. Other medication therapies typically require many months of therapy before the deep venous thrombosis is able to resolve.
But catheter thrombolysis is typically effecive within hours. tPA is the only medication described that actively dissolves blood clots. Other medications thin the blood and prevent clot propagation and spread. But tPA actually quickly dissolves blood clots away and causes them to resolve within hours. tPA thrombolysis is most commonly utilized in larger blood clots involving the largest veins in the body, including the iliac veins, femoral veins, and vena cava.
Vein stents are a way to treat venous pathology that can result in the development of dvt blood clots. A stent is a hollow metal tube than can open a diseased blood vessel back to its normal caliber. It can re-establish normal flow in a diseased or damaged blood vessel. They are inserted through a small puncture of the vein and positioned under x-ray guidance, so a ppen surgery is not required.
This procedure is referred to as a catheterization. Vein stents can be performed quickly after a clot is diagnosed. But they can also be placed in a delayed fashion after a blood clot has resolved in order to prevent DVT recurrence or to treat chronic symptoms that have resulted from the damage caused by the DVT.
Some of the reasons that vein stents are inserted after DVT blood clots are diagnosed are for the following reasons:
- Ongoing symtoms of leg pain, leg fatigue, and swelling that becomes chronic
- Venous stasis ulcers
- May-Thurner Syndrome (i.e. Iliac Vein Compression Syndrome)
- Scar tissue induced stricture of a leg or pelvic vein
Angioplasty is a procedure in which a balloon is expanded inside a diseased vein to stretch it back to normal size. Vein angioplasty is utilized when a DVT has caused a chronic stricture of a vein from resultant scar tissue. This procedure is done through a small catheter under x-ray guidance referred to as fluoroscopy. Although angioplasty is sometime effective in treating a venous stricture that was caused by a DVT, a stent is also often required. The result of the the angioplasty will determine whether a vein stent is also required.
Sometime balloon angioplasty is used to treat chronic fibrotic changes within deep veins that develop months or years after the acute DVT has been treated. Balloon angioplasty is particularly useful for treatment of long segments of diseased veins after extensive and long-segment DVT. Balloon angioplasty is also often needed to prepare a blood vessel before a stent is placed. By expanding the vessel with a balloon prior to placing a stent, the stent is more likely to readily expand to the appropriate size. Post-stent angioplasty also helps to stretch our the stent to a bigger size after the stent is in place.
IVUS / Endovascular Ultrasound
IVUS or Intra-Vascular UltraSound is a method to precisely evaluate the anatomy of a blood clot during and after an interventional treatment of a DVT. A thin narrow catheter device with an ultrasound senor on its tip is inserted into the vein and through the clot. The appearance of the vein, the clot, and the adjacent blood flow is able to be projected onto a video monitor next to the physician as the procedure is performed. The live images help guide the physician during the therpapy on the blood clot.
EKOS Ultrasonic Energy
EKOS is a novel therapy for treatment of deep venous thrombosis, or DVT. It involves the insertion of a small catheter device throught the DVT under x-ray guidance. The cather delivers short repetive pulses of ultrasound energy into the clot. These bursts of ultrasound energy are combined simultaneously with the administration of small quantifies of blood clot busting medications into the clot. The pulses of ultrasound energy help disperse the clot and help to cause the DVT to slowly dissolve.
AngioJet is a method of dissolving blood clots without the use of an open surgery. The device is a rheolytic thrombectomy system designed to remove thrombus with the Venturi-Bernoulli effect, with multiple high-velocity, high-pressure saline jets administering pressure into the clot, followed by the device quickly suctioning small pieces of the clot out of the vein and into the catheter. The AngioJet device tends to be utilized most frequenty in the cases of severe and extensive blood clots that are signifcantly hindering blood flow in large blood vessels. The device can be a way to rapidly remove severe blood clots.
Open Surgical Thrombectomy
Open surgery to remove DVT is rarely used in the present day due to advances in catheter technology. Open thrombectomy involved making an open surgial incision on a blood vessel in order to extract the DVT under direct visualization. It is only recommended in severe cases of blood clots that are threatening the viability of a limb and when other less invasive options are not feasible. An example of when open surgery may be indicated is when the patient would be at too high of a risk for bleeding if other methods such as tPA drugs were used instead.
Compression Stockings For DVT
Compression stockings are recommended for most patient with DVT. Compression stockings help to reduce swelling, reduce pain, help to preserve vein valve function during blood clot healing, and can help prevent development of additional blood clots. Compression stockings have been proven to help reduce the risk of post-thrombotic syndrome, a significant chronic vein disease that can occur after being diagnosed with a DVT.
Austin Vein Specialists – Experts in DVT Therapy
Austin Vein Specialists is a dedicated team of health care professionals who are committed to the treatment of venous diseases throughout the body, including DVT. Our physicians are board-certified and fellowship trained in vein disease management. We are board-certified vasclular and endovascular surgeons with decades of experience in the management of deep venous thrombosis. We have extensive experience in all of the medical, endovenous, and surgical therapies described above. We will be able to determine the most effective treatment plan for your particular DVT condition. Contact us today.