About Deep Vein Thrombosis (DVT)
DVT is a serious condition that results when a blood clot forms in a deep vein of the legs or occasionally, the arms or other veins. If DVT is left untreated, the blood clot can break loose and move through the bloodstream to the lungs, blocking circulation. This is called a pulmonary embolism (PE). DVT and PE are two parts of a life-threatening and possibly fatal condition called venous thromboembolism (VTE).
Penn Interventional Radiology is a leader in treating complicated DVT with advanced techniques.
DVT Treatment, before (left) and one month after (right).
More about the causes and symptoms of DVT >
How is DVT diagnosed?
The most common test used if a DVT is suspected is ultrasound. The ultrasound measures the blood flow through the veins to find any clots that might be blocking the flow. A series of ultrasounds may be done over several days to determine if a blood clot is growing or to be sure a new one hasn't developed.
Additional diagnostic tests include:
- Blood Test
Almost all patients who develop severe deep vein thrombosis have an elevated blood level of a clot-dissolving substance called D-dimer.
- CT or MRI Scans
Both computerized tomography (CT) and magnetic resonance imaging (MRI) can provide information that may not show up on an x-ray.
How is DVT treated?
There are two main types of DVT: Acute and chronic. Each is categorized and treated based on how long the blood clots have been present.
Acute DVT
Treatment options for acute DVT are based on the size of the clot and how long it has been present.
- Medication
The standard of care for the treatment of acute DVT is blood thinning medication (anticoagulation) such as heparin and warfarin (Coumadin). Blood thinning medications work by allowing blood to flow around a trapped clot while at the same time preventing clot from travelling to the lungs. However, these medications do not remove the existing clot from the vein. Blood thinning medications rely on the body's natural defenses to "dissolve" the clot which can take several months and often results in the vein remaining permanently blocked.
- IVC Filter
If blood-thinning medications are not recommended, a small filter may be implanted in the inferior vena cava (IVC), the large vein that returns blood back to the heart. The filter, called an IVC filter, works by allowing blood to flow around a trapped clot while preventing the clot from travelling to the lungs. An IVC filter does not speed up the process of dissolving the clot in the vein.
- DVT Thrombolysis
For patients with symptomatic acute DVT and a large clots, a minimally-invasive procedure known as DVT thrombolysis is commonly performed to rapidly reduce symptoms and remove the clot from the deep veins.
DVT thrombolysis involves inserting a small catheter into the leg using ultrasound and x-ray guidance. Clot-dissolving medications as well mechanical devices may be inserted into the catheter and used to remove or reduce the clot.
This technique will often uncover one or more areas of narrowing of the vein that caused the blood clot to form. We can treat this with angioplasty (widening the vein), or by inserting a mesh-like tube called a stent to keep the vein open.
While there is a small risk of bleeding from the procedure, DVT thrombolysis can speed the recovery from DVT and help to minimize future scarring of the veins from DVT. This potentially reduces the chances of developing a severe condition called Post Thrombotic Syndrome (PTS).
DVT thrombolysis can often be done as an outpatient procedure or a one to two-night hospital stay depending on the age of the clot. Patients with the best outcomes are those who have had symptoms for 10 days or less as this is when the clot is "fresh". Those with symptoms ranging from 10-30 days also do well.
Chronic DVT and Post Thrombotic Syndrome (PTS)
For patients who have developed post thrombotic syndrome due to chronic DVT, Penn Interventional Radiology uses advanced techniques to treat individuals who have had clots for months to years, or who continue to experience symptoms after medication or other therapies. Procedures mainly consist of angioplasty and use of stents to open blocked veins. Our expertise and advanced techniques can often significantly improve the quality of life for those affected by chronic DVT when previously no other treatment options were available.
How long is the recovery period?
Most patients can resume their normal activity the day of discharge from the hospital. You may notice some tenderness and mild bruising behind your knees or in your hip region, depending on the entry point(s) used to perform your procedure.
Are routine medications safe to take prior to a DVT procedure?
Routine medications can be taken with water. You should tell your physician if you are taking antiplatelet medications such as Plavix or aspirin, or any blood thinners, as these may or may not need to be suspended during the procedure
How do I prepare for my DVT procedure?
In general, you will have nothing to eat or drink after midnight before your procedure. You will want to bring your compression stockings to the procedure. You will also be given instructions as to whether to take your anticoagulation medication the morning of the procedure or not. More detailed information and instructions will be provided to you during your consultation.
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