Deep Vein Thrombosis

Thrombolysis procedureDeep vein thrombosis (DVT) is the formation of a blood clot, known as a thrombus, in the deep leg vein. Recently, it has become known as “Economy Class Syndrome” due to the occurrence after sitting on long flights. 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.

The deep veins that lie near the center of the leg are surrounded by powerful muscles that contract and force deoxygenated blood back to the lungs and heart. One-way valves prevent the back-flow of blood between the contractions. (Blood is squeezed up the leg against gravity, and the valves prevent it from flowing back to our feet.) When blood circulation slows down due to illness, injury or inactivity, blood can pool, which provides an ideal setting for clot formation.

Risk Factors

  • Previous DVT or family history of DVT
  • Immobility, such as bed rest or sitting for long periods of time
  • Recent surgery
  • Over the age of 40
  • Hormone therapy or oral contraceptives
  • Pregnancy or post-partum
  • Previous or current cancer
  • Limb trauma and/or orthopedic procedures
  • Coagulation abnormalities
  • Obesity

Symptoms

  • Discoloration of the legs
  • Calf or leg pain or tenderness
  • Leg or lower limb swelling
  • Warm skin
  • Surface veins becoming more visible
  • Leg fatigue

Catheter-directed Thrombolysis (Clot-Busting) Treatment
Catheter-directed thrombolysis is performed under imaging guidance 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 interventional radiologist inserts a catheter into the popliteal vein (located behind the knee) or other leg vein and threads it into the vein containing the clot using X-ray guidance. The catheter tip is placed into the clot and a “clot busting” drug is infused directly to the clot.

The more recent the clot, the faster it dissolves. 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.

For patients in whom this is not an option 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.

Clinical resolution of pain and swelling and restoration of blood flow in the vein is greater than 85% with the catheter-directed technique.

What to Expect
Prior to appointments, Gwinnett Medical Center patients are asked to come in for routine lab work. It is preferred that patients have their lab work performed at Gwinnett Medical Center so the radiology nurses have access to the results. Our radiology nurses call each patient shortly after the procedure is scheduled to obtain a health history and provide instructions.

For most interventional radiology exams, patients need to arrive in admissions two hours before their scheduled procedure time on the day of the exam. Patients will check in at admissions before being taken to the Imaging Nursing Unit, where an interventional radiologist will come to talk with the patient before the procedure. The patient will then be prepped for the exam and taken to the Interventional Radiology Suite for the procedure. Following the procedure, the patient will return to the Imaging Nursing Unit for recovery. The recovery time varies based on the procedure. After the patient is then discharged, he or she will receive a follow-up call the next day.

Call 678-312-3444 to schedule an appointment at one of our convenient locations in Lawrenceville, Duluth or Hamilton Mill.