Removal of Vein Clots
Do you need deep vein thrombosis treatment? Our physicians perform a minimally-invasive, non-surgical alternative called thrombolysis. Our Illinois clinic can perform this minimally invasive procedure on an in-patient basis or at one of the Adventist Midwest Hospitals in and around Chicago. We have participated in the multi-center ATTRACT Trial, a randomized trial to evaluate the benefit of aggressive non-surgical removal of leg vein and abdominal vein clotting.
Deep vein thrombosis (“DVT” or clots in the deeper leg veins) is a well-known cause of leg pain and swelling. Risk factors for DVT include:
- recent trauma
- major surgery
- cancer
- paralytic stroke
- estrogen treatment (birth control pills)
- immobilization
- obesity
- increased age, and history of previous clotting problems in the patient or family
A small catheter is passed into the affected vein via a tiny skin nick during a deep vein thrombosis treatment.
(Left) A large ulcer in a patient with chronic venous disease.
(Right) Vein damage by previous clots can result in chronic leg swelling and skin problems.
When confined to the lower leg, deep vein thrombosis treatment is usually anti-coagulation with heparinoids (injectable blood-thinners) followed by Coumadin, or other newer anticoagulants. DVT may be a source of life threatening clots traveling to the lung arteries.
Occasionally, lower leg DVT may extend up the thigh veins and into the pelvic veins. When that occurs, the delicate one-way valves in the veins may become permanently damaged. In a significant number of cases, this may lead to chronic, i.e., permanent, leg swelling and skin changes in the affected leg, despite coumadin as a deep vein thrombosis treatment. Coumadin and heparin can stop further clots from forming but do nothing to remove clots that have already formed. In cases of severe, extensive DVT, interventional radiologists can sometimes remove the clots from the leg and pelvic veins by introducing a tiny catheter (see photo) and injecting “clot busting” type drugs.
The procedure, called venous thrombolysis (which means “vein clot dissolving”), is performed by skilled interventional radiologists. Rapid intervention is needed, usually within the first week or two. Thrombolysis is performed on patients who are still leading active lives and might be disabled by chronic leg problems. The risk of serious complications, like dangerous bleeding, is quite low since only very small doses of the clot busting drug are infused.
A clotted leg vein before, then after infusion of a clot busting drug. The vein is open, and flowing well.
Sometimes, a special blender-suction catheter is used for more rapid clot removal.
Unfortunately, some patients with extensive clots who are denied the thrombolysis treatment may develop a condition known as chronic post-phlebitic syndrome. Chronic swelling, discoloration of the skin and even the development of sores may occur if deep vein thrombosis treatment is not given.
If extensive clots are allowed to permanently damage the leg veins, they cannot be dissolved later, since they rapidly harden into scar tissue.
Our physicians are very experienced in performing deep vein thrombolysis procedures.
Deep Vein Thrombosis in Large abdominal and Pelvic veins
Large veins in the abdomen may be opened with large stents, if clot removal fails. Here, a picture shows clogged veins in the pelvis and abdomen (left) with clots stopping flow. On the right, clots have been melted away, and metal stents hold open the veins allowing clear flow.
Angiovac Clot removal Device
A CT scan shows dark clot material trapped on a filter in the main vein in the abdomen (red arrows)
After removal with the Angiovac, the clot material is seen in collection canisters. The vein is open.
Our group has recently published* our experience using a revolutionary new clot removal system to rapidly suck out very large amounts of clot filling up the large veins in the abdomen that lead to the heart and lungs. This large-bore device, called Angiovac™, uses enormous power to pull out even older clot from the iliac (main pelvic) and inferior vena cava veins rapidly restoring flow. Many of these patients are critically ill, and other methods have failed.
If you, or your doctor, have questions about DVT treatment, please contact us. Time is of the essence, and new clots are much more easily removed than older clots!
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