What is DVT and PE?

A DVT, or deep vein thrombosis, is a condition whereby a clot is formed in a ‘deep’ vein in the body, usually the leg. These deep veins are the major conduit for return of blood to the heart, and so a blockage or obstruction can lead to severe symptoms and consequences. Obviously, the severity and the symptoms depend on multiple factors such as the size of the clot, the location of the clot, if the clot is blocking the entire lumen of the vein, and if there are already alternate channels/detours for the blood to return. DVTs in the legs are usually diagnosed with ultrasound; more extensive DVTs in the pelvis or abdomen are diagnosed with CT or MRI. Some DVTs are completely asymptomatic and do not require treatment, while others may cause significant pain and swelling in the leg and can require blood thinners to help your body allow the clot to dissolve.

One of the feared complications of a DVT is called PE, or pulmonary embolism. This refers to when a DVT clot in the leg breaks off and travels in the blood stream until it lodges, usually in the lung. A PE is dangerous as it can cause severe breathing difficulty and even circulatory collapse and death if severe.

What types of DVT treatment are performed IR? What is the role of interventional radiology if I have a DVT?

The role of the interventional radiology is generally to help treat more severe or chronic/challenging types of DVT and PE, or for which there is a treatable underlying cause. Most straightforward DVT’s and PE’s can be treated with blood thinners called anticoagulation medications or sometimes even by closely watching a patient, depending on how severe the clot is and where it is located in the body.

But what if a patient cannot receive blood thinners because of recent bleed or surgery? What if the DVT is too big and severe for blood thinners to work? What if the patient is having excruciating pain and the leg is at risk or compromised without time for the blood thinner to help the body dissolve the clot? And what if there is a catastrophic PE that is cause the heart to fail?

The above are all situations where one of our interventional radiologists is consulted and can help save a patient’s life. For severe and/or extensive DVTs, usually in the upper leg and pelvis, for which blood thinners alone will not work, IR can perform a complex procedure called thrombolysis to actively go in and break up and/or aspirate out the clot to restore flow; many times IR will use balloon angioplasty to open a closed vessel and place a device called a stent to keep it open. We will then help to manage your care afterwards to make sure no further clots form.

For other patients, there may be an underlying cause for partial or near complete obstruction of the vein, which may cause DVT or leg swelling. One scenario is called May Thurner Syndrome, whereby an adjacent artery causes narrowing or clot in a pelvic vein draining the left leg called the left common iliac vein. This is a disease process that can be diagnosed by one of our interventional radiologists using ultrasound as well as specialized CT or MRI, then treated using real-time x-ray imaging and specialized intravascular ultrasound (IVUS), commonly with balloon angioplasty and stenting.

In the case of severe PE that is causing severe pressure on the right side of the heart (called a submassive PE) or one that is so severe it is actually causing circulatory collapse (called a massive PE), IR can also help to go in and break up the clot and/or aspirate it out using special device and catheters. Again, this is all minimally invasive and performed through tiny nicks in the skin not much larger than an IV, hopefully avoiding major surgery.

Finally, in some cases of DVT, patients cannot take blood thinners either because it is contraindicated due to a recent bleed, surgery, or tumor; the blood thinner may have caused a bleed and cannot be used; or sometimes the blood thinner fails. In these cases, IR can place a special device called an IVC filter, which acts as a filter or sieve in the biggest vein between the legs and the lungs (called the inferior vena cava, or IVC) to “catch” any clots before they can do damage. These IVC filters are now mostly ‘retrievable’, which means after the threat of a DVT causing a PE is gone, these filters can be removed or retrieved. Not all filters are retrievable, and many retrievable filters may not be able be retrieved if they have been in for a long period of time or have tilted. The interventional radiologist will discuss with you the best time to take out your filter after placement.

What is May Thurner Syndrome?

May Thurner Syndrome is compression with possible clotting of a pelvic vein draining the left leg called the left common iliac vein. The cause is pressure from an adjacent artery. This results in left leg swelling, pain and tenderness in the left leg, increased warmth in the leg, and sometimes discoloration of the leg. This is a disease process that can be diagnosed by one of our interventional radiologists using ultrasound as well as specialized CT or MRI, then treated using real-time x-ray imaging and specialized intravascular ultrasound (IVUS), commonly with balloon angioplasty and stenting.

What is DVT thrombolysis?

For severe and/or extensive DVTs, usually in the upper leg and pelvis, for which blood thinners alone will not work, IR can perform a complex procedure called thrombolysis to actively go in and break up and/or aspirate out the clot to restore flow; many times IR will use balloon angioplasty to open a closed vessel and place a device called a stent to keep it open. We will then help to manage your care afterwards to make sure no further clots form.

What is an IVC filter and when is it placed?

In some cases of DVT, patients cannot take blood thinners either because it is contraindicated due to a recent bleed, surgery, or tumor; the blood thinner may have caused a bleed and cannot be used; or sometimes the blood thinner fails. In these cases, IR can place a special device called an IVC filter, which acts as a filter or sieve in the biggest vein between the legs and the lungs (called the inferior vena cava, or IVC) to “catch” any clots before they can do damage. 

Can IR remove or retrieve my IVC filter?

Most IVC filters placed in the last few years are now ‘retrievable’, which means after the threat of a DVT causing a PE is gone, these filters can be removed or retrieved. Not all filters are retrievable, and many retrievable filters may not be able be retrieved if they have been in for a long period of time or have tilted. The interventional radiologist will discuss with you the best time to take out your filter after placement. If you have previously had an IVC filter placed, we will be happy to discuss your situation in consultation to see if it is appropriate and possible to remove your IVC filter.

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