Treatment Options For Deep
Vein Thrombosis
Since the 1950s, with the advent of blood thinning medications such as Heparin and Coumadin, the treatment for DVT was simply to place a person with DVT on these medications (anticoagulation) and wait for symptoms to resolve. Evidence continues to grow that this method of treatment, while relatively effective in stopping continuing growth of clot, and lowering the risk of life-threatening pulmonary embolus, does not address a myriad of other problems and long-term consequences associated with DVT. Recent evidence suggests better strategies for combining rapid clot removal and anticoagulation that are more effective in treating both the short and long-term consequences of DVT. These strategies are rapidly becoming the new standard of care for dealing with DVT. Some facts to remember about anticoagulation with blood thinners include:
- Helps to prevent clot growth
- Helps to prevent pulmonary embolism
- Does not dissolve clot
- Does not prevent valvular damage
- Does not prevent post-thrombotic syndrome
- Does not act to rapidly reduce symptoms
- Simply, Is Not Enough
Contrary to popular belief, blood thinners do not act to dissolve clot. They only act to prevent clot from growing, while the body’s own system may or may not dissolve the clot over time. In fact, in the larger veins of the upper leg, clot will only clear in about 5% of cases, leaving a large, permanent clot burden which will chronically blocks blood flow and results in permanent damage to the venous walls and valves. To prevent this chronic problem, patients now have options that will actually remove clot, helping relieve symptoms and prevent chronic symptoms.
Thrombolysis and Pharmacomechanical Thrombolysis
Thrombolysis utilizes the well-proven and time-tested clot-busting agents, already proven useful in the treatment of clots in the treatment of stroke, heart attack and arterial thrombosis. The most common drug currently utilized is tissue plasminogen activator (t-PA). With this technique, a small catheter is placed into the vein behind the knee under ultrasound guidance, through a very tiny nick in the skin. The catheter is then actually directed into the clot under x-ray guidance and the clot-busting drug is slowly infused through the catheter. Depending on the age of the clot, the infusion and clot dissolution may be completed in a couple of hours or may take as long as a day or two. If there is an underlying blockage in the vein that may have caused the clot to form or would act as a stimulus for new clot to form, this may be able to be treated with angioplasty right at the time of the thrombolysis procedure.
Latest treatment options now include thrombolysis and combine this with a method of breaking up clots. This most recent option is referred to as pharmacomechanical thrombolysis. With this technique, the clot-busting medications are injected through a specially designed catheter that actually breaks apart and softens the clot. These special catheters utilize an ultrasound beam, or a special spinning wire that softens the clot. This allows the drug to seep into the areas of the clot that would otherwise not be able to be exposed to the medication. Clot has a very strong attraction to the clot-busting agent and the more of the clot that is exposed to the medication, the faster the clot will dissolve. This has decreased the time of the procedure, the cost of the procedure and the amount of the clot-busting drug that is necessary to achieve a successful result. In some cases, a successful result can be achieved in as little as 20 minutes.
Clot-filled vein in 40 year-old man with severe leg swelling and pain.
Same vein after pharmacomechanical thrombolysis with all of clot removed.
View these videos to see how some of our medical equipment works to clear veins. Shown below is the Diamondback 360°™.
