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Capital Region Health Park
711 Troy-Schenectady Road
Latham, New York 12110

47 New Scotland Ave
Albany, NY 12208

(518) 262-5149
Fax: (518) 262-4210

 

 

 

Interventional Care - Interventional Radiology

Community Vein Care at Community Care Physicians, P.C.   

Deep Vein Thrombosis (DVT)

A DVT is a blood clot, or thrombus, within a vein of the leg.  Patients are at risk for a DVT if they are inactive for a long period of time (such as during a long airline flight or if they are suffering from a prolonged illness).  In addition, damage to the blood vessels as a result of surgery or an injury can put patients at risk for clot formation. 

Cancer and genetic problems that result in clotting abnormalities can also put patients at risk for DVT.  Other risk factors for DVT include obesity, a history of heart problems, pregnancy, and the use of birth control pills.

Formation of a DVT within the legs can lead to leg swelling and aching.  The leg can become quite painful when walking or when it is touched.  In addition, the leg can feel warm or become red in color.  A small blood clot in the leg may not cause any symptoms.

Dangers of DVT
A DVT is dangerous because clots in the legs can potentially travel through the veins to the lungs.  When a clot reaches the lungs, it is known as a pulmonary embolism, which can cause severe breathing problems.  That is why prompt diagnosis and treatment is so important.  In addition, DVT can lead to a post-thrombotic syndrome and due damage to the vein and valves within the vein caused by the clot.  When this occurs, there can be abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling, and possibly skin ulcers.  Some form of this can occur in as many as 60-70% of patients with a DVT.  This is the reason why many physicians are becoming more aggressive in their treatment of DVT.

Diagnostic Tests for Deep Vein Thrombosis (DVT)

  1. Ultrasound: An ultrasound is typically the first test that is performed in a patient that is suspected of having a DVT.  It is a painless test that usually takes less than 30 minutes to perform.  During this test, the sonographer places the ultrasound transducer on the leg and images the veins of the leg from the groin to the calf.  It is possible to directly visualize blood flow and clot within a leg vein using ultrasound.

  2. Venogram: Historically, this test was used for diagnosing a DVT.  Today, it is reserved for patients who have difficult undergoing an ultrasound examination (usually due to large legs) or who have had an ultrasound examination that was unable to definitely conclude if a DVT is present.  An interventional radiologist performs this test.  It involves placing a small needle into a vein in the foot and then injecting an iodine-based dye into the veins.  This enables the veins to be directly observed with x-rays, which typically allows for a definitive diagnosis of DVT to be made.

Interventional Treatments for Deep Venous Thrombosis (DVT)

These are often reserved for patients who cannot be treated medically with blood thinners such as heparin or warfarin.

  1. Catheter-Directed Thrombolysis: This procedure is performed by an interventional radiologist and is best performed as soon as possible after a DVT is diagnosed.  During this procedure, a small catheter (tube) is placed directly into the affected vein, usually from behind the knee.  Once the catheter is in place, a drug can be administered directly into the clot in order to dissolve the clot.  New devices are now available which can disrupt the clot in order to facilitate delivery of the drug directly into the thrombus.  These devices also allow for the removal of the clot through the catheter.  By removing the clot, it is hoped there will be less damage to the vein and therefore fewer symptoms associated with a post-thrombotic syndrome.  Once the clot is dissolved and/or removed, it may be possible to see if there is any narrowing within the vein.  This can subsequently be treated with angioplasty or placement of a stent within the narrowed vein.

  2. Inferior Vena Cava Filter Placement: If a patient cannot be treated with blood thinners (due to an increased risk of bleeding) and is not felt to be a candidate for catheter-directed thrombolysis, then placement of an Inferior Vena Cava Filter may be indicated.  Filters can also be placed in patients who are felt to be at significantly increased risk for DVT formation who would be unable to tolerate a pulmonary embolism.  A filter is a small device that is placed directly into the Inferior Vena Cava, which is the main vein draining blood from both legs.  The filter stays within this vein and traps clot that travels from the legs before it is able to reach the lungs.

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