March 11, 2008
By Aaron Wittenberg, MD
Aaron Wittenberg, MD
More than 1.5 million Americans develop blood clots in the veins which run deep within the legs, a condition called deep vein thrombosis — or "DVT" for short. If untreated, a piece of the blood clot can break loose from the leg and travel to the lungs, where it's called a pulmonary embolism and can cause death. DVT can also cause ulcers and varicose veins.
The good news is that today there is a treatment for DVT that can be done on an outpatient basis and carries much less risk of internal bleeding that accompanied traditional treatment methods.
What are the main causes of deep vein thrombosis? DVT develops as a result of extended sedentary behavior such as prolonged bed rest due to illness or recovery from surgery or trauma. Sitting on an airplane for six or more hours without moving around, as many of us did over the recent holidays, can also lead to DVT.
People who are pregnant, taking oral contraceptives or incurring other hormonal changes are at risk for DVT, as are people who have had injury to their veins as a result of trauma, athletic accidents or surgery.
Other people at risk for DVT are those with a personal or family medical history of DVT, those who smoke or are significantly overweight or obese.
DVT develops because blood pressure is relatively low in the veins which return blood to the heart. If a person is not moving around, so muscles help the blood keep moving, blood tends to pool and clot at the lowest part of the body.
It's easy for someone to know they have a problem, even if they've never heard of DVT, because it causes leg pain and swelling and/or skin discoloration or redness. Frequently, DVT symptoms will affect just one leg. It is not uncommon for air travelers to notice one leg is swollen or painful after a long flight.
Traditionally, DVT has been treated with blood thinners like Heparin, Coumadin or Warfarin, which prevent new clots from forming while the body dissolves the old clot over time. However, blood thinners carry a high risk of serious internal bleeding, a risk which often outweighs their benefit.
That's why our new procedure for eliminating DVT is so exciting. Specially trained interventional radiologists can perform a minimally invasive low-risk procedure with a device called the Possis AngioJet to break up and suction the clot out of the deep vein.
They do this, while the patient is under local anesthetic, by running a flexible wire down the vein. They can then run a specialized catheter along the wire to the site of the clot. Tiny balloons on each side of the clot prevent it from breaking away and traveling to a lung.
Then a combination of a clot-dissolving drug and a miniature vacuum cleaner break up the clot and clean out the vein. The clot debris is then suctioned out through the catheter. Sometimes a mechanical stent is installed to prevent the stressed vein from collapsing and prevent future clot development at the site.
I usually follow up with my patients in one week, one month and 90 days to be sure there are no rare post-surgical complications. At six months, we perform an ultrasound to be sure no new clots are forming.
The benefits of this low-risk treatment for DVT are many. Hospitalization is reduced because it can usually be done on an outpatient basis. Exposure to blood-thinning drugs is lower so there is reduced risk of internal bleeding and decreased long term vein damage.
DVT symptoms are relieved much more rapidly. Pain usually diminishes overnight and swelling is almost always gone in a week to 10 days.
About Dr. Wittenberg
Aaron Wittenberg, MD, is a board-certified radiologist who specializes in diagnostic and interventional radiology at John C. Lincoln Deer Valley Hospital's Deep Vein Thrombosis Program, located at 19829 N. 27th Ave., in Phoenix, AZ 85024.
For more information, visit www.JCL.com/dvt or call 602-943-1111.
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