As a first approach, NYU Langone doctors often treat people who have deep vein thrombosis, or DVT, with anticoagulant and thrombolytic medications. However, if a very large blood clot has formed and threatens to break loose into the bloodstream, your doctor may recommend a minimally invasive procedure to prevent pulmonary embolism. These procedures may also be performed for people who cannot take anticoagulants, or blood thinners, and thrombolytics, also known as clot-busting medicines, because of a health condition such as a bleeding disorder.
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Minimally invasive techniques are also used to treat post-thrombotic syndrome, a condition that often develops after treatment for DVT.
In a thrombectomy, your doctor injects a contrast dye, which helps locate the clot using X-ray guidance. The clot can usually then be removed using a thin tube called a catheter, which is a long, flexible, hollow tube that is inserted through a vein in the groin or arm and threaded to the location of the blood clot.
NYU Langone’s vascular specialists use several minimally invasive methods of retrieving or breaking up and then removing blood clots using catheters. For example, one technique uses a catheter with a number of holes at the tip. The device sprays a jet of salt water into the clot to dissolve it and then, using suction, pulls the clot fragments into the catheter for removal. Other techniques may remove the clot whole.
Before the procedure, your doctor gives you a sedative, but you remain awake. If you have multiple blood clots, or if imaging doesn’t clearly reveal the location of the clot, doctors may use general anesthesia.
Afterward, your recovery time depends on the size and seriousness of the clot, your health, and your medical history. Your doctor may prescribe anticoagulant medications to thin the blood to prevent additional clots from forming.
Medication is often sufficient to dissolve even large blood clots. But if you can’t take the medication for health reasons, placement of an inferior vena cava, or IVC, filter may be an option. In this procedure, a surgeon implants a filter into the inferior vena cava, the large vein that carries blood from the lower body to the heart.
The filter is designed to catch a blood clot that breaks loose from a vein in the legs and is in transit to the lungs, where it can cause a life-threatening pulmonary embolism. The filter does not treat the blood clot, but it can be critically important to prevent clots from traveling to the lungs.
Using a local anesthetic and needle stick, your doctor places an intravenous (IV) line in the groin and threads a small catheter through it to the inferior vena cava in order to insert the filter. The filter can be removed up to a year later.
Sometimes, a DVT remains after treatment. This results in a blockage of the iliac vein in the pelvis and continued blockage of blood flow to the heart. It also can damage the valves in the legs that regulate blood flow, allowing blood to flow backward in the veins and collect in the leg. This condition, called post-thrombotic syndrome, can cause pain, swelling, itching, tingling, cramping, and a feeling of heaviness in the leg.
Anticoagulant medications, compression, elevation, and proper skin care to prevent ulcers are the most common forms of treatment. A minimally invasive procedure called iliocaval stenting can provide long-term relief, especially for people who have a blockage that does not go away on its own.
To perform this procedure, your doctor starts by placing an IV into the blood vessel in the groin. He or she then delivers a catheter into the blood vessel. The doctor uses fluoroscopy, which is a continuous X-ray that creates a real-time moving image of the iliac vein. He or she then guides small, flexible surgical tools through the catheter and to the site of the blockage. The blockages are opened with stents, which are cylinder-shaped devices that act as scaffolding to prop the vein open. These stents are similar to what is used to open blocked heart vessels for people experiencing a heart attack.
With blood flow restored, 80 to 90 percent of people experience a reduction of symptoms within a week after surgery. When the pain decreases, patients are able to walk more easily and have a better quality of life.
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