Understanding Deep Vein Thrombosis

Understanding Deep Vein Thrombosis

Cross section of muscle and vein showing open valve with arrow showing blood moving up. Cross section of varicose vein with thrombus and emboli.

Deep vein thrombosis (DVT) is a condition in which a blood clot or thrombus forms in a deep vein. A blood clot is most common in the leg, but can develop in a large vein deep inside the leg, arm, or other part of the body. Part of the clot called an embolus can separate from the vein. It may travel to the lungs and form a pulmonary embolus (PE). This can cut off the flow to a portion of the lung or to the entire lung. A PE is a medical emergency and may cause death. Healthcare providers use the term venous thromboembolism (VTE) to describe the two conditions, DVT and PE. They use the term VTE because the two conditions are very closely related. And, because their prevention and treatment are closely related.

Over time, a blood clot can also permanently damage veins. To protect your health, a blood clot must be treated right away.

How DVT develops

The deep veins of the legs are located in the muscles. These help carry blood clot from the legs to the heart. When leg muscles contract and relax, blood is squeezed through the veins back to the heart. One-way valves inside the veins help keep the blood moving in the right direction. When blood moves too slowly or not at all, it can pool in the veins. This makes a clot more likely to form.

Risk factors

Anyone can develop a blood clot. The following risk factors make a blood clot more likely to happen:

  • Being inactive for a long period, such as when you’re in the hospital, or traveling by plane or car

  • Injury to a vein from an accident, a broken bone, or surgery

  • Having blood clots in the past

  • Personal or family history of a blood-clotting disorder

  • Recent surgery

  • Cancer and certain cancer treatments

  • Smoking

Other factors can also put you at higher risk for a blood clot. They include:

  • Age over 60 years

  • Pregnancy

  • Taking birth control or hormone replacement

  • Having other vein problems

  • Being overweight

Common symptoms

A blood clot does not always cause obvious symptoms. If you do have symptoms, they usually happen suddenly. They may include:

  • Pain, especially deep in the muscle

  • Swelling

  • Aching or tenderness

  • Red or warm skin

  • Fever

Call your healthcare provider if you have these symptoms.

Symptoms of pulmonary embolism may include:

  • Trouble breathing

  • Fast heartbeat

  • Chest pain

  • Sweating

  • Coughing (may cough up blood)

  • Fainting

Call 911 if you have these symptoms. 

If you take medicine to help prevent blood clots, you have an increased risk of bleeding. Call 911 if you have heavy or uncontrolled bleeding. Call your healthcare provider if you have other signs or symptoms of bleeding like blood in the urine, bleeding with bowel movements, or bleeding from the nose, gums, a cut, or vagina.

Diagnosing DVT

Diagnosis begins with thorough questions about your symptoms and medical history along with a physical exam.

Diagnostic tests include:

  • An imaging test called a duplex ultrasound. This test uses sound waves to create pictures of veins and blood flow.

  • Blood tests to check for clotting and other problems.

If your healthcare provider thinks you may have pulmonary embolism, additional testing will be done.

Treating DVT

Treating a blood clot may include:

  • Medicine to thin the blood and prevent pulmonary embolism and other complications.

  • Staying in the hospital. This may or may not be necessary.

  • Surgery for some people, like those who cannot take blood-thinning medicines.

Preventing DVT

Many people who are in the hospital are at an increased risk of developing blood clots. So, preventing blood clots is an important part of in-hospital care. The care may include getting out of bed regularly, taking medicine, or using special therapies or devices. Other factors and conditions may increase the risk of blood clots. Review your risk with your healthcare provider.

What is percutaneous transcatheter treatment of deep venous thrombosis?

Percutaneous transcatheter treatment is one type of therapy for deep venous thrombosis (DVT). DVT is a blood clot that forms in a large vein deep in the body. It happens most often in a leg. The procedure uses a thin, flexible tube called a catheter to help remove the blood the clot.

During the treatment, a healthcare provider will insert a catheter into a blood vessel in your groin. Then he or she will move the tube through your blood vessels until it reaches the site of the clot. Percutaneous means that the procedure is done through a small puncture in the skin instead of a large incision.

Your healthcare provider might use one of several types of percutaneous transcatheter treatments. The catheter may be used to send clot-dissolving medicine to the DVT. This can help break up the clot. Or, your healthcare provider might use small tools to help break up the clot. In some cases, a tiny balloon or metal, mesh coil (stent) is inserted in the vein to help hold it open.

Why might I need percutaneous transcatheter treatment of deep venous thrombosis?

You may need this procedure if you have DVT. DVT can lead to possible problems such as:

  • Blood clot that moves to the lung and causes breathing trouble and risk of death (pulmonary embolism)
  • Leg swelling and pain
  • Enlarged veins (post-thrombotic syndrome)
  • Loss of the limb (rare)
  • Shock and death (very rare)

Your healthcare provider might advise this procedure if certain conditions apply to you. These may include if you:

  • Are having symptoms from your DVT
  • Are at high risk of pulmonary embolism
  • Have a clot above your knee
  • Have a very large and severe clot
  • Want to decrease the risk of post-thrombotic syndrome

Transcatheter treatment is not the only kind of treatment for a blood clot. You must have specific clinical factors to be a candidate for this procedure. Many people with blood clots are treated with medicines called blood thinners. These are given as an injection or through an IV. They can prevent a blood clot from getting larger.

All treatments for blood clots have their own risks and benefits. Ask your doctor if surgical thrombectomy might be a good choice for you. You might find it helpful to talk to a doctor who specializes in blood vessel problems. This type of doctor is called a vascular specialist.

What are the risks of percutaneous transcatheter treatment of deep venous thrombosis?

All procedures have risks. The risks of this procedure include:

  • Excess bleeding that can be severe enough to cause death
  • Infection
  • Damage to the vein at the site of the blood clot
  • Reaction to anesthesia
  • Detaching of the stent, if one is used

There is also a risk that your blood clot will form again. Your own risks may vary depending on your general health and how your blood clots. They may also vary depending on how long you’ve had the clot, and where it is in your body. Talk with your healthcare provider about all your concerns and questions.

How do I prepare for percutaneous transcatheter treatment of deep venous thrombosis?

Before the procedure, you will need to sign an Informed Consent form. This gives your doctor permission to do the procedure. It also states that you fully understand the risks and benefits of the procedure and have had all of your questions answered. Before you sign, be sure all of your questions are answered to your satisfaction.

Talk with your healthcare provider how to prepare for your procedure. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin, vitamins, and herbal supplements. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your procedure. Talk with your healthcare provider if you need help to stop smoking.

Before the procedure, make sure to tell the medical team if you:
  • Have any allergies
  • Have any recent changes in your health, such as fever
  • Are pregnant, or could be
  • Have ever had a problem with anesthesia
You may need some tests before the procedure, such as:
  • Ultrasound, to measure blood flow in the leg and help diagnose DVT
  • Venogram, to get an image of your veins and the blood clot
  • Computed tomography (CT) scan, to get more information about the blood clot
  • Magnetic resonance imaging (MRI), if more information is needed
  • Blood tests, to check your overall health or look for clotting problems in your blood

Do not eat or drink after midnight the night before your procedure.

What happens during percutaneous transcatheter treatment of deep venous thrombosis?

Talk with your healthcare provider about what to expect during the procedure. The details will vary depending on the type of procedure you have. They will also vary depending on what part of the body is treated. A typical procedure may go like this:

  • An IV will be put in your arm or hand before the procedure starts. You’ll receive medicines through this IV. You may be given a blood thinner such as heparin. This is to help prevent new blood clots forming during the procedure.
  • You’ll also be given anesthesia through the IV line. This will prevent pain and make you sleep during the procedure. Or, you may be given sedation. This will make you relaxed and sleepy during procedure.
  • Hair in the area of your procedure may be removed. The area may be numbed with a local anesthesia.
  • The healthcare provider will make a small incision in a blood vessel in your groin. He or she will then insert a long, thin wire into this cut. The wire acts as a guide for during the procedure.
  • The healthcare provider will then insert a thin, flexible tube (catheter) over the wire. The catheter may have other things attached to it, depending on the type of treatment. For example, it might carry clot-dissolving medicine. It may have a tiny deflated balloon or other device attached. The tube will be threaded through the blood vessel all the way to the site of the blood clot. Continuous X-ray images may be used to show exactly where the tube is.
  • Your healthcare provider will then work to dissolve or remove the clot. A combination of treatments may be used. For example, a clot-dissolving medicine may be used along with a balloon or other device.
  • When the clot is treated, the healthcare provider will take the tube out of the blood vessel.
  • The place where the tube entered will be closed and bandaged.

What happens after percutaneous transcatheter treatment of deep venous thrombosis?

After the procedure, you will spend several hours in a recovery room. Your healthcare team will watch your vital signs, such as your heart rate and breathing. To help prevent bleeding, you may need to lie flat without bending your legs for several hours after the procedure. You may need to stay at the hospital for a day or more, depending on your condition. Your healthcare provider will tell you more about what to expect.

After the procedure, you may need to take medicines to help prevent blood clots. You may need to take them for a short time, or take them for a longer time. The length of time depends on the cause of the blood clot. You may also need to take medicine to prevent clots before any future surgery. Your healthcare provider will let you know about any other changes in your medicines. You can take pain medicine if you need it. Ask your healthcare provider which to take.

Your healthcare provider will likely advise you to get back on your feet soon after the treatment. You may need to wear compression stockings. This is to help prevent the clot from forming again. It can also help prevent a new one from forming.

You should stop smoking. This will lower your risks of blood clots forming in the future. Talk with your healthcare provider if you need help to quit smoking.

Your healthcare provider will keep track of your health after you go home. You’ll have follow-up appointments. Your healthcare provider may check on your blood vessels with an imaging test called a venogram. Make sure to keep all of your follow-up appointments. This will help your healthcare provider can keep track of your progress.

Call your healthcare provider right away if you have any of the following:

  • Swelling or pain that gets worse
  • Fluid or blood leaking from the incision site
  • Fever
  • Bleeding anywhere on your body
  • Weakness, pain, or numbness in the area
  • Symptoms of a blood clot

Follow all of your healthcare provider’s instructions. This includes any advice about medicines, exercise, and wound care.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would  happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Saint Luke's Cardiovascular Consultants

A leader in cardiac care, Saint Luke’s Cardiovascular Consultants treats patients throughout the Kansas City area and surrounding communities. Our medical team consists of both board-certified clinical cardiologists as well as physicians certified in specialty areas of cardiology including interventional cardiology, echocardiography, nuclear cardiology, preventive cardiology, and electrophysiology.