What is a DVT?
DVT is the condition when a clot develops in the veins of your legs (or sometimes your arms). The clot can cause leg (or arm) swelling and sometimes pain. It can also break free and travel to the heart and lungs (this is called a “pulmonary embolus” or “PE”). When the clot breaks free it can cause a variety of problems from mild shortness of breath to complete cardiac arrest.
What causes a DVT?
There can be many underlying causes for DVTs such as recent major surgery, presence of a central venous catheter, trauma, immobilization, malignancy, pregnancy, the use of oral contraceptives or heparin, blood disorders, and a number of other major medical illnesses. Typically the most common acquired cause is immobility.
What can be done about it?
Usually in most cases symptoms are mild and can be treated with prescription blood thinning medications (anticoagulants) such as Warfarin, Xarelto, Eliquis or Pradaxa. If symptoms are severe or don’t improve on anticoagulation then a vein study using a catheter and fluoroscopy guidance (X-ray) can be done to try and dissolve the clot directly using medication and/or the clot can try and be removed. This procedure is called a venogram with thrombolysis (dissolve clot) or thrombectomy (remove clot).
How is a venogram with possible intervention done?
The procedure is done at El Camino Hospital where you will be set up with an IV to allow access for moderate (also known as “twilight”) sedation. You will then be taken to the procedure room where you will have a team of two nurses, a radiology technician and your interventional radiologist. You will be connected to heart, blood pressure and oxygen monitors during the entire procedure. IV medication will be administered to make you comfortable (moderate sedation). Then your interventional radiologist will administer numbing medication (local anesthetic) to the procedure site. Using fluoroscopy guidance (X-ray) a catheter will be inserted through a vein. A small amount of dye may be used to “map” out the veins and assess for any abnormal areas of narrowing and/or clot. If a clot is discovered, we either try breaking it up (thrombolysis) by infusing medication right at the clot and/or remove it (thrombectomy) with a device. If the cause of the DVT was found to be narrowing of the vein (stenosis), we will treat it with balloon dilation (angioplasty), and sometimes a stent (self expanding metallic brace) will need to be placed at the site of balloon dilation. In some cases we also may place a filter in the inferior vena cava (IVC filter) to catch any clots that break free. If an IVC filter was placed, at some point within the next few months we will evaluate if it may need to be removed.
Why did we do this procedure?
We typically treat DVT because of swelling of the extremity and sometimes pain. One benefit is that by removing the clot that causes DVT we will also reduce the chance of a PE and the possibility of severe consequences.
What should I watch for?
You may be sore after the procedure, but this should not get worse and should subside within 2-3 days. During this time, you may take a non-steroidal anti-inflammatory medication such as Ibuprofen (Motrin, Advil), Naproxen (Aleve), Acetaminophen (Tylenol), or other similar over-the-counter medications. If you develop sudden extremity pain or new swelling, call our office (650) 404-8445 or go to the emergency room if after 5pm or on the weekend. If you are taking an anticoagulant and develop significant bleeding (more than just a small cut or bruise) or have signs of weakness of your limbs or slurred speech, go directly to the Emergency Room.
When should you call your physician?
New leg or arm swelling
Pain in the treated extremity
Shortness of breath
If on anticoagulants, any significant bleeding or signs of stroke
You can reach your Interventional radiologist at 650-404-8445 during M-F 8-5pm, or the physician can be reached through the operator after hours or on weekends by calling 408 739-6000 and asking for the Interventional Radiologist “on call.”
If you received sedation on the day you were treated, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.
You may shower 24 hours after the procedure.
You may use over the counter medication such as Acetaminophen (Tylenol) or ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.
You can resume your normal diet. Therefore light meals are recommended until you know that you can eat without problems.
You will likely be placed on a blood thinner medication called an anticoagulant to prevent the development of more Deep Vein Thrombosis, and this medicine will also reduce the risk of PE. These medications include some that are taken by mouth and some that are injected beneath the skin. The common ones that are taken by mouth include Warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). The ones that are injected beneath the skin include low-molecular weight heparin (Lovenox) and fondaparinux (Arixtra). Specific instructions will be given if you were prescribed any of these.
Regardless of the type of anticoagulant, it will “thin” the blood and increase the chance of bleeding. Therefore, avoid high impact activities and watch out for any activity that may involve falling.
If you develop significant bleeding (more than just a small cut or bruise) or have signs of weakness of your limbs or slurred speech, go directly to the Emergency Room.
The length of time you will stay on an anticoagulant will be determined after the first month or two following your procedure. Usually the minimum amount of time is 3 months, but some patients will need life-long anticoagulation.