DVT thrombolysis may be considered for a clot in the deep veins in the thigh and pelvis (iliofemoral DVT). This treatment is a minimally invasive surgery to dissolve and remove the clot percutaneously. It is performed by first placing an make this a hyperlink ), then introducing a small tubecatheter into the popliteal vein behind the knee through a two-millimeter incision. The catheter is guided up the vein through the clot. A variety of techniques can be used to remove the clot. Most commonly, we use a Trellis device. This device has a catheter with balloons at its tip and in its mid-shaft. Between the balloons, the catheter is perforated with tiny holes. The catheter is advanced through the clot, and the balloons are inflated proximal and distal to the clot, to isolate a segment of clotted vein. A solution that dissolves the clot (tissue plasminogen activator, or TPA) is instilled through the side holes of the catheter and then an oscillating wire is inserted through the catheter to disperse the solution through the clot. The dissolved clot is then aspirated out of the vein. Another device we commonly use is Angiojet, which uses a jet spray and suction catheter to break up and remove clot. The procedure is done under light sedation or a general anesthetic and typically takes about two hours. Afterwards, patients are continued on blood thinners for a period of time while the vein is healing.
Thrombolysis is contraindicated for patients with advanced age, bleeding problems, recent surgery, or head trauma. It is not effective on older clots. We do not generally recommend treating clots that are over six weeks old because the likelihood of significantly impacting clot burden is low.
The standard of care for DVT remains anticoagulation with blood thinners. The main reasons to consider DVT thrombolysis are to decrease leg pain and swelling and to preserve valve function in the deep veins. We believe that a successful early thrombolysis is associated with lower risk of developing post phlebitic syndrome (chronic leg swelling and skin changes).