• Catheter-Directed Thrombolysis: A Treatment Option for You?

    HCA image for PE/DVT You might be surprised to learn that it is not unusual for the blood to clot inside a vein from time to time. Most clots are small, cause no symptoms, and are dissolved by an enzyme in your blood. However, if the clot becomes large enough, it can lead to potentially life-threatening health problems.
    In most cases, medicines can be used to treat a majority of clotting problems. There is also another treatment option called catheter-directed thrombolysis. Like medicines, this treatment offers a way to treat dangerous clots. However, it is not an option that is best for everyone with clotting problems. Talk to your doctor to find out if catheter-directed thrombolysis is appropriate for your condition. In the meantime, here is an overview on this treatment option.

    What Is Deep Vein Thrombosis (DVT)?

    Deep vein thrombosis (DVT) occurs when a blood clot forms in a vein deep within the body, particularly the deep veins that lie near the center of the legs. Generally, contractions of the muscles in the arms and legs help force blood back through these deep veins to the heart.
    DVT may result from a combination of factors, such as having:
    • Sluggish blood flow
    • Changes in the level of circulating clotting factors
    • An injury to a blood vessel
    Sluggish blood flow can be the result of sitting for long periods of time, like on a long airline flight, or long periods of bed rest, such as after surgery, serious illness, or injury.
    Clotting factors are substances that circulate naturally in the blood to regulate clot formation. However, certain trauma to the body, such as surgery, injury, or giving birth, may increase the level of clotting factors circulating in the blood. This, in combination with the reduced mobility that results from these actions, may set the stage for DVT. Similarly, many cancers increase the production of substances that promote clotting and in effect may cause DVT or pulmonary embolism.
    Typically, these clots come on suddenly and without warning. They can cause swelling and pain in the leg. The greatest problem, however, is that so long as the clot is present, the patient is at risk for a pulmonary embolism (PE).

    What Is Pulmonary Embolism (PE)?

    PE is a potentially fatal complication of DVT. PE is a blockage of an artery that occurs when a clot formed in another part of the body breaks loose and travels through the bloodstream until it becomes stuck in a large blood vessel in the lungs.
    The clot, called an embolus, is usually a blood clot (although it can also be an air bubble, or a piece of fat, bone marrow, or tumor tissue) and generally originates in the deep veins of the legs or hips. Once the clot becomes stuck in the artery in the lungs, it prevents blood flow to that portion of the lung, causing it to become damaged and eventually die. This can cause the lung to stop working properly, puts a strain on the heart, and, if not treated, may lead to death.

    What Is Catheter-Directed Thrombolysis?

    Catheter-directed thrombolysis involves inserting a catheter into a vein in the leg and carefully threading it through the veins until it reaches the site of the blood clot.
    Once the tip of the catheter reaches the clot, a clot-dissolving drug is infused into the clot through the catheter. In most cases, the blood clot will completely dissolve within one to two days. The doctor monitors the procedure using special x-rays and ultrasound scans. These images will also allow the doctor to determine if the vein wall is narrowed or damaged, making it prone to more clots in the future. If this type of damage has occurred, the doctor may need to do an additional procedure, such as a balloon angioplasty or place a small mesh stent into the vein to keep it from clotting again.

    What Are the Benefits of Catheter-Directed Thrombolysis

    Post-thrombotic syndrome (PTS) is a chronic condition that occurs in some people who have DVT, even those who have been treated with clot-dissolving drug. With PTS, there is an abnormal pooling of the blood in the leg, which may be accompanied by a range of symptoms, like chronic leg pain, heaviness in the leg, swelling, discoloration, and severe skin ulcers.
    If you have DVT, the catheter procedure may be an option for you if you meet certain criteria, such as:
    • Having a blood clot in the vein in the thigh
    • Having a low risk for bleeding complications
    The potential benefits of catheter-directed thrombolysis include:
    • Reduced risk of developing PTS
    • Restoration of normal blood flow in the affected leg
    As with any procedure, though, the benefits need to be balanced with the risks, like the increased risk of bleeding.

    Getting Medical Care

    If you have symptoms of DVT, such as leg pain and swelling, make an appointment with your doctor. If you have symptoms of PE, you should seek emergency medical care right away.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    Society of Interventional Radiology http://www.sirweb.org/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca/home/index%5Fe.aspx/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php/

    References

    Catheter-directed thrombolysis. RadiologyInfo.org website. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=thrombo. Updated July 14, 2011. Accessed April 17, 2012.

    Catheter-directed thrombolysis: Information for patients. Hong Kong Society of Interventional Radiology website. Available at: http://www.hksir.org.hk/document/patinfleaflet/eng/doc/thrombolysis.doc. Accessed August 21, 2003

    Deep vein thrombosis (DVT). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated March 31, 2012. Accessed April 17, 2012.

    Deep vein thrombosis overview. Society of Interventional Radiology website. Available at: http://www.sirweb.org/patPub/DVToverview/shtml. Accessed March 3, 2008.

    Deep vein thrombosis/pulmonary embolism (DVT/PE). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncbddd/dvt/facts.html. Updated January 31, 2012. Accessed April 17, 2012.

    Dickson BC. Venous thrombosis: on the history of Virchow's triad. Univ Toronto Med J. 2004; 81:166.

    Elting LS, Escalante CP, Cooksley C, et al. Outcomes and cost of deep venous thrombosis among patients with cancer. Arch Intern Med. 2004; 164:1653.

    Enden T, Haig Y, Klow N, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet. 2012;379(9810):31-38.

    New treatment option for DVT. Interventional Radiology Grand Rounds. Society of Cardiovascular & Interventional Radiology. 1999. Vascular Disease Treatments. Society of Interventional Radiology website. Available at: http://www.sirweb.org/patPub/vascularTreatments.shtml. Accessed March 3, 2008.

    Post-thrombotic syndrome. Venous Disease Coalition website. Available at: http://www.venousdiseasecoalition.org/diseaseinfo/pts/. Updated July 19, 2010. Accessed April 17, 2012.

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