Acute deep vein thrombosis or DVT, is a common condition that occurs in the legs of men and women of all ages. It causes leg swelling, pain and can limit walking. The larger the blood clot, the greater the number of veins that are damaged and the more severe are the symptoms.
DVT Treatment Options
Traditional treatment is a blood thinner Warfarin, Lovenox (enoxaparin), Eliquis (apixaban) or Xarelto (rivaroxaban). All these blood thinners prevent new blood clots from forming, current blood clots from growing, and blood clots from traveling to the lungs and becoming a pulmonary embolus (PE). Pulmonary emboli can cause chest pain and shortness of breath, damage heart function, make the blood pressure low and can lead to death.
Though blood thinners are effective in preventing this condition from worsening in the short term, it does nothing to prevent the long–term complications of DVT. DVT clogs up the veins, which are pipes moving blood out of the legs. This can lead to permanent leg pain and heaviness, swelling, discoloration of the skin of the legs and leg wounds (i.e. ulcers) that are difficult to heal and frequently recur. These symptoms are called the Post Thrombotic Syndrome (PTS) and can cause permanent disability and decades of suffering.
Will you develop PTS? If so, how severe might the symptoms progress? These and other questions can be answered by a vascular surgeon with expertise in both deep vein disease and deep vein therapies.
Blood clots in the veins in the upper leg may require treatment to dissolve the DVT (i.e. thrombolysis). This removes the blood clot and opens the veins, and prevents or decreases the long-term disability of the PTS. Vascular surgeons with expertise in this treatment are now using less invasive techniques (e.g. Trellis, Ekos, Angiojet) with a low risk of complications. If you have a DVT extending into the upper leg and groin area and you have leg pain and/or swelling,you should have a detailed discussion of thrombolysis therapy with a qualified vascular surgeon.
Early Treatments Improves Success
It is important to consider that treatment of a new DVT with thrombolysis is most effective if performed in the first week or two after diagnosis. The effectiveness of therapy diminishes after 4 weeks. So a discussion about the risks and benefits of thrombolysis therapy, should occur in the first days or weeks following a diagnosis of acute DVT. Fortunately, we have new therapies that avoid the risk associated with the use of blood thinners while still improving the PTS symptoms of patients who have had a DVT in the past. Though not as effective as early thrombolysis for acute DVT, these new techniques can be very effective for making PTS symptoms improve or resolve.
Not all doctors caring for vascular disease and deep vein thrombosis perform these therapies, so finding the right doctor for this problem is important. At SCVC we have been performing these procedures regularly since 2007.
Please contact Dr. Gagne at PGagne@TheVascularExperts.com with any additional questions.
Paul J. Gagne, MD, FACS, RVT
Paul J. Gagne, MD, FACS, RVT is a board certified general and vascular surgeon at The Vascular Experts, where he specializes in vascular and endovascular techniques for the treatment of arterial and venous disease.
Dr. Gagne Practices at the Darien office of The Vascular Experts.