Endovascular Clot Removal
Deep Venous Thrombosis (DVT) is unfortunately common and a major cause of death and disability in Australia. DVT can cause pain and swelling of the affected leg. Over time, the clot may either continue to block the vein or cause dysfunction of the critical anti-reflux venous valves. This can develop into problematic ulceration of the leg (Venous ulcers).
For most patients, treatment with a blood thinner and compression stockings is sufficient to treat the acute symptoms associated with DVT. However, patients with ongoing pain and swelling may benefit from removal of the clot. This is particularly true for patients where the clot extends up the leg into the veins in the abdomen (iliac veins).
Endovascular clot retrieval procedures offered in our practice include mechanical and pharmacomechanical devices to remove the clot. These may be combined with intravenous blood thinners and clot busting medications to further support retrieval of the clot.
Indications and Investigations
This procedure is usually recommended for patients where conservative therapies have failed. An assessment is made of the limb to determine the state of the venous drainage of the leg and the state of the veins in the abdomen. This often involves diagnostic ultrasound and diagnostic venography. If there is a significant amount of clot burden, and the symptoms are severe enough to justify intervention, then clot retrieval is recommended.
Before undergoing surgery, inform your doctor about any medications or supplements you are taking. You may need to discontinue certain medications. Also, inform your doctor about any existing medical conditions or illness. Avoid oral intake of any food or drink, including water, for about 9 to12 hours before your surgery. Your prescribed medications can be taken along with a small sip of water.
During the procedure, a balloon and wires are placed into the veins of the leg. The procedure is performed in the operating room with the patient under general or local anaesthesia with mild sedation. Your doctor will make a tiny incision over the groin and insert a small tube called a catheter into the femoral vein. With the help of X-ray imaging, the catheter is guided to the site of the clot. Wires are then used to cross the blocked vein, and retrieval devices are then deployed over the wire to remove the clot. After the procedure X-rays are taken to ensure the vein is open and flowing into the wound. The catheter is then removed and the incision, in your groin, is closed.
After the surgery, you will be kept in hospital for observation. You will be given blood thinning medications to prevent blood clot formation. It is important to take the blood thinners as prescribed to prevent re-blockage of the vein. An ultrasound will be performed 1-2 days after the procedure to confirm the vein is still patent.
The possible complications of endovascular repair include:
- Bleeding in the groin that requires surgery
- Re—blockage of the vein
- Allergic reaction to anaesthetic agents/ contrast agents etc