Deep Vein Thrombosis in India

The formation of a thrombus, or a blood clot, is caused by deep vein thrombosis (DVT) in the deep leg vein. This is a very serious condition that may cause damage to the leg that is permanent. This is also known as post thrombotic syndrome. It may also cause a life-threatening pulmonary embolism, or blood clot in the lungs. 600,000 new cases are diagnosed each year. Of every 100 people who have DVT, one those will die. This has recently been called the “Economy Class Syndrome” because of it developing after sitting on long flights.

The veins are surrounded by powerful muscles that contract and force oxygen-less blood back to the lungs and the heart. These deep veins are near the center of the leg.

Because blood is squeezed up the leg against gravity and the valves prevent it from flowing back to our feet, one-way valves prevent the back-flow of blood between the contractions.

Blood can pool when the circulation of the blood slows down due to illness, injury or inactivity, providing an ideal setting for clot formation.

A common after-effect of having Deep Vein Thrombosis (DVT) if treated with anticoagulation drugs, or blood thinners, is post-thrombotic syndrome, which is under-recognized, because the clot remains in the leg. Anticoagulants don not actively dissolve the blood clot, contrary to popular belief. They just prevent new clots from forming. Even though the body will eventually dissolve a clot, the vein often becomes damaged in the meantime. A large number of these patients develop damage that is irreversible in the leg veins and the valves, thus resulting in the abnormal pooling of blood in the leg, fatigue, swelling, chronic leg pain, and in extreme cases, horrible skin ulcers. This is usually considered a long-term outcome but it actually occurs in as many as 60-70 percent of people and develops within two months developing Deep Vein Thrombosis (DVT). Through increasing information that blood clot removal via a procedure called interventional catheter-directed thrombolysis in selected cases of Deep Vein Thrombosis can stop the debilitating sequel of post-thrombotic syndrome and can improve the quality of life for the patient(s).

If left untreated, DVT, or deep vein thrombosis, can break off and get into the circulation, getting stuck in the lung, where stops the oxygen supply, and causes heart failure, which is known as a pulmonary embolism. Pulmonary embolisms can be fatal. If caught early, patients with Deep Vein Thrombosis (DVT) can reduce their probability of developing a life-ending pulmonary embolism to less than one percent. Heparin and Coumadin, both blood thinners, are effective in stopping further clotting and can stop a pulmonary embolism from developing.

Catheter-directed thrombolysis is done by interventional radiologist through guided imagining. Performed in a hospital’s interventional radiology suite, the procedure is designed to quickly dissolve the clot, restore the flow of blood in the vein and hopefully maintain valve function to lessen the risk of post-thrombotic syndrome. The interventional radiologist embeds a catheter into the popliteal (a spot behind the knee) or other leg vein and strings it into the vein containing the clot utilizing imaging direction. The catheter tip is put into the clot and a “clot busting” medication is infused specifically to the thrombus (clot).The newer the clot, the quicker it breaks down – one to two days. Any narrowing in the vein that may prompt future clot arrangement could be recognized by venography, an imaging study of the veins, and treated by the interventional radiologist with an inflatable angioplasty or placement of a stent.

An interventional radiologist can insert a vena cava filter (a small device that functions like a catcher’s mitt to stop blood clots but allow normal non-clotting blood to pass) in patients whom this is not appropriate for and blood thinning medications are not an appropriate measure.