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Deep Venous Thrombosis

 

Acute DVT


Standard anticoagulation with coumadin, heparin or low molecular weight heparin (i.e. lovenox) prevent more clot from forming, but does not remove the existing clot from the vein. This therapy relies on the body to "dissolve" the clot. Unfortunately, this often does not occur and the vein will remain blocked forever.

At Tulane we have a variety of new devices and methods that remove the clot from the vein. Some devices allow us to administer a "clot-busting" drug directly into the clot. Other devices break up the clot into tiny pieces that are then removed using a catheter. Often, these techniques uncover a particular narrowing of the vein that caused the blood clot to form, and we are able to treat this by implanting a stent to open the vein. The benefit treating this narrowing, is that it will likely decrease your risk of developing blood clots in the future. This is typically an outpatient procedure, or a single over-night stay.

Patients with the best outcomes are patients that have had symptoms that are less than 30 days. The clot seems to respond very favorably when it is "fresh". The optimal outcomes are seen in patients with symptoms less than 14 days.

Unfortunately, many physicians that are not interventional radiologists are unaware or unfamiliar with these new techniques. We recommend a consultation with our experienced Stanford faculty.

 

Chronic DVT


Patients with chronic DVT experience leg swelling, pain and often skin discoloration of the leg below the knee. These patients typically wear compression stockings in order to help with these symptoms. These symptoms are related to the vein being blocked and not allowing blood flow out of the leg.

At Tulane we have a variety of new techniques to re-open veins that have been blocked for years. We have opened up veins that have been blocked for 25 years, with significant improvement in the patients' symptoms. We place a metal stent into these blocked veins to keep the vein open. The stent is similar to those put in the heart, except the stents we use in veins are much larger. This is typically an outpatient procedure and the patient is discharged the same day, able to walk, with just a Band-Aid where we entered the vein.

Of particular interest to our faculty are blood clots that occurred while on oral contraceptives, also known as birth control pills or while pregnant. We have developed an effective method to treat these women, and get them back to their active lifestyle.

Who is at risk to develop DVT? Patients with; cancer, taking hormonal contraceptives (birth control pills), pregnant, recent surgery, immobilization, family history of blood clots.

 

Pulmonary Embolism


Left untreated, a deep vein thrombosis (DVT) can break off and travel in the circulation, getting trapped in the lung, where it blocks the oxygen supply, causing heart failure. This is known as a pulmonary embolism, which can be fatal. With early treatment, people with DVT can reduce their chances of developing a life threatening pulmonary embolism to less than one percent. Blood thinners like heparin and coumadin are effective in preventing further clotting and can prevent a pulmonary embolism from occurring.

    * It is estimated that each year more than 600,000 patients suffer a pulmonary embolism.

    * PE causes or contributes to up to 200,000 deaths annually in the United States.

    * One in every 100 patients who develop DVT die due to pulmonary embolism.

    * A majority of pulmonary embolism are caused by DVT.

    * If pulmonary embolism can be diagnosed and appropriate therapy started, the mortality can be reduced from approximately 30 percent to less than ten percent.

Symptoms of Pulmonary Embolism

The symptoms are frequently nonspecific and can mimic many other cardiopulmonary events.

    * Shortness of breath

    * Rapid pulse

    * Sweating

    * Sharp chest pain

    * Bloody sputum (coughing up blood)

    * Fainting

IVC Filter

An inferior vena cava (IVC) filter is a medical device inserted for the prevention of pulmonary embolism (PE). Many patients have received a retrievable IVC filter for temporary prevention of PE. When the filter is no longer needed, prompt removal is desired to avoid long-term complications. For some patients, standard retrieval methods fail to achieve filter removal. For these patients, the Tulane Division of Vascular and Interventional Radiology has pioneered new endovascular methods to retrieve a variety of IVC filters, regardless of implantation length, which have become embedded within the IVC.

Using these cutting-edge techniques, we have successfully removed embedded IVC filters in many patients from around the country. Since each complex filter case presents with a unique set of challenges, we believe the treatment must be meticulously planned and personalized to fit each patient. We invite you to explore your treatment options at Tulane IR, and we look forward to managing any issues related to your IVC filter.

Radiology Department SL-54, 1430 Tulane, LA 70112 504-988-7627 website@tulane.edu