Percutaneous Transcatheter Treatment of Deep Venous Thrombosis (DVT)

Percutaneous transcatheter treatment is one type of therapy for deep venous thrombosis (DVT). DVT is a blood clot that forms in a large vein deep in the body. It happens most often in a leg. The procedure uses a thin, flexible tube called a catheter to help remove the blood the clot.

During the treatment, a healthcare provider will insert a catheter into a blood vessel in your groin. Then he or she will move the tube through your blood vessels until it reaches the site of the clot. Percutaneous means that the procedure is done through a small puncture in the skin instead of a large incision.

Your healthcare provider might use one of several types of percutaneous transcatheter treatments. The catheter may be used to send clot-dissolving medicine to the DVT. This can help break up the clot. Or, your healthcare provider might use small tools to help break up the clot. In some cases, a tiny balloon or metal, mesh coil (stent) is inserted in the vein to help hold it open.

You may need this procedure if you have DVT. DVT can lead to possible problems such as:

• Blood clot that moves to the lung and causes breathing trouble and risk of death (pulmonary embolism)
• Leg swelling and pain
• Enlarged veins (post-thrombotic syndrome)
• Loss of the limb (rare)
• Shock and death (very rare)

Your healthcare provider might advise this procedure if certain conditions apply to you. These may include if you:

• Are having symptoms from your DVT
• Are at high risk of pulmonary embolism
• Have a clot above your knee
• Have a very large and severe clot
• Want to decrease the risk of post-thrombotic syndrome

Transcatheter treatment is not the only kind of treatment for a blood clot. You must have specific clinical factors to be a candidate for this procedure. Many people with blood clots are treated with medicines called blood thinners. These are given as an injection or through an IV. They can prevent a blood clot from getting larger.

All treatments for blood clots have their own risks and benefits. Ask your doctor if surgical thrombectomy might be a good choice for you. You might find it helpful to talk to a doctor who specializes in blood vessel problems. This type of doctor is called a vascular specialist.

All procedures have risks. The risks of this procedure include:

• Excess bleeding that can be severe enough to cause death
• Infection
• Damage to the vein at the site of the blood clot
• Reaction to anesthesia
• Detaching of the stent, if one is used

There is also a risk that your blood clot will form again. Your own risks may vary depending on your general health and how your blood clots. They may also vary depending on how long you’ve had the clot, and where it is in your body. Talk with your healthcare provider about all your concerns and questions.

Before the procedure, you will need to sign an Informed Consent form. This gives your doctor permission to do the procedure. It also states that you fully understand the risks and benefits of the procedure and have had all of your questions answered. Before you sign, be sure all of your questions are answered to your satisfaction.

Talk with your healthcare provider how to prepare for your procedure. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin, vitamins, and herbal supplements. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your procedure. Talk with your healthcare provider if you need help to stop smoking.

Before the procedure, make sure to tell the medical team if you:

• Have any allergies
• Have any recent changes in your health, such as fever
• Are pregnant, or could be
• Have ever had a problem with anesthesia

You may need some tests before the procedure, such as:

• Ultrasound, to measure blood flow in the leg and help diagnose DVT
• Venogram, to get an image of your veins and the blood clot
• Computed tomography (CT) scan, to get more information about the blood clot
• Magnetic resonance imaging (MRI), if more information is needed
• Blood tests, to check your overall health or look for clotting problems in your blood

Do not eat or drink after midnight the night before your procedure.

Talk with your healthcare provider about what to expect during the procedure. The details will vary depending on the type of procedure you have. They will also vary depending on what part of the body is treated. A typical procedure may go like this:

• An IV will be put in your arm or hand before the procedure starts. You’ll receive medicines through this IV. You may be given a blood thinner such as heparin. This is to help prevent new blood clots forming during the procedure.
• You’ll also be given anesthesia through the IV line. This will prevent pain and make you sleep during the procedure. Or, you may be given sedation. This will make you relaxed and sleepy during procedure.
• Hair in the area of your procedure may be removed. The area may be numbed with a local anesthesia.
• The healthcare provider will make a small incision in a blood vessel in your groin. He or she will then insert a long, thin wire into this cut. The wire acts as a guide for during the procedure.
• The healthcare provider will then insert a thin, flexible tube (catheter) over the wire. The catheter may have other things attached to it, depending on the type of treatment. For example, it might carry clot-dissolving medicine. It may have a tiny deflated balloon or other device attached. The tube will be threaded through the blood vessel all the way to the site of the blood clot. Continuous X-ray images may be used to show exactly where the tube is.
• Your healthcare provider will then work to dissolve or remove the clot. A combination of treatments may be used. For example, a clot-dissolving medicine may be used along with a balloon or other device.
• When the clot is treated, the healthcare provider will take the tube out of the blood vessel.
• The place where the tube entered will be closed and bandaged.

After the procedure, you will spend several hours in a recovery room. Your healthcare team will watch your vital signs, such as your heart rate and breathing. To help prevent bleeding, you may need to lie flat without bending your legs for several hours after the procedure. You may need to stay at the hospital for a day or more, depending on your condition. Your healthcare provider will tell you more about what to expect.

After the procedure, you may need to take medicines to help prevent blood clots. You may need to take them for a short time, or take them for a longer time. The length of time depends on the cause of the blood clot. You may also need to take medicine to prevent clots before any future surgery. Your healthcare provider will let you know about any other changes in your medicines. You can take pain medicine if you need it. Ask your healthcare provider which to take.

Your healthcare provider will likely advise you to get back on your feet soon after the treatment. You may need to wear compression stockings. This is to help prevent the clot from forming again. It can also help prevent a new one from forming.

You should stop smoking. This will lower your risks of blood clots forming in the future. Talk with your healthcare provider if you need help to quit smoking.

Your healthcare provider will keep track of your health after you go home. You’ll have follow-up appointments. Your healthcare provider may check on your blood vessels with an imaging test called a venogram. Make sure to keep all of your follow-up appointments. This will help your healthcare provider can keep track of your progress.

Call your healthcare provider right away if you have any of the following:

• Swelling or pain that gets worse
• Fluid or blood leaking from the incision site
• Fever
• Bleeding anywhere on your body
• Weakness, pain, or numbness in the area
• Symptoms of a blood clot

Follow all of your healthcare provider’s instructions. This includes any advice about medicines, exercise, and wound care.

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure