DVT, or blood clots in your leg, can be a life-threatening condition. It can be treated by taking oral anticoagulation medication, wearing compression stockings, elevating the leg to reduce swelling, and continuing to walk and keep yourself hydrated. Your vascular doctor can tell you more about your treatment options.
The blood clot is dissolved by the body in 3 to 6 months. Blood thinners do not dissolve the clot, but they help to make sure the clot does not become worse. Lately a procedure to remove clots has been undertaken with increasing frequency to reduce the severity of post thrombotic syndrome (PTS).
Main reasons to consider surgical correction of DVT are to help reduce severity of both thrombotic syndrome and/or to treat extreme outflow obstruction resulting in a rare but limb-threatening condition called phlegmasia.
Patients who have iliofemoral DVT are at highest risk for severe morbidity from PTS. This means that the blood clot is extending into the vein in your pelvis. Veins have valves inside them that make sure that the blood flows in the correct direction and back to the heart. The blood clots can damage these valves and result in venous hypertension, reflux (blood flows in opposite direction in the vein away from the heart), and ultimately result in venous ulceration around the ankles. It is important to remember that venous ulceration is very different from arterial ulceration and unlike arterial ulcers and can never cause you to lose your legs. However, venous ulceration is a source of significant morbidity and discomfort. When thrombus burden is removed quickly, luminal patency is restored and the wall function is maintained.
Catheter Directed Thrombolysis: ATTRACT Trial
This was a high-quality research strategy carried out in multiple hospitals in the U.S. in 2019 to evaluate if there is any benefit of removing the clot burden over just putting patients on blood thinners. Pain and swelling in the leg associated with blood clots is called post thrombotic syndrome (PTS). The main finding was that the severity of post thrombotic syndrome was much lower when treated with thrombolysis at 2 years follow-up.
It is important to note that the incidence of post thrombotic syndrome was the same whether a procedure was carried out or not, meaning the same number of patients got a complication of post thrombotic syndrome whether a procedure was carried out or not. Also the recurrence rate of the DVT was the same at 2 years whether a procedure was carried out or not meaning removal of blood clot by procedure did not reduce the chances of getting a blood clot in your legs again. If the blood clot was in the vein below the groin or in the veins below the knees, no difference was seen in terms of benefit by utilizing the procedure. Thrombolysis or thrombectomy should be reserved for select patients—those who are young, active, able to walk, at low risk of bleeding, and have clots extending into the pelvic veins or inferior vena cava, or those presenting with the rare condition phlegmasia stenosis. Phlegmasia is a condition where the blood clots impair the return of blood to the heart, causing circulatory compromise to the leg.