Patient Information for patients undergoing Treatment for a deep vein thrombosis (DVT)

Who this information is for

This information is for patients who have been diagnosed with a deep vein thrombosis and a procedure to remove the clot has been recommended.

This aims of this information are to explain the procedure and risks.

What is a DVT?

This is a blood clot in one of the deep veins of the body, most commonly the leg (although the arm and other deep veins can be affected in around 10% of cases). DVTs often have a clear cause (such as major surgery, or trauma) and these are known as ‘provoked’ DVT. Where there is not a clear cause, the DVT is labelled ‘unprovoked’.

What is an iliofemoral DVT?

An iliofemoral DVT is large blood clot that blocks one or more of the deep veins within the upper leg, pelvis, and abdomen. This often causes pain, heaviness and swelling, with difficulty walking. Iliofemoral DVT can extend from the thigh into the main vein in the abdomen (tummy) that drains blood from the legs called the Inferior Vena Cava.

The following information will help explain some of the ways these blood clots can be treated by a vascular surgeon or interventionalist.

How will I find out about my DVT?

Usually, the blood clot has been diagnosed before you meet a Vascular specialist. The first treatment that is started is a medication called anticoagulation which is often called a ‘blood thinner’. This can be given as an injection, or a tablet.

An ultrasound scan (‘jelly scan’) will usually have been used to find the DVT. If it looks like clot is an iliofemoral DVT then another more detailed scan may be arranged. This is usually a CT or an MRI scan.

For more information on DVT in general please see the Thrombosis UK website (opens in a new tab) or Circulation Foundation website (opens in a new tab).

Treatment options

Treatment depends on the severity of your DVT, the location of the blood clot, your fitness, quality of life and other health problems. These will be discussed with you when you are seen. The decision will be made with you and the other doctors looking after you.

There are two-main treatment options outlined below.

Medication, compression, elevation.

For all patients with a DVT, anticoagulation (blood-thinning) medication is needed. This is essential to reduce the risk of the blood clot extending further, but also to prevent blood clots dislodging and travelling to the lungs.

Compression stockings can help with improving symptoms, particularly in the early period after DVT is diagnosed. Elevating the leg when sitting will help to bring down the swelling. Drinking plenty of water is important and aiming to regularly walk/mobilise can help with symptoms.

A procedure to clear the DVT

With anticoagulation alone, the veins will not always go back to normal, and this can lead to long-term symptoms, including aching, heaviness, swelling, pain on walking and sometimes skin changes or wounds (termed ulceration) in the affected leg. These symptoms are termed ‘post-thrombotic syndrome’ or PTS for short.

If the vascular specialist believes that removing the DVT would be possible, with low risks and would reduce the severity of PTS in the future, they will discuss with you the option of a procedure to remove the clot. This can also have the added benefit of improving the symptoms of the DVT at the time, allowing quicker return to normal activity and work, but is mainly to help reduce the medium- to long-term symptoms (i.e. to prevent PTS).

The procedure to remove the DVT

This can be performed under local or general anaesthesia. Your specialist will help plan this and talk you through these options. X-rays are needed for this procedure.

To clear the DVT, a small needle is used to thread a wire into the vein. This can be behind the knee, in the mid-thigh or in the neck. The wires are passed under X-ray guidance through the clot in the veins. This will allow a special catheter or clot retrieval device to enter the vein and clear the clot.

There are a several different procedures that can be performed depending on the size, position, and age of the DVT. This will be discussed with you by your surgeon or interventionalist. Sometimes only a single procedure is needed, where specialist device is used to remove the clot from inside the vein. these are performed in a ‘single-session’. This is often called a ‘thrombectomy’ (to remove thrombus/clot).

Another option is to have ‘clot-busting’ medication that is dripped directly into the clotted vein, termed ‘thrombolysis’, over several days. In these cases, a catheter (tube) is left in the vein, and you will be kept in hospital and watched. A repeat X-ray check is then carried out at between 24 and 72 hours.

Will I need a stent during this procedure?

During these procedures a sometimes a ‘stent’ (a metal tube) may be placed into the vein if there are any narrowings, scarred areas or if there is damage from the clot. This acts like a metal scaffold that is left behind in the vein to hold it open. It cannot be removed. Stents help to improve flow of blood in the affected vein (for more information please see the ‘deep venous stenting leaflet’).

Aftercare

After ‘thrombectomy’

• You will be sent back to the ward and monitored by nursing teams. The small needle hole and cut to the skin will usually be closed with skin glue or dressings.
• You will often be discharged home the next day or shortly afterwards.
• You will have ‘inflatable calf-pumps’ (while in hospital only) on the legs to keep the blood flowing and receive an injectable blood thinner in the recovery period.
• You will be able to walk around after the procedure and remove the ‘calf-pumps’ in time which will be replaced with a compression stocking. Drinking plenty of water is encouraged.

After ‘clot-busting medication’ (thrombolysis)

• If you receive clot busting medication, then you will be kept on the ward for observation while the ‘drip medication’ is running. A check Xray is often performed and might mean that the drip is needed for a bit longer to clear the clot in the vein.
• Usually this continues for no more than 72 hours.
• You may need multiple trips to the procedure room. Once the final check Xray has been completed, the tube in the vein will be removed. Clot dissolves differently for different people, but most dissolve within 72 hours.
• You will be asked to walk, wear a compression stocking, drink plenty of water and be given the ongoing anticoagulation to continue after discharge.

Risks and complications

All procedures carry risk, but DVT treatments are considered low risk.

At the puncture/needle site:

• Some bruising is common after the puncture to the vein.
• It is very rare for any significant bleeding after these procedures.

Related to the contrast (dye):

• Some patients experience an allergic reaction to the contrast, but this is very rare (1 in 3000).
• Any procedure involving X-ray and dye can affect the kidney function (particularly in patients with kidney disease), but this usually recovers quickly. There is a 1 in 100 of permanent damage. There are measures that can be taken to minimise this if needed, your surgeon or interventionalist will discuss this with you.
• Staying well hydrated and precautions such as stopping metformin if diabetic can help reduce the chances of kidney problems.

Related to the treatment:

• Common to all DVT treatments there is the risk of failing to remove the clot or the clot recurring early afterwards and having ongoing symptoms into the long-term.
• If you undergo stenting, this can sometimes cause back pain, but this usually settles with time and simple pain killers (stenting information is available).
• There is a very small chance of internal bleeding and a very small chance of clots travelling to the lungs (pulmonary embolus) at the time of treatment.
• The bleeding risk is low for ‘thrombectomy’ but slightly higher for ‘thrombolysis’ where there is a very small risk of life-threatening bleeding (very rare).

Going home

• You will be given anticoagulation (blood thinning) medication to go home with. It is important that you take this regularly. If this in injection form, you will be taught how to give yourself the injections before discharge.
• An ultrasound will be arranged as an out-patient. If you have a stent inserted, you may require regular scans to keep an eye on any stents. We will explain this to you if needed.
• You should be able to walk around, and you will be encouraged to be active in the recovery period. You will often be provided with a stocking
• We will give you instructions on when to wear the stockings and if they will be required long-term. Stockings are usually worn during the day and taken off at night.
• As the swelling reduces you may need to be measured for a new smaller pair of stockings.
• For DVT, sometimes a long-term stocking be beneficial.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart

Contacts/further information

Do feel free to contact the Cambridge Vascular Unit vascular specialist nurses on 01223 596382 or email the vascular nurses if you have any questions or anxieties.

References/sources of evidence

• The Vascular Society website (opens in a new tab)
• Circulation Foundation website (opens in a new tab)