Modern endovascular techniques dissolve the clot after venous thrombosis.
Until recently, when a patient suffered from deep vein thrombosis and, even worse, its most difficult complication, pulmonary embolism. The only means of treatment suggested by the vascular surgeon was to take anticoagulants for a long period of time, which could exceed a year, and to monitor the clot with frequent triplexes in the belief that the clot even in the lungs would gradually (but never completely) dissolve and the patient’s life would – at least partially – return to normal.
Unfortunately, however, the clot never completely dissolved, the patient’s leg was often swollen – especially in summer or when standing – and there may have been ulcers, and the patient was in a constant state of anxiety about a possible new clot and a constant need to adjust his life to the “bad thing that happened to him” and to “learn to live with it”. These situations are thankfully largely a medical thing of the past, because the most modern endovascular techniques make the clot dissolve.
Thrombolysis and thrombectomy
With the help of endovascular surgery ( which we know from its application for years in arteries – balloon, stent, etc.) we can intervene and dissolve the clot (thrombolysis) within the first 48 hours from the moment a thrombosis occurs, wherever it is located- femoral, popliteal, iliac, iliac, inferior vena cava and even in the pulmonary veins in the case of pulmonary embolism- in a simple and painless way for the patient: under local anaesthesia and usually through the leg (femoral vein). With very small materials we reach, with the help of imaging guidance, the site of the clot and there, using special catheters, we inject material that dissolves the clot and cleans the vein.
In case the clot remnants – after waiting usually half an hour- are relatively large, we have the possibility to repeat thrombolysis, but also to aspirate these pieces and remove them from the body using special aspiration micro-devices through a procedure called vacuum aspiration thrombectomy(Aspiration Thrombectomy).
With the combination of these two techniques we achieve the immediate dissolution and aspiration of the clot at a rate of more than 90%, the venous system returns to normal and the patient does not experience any of the difficulties in daily life that can be caused by thrombosis, which until now has been treated with “drugs and socks”. In fact, from the next day he is able to return to his normal life without discomfort. In the case of pulmonary embolism, such a successful thrombolysis procedure removes once and for all the possibility of a fatal outcome to which pulmonary embolism can lead. We are therefore talking in this case about a life-saving intervention for the patient’s life, which until now has been treated simply with anticoagulation, medication and observation usually in an Intensive Care Unit or at best in an Intensive Care Unit for a long period of time.
And after 48 hours , what? The location of the venous stent
It is true that after the first 48 hours of a thrombosis the clot becomes more compact, more stable and therefore more difficult to dissolve. But even in this case we have the solution to reduce the clot and restore the vein. We apply thrombolysis again and on the remaining clot we place a metal splint, a stent, just like in arteries, which opens the lumen of the vein, firmly sticking the clot to the wall. And all this under local anaesthesia and immediate mobilisation of the patient on the same day.
In this way we will not see chronically swollen feet again after an old thrombosis treated with medication, we will reduce the post-thrombotic syndrome and we will see fewer blackened and vein ulcerated feet after a chronically neglected thrombosis.
In the vascular surgery department of the General Clinic there is now the medical specialization and the latest technology equipment for everything described above, unique in Northern Greece. The clot is now dissolved. It is dissolved and absorbed, dissolved and stented, wherever it is, from the leg, arm, abdomen to the lungs.
And this is done painlessly and quickly, ensuring the quality of life that until now the patient who has suffered venous thrombosis is deprived of. This patient who has been taught that he will have to take “anticoagulants and a stocking for life ” and has to “get used to living with it” Not anymore.
Drmed Dimitris N. Papadimitriou, FACS, FEBvasc
VASCULAR SURGEON – ENDOVASCULAR SURGEON
Τ. Rev. Director of the Vascular Surgery Clinic 424 GSNE
Associate of Euromedica General Clinic of Thessaloniki
Visiting Vascular Surgeon HERZZENTRUM, Universitatspital Zurich, Zurich , Zurich,Switzerland