Thrombolysis for DVT Surgery in Udupi

Overview

Thrombolysis for DVT is a medical therapy used to treat deep vein thrombosis (DVT), which involves medications known as thrombolytic drugs to break down the blood clot. Deep vein thrombosis is the formation of a blood clot in your lower leg, thigh, or pelvis. DVT is considered a severe condition since the blood clots can get dislodged in the bloodstream and travel to your lungs, causing pulmonary embolism and permanently damaging your leg vein. Hence early diagnosis and prompt treatment are important. Thrombolysis for DVT can be performed in two ways: systemic thrombolysis (through an IV line) and catheter-directed thrombolysis (using a thin, tube-like device).

What is Meant by Thrombolysis For DVT?

“Thrombo” means related to the clotting of blood, and “lysis” means the disintegration or breakdown of a cell or a structure. Thrombolysis (also called thrombolytic therapy for DVT) is a procedure that uses medications to dissolve blood clots that cause blockage in your veins or arteries. It also aids in preventing the formation of new blood clots. Thrombolysis is often used to treat deep vein thrombosis (DVT), which causes serious life-threatening complications if left untreated. DVT lysis reduces damage to your body’s organs and tissues by breaking down the clots and improving blood flow. 

There are two types of thrombolytic therapies:

• Systemic thrombolysis- The thrombolytic drugs for DVT are injected through an IV (intravenous) infusion.
• Catheter-directed thrombolysis- The thrombolytic medications are delivered through a tube-like device known as a catheter to break down the blood clot.

When is Thrombolysis For DVT Recommended?

Deep vein thrombosis (DVT) is a blood clot that forms within one or more of the deep veins of your body, usually in your lower legs. Leg pain and swelling are common symptoms when you suffer from DVT; if left untreated, the clot can break down and travel to other internal organs through the bloodstream (emboli). The most serious complication of DVT is pulmonary (lungs) embolism (dislodged clot) that blocks the normal blood flow to the lungs.

The clinical severity of DVT can be determined through a 3-risk scoring scale (Wells score) to check your probability of developing DVT, which includes:

• Scale 0- Low risk of DVT
• Scale 1 to 2- Moderate risk of DVT
• Scale 3- High risk of DVT

Thrombolysis is recommended as an effective treatment method for deep vein thrombosis. Thrombolysis for DVT indications includes:

• Failure of anticoagulants (blood thinners) to treat DVT
• Preventing life/limb/organ-threatening complications of DVT
• DVT present in the upper half of your body

Indications for Catheter-directed thrombolysis include:

• Treating acute iliofemoral DVT, which is a blood clot involving the iliac vein (blood vessel of the pelvis), and/or femoral vein (a large blood vessel in your thigh). 
• Acute onset of thrombus (blood clot) less than 21 days. 
• Younger individuals with long life expectancy. 

How to Prepare For Thrombolysis For DVT?

During the first visit, your healthcare provider will discuss your symptoms with you, as to when and how often they occur. Your medical history will be recorded to determine the following:

• Presence of other medical conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), asthma, blood disorders, or other diseases related to the heart, lungs, kidneys, or thyroid glands. This could possibly increase your risk of complications during or after the procedure.
• History of previous surgeries, injuries, and allergies to anesthesia or other medications.
• Medications being taken include blood thinners, anti-inflammatory drugs, antidepressants, and other herbal supplements.

Next, your doctor will perform a physical examination to check for any swelling, tenderness, skin discoloration, or prominent bulges that indicate blood clots. 

Furthermore, your doctor will order certain medical tests to diagnose deep vein thrombosis, which include:

• Complete blood count- This test helps to check your blood components (red blood cells, white blood cells, etc.) and bleeding and clotting time.
• D-dimer blood test- This test involves taking your blood sample to check for D-dimer (a type of protein) levels, that is usually increased if you suffer from DVT.
• Duplex venous ultrasound- This test uses ultrasound waves to show blood clots in your veins and to check the blood flow.
• Venography- This test injects a contrast dye into your leg veins to check the blood flow through various X-ray images captured.
• MRI (Magnetic Resonance Imaging) scan- This scan uses a magnetic field to identify any abnormalities in your blood vessels. 

Once your doctor confirms the presence of DVT, he/she may recommend the following DVT thrombolysis guidelines to prepare you for the thrombolysis procedure:

• You will be advised to stop certain medications such as blood thinners at least 2 weeks before the thrombolytic therapy.
• You must avoid smoking and alcohol consumption 2 weeks before the procedure.
• Your doctor will advise you to fast for 8 to 12 hours before the DVT lysis.
• You will usually need to undergo angiography, a test used to get a clear picture of your blood vessels. It uses a contrast dye injected into your veins to check the blood flow and the presence of any blockage present within them.
• You must sign a consent form before the thrombus (a blood clot) thrombolysis, which is legal permission given to your surgeon to perform the procedure.
• You must arrange for someone to stay with you in the hospital and help you drive back home once you are discharged.

How is Thrombolysis For DVT Performed?

Thrombolysis for DVT is an inpatient procedure (requires 2 to 3 days of hospitalization), that is usually performed by a vascular surgeon (a specialist who diagnoses and treats problems associated with blood vessels).

• On the day of the procedure, your nurse in charge will check your vitals (blood pressure, heart rate, pulse, oxygen levels, and blood sugar levels), and disinfect the area where the thrombolytic drugs for DVT are introduced.
• Your anesthesiologist (a doctor who specializes in anesthesia care and pain management) will administer either local (only numbs the area where a procedure is conducted) or general anesthesia (a numbing agent that puts you to sleep).
• Your vascular surgeon will make a small incision/cut/puncture in your wrist, elbow, or groin vein. This area is known as the access site.
• Your surgeon will then introduce a small IV line for systemic thrombolysis through the access site or a long catheter for catheter-directed thrombolysis.
• Angiography will be performed to map the blood vessels, which help locate the blood clot. A contrast dye will be injected through the access site, which helps locate the blood clot through X-ray images. The dye does not pass through the vein where a blood clot is present.
• The procedure is performed in two ways:

IV thrombolysis for DVT

• In this procedure, your surgeon will inject the clot-dissolving medications through the IV line (a thin needle inserted at the access site).
• The medication will travel through the bloodstream to reach the clot and dissolve it.
• This procedure usually takes 60 to 90 minutes. 

Catheter-directed thrombolysis for DVT

• In this procedure, your surgeon will use a long catheter and guide it through the vein to reach the location of the blood clot.
• Once the catheter reaches the clot, the thrombolytic medications will be injected through it.
• Sometimes, your surgeon may also use mechanical devices to dissolve the clot (mechanical thrombolysis). A machine will be attached to the catheter at the clot site that will spray a saline solution to break the clot and a suction tool that suctions the broken fragments of the clot.
• If your surgeon notices any narrowing of the affected vein (stenosis), a procedure called “angioplasty” can be performed, where a special balloon is introduced to widen or expand the blocked or narrowed vein. This helps to prevent any risk of clot formation in the future.
• The procedure may take 24 hours to 72 hours to dissolve the clot, depending on the size, location, and severity of the deep vein thrombosis.

What to Expect After Thrombolysis For DVT?

You will spend the day of your procedure in the ICU (intensive care unit), where your vitals will be closely monitored. Once stabilized, you will be shifted to your room for further recovery. 

• You are expected to feel mild pain, bruising, and discomfort at the access site, which will resolve gradually.
• You may feel dizzy and weak due to the effect of anesthesia.
• Your surgeon will prescribe you painkillers and antibiotics to manage pain and prevent infection, respectively.
• You will receive fluids until your surgeon allows you to resume your normal diet. This may be possible on the 2nd-day post-DVT lysis procedure.
• Your surgeon will periodically monitor X-ray images to see if the clot has dissolved. 
• Once the clot dissolves to a satisfactory range, your surgeon will remove the IV or catheter.
• You will be discharged from the hospital once your vitals are stabilized.
• You will be prescribed anticoagulants for a period of 3 months to dissolve the clot completely and prevent the formation of any clots in the future.

What Are The Benefits And Risks of Thrombolysis For DVT?

Thrombolysis for DVT effectively dissolves the blood clots formed in your thighs, pelvis, or lower legs. The key benefits of the procedure are listed below.

Benefits 

• Dissolves the blood clots to prevent disability, loss of limb, or even death.
• Reduces the clot burden and protects you from valvular damage (the damage caused to the heart valves).
• Relieves you from symptoms associated with DVT (pain and swelling), thus improving your quality of life.

Risks

The main risks of thrombolytic therapy include

• Allergic reactions that cause skin rashes, hives, itching, dizziness, confusion and breathing difficulties.
• Bleeding in your nose, stool, or urine.
• Abnormal bleeding at the site of IV or catheter insertion. 
• Internal bleeding, especially in your brain, can eventually cause a stroke.
• Dislodgement of the blood clot to another part of the body. 
• Angioedema, which means the presence of swollen tissues. 
• Low blood pressure, which is also called hypotension.
• Ventricular arrhythmias are abnormal heart rhythms leading to the twitching of the lower chambers of your heart. 

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