DVT Thrombolysis

DVT thrombolysis is a minimally invasive procedure to dissolve and remove a clot in the deep veins in the thigh and pelvis (iliofemoral DVT). The surgeon makes a 2-millimeter incision in the popliteal vein behind the knee. A catheter is then introduced into the incision and threaded up to the clot, which can be removed using a variety of techniques:

  • The Trellis Device
    This device has balloons at its tip and in its mid-shaft. Between the balloons, the catheter is perforated with tiny holes. Once the Trellis is threaded up to the clot and properly positioned, the balloons are inflated on each end of the clot, blocking off the segment of clotted vein. A clot-dissolving medication called tPA is released into the clotted area through the side holes of the catheter and then an oscillating wire is inserted through the catheter to disperse the tPA throughout the clot. Once the clot is fully dissolved, it is aspirated out through the vein.
  • The Angiojet
    This device uses a jet spray and suction catheter to break up and remove the clot. The procedure is done under light sedation or a general anesthetic. Afterwards, patients continue on blood thinners while the vein is healing.

The standard of care for DVT remains anticoagulation with blood thinners. The main reasons to consider DVT thrombolysis are to decrease leg pain and swelling and to preserve valve function in the deep veins. We also believe that a successful early thrombolysis is associated with lower risk of developing post phlebitic syndrome (chronic leg swelling and skin changes).

Thrombolysis is not recommended for patients with advanced age, bleeding problems, recent surgery, or head trauma. It is not effective on clots that have been in place for more than six weeks.