New
Procedure Helps Remove Deep Vein Blood Clots
A new non-surgical treatment for the removal of blood clots
appears to be safer, faster, and more effective than traditional therapies,
according to a report from the Society of Interventional
Radiology meeting.
Removing blood clots reduces the risk for pulmonary embolism
and disability among patients with deep vein thrombosis (DVT).
DVT involves a blood clot in a vein, usually in the lower
leg or thigh. In some cases, the clot can break off and move up into the blood
vessels of the lungs, triggering a potentially fatal condition called pulmonary
embolism.
DVTs
gained media prominence as so-called "economy class
syndrome" after a number of passengers on long-haul flights developed the dangerous
condition.
But the
new clot-removal method, called the "rapid lysis" technique,
could offer fresh hope to patients.
"There's a tremendous benefit to patients as a result of
this technique," says study lead author Dr. Mark J. Garcia, an interventional
radiologist in the department of radiology at Christiana Care Health System.
DVT clots develop in situations where circulation slows
down, causing blood to pool. Although it can strike at any age, the risk is
highest among men and women over the age of 60.
Patients being treated for cancer and those experiencing
surgery, injury, or prolonged immobility are also at an elevated risk, as are
women in the early stages of pregnancy and patients who have varicose veins
or who are overweight.
Standard treatment typically involves injectable or pill-form
blood thinners, also known as anticoagulants, which can prevent the formation
of new clots and halt the growth of clots already formed.
Such treatment does not, however, help to dissolve an existing
clot. While most clots eventually dissolve on their own, large clots provoking
severe symptoms may not. In such instances, clots can be dissolved by means
of a thrombolytic medication delivered by catheter.
This approach is not without its drawbacks, however.
According to the researchers, the clot-busting procedure
can take as much as two to four days to work, significantly raising the risk
for sudden bleeding. Physicians usually use the medication to address blood
clots as a last resort.
But without quick and complete clot removal, permanent vein
damage can occur over time, resulting in permanent disability.
This condition - known as post-thrombotic syndrome (PST)
- is characterized by chronic leg pain and swelling, along with skin thickening
and severe ulceration. In extreme cases, gangrene and amputation can ensue.
In fact, half of the patients treated with blood thinners
alone for a leg DVT eventually go on to develop PST, the researchers say.
Dr. Garcia
and his team tested the potential of the new "rapid
lysis" technique to safely and quickly dissolve clots.
They focused on 102 men and women, averaging 47 years of
age, who were all seeking care for extensive, large-volume DVTs. In most of
these cases, the DVT ran the entire length of the leg - from ankle to pelvis,
or even beyond.
Radiologists first used imaging equipment to direct a catheter
through the affected leg to the point of the clot. Using a high-powered spray
device, a diluted, clot-dissolving medication was then delivered into and throughout
the clot, effectively breaking it up.
The remnants of the clot were then sucked up by a saline
jet that essentially vacuumed the clot into the catheter, removing it from
the bloodstream as the catheter was pulled down and out of the affected leg.
After a year tracking patient progress, Dr. Garcia and his
colleagues found that the rapid lysis treatment achieved full clot removal
and blood flow restoration in over half of patients.
In terms of PST, surveys up to one year after treatment
revealed that just under 70 percent of the patients said they had no leg pain
or swelling, and nearly 80 percent said they experienced no heat or burning
discomfort in the affected limb.
Dr. Garcia concludes that the new technique is useful in
treating the largest and most difficult clots safely and quickly, representing
a significant advancement in DVT therapy.
Dr. Samuel
Goldhaber, a professor of medicine at Harvard University School of Medicine,
says that
in his opinion, "This treatment would
address only a small niche of patients.
"It could help those who need more than an anticoagulant
but who have had recent surgery or have a preexisting bleeding risk of some
kind, and so are not eligible for traditional clot-busting therapy," he says.
"This type of catheter - one that basically sucks up the
clot - is one of several more aggressive options for treating DVT now under
development," adds Dr. Goldhaber. "The example they looked at seems promising,
and hopefully this will lead to larger trials that will test these catheters
more thoroughly.
Always consult your physician for more information.
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