Deep Vein Thrombosis Q&A with Dr. Nielsen
Deep vein thrombosis, commonly described as DVT, occurs when a blood clot occurs in a deep vein. This can impede the blood flow in the extremity causing pain, swelling, and redness. It is important to seek care if you suspect you have DVT as it can lead to a serious condition called pulmonary embolism.
Dr. Ryan B. Nielsen sat down to discuss DVT and how it may be treated:
Introduction
Dr. Nielsen: I am Dr. Ryan Nielsen. I am an Interventional Radiologist. I have been with Utah Radiology Associates for over 20 years, and I’ve been with IVC since its inception.
Dr. Ryan B. Nielsen is fellowship-trained and board certified in interventional radiology. His expertise includes treatment of disorders of arterial and venous circulation, acute stroke intervention, and therapeutic embolization.
What Is DVT?
Dr. Nielsen DVT is a blood clot. The word DVT, the acronym, means deep vein thrombosis. So specifically, it’s a blood clot that occurs in a deep vein. Which typically are the veins in your legs.
What causes DVT?
Dr. Nielsen: DVT is caused by what’s called Virchow’s Triad. It was described by a scientist/physician named Virchow and the components that cause DVT are venous stasis, which means the blood is stagnant, an injury to the vessel, and the third component is hypercoagulability. Or propensity for the blood to form clots which can be genetic or can be based on different factors.
Who does DVT typically affect?
Dr. Nielsen: DVT can affect anyone, particularly those who have the factors described in Virchow’s Triad. So, anyone who has venous stasis, anyone who has sustained some kind of vascular injury, or somebody who has hypercoagulability or a propensity to form blood clots. Those can be temporary, or they can be permanent. So, there are factor that increase your likelihood of clots. Such as, having venous stasis, pregnancy, people on oral contraceptive pills, someone who has recently had surgery, or has recently had trauma among other things.
Risk factors of DVT: Virchow’s Triad
- Stasis or change of blood flow
- Vascular injury
- Hypercoagulability
Is DVT life threatening?
Dr. Nielsen: DVT in and of itself is not life threatening, it just causes leg swelling and pain. However, the condition of DVT can be life threatening because sometimes that clot, if it is unstable can break off from the leg and go up the vena cava, through the heart, and into the lungs. Which is called a pulmonary embolism. A pulmonary embolism reduces your ability to pump blood to the lungs and get oxygenated blood and that can be fatal.
What is the difference between acute and chronic DVT?
Dr. Nielsen: DVT can be acute or chronic. Acute means it happened recently. And that’s typically within days to up to three weeks. After about three weeks, the body starts to try to dissolve the clot and the clot starts to become fibrinous or firm and eventually becomes almost like scar tissue adherent to the wall of the vein, and that is chronic DVT.
How is DVT diagnosed?
Dr. Nielsen: DVT is generally diagnosed initially clinically. People will have leg pain and leg swelling are the most common symptoms. And with imaging it’s typically diagnosed with ultrasound.
How is DVT treated?
Dr. Nielsen: DVT is treated in a couple of different ways. In the acute setting, it can be treated with both medications, the standard treatment has been just an oral pill that you take, either coumadin or warfarin or other pills that thin the blood and help to dissolve the clot. More recently in the last several years, acute DVT has been treated by directly infusing medications that dissolve the clot or using mechanical devices that can suck out or pull out the clot. Chronic DVT is a different thing. That’s adherent to the vein wall so you really can’t get it out. But it can cause obstruction to venous flow and cause increased pressure in the veins. So, that can be treated by balloon angioplasty or stent placement.
How successful are DVT treatments?
Dr. Nielsen: DVT treatments are very successful in the acute phase. If you catch it early, ideally within three weeks or less, almost always the medications or pharmacological and mechanical thrombectomy, the treatments, can remove that acute DVT. With the chronic DVT, it’s much more difficult to treat because it is like scar tissue. So, we are not really treating the clot itself, we are treating the problems it causes. Like narrowing in the vein, which needs to be opened with a stent or balloon angioplasty.
How long before the patient feels relief?
Dr. Nielsen: If we are treating an acute DVT with pharmacological and mechanical thrombectomy, which means we are going in and removing the clot. Most often the patient will feel relief very quickly. Because we have removed the clot that’s causing the pressure and the swelling in the vein and the leg. If you treat it with typical oral medications, it can take several days to weeks before it starts to feel better because it takes that long for the body and medication to dissolve the clot. So typically, we are trying to get acute DVT and treat it immediately with those mechanical devices and blood thinning drugs so we can give somebody fairly immediate relief.
