Deep Vein Thrombosis

Deep vein thrombosis (DVT) develops when a blood clot forms in a vein deep inside the body, usually in your legs. Without treatment, DVT can become serious if the clot breaks off and travels to a critical area such as the brain, heart or lungs. A blood clot in the lungs results in a life-threatening condition called pulmonary embolism (PE).

Blood clots can result from anything that slows blood flow in deep veins or prevents blood from clotting the way it should.

Risk factors that can slow blood flow:

• Damage to a vein, such as from a catheter (thin tube used in many procedures)
• Excess weight or obesity
• Long periods of inactivity, such as long car or plane trips or long-term bed rest
• Pregnancy or childbirth within the past six weeks
• Recent surgery or injuries such as fractures in the legs or pelvis
• Smoking

Risk factors that interfere with blood clotting:

• An inherited blood-clotting disorder
• Certain types of cancer or cancer treatments
• Family history of blood clots, DVT or PE
• Hormone therapy, such as contraceptives or postmenopausal hormone replacement therapy
• Other health conditions such as heart failure, sickle cell disease, or autoimmune disorders such as lupus

Sometimes, DVT shows no symptoms until a serious complication happens. When symptoms do appear, they usually affect one leg. The signs and symptoms typically affect the area where the clot forms and can include:

• Redness or feeling of warmth
• Leg pain that may start in your calf and feel like a cramp
• Leg swelling (edema)

If you have DVT symptoms, you’ll typically see one of our specialists in vascular disease for a comprehensive evaluation. Your first visit usually includes:

• Questions about your symptoms, medical history and possible risk factors
• Review of your family health history
• Physical exam to look for signs such as redness or swelling

Tests and imaging for DVT

You’ll likely need one or more tests so that we can rule out other conditions and confirm a diagnosis. In our nationally accredited vascular testing labs, our certified imaging technologists provide excellent results using the latest equipment. Tests that you may need include:

• Blood tests: We measure levels of D-dimer, a substance associated with blood clots, or check for an inherited blood clotting disorder.
• Computed tomography venography (CTV): This type of venography uses CT scans, specialized X-rays taken from various angles to produce cross-sectional images of affected veins. CT venography provides greater detail about blockages and blood flow in veins.
• Doppler waveform analysis: We use specialized ultrasound (sounds waves) to measure your ankle-brachial index, a ratio of the blood pressure in your ankle to that in your arm. This analysis helps confirm a diagnosis of blocked blood vessels and determine the severity.
• Duplex ultrasound: Combining traditional and Doppler ultrasound, this imaging study checks for pooled blood or clots in leg veins. We also use duplex ultrasound in the abdomen to check the inferior vena cava (IVC) — the large vein from the lower body — and pelvic veins for blockages or clots.
• Intravascular ultrasound: Using a minimally invasive procedure, we insert a catheter (thin tube) through a small skin puncture into the affected vein. The catheter is tipped with a miniature ultrasound probe to provide images of blockages anywhere along the vein.
• Magnetic resonance imaging (MRI): A large magnet and radio waves produce cross-sectional images inside the body to look for clots in the veins.
• Venography: We take X-rays after injecting a dye that outlines the veins so they show up better on the scans. Although we rarely use this scan, it can provide another look at blood flow when needed.

Your treatment options vary and depend on the severity of the blood clots. Specialists at Henry Ford have expertise in the full range of treatments, from medications to minimally invasive procedures. We work closely with you to find the right treatments, based on your specific health needs.

DVT treatment aims to:

• Prevent existing clots from expanding
• Prevent clots from breaking loose and causing a stroke or PE
• Reduce the risk of new clots forming

Medication and monitoring for deep vein thrombosis

For small clots, our vascular medicine specialists usually begin with noninvasive treatment such as medications and monitoring. You may need one or a combination of these treatments:

• Anticoagulants (blood thinners): Heparin is usually the first blood thinner given for DVT, and you receive it through a vein by injection or an intravenous (IV) catheter, a thin, flexible tube. Warfarin (Coumadin®) and Xa inhibitors are oral pills that you may receive after or instead of heparin. Blood thinners help stop existing clots from growing and new ones from developing.
• Observation with imaging: We may monitor you at regular intervals with imaging, such as duplex ultrasound, for single clots or those lower in your legs.

Minimally invasive DVT treatment

For larger clots or those close to the lungs, our vascular team coordinates your care with Henry Ford interventional radiologists. These specialists are experts in minimally invasive procedures to remove clots or widen narrowed or blocked veins.

Vascular surgeons and interventional radiologists use endovascular treatments, which go inside veins and only require a small incision. Most people can go home the same day or the next. A minimally invasive procedure can help you heal faster, with less pain and an easier recovery.

Your minimally invasive treatment options include:

• Catheter-directed thrombolysis: Your doctor inserts a catheter into the vein and guides it to the clot. Through the catheter, the doctor uses tools to either remove the clot or deliver clot-dissolving medication. Thrombolysis, an outpatient procedure, treats clots at high risk for PE.
• Interventional thrombectomy: We use advanced endovascular devices along with thrombolysis to treat clots. Your doctor guides the device to the clot and administers clot-dissolving medications. One device uses ultrasound, and the other a vibrating wire, to help break up the clot. The doctor uses the catheter to retrieve the medications and the remains of the clot.
• Inferior vena cava filter placement: A filter placed in the IVC can prevent clots from reaching the lungs. Your doctor inserts the filter through a catheter and guides it into the IVC. The filter attaches to the vein’s walls to catch any blood clots from the legs. An IVC filter is an option for people who can’t take blood thinners.
• Venous angioplasty and stenting: Your doctor can open severe blockages in deep veins using a catheter with a balloon tip. After guiding the catheter to the blockage, the doctor inflates the balloon to widen the vein. In some cases, we may place a stent (tiny, metal-mesh tube) in the vein to hold it open.
• Inferior vena cava filter removal: When you no longer need the IVC filter, your vascular surgeon or interventional radiologist can safely remove it with an endovascular approach or robotic-assisted technique. The robotic system provides additional flexibility to work in hard-to-reach areas.

Surgery to treat DVT

In rare cases, you may need open surgery for DVT. Your vascular surgeon takes a healthy vein from elsewhere in your body and attaches it above and below the blocked section.

Known as vein bypass surgery, this procedure sends blood around the blockage for improved blood flow. Learn more about our skilled vascular surgery team.

Even after treatment, DVT can cause circulation problems in your legs. If DVT damages veins, it can lead to post-thrombotic syndrome, also known as chronic venous insufficiency (CVI). People with this condition have reduced blood flow in affected veins.

Depending on what caused the DVT and your overall health, you will likely need to continue taking blood thinners for a certain period of time. Our vascular medicine specialists provide ongoing care to manage your health and prevent another DVT or a complication such as CVI.