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Interventional Radiologists Provide Treatment for DVT and Varicose Veins

A condition called DVT (deep vein thrombosis) occurs when a blood clot (a thrombus) forms in the deep leg vein or pelvis, often from prolonged sitting while flying or having a sedentary lifestyle. Alternatively, DVTs may be related to underlying inherited tendencies towards clotting.  DVTs like this are considered “acute” DVT. If a part of the clot breaks off and travels to the lung, it blocks blood flow and can cause a pulmonary embolism. Symptoms include new onset of pain and/or swelling in your legs. Quick diagnosis is critical.

Interventional radiologists at the Brigham and Women’s Hospital Vascular and Vein Care Center are treating vein issues in unique and effective ways. Dr. Richard Baum, Director of the Division of Angiography and Interventional Radiology, and his staff use imaging tools, such as x-rays and ultrasound, to perform procedures using catheters, wires, and stents in the same way as cardiologists and vascular surgeons. Most of their outpatient work focuses on chronic venous insufficiency and varicose vein treatment.

The doctors at the Vascular and Vein Care Center are involved throughout the entire course of care, from imaging to treatment and recovery.  “As we are trained to do ultrasounds, we perform the ultrasound assessment for varicose veins ourselves,” Dr. Susan Kiernan O’Horo, a physician at the Division of Angiography and Interventional Radiology, says. “This allows us to identify the problem and discuss potential solutions with the patient in the same visit.”

In the body’s venous system, arteries take blood away from the heart, and veins bring it back. There are two parallel systems in the legs, the superficial and the deep veins.

Deep System

DVT is a clot in the deep system. Veins in this system are responsible for returning  85-90 percent of the blood to the heart, so acute DVT should be addressed immediately.  Dr. O’Horo says, “When a clot in the deep system is identified, anticoagulation, medication to thin the blood, is prescribed to prevent an additional clot from forming.” That helps activate the body’s natural system of breaking up blood clots, and dissolves them over time.  Alternatively, injecting medication that actively dissolves blood clots can be helpful in some cases.

Chronic venous insufficiency results from having a prior acute DVT. Identifying the problem is key, as patients come in for treatment because of pain and swelling — symptoms of both varicose veins and chronic DVT. The physicians at Brigham and Women’s Hospital conduct a full history and physical exam and use ultrasound to determine what they think is causing the problem. “If it is determined they have chronic venous insufficiency due to a previous DVT, we can perform venography and possibly open up the old diseased vein with a stent,” Dr. O’Horo says. Many patients feel significantly better and can engage in activities they were unable to do before.

Superficial System

Varicose veins are part of the superficial system and lie closer to the surface of the skin. The superficial system acts as a backup and generally contributes about 10 percent of the blood return to the heart. “In our outpatient centers, we do EVLA [endovenous laser ablation], phlebectomy, and sclerotherapy to treat the superficial system,” Dr. O’Horo says. The EVLA success rate at Brigham and Women’s is greater than 95 percent, with less than a three percent complication rate. The procedure involves using numbing medication and placement of an IV in the vein to guide the laser by ultrasound. “Most straightforward cases take about an hour, and patients are able to resume normal activities right away.”

Reduce Your Risk

To reduce your risk of DVT while flying, wear graduated compression stockings, stay hydrated, contract your calf muscles, and get up and move around every hour or two. If you are obese, have had recent surgery, or take oral contraceptives or hormone replacement therapy, you may also be at risk for DVT.

If you think you might have a new blood clot, an acute DVT, you should contact your regular doctor right away or go to an emergency room to be evaluated. If you have concerns that you may have chronic or superficial venous insufficiency, contact the physicians at Brigham and Women’s Hospital for an evaluation.