What is Venous Disease?
Your arteries transport blood from your heart to the rest of your body. Your veins carry blood back to your heart. Valves in the veins prevent blood from flowing backward. When your veins are unable to transport blood back to the heart, it’s called venous insufficiency.
Vascular and interventional radiologists at MedStar Harbor Hospital use minimally invasive techniques with image guidance to diagnose and treat venous diseases, including deep vein thrombosis (DVT), varicose veins, pulmonary arterio-venous malformations (AVMs), and pulmonary thrombosis.
What are Varicose Veins?
Varicose veins occurs when the valves in the veins are missing or impaired, allowing blood to flow back through the veins instead of being transported back to the heart. Often, blood will pool in the veins in your legs.
Decreased blood flow from the leg veins to the heart may cause aching and fatigue. In severe instances, wounds may form on the lower parts of the leg called ulcers.
How are Varicose Veins Treated?
One treatment for venous insufficiency is vein ablation. This is a minimally invasive procedure in which a small catheter is placed in the vein using ultrasound guidance. Once the catheter is placed, a laser or radiorefrequency energy will be used inside the vein to seal is closed.
The goal of treatment is to restrict the flow of blood through the abnormal varicose vein. By sealing the varicose vein, blood flow will be routed to other healthy veins.
What is Deep Vein Thrombosis?
Deep vein thrombosis (DVT), or blood clots occur when blood flow in the veins is obstructed, causing blood to build up below the clot. DVT can be life threatening if the clot were to move from your legs to your lungs.
How is Deep Vein Thrombosis Treated?
DVT is treated by addressing the clot and preventing it from traveling to the lungs. In some patients, an IVC filter and/or stent is placed in a deep vein, which prevents the clot from spreading. For other patients, a method to break down and remove the clot is used.
Minimally invasive catheter directed thrombolysis (CDT) involves placing a catheter to mechanically break down the clot, as well as administering “clot-busting” drugs. CDT may be used to prevent long term consequences of a clot forming in the leg veins, including pulmonary embolism which can occur if a clot reaches the lungs. Depending on the location or amount of clot, patients may be at a higher risk for developing post-thrombotic syndrome. Post-thrombotic syndrome causes irreversible damage in the leg veins and their valves, resulting in abnormal pooling of blood in the leg. This can lead to pain and swelling, and in severe cases, leg wounds and ulcers. Post-thrombotic syndrome is an under-recognized effect of DVT treated with blood thinners.
Interventionalists are also able to close abnormal connections between arteries and veins which may occur in the lungs (arterio-venous malformations) that can be the source of poor oxygenation, infection of the brain, and even stroke.
What is an IVC Filter?
Blood clots in the veins of the legs and pelvis can travel to the lungs, and may cause a pulmonary embolism or blockage. IVC filters are placed in the large vein in the abdomen to help reduce the risk of pulmonary embolism. The filter is a small metal device traps clots before they can reach the heart and lungs, where they could cause severe complications such as pain, difficulty breathing, shortness of breath, or even death. IVC filters are an option for patients who do not respond to or are unable to take blood thinners.
If you have an IVC filter, you should maintain regular appointments with your doctor. IVC filters can be left in place as permanent filters, but many filters can be removed after being in place for several years. This should be assessed by your physician or interventional radiologist. Removing an IVC filter eliminates the risk of long term deterioration of the filter or recurrent DVT, however, it does not address the cause of DVT. Patients may need to continue or begin other treatment options for DVT.