Vascular Diseases Treatments
Treatments for Deep Vein Thrombosis
The traditional treatments for DVT are:
- bed rest
- elevation of the affected limb
- pressure stockings, and
- drugs to prevent blood from clotting. These drugs, called anticoagulants, keep the clot from growing larger and may prevent clots from breaking off to travel to the lungs – called pulmonary embolism. But they cannot dissolve clots that already have formed. These must be dissolved over time by the body's own system for breaking down clots, or by a new technique called:
Catheter-Directed Thrombolysis
This procedure dissolves blood clots in the veins without surgery. “Clot busting” drugs
(thrombolytic agents) are injected directly into the site of the clot (the deep vein thrombus).
Catheter-directed thrombolysis usually is performed in a hospital radiology suite by an interventional radiologist. The physician inserts the catheter into a vein in the leg and threads it to the site of the clot. With his special training as a radiologist, the doctor is able to expertly guide and watch the progress of the procedure on an X-ray video monitor. When the catheter tip is in the clot, the clot-dissolving drug is sent (infused) through the catheter tube. In most cases, it takes a few days for the clot to completely dissolve. The interventional radiologist can “see” and monitor the treatment using special X-rays, called
venograms, and ultrasound scans. With X-ray and ultrasound pictures, the physician also can see if – after the clot dissolves – the vein wall is narrowed or damaged, which can lead to more clots in the future.
Balloon Angioplasty and Stenting. If a vein has been narrowed or damaged, it may be necessary for the interventional radiologist or other physician to perform balloon angioplasty, a procedure in which a catheter is placed in the vein under X-ray guidance to the site of the narrowing, and a balloon is inflated to press open the narrowed blood vessel. In many cases, a small mesh cylinder called a stent may be inserted through the catheter and left behind
in the vein to keep it open.
Balloon Angioplasty: A catheter is directed into the blood vessel and a balloon is inflated to press open the narrowed wall. |
Treatments For Varicose Veins
Behavioral changes can help prevent the formation of varicose veins.
- Cross the legs at the ankles instead of the knees when sitting
- Avoid high heels, which limit the use of the calf muscles.
- Avoid restrictive clothing which limit blood flow in the groin or calf.
- Avoid prolonged sitting or standing.
- Take breaks to elevate the legs or walk around to help move the blood along and prevent valve failure.
Existing varicose veins won’t get better without treatment
Treatment may consist of:
- Rest.
- Elevation of the leg.
- External support such as elastic wraps or support hose. Elastic stockings are preferred over elastic bandages.
- Laser treatment. A new laser treatment is being provided by interventional radiologists as an alternative to surgical treatments. The EndoVenous Laser Treatment uses a laser fiber to heat and seal the main vein that is causing the varicosity.
- RF Energy. Radiofrequency (RF) energy is another new technique provided by interventional radiologists as an alternative to surgery. RF energy heats the problem vein from the inside, shrinking it. Nearby veins take over.
- Sclerotherapy. In this treatment, a thin tube called a catheter is directed to the vein and a substance is injected that causes the veins to scar and close – rerouting the blood to healthier veins. The affected vein forms a knot of scar tissue that is absorbed by the body over time.
- Phlebectomy. In this procedure, varicose veins are removed through a series of small holes in the skin under local anesthesia.
- Vein stripping involves removal of a long vein through small incisions in the skin.
- Endoscopic repair. This procedure is performed in advanced cases of vascular disease involving sores or ulcers on the legs. Surgeons insert an endoscopic camera into the varicose vein via small incisions to visualize and treat the defects.
Treatments for Phlebitis
Thrombophlebitis in the superficial veins is generally treated at home with periods of rest with the leg elevated, pain relievers such as aspirin and, if needed, antibiotics. Warm compresses may ease the inflammation and elastic stockings may be prescribed.
Deep vein thrombophlebitis is treated with anticoagulants (drugs that prevent the blood from clotting) or with
thrombolysis, a procedure in which clot busting drugs are infused to the site of a blood clot. This procedure usually is performed by an interventional radiologist.
Treatments for Venous Stasis Disease
Over time, untreated DVT or other conditions may damage a valve in the vein so that it does not close completely. When this occurs, blood flows back into the vein below the valve and collects in the lower leg veins. Pooling of blood in these lower leg veins may cause swelling and tissue damage and lead to painful sores or ulcers. This condition is known as venous stasis disease.
Fortunately, prompt treatment of DVT or other vein disease can prevent complications such as pulmonary embolism and venous stasis disease.
Treatments for Pulmonary Embolism
Pulmonary Embolism is a common event, especially in hospitalized patients. It is estimated that more than 600,000 new cases of pulmonary embolism occur in the United States each year and 200,000 people die of the disorder. Treatment options include:
- Anticoagulation. Blood thinners are prescribed to prevent the clot from growing or new clots from forming while the body dissolves the existing clot on its own.
- Vena cava filters are devices that are placed in some patients when there is a possibility of recurrent blood clots, or emboli, or in patients with chronic pulmonary disease to prevent further damage to the blood vessels of the lungs. Vena cava filters usually are placed by physician specialists called interventional radiologists who perform procedures without surgery by guiding catheters and other small instruments through the blood vessels under X-ray guidance.
- Thrombolytic therapy, is another interventional radiology technique in which clot busting drugs are fed (infused) through a catheter directly to the site of the blood clot in the lung.
- Percutaneous thrombectomy. In this procedure, a catheter is sent to the site of the clot under X-ray guidance and a device is used to break up the clot into small pieces that are easily absorbed by the body.
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