When veins become blocked, usually after a previous thrombosis, this can lead to troublesome symptoms in some, but not all, cases. The larger veins in the pelvis, the iliac veins, are prone to this problem. In order to try and avoid these veins being blocked or damaged by thrombosis there is a growing interest in dissolving and removing the clot when a thrombosis occurs. So large DVT's involving the iliac veins are sometimes suitable for this treatment approach. Selection of cases is important, the DVT needs to be recent, the risk of complications from clot dissolving drugs needs to be low, and the patient needs to be in relatively good general helath. If these factors are not present, these DVT's can still be treated with anticoagulation, (thinning the blood) and with time the leg will improve.
To remove the clot, a catheter is placed in the vein to administer the clot dissolving drug directly into the thrombus. This is called lysis. A number of small catheter devices can also be used inside the vein to agitate and break up the clot, aspirating (sucking) away the free clot. A combination of this and lysis can clear veins relatively quickly (hours). Anticoagulation will usually then be used to stop the clot occurring again. The duration of this anticoagulation varies depending on the cause of the DVT, if it is a recurrent DVT and the extent and position of the DVT.
Sometimes a narrowing or stenosis of the iliac vein is found after clot removal. This may have been a contributary factor to the clot, and it may need treating. Venous stents can now be placed to open up narrowed veins. These are larger than some arterial stents, very strong but flexible.
Venous stents showing ability to flex without kinking.
Stenting Blocked Veins
In some cases veins have been blocked for a long time. Any clot in the veins has been changed over time into scar tissue in the vein. Lysis will not clear long term, chronic, blockages. A relatively new treatment in this situation is to use balloons and stents to dilate up the blocked veins. This requires careful planning, and is only suitable for certain cases. Specialists in this field can however open up veins that have been blocked for some time, and help patients with swollen painful legs or ulcers due to venous disease.