Q: I’ve had pain and swelling for years. Is it too late to do anything about it?
A: If there is an obstruction in your veins, there are special endovascular techniques to open it up. By wiggling a wire through the obstruction and then opening it with a combination of balloons and stents, flow can be restored. We have successfully performed this procedure on a number of patients.
Q: Are the deep vein procedures always successful?
A: It depends on the extent of the obstruction and the severity of your symptoms . In short, yes, it does work, and opening up obstructions can heal ulcers and reduce swelling and pain. Even if there is a component of deep venous reflux (blood going the wrong way), opening up the obstruction can make a significant difference.
Q: What if I have a combination of superficial and deep venous disease?
A: Our specialists in the Thrombosis and Deep Venous Care program can address both problems. In one session we can correct the deep component and in another the superficial one.
Q: Can this therapy be used for arm clots?
A: It can, although there are several other considerations for the upper extremities. Arm clots are frequently caused by catheters that are placed in the hospital. Spontaneous arm clots may be caused by an obstruction to venous flow near the clavicle (collar bone). We have successfully treated many cases of upper arm clots using catheters and wires as described above, and are happy to discuss the options with you.
Q: If the procedure works, how do I maintain the result?
A: You may be placed on a short course of a combination of blood thinners to make sure the veins and stents stay open. Beyond that, staying active, wearing compression stockings, and keeping your weight under control will give you the best chance of having a lasting result. In the rare event that your leg flares up again, there remains the possibility of opening up any new blockages.
Q: I had a pulmonary embolism a while ago, but I haven’t gotten back to my normal self. What’s going on?
A: This is an active area of research. More focus is being placed on the long-term outcomes from pulmonary embolism, and it is recognized that quite a few people share your story. If you feel that you are not getting back to your normal self at the rate that you want to, we are happy to see you in our practice and begin the process of figuring out how to get you better. This might include an echocardiogram to evaluate your heart function, a radionuclide scan to see if you have residual clots, and/or referral to one of my specialty colleagues.
Q: An IVC (Inferior Vena Cava) filter was placed in me. Why?
A: There are several indications for placement of IVC filters. In some cases, patients cannot safely be on blood thinners (the standard treatment for DVTs). Other patients have worsening clots or pulmonary emboli in spite of the blood thinners, and therefore need the added protection afforded by the filter. A filter may have been placed in you because you were about to have a major surgery, which is a risk factor for developing clots.
Q: Are IVC filters dangerous?
A: The majority of people with IVC filters have no complications from the filter being in place. That being said, there are some known complications that the FDA (Food and Drug Administration) has issued warnings about. These include penetration through the inferior vena cava (main vein leading from the legs to the heart) and narrowing that can result in more DVTs and lower extremity swelling. Sometimes the penetrating legs can irritate adjacent structures and cause symptoms.
Q: Can my IVC filter be removed?
A: Most people nowadays have “retrievable” filters placed, meaning they can be removed at a later date. The ideal retrieval time is between 1 and 3 months after insertion. If you no longer need the filter, and you’re in this time frame, it is probably a good idea to have the filter removed.
Q: My filter has been in longer than 3 months. Can it still be removed?
A: Yes. However, it can be harder to remove filters that have been in for a while, requiring more advanced techniques. Much depends on whether the filter is causing symptoms and whether removal is truly appropriate. We are happy to see you in consult and discuss this possibility further.