Diseases &… Heart & Vascular Diagnostic /…

Effective therapy for deep vein thrombosis

Department for Cardiology, Angiology and Pneumonology

Vein thromboses frequently have long-term consequences. Many patients suffer massive pain and swellings or post-thrombotic syndrome (PTS) for years. In the last few years, catheter intervention offered by specially trained experts at Heidelberg University Hospital has provided some relief.

Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) is an acute disease that represents a frequent medical condition.  Treatment comprises blood thinners (anti-coagulation) and compression therapy. With the aid of this treatment, complications, such as lung embolisms or the renewed occurrence of thrombosis, can be prevented very effectively. However, this treatment is not effective for preventing post-thrombotic syndrome (PTS), which occurs in about 50% of the patients with DVT within two years and which is a major problem for those afflicted.

Treatment of post-thrombotic syndrome (PTS)

PTS comprises complaints that occur due to damage to the walls of the veins and venous valves by blood clots. This includes weakness in and heaviness of the affected leg, but also swollen legs and skin changes. Some 6-7% of the afflicted patients suffer from severe PTS including open wounds that are also known as leg ulcers. This can significantly restrict mobility and was unable to be treated adequately until recently.
In past few years however, new catheter techniques and materials have been developed to invasively treat and take care of the underlying problem of PTS, namely stenosis or occlusion of a vein.

Heidelberg University Hospital is currently the only center in southern Germany that can perform these interventions.

The interventions are performed with great success by specially trained specialists in the Department for Cardiology, Angiology and Pneumonology at Heidelberg University Hospital. Only very low risks and few side effects are associated with this very safe procedure.
Patients receive local anesthesia, mostly in the area of the hollow of the knee. Then the vein punctured and a so-called port is inserted. After a review of the invasive visualization of the stenosis/occlusion, special fine wires pass through this region. They are used as a guide so that a balloon can be pushed into the area to be treated. After the expansion of the vein with the help of the balloon catheter, a stent is implanted in order to keep this area open for as long as possible. The duration of the intervention depends on the degree of the vascular areas changed by thrombosis.

Effective therapy for deep vein thrombosis


Image 1 of 3

Invasive visualization of the pelvic vein: Normal blood circulation in the pelvic area (black arrow). Only minimal blood flow in the upper part (white arrow). The cause is an extensive, subtotal stenosis in the area of the pelvic vein (Vena iliaca com).

Image 2 of 3

Dilatation of the subtotal occlusion: Careful passage of a wire through the subtotal occlusion into the inferior vena cava. A special high-pressure balloon for venous interventions is inserted via the wire until the thread-like narrowing of the vein. The subtotal occlusion is eliminated by expanding the balloon.

Image 3 of 3

Stent implantation: After the dilatation of the sub-total occlusion, a stent is implanted with the objective of keeping the vein open for a long time. Only stents that have been made especially for veins are used.

Invasive intervention is also effective for patients who have had PTS for many years.

With this treatment, we at Heidelberg University Hospital are able to effectively and lastingly improve PTS and hence the patients’ complaints.  Symptoms improve within days after the intervention; in most cases, the patient can be discharges from the hospital after about 2-3 days.  As a rule, no further follow-up treatment is required.