Blood clots below and above the knee. How to treat deep venous thrombosis? 13

Treatment of below the knee deep venous thrombosis is a hotly debated clinical issue. Leading radiologist discusses current approach to treating deep venous thrombosis. Should blood clots below the knee be treated with anticoagulation? What about treatment of blood clots above the knee? How removable inferior vena cava filters changed therapy of DVT? This radiologist has a special interest in vascular imaging.

Below knee deep venous thrombosis treatment. Above knee deep venous thrombosis treatment. How Is Deep Vein Thrombosis Treated? Dr. Anton Titov, MD. Deep Venous Thrombosis Treatment is anticoagulation. Decision whether to treat below the knee DVT is very important decision to make. Video interview with leading expert in radiology, CT and MRI specialist. Crucial decision in treatment of lower extremity deep vein thrombosis is the need to treat blood clots below the knee. Currently such clots are treated by anticoagulation. Inferior Vena Cava Filter is also used to treat DVT in patients who cannot tolerate anticoagulants. Medical Second Opinion is important in all cases of deep venous thrombosis and pulmonary embolism. Medical medical Second Opinion ensures that diagnosis is correct and complete. Medical Second Opinion also helps to choose the best treatment strategy for clots in leg veins. Seek medical Second Opinion on venous thromboembolism and be confident that your treatment is the best. When should IVC Filter be used to treat DVT? Dr. Anton Titov, MD. Inferior Vena Cava Filters are used to treat recurrent thrombosis when anticoagulation is not possible. Vena Cava Filters for venous disease treatment can be removed when risk of DVT decreases or disappears. Not there are removable inferior vena cava filters. Below knee deep venous thrombosis treatment. Dr. Anton Titov, MD. How important for treatment decision is the notion that the blood clot from the leg vein might extend beyond the knee area? Dr. Anton Titov, MD. Does location of blood clot below the knee or extension of clot above the knee alter the treatment of DVT? Dr. Anton Titov, MD. Dr. Kent Yucel, MD (Vascular imaging specialist, Tufts Medical Center): That is a controversial area, and the pendulum has swung back and forth over the years. Opinion changed from aggressively treating clots below the knee to ignoring clots below the knee to repeat imaging for clots below the knee. Now, the consensus is to be more aggressive and go ahead and treat the clots below the knee. Everyone agrees because those veins are much smaller than the veins above the knee. The blood clots if they travel to the lungs are much lower risk (for massive pulmonary embolism) because there are much smaller. That is the reason that patients have thought maybe it is not worth being worried about (deep venous thrombosis below the knee). The problem with clots below the knee is that they can keep growing. They can spread above the knee to the big veins. And for that reason the developing consensus now is to be more aggressive and go ahead and treat those patients for deep vein thrombosis (DVT). Dr. Anton Titov, MD. And a major treatment remains anticoagulation or filters in the inferior vena cava? Dr. Anton Titov, MD. Dr. Kent Yucel, MD. Right. The best therapy for deep venous thrombosis is anticoagulation, if patients can receive it. But there are patients who cannot be anticoagulated for variety of risk factors. Generally risk of bleeding (is a contraindication to anticoagulation). And those DVT patients can have filters in their inferior vena cava. It is a big vein in their abdomen that goes to the heart and lungs. It used to be that vena cava filters were permanent devices. So it was a big decision, especially for young patient, to leave a permanent device in for a temporary disease. But now inferior vena cava filters can be removed. So there are removable vena cava filters now. So the decision is much easier now. Because once the problem is over, then vena cava filters can be removed. Below knee deep venous thrombosis treatment. Video interview with leading expert in radiology, CT and MRI specialist. Controversies of DVT therapy explained.