Treatment

Treatment options

  • If DVT involves the femoral vein we give compression stocking and leg elevation till the body finds its way around the blockage.
  • In the first 3 weeks, we perform lysis to reduce the long term effects of venous hypertension.
  • There is little we can do to improve chronic venous thrombosis.
  • If venous obstruction involves the pelvic veins then thrombolysis and venous stenting is done and has been successful.
  • Clots one-month-old are not helped by thrombolysis but stenting may help. Stents could be applied to the IVC if needed.
  • Stents give good success in improving chronic blockage of the pelvic venous system. This reduces the pressure of the veins in the legs and improves the symptoms.

Pelvic / abdominal vein obstruction

  • This causes unexplained pain in the legs and swelling, pelvic pain or leg ulcers that are difficult to heal.
  • The leg pain worsens with exercise because of the increased flow of blood in the legs with exercise. This increased flow in the legs causes an increase in the pelvic veins which dilate to accommodate around the obstruction causing pelvic pain. This may be intermittent or constant.
  • Pain shortly after intercourse (dyspareunia) due to infection of the uterus, ovaries or endometrium.
  • The commonest cause of pelvic pain is compression of the iliac veins in the pelvis as it is squeezed between the iliac artery and the spine. Besides ovarian or uterine cyst or cancer may compress the vein.

Pelvic vein compressed between the iliac artery and the spine with a stent within

  • It can also recur in those with previous iliac vein DVT.
  • The pelvic vein may be totally occluded or may channelise leaving it narrow
  • Most IVC obstructions are due to scarring at the site of IVC filters. The IVC filters prevent large clots from moving to the lungs from the legs or pelvic veins.