One of the main concerns of patients considering venous angioplasty treatment for MS is the risk of thrombosis, which is the formation of blood clots in the veins. This is partly due to the media’s portrayal of thrombosis as a major risk of CCSVI treatment. Actually, thrombosis of veins after the liberation treatment is very infrequent; less than 2% of patients experience vein clots. The goal of this post is to address these concerns by providing a description of thrombosis as well as viable treatment options.
Most of the actual knowledge of vein thrombosis comes from the deep venous thrombosis, or clot formation inside the deep leg veins, a condition frequently found in clinical practice. There are several factors that predispose every person to a deep venous thrombosis, including trauma, dehydration, blood disorders, etc.
Oftentimes, oral blood thinners are prescribed for vein clots. The intention of this treatment is prevent future clots. However, blood thinners are very rarely able to dissolve the existing clots completely, leading to a post-thrombotic syndrome characterized by several conditions related to the chronic blockage of the vein.
In such instances, the only way to restore normal circulation is through treatments that clear the vein such as dissolution, fragmentation and/or aspiration of the clot, sometimes with balloon angioplasty and stenting. These direct treatments are the most efficient way to avoid the uncomfortable and dangerous post-thrombotic syndrome. However, for best results, direct treatment of the venous clot must be done at the onset of symptoms. If the condition is allowed to persist, it could cause total occlusion of the vein, making a complete clearance very unlikely.
Below I show the images of three recent cases of venous thrombosis treated in our clinic.
The first case is from a young woman who was 29 weeks pregnant. The pregnancy was complicated with a severe thrombosis of the left iliac vein (in the hip), presenting a great danger to both her and her unborn child. As you can see from the left and center images below, this important vein was almost completely blocked (left), and the backbone of the fetus can be seen compressing the vein (center). The photograph on the right shows the vein cleared with restored flow after a complete mechanical aspiration of the clot (red arrows).
The second case is from a patient who developed acute thrombosis of the left jugular vein (pictured below, left) two days after receiving the liberation treatment at our clinic. The symptoms were neck pain and neurological worsening. After not responding to oral treatment, the clot was successfully cleared through balloon angioplasty 15 days after her initial treatment. See the balloon inflated in the middle and the cleared vein on the right.
The third case is from a patient after receiving the liberation treatment in the USA. He presented neurological worsening and came for treatment two weeks after the diagnosis of left jugular thrombosis with total occlusion (red arrows in figure A). The patient was treated with a combination of oral anti-coagulants (blood thinners) during this period without success.
The patient required a direct catheterization of the vein with serial dilations using increasing balloon diameters, starting with 1.5mm through a 10mm balloon (B to G) and final stent placement shown in figure H.
See the dramatic change from total occlusion to complete clearance and restored flow of the vein.
These cases are to illustrate that the vein thrombosis most be treated quickly and aggressively in order to clear the vein completely to allow for unrestricted blood flow.
Patients who suspect they are experiencing post-treatment blood clots should seek out a non-invasive test of their veins, such as an ultrasound-Doppler, to diagnose the problem. If the ultrasound-Doppler confirms the blood clot, request direct thrombus treatment to clear the vein. The oral blood thinners regularly prescribed are not likely to dissolve clots, which can lead to a complete and permanent vein occlusion.
Rafael Moguel M.D.