July/August 2025
A Deeper Problem
How to know if you have deep vein thrombosis
Varicose veins—the twisty, bumpy bluish lines on your legs that tend to come with age—are not fun to look at but are not generally dangerous. It means the valves in the veins closer to the skin have weakened, making the blood that is destined for the heart to pool up in the leg instead. Sometimes they can cause mild pain, itching or swelling.
But they are a form of venous insufficiency—meaning the blood is not efficiently returning to the heart—and if they are causing symptoms, it’s a good idea to speak with your doctor about being evaluated for deep vein thrombosis, or DVT.
As the name implies, deep vein thrombosis occurs in veins located deeper within the muscles of the legs. These deep veins carry the majority of the blood back to the heart, and if the blood flow is slow and clots form, this increases the risk for sudden, severe illness.
“A blood clot in the deep veins could break loose and travel to the lungs, causing a pulmonary embolism,” explains Peter Hunt, MD, RPVI, a vascular surgeon with St. Joseph’s/Candler Physician Network – Vascular Specialists. “That’s like a roadblock in one of the main blood vessels leading to your lungs. It’s a life-threatening medical emergency.”
Finding And Treating DVT
Swollen varicose veins are not the only condition that brings patients to Dr. Hunt. Swelling in one leg, even without the presence of varicose veins, is a common sign of DVT. Pain, tenderness or warmth, or an unusually heavy feeling in one leg should also be evaluated.
“Patients are given an ultrasound, which is a safe, non-invasive way for me to directly see the veins and identify the presence of a thrombus, or blood clot,” Dr. Hunt says. “Ultrasounds help me determine the size and location of the clot, so we can start treatment in a timely manner.”
Once the ultrasound has confirmed the diagnosis of DVT, the first step in treatment is anticoagulants, also known as blood thinners. These medications prevent existing clots from getting bigger and can reduce the risk of developing more clots.
“Typically, I prescribe blood thinners for three months, then we do another ultrasound,” Dr. Hunt says. “If the ultrasound confirms that the clot is looking better, then we can take the patient off of the blood thinners.”
Severe blood clots may need thrombolytics, also known as clot busters. Because of the bleeding risk they cause, thrombolytics are only used in certain situations.
Pulling Out The Clot
In some cases, a minimally-invasive surgical procedure may be the best option.
“If the clot gets into the iliac veins, which are major blood vessels in the pelvis, we will perform a procedure with a special device called the ClotTriever,” Dr. Hunt says. “This way we can physically remove both acute and chronic thrombosis without having to use the clot-busting drugs that can raise the risk for internal bleeding.”
For this procedure, the ClotTriever catheter is inserted through a small incision and then guided through the vein using X-ray imaging. The end of the catheter is fitted with a mesh bag and a tool to help loosen the clot from the wall of the vein.
“It looks like a tiny wind sock,” Dr. Hunt says. “You open it up around the clot and then pull back, trapping the thrombus inside it.”
Dr. Hunt then slowly pulls the catheter out as the mesh bag closes around the clot and holds it securely. The catheter comes back out of the small incision and Dr. Hunt can then physically examine the clot itself.
“DVT is usually a mixture of acute and chronic clots,” he says. “The acute clot is kind of like a blackened currant jelly, and then mixed in with that is this sort of tan, rubbery material which is the chronic clot.”
With the entire clot removed in one procedure, patients can avoid taking strong thrombolytics and can also avoid a long hospital stay.
“We don’t have to keep patients in the Intensive Care Unit with this procedure,” Dr. Hunt says. “They can usually go home the same day or the following day, depending on how they feel. It’s a great procedure that works really well.”