Two-hour treatment for deep vein thrombosis

A NEW device for the treatment of deep vein thrombosis (DVT) has been found by an Irish researcher to be highly effective and much faster than the standard treatment.

Dr Gerard O'Sullivan, an interventional radiologist at University College Hospital Galway, said the standard treatment for DVT - a common cause of admission to Irish hospitals - involves up to one week of bed rest in hospital and as much as six weeks off work.

However, he says that a new Trellis device, which he is using on patients at UCHG, sucks out the deep vein blood clots and successfully treats DVT in only two hours. His paper, "An endovascular approach to deep venous thrombosis utilising isolated thrombolysis and adjunctive measure", was published in the latest issue of the Journal of Vascular and Interventional Radiology.

Dr O'Sullivan explains that the standard treatment for DVT is anti-coagulation therapy, which typically means in-patient admission and bed rest for at least one week.

"DVT can occur below or above the knee or around the groin. The higher up or closer to the body it is, the more dangerous and symptomatic. Patients can get massively swollen legs and there is the risk of parts of the clot breaking off and going to the lungs, where it can cause a pulmonary embolism."

Dr O'Sullivan says that while the standard treatment works fine on smaller clots, it is less useful in more serious cases of DVT. "The standard treatment diminishes the chance of the clot growing but it does not attack or destroy it. We depend on the body's own enzymes to do this in some people."

He explains that interventional radiologists are now turning to more aggressive forms of treatment. The Catheter Directed Thrombolysis, developed 13 years ago, involves guiding a catheter along the vein and breaking the clot up with drugs. The downside of this procedure is that patients have to spend three days in intensive care afterwards and there is some risk of bleeding.

Three years ago, Dr O'Sullivan was contacted by former colleagues at Stanford University in the US to see if he would be interested in trying out a new FDA-approved device that had been developed by professor of surgery at Stanford, Dr Thomas Fogarty.

Since then, he has treated patients from all over the State with the Trellis device. It is now being manufactured by Brachus Vascular, a Fogarty-owned company that Dr O'Sullivan says he has no financial connections with. He points out that there are currently other interventional radiologists using it in Ireland.

He explains: "The device, which is guided through the vein, has balloons at either end to prevent the potential of any clot breaking off. It spins around 4,000 revs per minute in the treatment section to suck out the clot. There is quicker clot clearance than standard treatment; it's gone in two hours as opposed to three days or six weeks."

Dr O'Sullivan has used this interventional technique - which is called isolated pharmaco-mechanical thrombolysis - on about 100 limbs in 80 patients in Galway to date.

Patients experience dramatic relief of pain, swelling and skin discolouration in just a few hours, he says.