Can - or should - the blood clot(s) in my leg(s) be removed surgically?

Henry I. Bussey, Pharm.D., FCCP, FAHA
January, 2007

Surgical removal of blood clots in the legs is not the typical approach in most patients. Often times patients will wonder about this possibility, especially if they have post-thrombotic syndrome. Post-thrombotic syndrome is a condition of ongoing swelling and discomfort in the leg following a blood clot in the leg (also called a deep vein thrombosis or DVT). More information about post-thrombotic syndrome is available on ClotCare at http://www.clotcare.com/
clotcare/faq_postthromboticsyndrome.aspx. The swelling and discomfort that occurs with post-thrombotic syndrome is due to increased pressure inside the veins in the leg. This increased pressure is largely due to damage to the valves inside the veins that help the blood flow back toward the heart. When a DVT occurs, the vein becomes inflamed, and the inflammation may damage the valves inside the vein. In such case, removal of the clot may not provide the anticipated benefit because the problem is not the obstruction caused by the clot. Rather, the damage to the valves in the vein are causing the swelling and discomfort. However, in some cases remarkable improvement in the post-thrombotic syndrome has been reported with removal of the clot. The potential for such benefit, however, must be carefully weighed against the possible complications that may result from such a procedure. This issue is clearly a controversial and evolving area with new data and new procedures being developed on an ongoing basis. For patients or clinicians who want to learn more about the current status of surgical removal of clots in the legs, they may find it useful to seek out a specialist in their area. The Society of Interventional Radiology maintains a website that can help locate such a specialist in your area. Just follow the steps below:

1. Go to http://directory.sirweb.org
   
   
2. You may search by state, region or physician
   
   
3. For "Area of Expertise" select "Venous disease" or "Varicose veins-venous ablation"
   
   
4. Click "Search" then scroll to the bottom of the page to find the list of physicians

Additional Resource

The American Venous Forum has a "Find a Doctor" form on its website at http://www.venous-info.com/membership/search/membdir.html. Additionally, the AVF has a Layman's Handbook of Venous Disorders at http://www.venous-info.com/handbook/hbkCover.html.