Certain cancer patients may develop blood clots in their arms or legs due to the biology of their tumors, or due to other risk factors. These blood clots are called "deep vein thrombus" or "DVTs" and sometimes can dislodge and travel into the venous circulation of the lungs, which can lead to a life-threatening condition called pulmonary embolus. Oftentimes these conditions can be treated with blood thinning medication alone. However, for some individuals, this may not be an option, or more aggressive treatment of their clots may be required.
Sometimes a simple procedure can be performed to place a filter device in one of the large veins that acts as a "net" to catch any large clots that may break off and migrate to the lungs.
Other times, more direct therapy, such as, "clot-busting" must be performed by the interventionalist.
In addition to causing pulmonary emboli, deep venous thrombosis is a very serious condition that can cause permanent irreversible damage to veins of the leg and their valves, known as post-thrombotic syndrome. In the United States alone, approximately 600,000 new cases of acute DVTs are diagnosed each year, and 1 in every 100 people who develops a DVT may eventually succumb to this disorder or its complications. Post-thrombotic syndrome results in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling, and, in extreme cases, severe skin ulcers.
Risk Factors for DVTs
• Previous DVT or family history
• Immobility, such as bed rest or sitting for long periods of time
• Recent surgery
• Advanced age
• Hormone replacement therapy or oral contraceptives (OCP)
• Pregnancy or post-partum
• Coagulation abnormalities
• Discoloration of the legs
• Calf or leg pain or tenderness with leg swelling
• Prominent surface veins
• Leg fatigue
• Post thrombotic syndrome
• Life-threatening pulmonary emboli
Catheter-directed thrombolysis is performed under direct imaging guidance by an interventional radiologist. This procedure, performed in a hospital’s interventional radiology suite, is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserves valve function to minimize the risk of post-thrombotic syndrome or even pulmonary emboli. Treatment duration may range from one to a few days.
Enteric Access (Gastrostomy Tube)
Patients with Head and Neck cancer and certain individuals who are unable to tolerate oral intake of nutrition, may require additional direct enteric supplementation via a feeding tube. Doctors may sometimes recommend placement of a gastrostomy (G-tube) tube in the stomach if the patient is unable to take sufficient food by mouth. In this procedure, the feeding tube is inserted through a small nick in the skin and placed into the stomach under image-guidance.