Q: I suffered from deep vein thrombosis (DVT) & pulmonary embolism way back in 2000. I still have occluded veins posing local problem, though pulmonary embolism did not recur. Is there any technique that can dissolve my thrombus of lower limb? They have been there for 7 years. What will be the success rate? I am already at proper anti-coagulant & my homocysteine levels are within normal levels.

A:The venous thrombosis of the long-standing duration is of significance only in relation to the venous insufficiency it has created and the residual effect of the same. Usually when the veins thrombose, these most often open to some extent. These can be opened fully if the treatment is instituted within a few hours or a day of detection, when the clot is soft and can be dissolved by using the thrombolytic agents. If these veins have been blocked for 7 years, then these will not open, as these veins are totally fibrosed (clogged with scar tissue). There should be no attempt to unblock these, as the effort will be unrewarding. Also that if the leg has not come to any serious harm in these years, then no procedure is needed. One can use physical means like wearing a compression stocking and regular walking, this will increase the efficiency of the collateral channels that open up following DVT. There are some intermittent compression devices also available, which should help. Unfortunately, you have not written what sort of problems you are getting so I cannot give any specific advice. It is a relieving feature that you have not had any recurrence of pulmonary embolism. There are very selected cases where surgery is recommended for the blocked veins, where a bypass is done to relieve the severe chronic venous insufficiency. If you are comfortable with the anticoagulant therapy, then you should just concentrate on the physical therapy.