Specialties: Coronary artery disease and myocardial infarction, cardiac catheterization, balloon angioplasty and stent placement, peripheral vascular disease, and heart failure.

       In clinical practice, we often encounter a rapidly developing, unpredictable, and potentially fatal condition: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). These two conditions fall under the category of venous thromboembolism. Though they may appear harmless on the surface, they often strike without warning, catching both patients and their families off guard, and in some cases, can be fatal. From a physician’s perspective, these diseases require prompt identification and treatment, and more importantly, should be well understood by the general public to reduce the risk of delayed care.

       As the name suggests, deep vein thrombosis refers to the abnormal formation of blood clots within the deep veins of the body, most commonly in the veins of the calf or thigh. When these clots dislodge, they can travel through the bloodstream to the lungs and block a pulmonary artery, resulting in a pulmonary embolism. This is a life-threatening emergency that can lead to respiratory failure, low blood pressure, or sudden death.

       The formation of blood clots is typically associated with three major mechanisms. The first is blood flow stasis, which can occur due to prolonged sitting, bed rest, or reduced mobility after surgery. The second is damage to the vessel wall, often due to trauma, surgical procedures, or infections. The third is hypercoagulability of the blood, which may be related to cancer, pregnancy, hereditary conditions, or hormone therapies. These factors may exist independently or in combination to contribute to thrombus formation.

       Many patients do not notice anything unusual at first, only seeking medical attention when their leg becomes swollen, painful, warm, or tender. However, the more serious manifestations often arise from a pulmonary embolism. Some individuals may suddenly experience shortness of breath, chest tightness or pain, rapid heartbeat, or dizziness. These symptoms are frequently mistaken for heart disease, asthma, or anxiety, leading to delays in seeking treatment. Even more concerning, some patients’ first symptom is sudden death, highlighting the critical importance of early recognition and prevention.

       For diagnosis, physicians rely on the patient’s medical history, symptoms, and clinical risk assessments to determine the appropriate tests. Initial blood tests such as D-dimer can help rule out low-risk cases, while ultrasound can directly visualize blood flow in the leg veins. If PE is suspected, Computed Tomography Pulmonary Angiography (CTPA) is the most commonly used and accurate imaging modality, clearly showing the location and severity of the clot. These tests are essential for making a prompt diagnosis and evaluating treatment options.

      Once a diagnosis is confirmed, the first line of treatment usually involves anticoagulant medications. These drugs effectively prevent the clot from growing and stop new clots from forming. Traditionally, low-molecular-weight heparin and warfarin have been used. In recent years, however, more patients have been treated with novel oral anticoagulants (NOACs) such as apixaban or rivaroxaban, which offer convenience and do not require frequent blood monitoring. For patients with large clots or unstable vital signs, doctors may consider hospitalization and thrombolytic therapy to dissolve the clots, although these medications carry a higher risk of bleeding and must be used with caution.

       In particularly severe cases—such as when a clot blocks a major pulmonary artery, causing severe hypoxia, hypotension, or even shock—conventional medical treatment may not work quickly enough. In such situations, Catheter-Directed Thrombectomy becomes a critical interventional option. This minimally invasive technique, which has rapidly advanced in interventional radiology and cardiovascular medicine at our hospital in recent years, offers the benefits of safety, speed, and reduced invasiveness.

       The principle behind catheter-directed thrombectomy is to insert a thin catheter through a blood vessel in the groin or neck, navigate it through the vascular system to the site of the pulmonary embolism, and use negative pressure or mechanical devices to extract the clot. Common devices include the Penumbra Indigo and AngioJet systems, both of which can remove blockages quickly, restoring pulmonary blood flow and improving oxygenation and blood pressure. Most importantly, this procedure typically does not require high doses of thrombolytic drugs, significantly reducing the risk of intracranial or other major bleeding. We have already successfully performed catheter-directed thrombectomy on several patients, saving lives—particularly in high-risk individuals who cannot receive thrombolytics, such as those with prior strokes, active bleeding, or advanced age. For these patients, catheter intervention provides a vital, life-saving alternative.

    Despite advancements in treatment technology, prevention remains even more crucial. If you often sit for long periods, take long-haul flights, or have recently undergone surgery or hospitalization, it is essential to move your limbs, wear compression stockings, stay hydrated, and consult your doctor about the need for preventive medication. Individuals with a family history of thrombosis, cancer patients, or pregnant women should also remain vigilant—prevention is always better than cure.

    In the world of medicine, DVT and PE may not be the most talked-about conditions, but they are among the most dangerous threats we face. With proper awareness, effective treatment, and proactive care for high-risk populations, we can greatly reduce complications and mortality. The smooth flow of every blood vessel is the foundation of life stability, and every alertness to thrombosis is the first step in safeguarding health.

Deep Vein Thrombosis (DVT) schematic diagram

 Pulmonary Embolism (PE) schematic diagram

Diagram illustrating the catheter suction procedure