Alexandru Mischie – Venous Interventions

What is venous thrombosis ?

It is a condition characterized by the formation of blood clots (thrombi) in the venous system, in different parts of the body. A blood clot can cause local complications (swollen leg) or “climb” to the heart and cause serious complications (pulmonary embolism = blood clots in the pulmonary arteries) which can be life-threatening.

Alexandru Mischie says that the factors that cause venous thrombosis can be multiple:


  • fractures (hip or leg)
  • hip replacement or knee
  • knee arthroscopy
  • surgery – major intervention
  • laparoscopy


Iatrogenic (provoked by):

  • Central Venous Catheters
  • Estrogens (birth control pills or hormone replacement)
  • Chemotherapy


Major trauma / spinal cord


Medical conditions:

  • bed rest> 3 days
  • stroke with paralysis
  • history of DVT or MET
  • heart failure or respiratory failure
  • malignancies


Other conditions:

  • congenital malformations of the venous system (eg. Agenesis of the inferior cava)
  • immobilization (travel by plane or car)
  • pregnancy (postpartum / antepartum)
  • obesity
  • varicose
  • advanced age



  • AFL (antiphospholipid syndrome)
  • AT ↓↓ (severe antithrombin deficiency)
  • Lupus anticoagulant
  • 20210 PT (prothrombin gene mutation) homozygous or heterozygous
  • Protein C / S – severe deficiency, family history
  • H-homocysteinemia
  • factor V Leiden, homozygous or heterozygous
  • elevated factor VIII and IX


Venous thrombosis can be treated with:

  • anticoagulants (blood thinners)
  • thrombolytic (clot melters)
  • stents (open the vein for blood to move normally);
  • venous filters (stop migration of blood clots to the lungs)
  • variceal sclerosis.
  • catheter-based embolectomy (thrombus fragmentation in pulmonary embolism)


Find more on Twitter.


What is the catheter-based embolectomy (thrombus fragmentation in pulmonary embolism) ?

It is indicated when anticoagulants (blood thinners) or thrombolytics (melt clots) fail to remove the blood clot. The procedure is called catheter-based embolectomy and involves advancing a catheter to the pulmonary arteries (where is the thrombus) and mechanical fragmentation by advancing and withdrawing repeatedly a catheter in order to break the trombus into smaller pieces which can then be melted by the drugs.


What are stents for venous disease ?

Stenting of veins are aimed at openning the vein for blood to move normally. Recommended as a last resort in post-thrombotic syndrome. Is identical as a coronary stenting procedure, only the stent is mounted on a vein.


What is an inferior vena cava filter:

If you can not take anticoagulants, there is a possibility your doctor recommends implanting a venous filter. Dr. Mischie explains that the procedure follows the classical venous catheterisation technique: a catheter is introduced into the inferior vena cava ; this catherer has on top of a filter in the form of a perforated cone), whose role is to “capture” any thrombi that originate from leg veins or pelvis. Both during the procedure and later complications can occur:

  • In 10% of patients : thrombosis at the site of introduction;
  • In 20% of patients: recurrent venous thrombosis;
  • In 40% of patients: post-thrombotic syndrome;
  • Occlusion of the inferior cava: 33% of patients to 9 years;
  • Migration / thrombosis of the filter.


Varicose veins

Varicose veins are dilations of the veins, which sometimes may contain thrombus and cause complications. Treatment options can be: laser ablation or injection of a sclerosing agent. By puncturing a vein in the leg a catheter is introduced to the place of venous dilation; then the catheter is withdrawn slightly and the dilated tissue is “burned” by the laser (the catheter tip has a laser attached) or by injecting a foam (sclerosing agent). Local anesthesia is required. The procedure lasts 30 minutes.


All data on this site is purely informational and should not be considered medical advice. If you need a medical oppinion consult a physician.