Mechanical Thrombectomy for DVT & PE

Sudden unexplained breathlessness, chest pain, coughing up blood or fainting needs immediate emergency assessment. Go to the nearest emergency department. Do not wait for an appointment or WhatsApp reply.

A clot can cause a painful, swollen leg or strain the heart by blocking blood flow through the lungs. Removing it through a vein puncture can help some patients recover.

This is called mechanical thrombectomy. Dr. Kulin Sheth uses a thin tube called a catheter to reach and remove clot with suction or a retrieval device.

• A clot in a deep vein, usually in the leg or pelvis, is called deep vein thrombosis (DVT).
• A clot that travels to the lungs and blocks a lung artery causes pulmonary embolism (PE).

Many patients recover with blood-thinning medicines alone. The first step is deciding whether clot removal could help you. Our DVT and pulmonary embolism guide explains the conditions.

For a clot in the leg or pelvis

The aim is to improve blood drainage from the leg, easing swelling, pain and difficulty walking.

Dr. Kulin Sheth considers:

• Whether the clot involves major veins in the pelvis and upper thigh, called iliofemoral DVT.
• How much symptoms affect walking and everyday activity.
• How long the clot has been present and whether it can be cleared safely.
• Your overall health, bleeding risk and any underlying vein narrowing.

Smaller or less extensive clots, including many calf clots, are usually managed with medicines or monitoring. Older, organised clots may need a different approach.

Rapidly worsening swelling, severe pain or a blue, pale or cold leg needs emergency care.

For a clot in the lungs

Removing clot can help blood pass through the lungs more easily and relieve strain on the right side of the heart.

• If breathing or circulation is failing or worsening: the hospital team assesses urgently whether catheter treatment, clot-dissolving medicine or surgery is needed.
• If blood pressure is stable but the heart is strained: scans, blood tests, oxygen needs and monitoring help decide whether a procedure would help.
• For low-risk PE: blood thinners are usually sufficient.

Your condition, scans, other illnesses and suitability for clot-dissolving medicines guide the recommendation.

This is a minimally invasive catheter procedure, rather than open surgery. It uses a small vein puncture, usually avoiding a large incision or opening the chest.

1. Getting ready: the team reviews your scans, blood tests, kidney function and medicines, and explains the treatment plan.
2. Keeping you comfortable: local anaesthetic numbs the entry site. Sedation helps you relax when appropriate; some patients need general anaesthesia.
3. Reaching the clot: ultrasound and X-ray imaging guide a wire and catheter through the vein.
4. Removing the clot: suction or retrieval tools clear clot, with contrast imaging to check blood flow.
5. Finishing: the catheter is removed and the puncture site secured. Occasionally, a catheter stays in place for further clot-dissolving treatment.

Will I be awake? Will it hurt?

You may be awake with local anaesthesia and sedation, or asleep under general anaesthesia, depending on your condition. Tell the team about pain, breathlessness or discomfort.

Why might I need to lie face down?

Some leg-clot procedures use a vein behind the knee, requiring you to lie face down, also called prone. Other access routes and lung-clot procedures use different positions.

Mention back pain, breathing problems or limited mobility so positioning and anaesthesia can be planned.

Dr. Kulin Sheth personally performs thrombectomy for both DVT and PE at Apollo CVHF Hospital, Bodakdev. He also proctors other doctors and hospitals, guiding them through these procedures.

His experience spans the Penumbra and Inari systems described below, catheter-directed clot-dissolving treatment, venous stenting and inferior vena cava filter placement.

As an interventional cardiologist, he combines catheter treatment with assessment of heart function and circulation, particularly relevant when PE strains the heart. He works with the critical care team for critically ill patients.

Experienced interventional radiologists and vascular specialists also provide this care. Procedural experience and hospital support matter.

Consultations and routine follow-up are at Sheth Heart Clinic, Bopal.

Dr. Kulin Sheth chooses the device according to your vessel anatomy, clot and treatment goal.

Device choice follows the decision that clot removal is appropriate for you.

Catheter-directed thrombolysis (CDT) delivers clot-dissolving medicine directly into or near the clot through a catheter.

• It may be used alone or before or alongside mechanical removal.
• The medicine may run for hours or longer while you remain in hospital for monitoring.
• Repeat imaging helps assess progress; another treatment session may be needed.
• Movement may be restricted while the catheter remains in place.

The team considers recent surgery, previous bleeding and other health conditions before recommending CDT. Although the dose is often lower than whole-body thrombolysis, bleeding precautions remain important.

Both restore blood flow. Surgery remains important when it offers the most suitable treatment.

• Venous stent: a permanent metal scaffold can hold open a significantly narrowed vein after clot removal. It needs its own medicine and scan follow-up plan.
• Inferior vena cava filter: a filter in the large vein returning blood from the lower body may help when blood thinners cannot safely be given, or in other carefully assessed circumstances. It does not remove existing clot. A retrievable filter needs a removal plan.

Dr. Kulin Sheth performs these when indicated. Filters are not routinely added to effective blood-thinner treatment.

The team assesses bleeding risk, kidney function and overall health before treatment, then monitors breathing, circulation and the puncture site afterward.

Important risks include:

• Bruising, bleeding or swelling at the entry site.
• Blood loss during suction or significant bleeding, sometimes requiring a blood transfusion. Transfusion is not routine.
• Injury to a vein, heart structure or lung artery, occasionally requiring urgent treatment.
• Clot movement, another embolism, an abnormal heart rhythm or worsening circulation.
• Contrast allergy, kidney injury and radiation exposure.
• Incomplete clot removal or early re-clotting, which may need further treatment.
• Rare life-threatening complications, including death. The underlying illness also affects risk.

CDT adds internal bleeding risk, including rare bleeding into the brain. The discussion covers your individual risks and alternatives.

Hospital stay with Dr. Kulin at Apollo CVHF is usually 2–3 days. Severe PE, continuing clot-dissolving treatment or complications may require longer monitoring.

The first few hours

• You may need to lie still, particularly keeping the accessed leg straight, to let the puncture site seal and reduce bleeding.
• These precautions usually last a few hours; timing depends on the access site, catheter size, closure method and any continuing CDT.
• The team will tell you when it is safe to sit up and walk.

Going home

• Continue your prescribed blood thinners and follow puncture-site care instructions.
• Build up walking and daily activity gradually.
• Discuss return to work, exercise and travel according to your recovery.
• Attend routine follow-up even if you feel much better.

Before treatment, bring your scans and medicine list, and mention recent surgery, bleeding, kidney disease, contrast reactions or pregnancy. Follow your individual fasting and medicine instructions; do not stop blood thinners yourself.

Why do I still need medicines and follow-up?

Removing the clot clears a blockage. Further care addresses why it formed and helps prevent another one.

“Clot nikal gaya, toh dava bandh?”

Blood thinners usually continue after clot removal. Their duration depends on the cause, recurrence risk and bleeding risk.

Routine follow-up at Sheth Heart Clinic includes:

• Recovery: reviewing leg swelling, pain, walking, breathing and the puncture site.
• Medicines: checking the dose, tolerance, bleeding concerns and how long treatment should continue.
• Blood tests: monitoring blood count, kidney function and other tests appropriate to your medicine. Warfarin needs clotting blood tests.
• Imaging: Doppler scans, heart ultrasound or other scans when they can guide care. Venous stents need ongoing surveillance; retrievable filters need review for removal.

You may need further laboratory work-up or other tests to investigate why the clot formed. Dr. Kulin reviews recent immobility, surgery, hormones, cancer history, previous clots, family history and possible vein narrowing.

• Tests are chosen according to your history and findings, rather than giving everyone the same panel.
• Testing for an inherited or acquired tendency to clot, called thrombophilia testing, is useful when it could change treatment. Acute clots and blood thinners can affect some results, so timing matters.
• Further imaging or investigation of another illness may be appropriate when symptoms or examination suggest it. Extensive cancer scans are not automatic for every unexplained clot.

Persistent leg heaviness, swelling or skin changes may reflect vein damage called post-thrombotic syndrome. Continuing breathlessness after PE also needs assessment, including for persistent clot-related pressure in the lung circulation. Follow-up helps identify and treat these problems.

Sudden breathlessness, chest pain, fainting, major bleeding or rapidly worsening leg symptoms needs urgent hospital assessment.

The treatment goal is clearer blood flow and better recovery: easier walking for a swollen leg, or less strain on the heart and circulation with PE.

• DVT: studies report symptom relief and improved vein opening. Some studies had no medicines-only comparison group, so evidence on preventing long-term vein damage is still developing. ATTRACT, which combined clot removal with clot-dissolving medicine, did not reduce overall post-thrombotic syndrome and increased major bleeding. It did not test every newer device.
• PE: trials in particular patient groups have shown earlier improvement in heart strain and, in one trial, better function at 90 days. PEERLESS favoured thrombectomy over CDT mainly through less deterioration and intensive-care use, without showing a survival or major-bleeding advantage. These findings help guide individual treatment.

Recovery varies, and some patients need further treatment. Clot removal cannot guarantee prevention of all future leg or lung problems.

If clot removal has been recommended and you would like to understand your options, call or WhatsApp to arrange a second opinion with Dr. Kulin Sheth. He personally reviews your reports and scan images to discuss whether blood thinners, mechanical thrombectomy, CDT or surgery is appropriate for you.

You can also arrange a consultation at Sheth Heart Clinic for planned treatment discussions or follow-up after discharge.

References

• 2026 multisociety guideline on acute pulmonary embolism
• European Society for Vascular Surgery: venous thrombosis guidelines
• American Society of Hematology: treatment of DVT and PE
• ATTRACT trial: drug-assisted catheter clot removal for DVT
• CLOUT registry: one-year outcomes after DVT mechanical thrombectomy
• STORM-PE trial: aspiration thrombectomy plus anticoagulation versus anticoagulation alone
• STORM-PE: functional outcomes at 90 days
• PEERLESS trial: mechanical thrombectomy versus catheter-directed thrombolysis
• Cambridge University Hospitals: procedures and recovery for DVT
• RadiologyInfo: catheter-directed thrombolysis
• Penumbra: Indigo aspiration catheters and Lightning systems
• Penumbra: Lightning Flash 2.0 system description
• Inari: FlowTriever system
• Inari: ClotTriever system
• NICE: investigating causes and selecting clotting-disorder tests after DVT or PE
• American Society of Hematology: guidance on thrombophilia testing