Venous Disease Program

Overview

Clinicians at the Fireman Vascular Center’s Venous Disease Program are leaders in the investigation and use of surgical and endovascular interventions to treat and prevent complications of deep vein thrombosis (DVT), the presence of a blood clot in the deep veins of the body. Our clinicians also use a number of minimally invasive approaches to treat varicose veins and other venous disorders without open surgery, resulting in faster recovery times.

A Multidisciplinary Approach to Vascular Care

The Mass General Fireman Vascular Center is one of the only vascular centers in the country with specialists represented in every area of vascular disease. The Venous Disease Program brings together a team of clinicians from multiple disciplines to provide care from many perspectives, including:

• Vascular medicine and cardiology
• Vascular and endovascular surgery
• Vascular imaging and intervention
• Hematology
• Wound care
• Anticoagulation management service

We work together with the patient and referring physicians to coordinate personalized treatment plans for all patients.

Diagnosis: Specialists Dedicated to Vascular Imaging

Our team is composed of full-time, board-certified specialists who are specially trained to detect abnormalities in the vascular system and whose practice focuses specifically on vascular disease. Each member of the team specializes in radiology, vascular medicine or vascular surgery, and is fellowship trained with additional expertise in vascular procedures.

Depending on the patient, we may use one or more techniques to diagnose venous disease, including:

• Duplex ultrasound
• CT scan
• Magnetic resonance imaging (MRI)
• Specialized blood tests
• Venograms

These tests are available at the Mass General main campus or at the center’s convenient Waltham location.

The Latest Treatment Options for DVT

Our primary treatment goal is to prevent pulmonary embolism and post-thrombotic syndrome, a painful complication of DVT. We offer a number of medical, minimally invasive and surgical approaches, including:

Mechanical Thrombectomy: During this procedure, the clot is surgically removed or emulsified with the use of a specialized catheter from the vein. To prevent post-thrombotic syndrome, Mass General physicians are among the first in the nation to use the thrombectomy to treat patients within two weeks of a DVT, a new, proposed standard of care

Thrombolysis: In this minimally invasive technique, clot-dissolving medications are injected directly into the clot. Our physicians are currently investigating combining thrombectomy devices and thrombolytic medications to clear the vein of clot and hopefully prevent post-thrombotic syndrome

Anticoagulant Medications: People with DVT typically require treatment with anticoagulant medications such as heparin and warfarin to prevent clots from growing larger. Our specialists work together to carefully follow patients and adjust medications, as appropriate

Inferior vena cava filters: If a patient cannot take anticoagulant medications or it is not the optimal treatment, then a special filter may be placed in his or her vein to catch the clot if it breaks free. This also prevents pulmonary embolism, a life-threatening condition where the clot travels to the lungs

Minimally Invasive Treatments for Varicose Veins

Minimally invasive treatments generally offer patients shorter recovery times and smaller scars than traditional open surgical procedures. For patients with varicose veins, we specialize in a number of minimally invasive treatment options, including:

• Sclerotherapy: In this technique, a chemical is injected into the affected veins to harden them so they can no longer fill with blood
• Radiofrequency ablation (RFA): This therapy uses heat delivered through a catheter to treat varicose veins. Our physicians were among the first in Boston to perform an endovenous (via the veins) radiofrequency ablation
• Endovenous laser therapy (EVLT): In this approach, lasers are used to treat affected veins in a similar manner to radiofrequency ablation (RFA)

Our physicians also fit patients with compression stockings, which squeeze varicose veins from flowing backward and offer support to the leg’s veins.

Taking Care of Chronic Wounds

Patients with vascular disease and poor circulation often experience chronic wounds that fail to heal or show delayed healing. Our wound care specialists provide expert, innovative care that promotes rapid healing and helps prevent and treat leg ulcers and other complications of venous disease.

Comprehensive Care for Difficult Cases

Venous Disease Program physicians are skilled in treating complications from venous disease as well as less common conditions such as pelvic congestion syndrome, May-Thurner syndrome and Paget-Schröetter syndrome. Patients from across the country—and around the world—come to the Fireman Vascular Center because of our expertise in treating these and other rare venous disorders.

The breadth of resources at Mass General also allows us to address these complications with success:

• Pulmonary embolism: DVT increases the risk of pulmonary embolism, a life-threatening condition in which the blood clot breaks off from the wall of the blood vessel and travels through the bloodstream to the lungs. Our physicians strive to prevent pulmonary embolism with interventions such as medications, inferior vena cava filters, thrombectomy and thrombolysis
• Post-thrombotic syndrome: Some patients with DVT can develop symptoms such as swelling, pain and leg ulcers, even years after the clot formed. Our use of combination thrombolysis and thrombectomy shows promise for preventing this syndrome
• Chronic DVT: At the Venous Disease Program, we offer hope for patients with chronic DVT through innovative treatment approaches such as thrombectomy, angioplasty and stenting. We also guide patients through lifestyle changes and connect them to our wound care specialists

About This Program

The Venous Disease Program at the Massachusetts General Hospital Fireman Vascular Center offers the complete range of diagnostic, surgical and endovascular interventions to treat patients with deep vein thrombosis and varicose veins.

National Leaders in Our Field

The Fireman Vascular Center has a long tradition of excellence in clinical care, and our clinicians are leaders in the diagnosis and treatment of DVT and varicose veins. Our distinguished staff is made up of many national figures in their respective fields. These physicians are at the forefront of new research and serve on national and international professional boards and societies.

One Call Coordinates Care

Our dedicated access specialist is available Monday through Friday from 8:30 am to 5:00 pm to take relevant information about your condition and symptoms and to make a timely appointment with the most appropriate specialist. Call 877-644-8346 or request an appointment online

We strive to see patients as soon as possible and assign every patient one clinician to organize care amongst members of our multidisciplinary team. From diagnosis to treatment and through follow up, this physician guides patients throughout the entire treatment process.

Shaping Treatment through Research and Clinical Trials

The Fireman Vascular Center participates in major clinical studies evaluating new technologies and devices to treat DVT and varicose veins. This allows us to bring our patients promising new treatments as quickly as possible.

Our clinicians are currently taking part in the ATTRACT trial, the first major national trial combining thrombolysis with thrombectomy to treat DVT supported by the National Institutes of Health. Several of our physicians participate as lead investigators for this trial and are members of its national steering committee.

Patients interested in participating in clinical trials can browse online for open trials.

Currently open clinical trials include:

• The use of Varithena® to treat chronic venous insufficiency resulting in leg ulcers