In the past, treating blood clots in the lungs (pulmonary embolism) required major open-chest surgery—a high-risk procedure with mortality rates reaching 30–50%. Today, thanks to advances in medical technology, Dr. Suci Indriani, Sp.JP (K), FIHA from Mandaya Royal Hospital Puri offers a far safer and more modern solution: minimally invasive endovascular procedures.
“In the past, treatment was done surgically—cut open, operated on—and the mortality rate was extremely high. That’s why we now rely on endovascular techniques. Endovascular means performing the procedure percutaneously or with a catheter,” explained Dr. Suci.
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Treatment Options for DVT
1. Medication (Anticoagulants)
For early-detected and non-severe DVT, medication is the first-line therapy. “In general, treatment can be done with medication alone—taking or injecting blood thinners,” said Dr. Suci.
Types of anticoagulants include:
- Heparin – administered via injection or IV, fast-acting
- Warfarin – an oral tablet, takes several days to become therapeutic
- DOACs (Direct Oral Anticoagulants) – such as rivaroxaban, apixaban, dabigatran, and edoxaban
For first-time DVT without previous history, blood thinners are typically given for 3–6 months.
“If it’s the patient’s first time experiencing leg swelling without prior issues, it’s considered spontaneous. Usually, long-term medication is required. But if the patient had a known trigger such as surgery and has no underlying disease, after 3–6 months the medication can be discontinued if the clot has resolved,” Dr. Suci explained.
2. Catheter-Based Procedures (Endovascular)
For more severe or extensive DVT, Dr. Suci describes several modern catheter techniques:
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Aspiration (suctioning the clot)
“Actively removing the clot can be done with various techniques, starting from aspiration—literally sucking out the clot,” she said.
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Clot fragmentation + aspiration
The clot is broken into smaller pieces and then suctioned out.
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Catheter-directed thrombolysis
“The third method involves administering a strong thrombolytic agent directly into the clot through a catheter left in place for 12–24 hours. It’s then re-evaluated and continued if needed,” she explained.
Thrombolytics such as alteplase or streptokinase are used.
3. Compression Stockings
Compression stockings apply pressure to the legs to prevent blood pooling and reduce swelling.
“Compression stockings also help reduce swelling from DVT and post-thrombotic syndrome,” added Dr. Suci.
Pulmonary Embolism Treatment: Advanced Procedures Without Major Surgery
1. Mechanical Thrombectomy With Aspiration Device
Dr. Suci is among the few specialists in Indonesia experienced in performing advanced pulmonary artery mechanical thrombectomy using an aspiration device.
“The principle is suctioning the clot directly,” she noted.
Indications:
- Large clot burden involving major pulmonary branches
- Hemodynamic compromise (low blood pressure, poor perfusion)
How the procedure works:
Dr. Suci describes the steps simply: “We access through the femoral vein, then advance into the pulmonary artery. The clot is suctioned using a special large catheter, some with built-in AI to optimize aspiration.”
Advantages:
- Patient remains conscious. “No need for general anesthesia,” she said.
- Fast procedure. “Less than an hour including preparation,” compared to hours of open surgery.
- Immediate improvement. “Blood pressure stabilizes, heart rate decreases, oxygen saturation improves.”
- Lower risk compared to open surgical embolectomy, which carries high mortality.
Mechanical percutaneous thrombectomy is now becoming a preferred first-line option in many cases.
2. Other Technologies
Dr. Suci also highlights additional systems:
- Ultrasound-assisted thrombolysis (clot breakup with ultrasound before aspiration)
- Penumbra Indigo System
- Rheolytic thrombectomy (high-velocity saline jets)
“The point is: the clot must be removed. Small clots may dissolve on their own, but large ones that block major vessels will not clear even after a year with medication alone. That’s why we need effective devices to break and remove the clot,” she emphasized.
The Importance of Early Treatment
Dr. Suci stresses the urgency: “You need to come in as early as possible. Acute cases are usually under two weeks. Beyond that, the risk of complications increases.”
She warns that delayed cases may deteriorate quickly: “Sometimes patients arrive extremely breathless with low oxygen levels. At that stage, many interventions are no longer effective.”
Not all hospitals can perform these advanced procedures, so early referral is essential.
After Treatment: What Patients Should Do
Post-treatment care typically includes:
- Inpatient monitoring and maintenance anticoagulants
- Long-term anticoagulation therapy as indicated
- Routine follow-up to prevent recurrence
- Compression stockings
- Lifestyle adjustments: regular walking, adequate hydration, avoiding prolonged sitting/standing
Can DVT and Pulmonary Embolism Be Prevented?
For high-risk individuals:
- Prophylactic blood thinners
- Compression stockings
- Early mobilization after surgery
For the general population:
- Regular walking (10,000 steps/day)
- Reduced salt intake
- Adequate hydration
- Avoid prolonged sitting/standing
- Foot and ankle exercises during long trips
- Avoid trauma
During travel:
- Stand or walk occasionally on flights
- Take breaks every hour when driving
- Perform ankle and toe exercises if unable to walk
- Wear compression stockings during trips longer than three hours
Dr. Suci notes a concerning trend:
“DVT and PE are underdiagnosed in Indonesia. Many patients seek help only after chronic swelling or lung pressure buildup has occurred.”
Modern Endovascular Solutions Now Available at Mandaya Royal Hospital Puri
The treatment of DVT and pulmonary embolism has undergone a major transformation. With advanced endovascular expertise, Dr. Suci Indriani at Mandaya Royal Hospital Puri provides safer and highly effective alternatives to traditional major surgery.
Early detection and timely intervention remain critical. Do not hesitate to seek consultation if you experience suspicious symptoms.
Mandaya Royal Hospital Puri — Dr. Suci Indriani, Sp.JP (K), FIHA, Cardiologist, Vascular Medicine & Interventional Cardiology Consultant
Clinic Hours:
- Monday: 17:00 – 20:00 WIB
- Friday: 17:00 – 20:00 WIB
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