A deep venous thrombosis (DVT) is a blood clot that forms in a deep vein in the leg where it can cause pain and swelling. These clots can break loose and pass into the heart and then into the lungs. Patients can survive smaller clots and be treated with blood thinners. Larger clots, however, can be fatal. UCLA patient Todd Dunlap, 62, arrived at Ronald Reagan UCLA Medical Center’s emergency room on last month’ he complained of shortness of breath, fatigue, and extreme cold. When a CT scan revealed a 24-inch clot stretching from his legs into his heart, doctors feared that it could break loose and lodge in his lungs, blocking oxygen and killing him instantly.
Dr. John Moriarty gave Mr. Dunlap a choice; he could have open-heart surgery or undergo a new minimally invasive procedure using a device called AngioVac to vacuum the massive clot out of his heart. The procedure was definitely in experimental territory; it had never been successfully performed in California. Mr. Dunlap chose the AngioVac and experienced a good outcome.
A team of UCLA interventional radiologists and cardiovascular surgeons slid a tiny camera down Dunlap’s esophagus to visually monitor his heart. Next, they guided a coiled hose through his neck artery and plugged one end into his heart, against the clot. They threaded the other end through a vein at the groin and hooked the hose up to a powerful heart-bypass device in the operating room to create suction. “Once in place, the AngioVac quickly sucked the deadly clot out of Mr. Dunlap’s heart and filtered out the solid tissue,” explained Dr. Moriarty, a UCLA interventional radiologist with expertise in clot removal and cardiovascular imaging. He added, “The system then restored the cleansed blood through a blood vessel near the groin, eliminating the need for a blood transfusion.”
The procedure took three hours, following which he spent three days in intensive care before transferring him to the hospital’s cardiac ward; he was discharged four days later. Open-heart surgery takes twice as long to perform and often requires the surgeon to divide the breastbone lengthwise down the middle and spread the halves apart to access the heart. After the heart is repaired, surgeons use wires to hold the breastbone and ribs in place as they heal. The procedure can necessitate extended rehabilitation before the patient makes a full recovery.
“Retrieving a clot from within the heart used to require open-heart surgery, resulting in longer hospitalization, recovery and rehabilitation times compared to the minimally invasive approach provided by the AngioVac system,” explained Dr. Murray Kwon, a UCLA cardiothoracic surgeon who collaborated on Dunlap’s procedure. An option to surgery is the administration of a drug known as tissue plasminogen activator (tPA), which can dissolve the clot within three to four days. The UCLA physicians tried tPA initially; however, it failed due to the clot’s large size and density. “The AngioVac was the last resort for Mr. Dunlap,” said Dr. Moriarty. “The clot clogged his heart chamber like a wad of gum in a pipe. Every moment that passed increased the risk that the clot would migrate to his lungs and kill him. We couldn’t have asked for a better outcome.”
“I’m thrilled that I didn’t have to go through open-heart surgery,” said Mr. Dunlap, a resident of Newbury Park, California, who is the father of two adult sons and a recent grandfather. He added. “This procedure is a great option for the older, frail person who wouldn’t survive open-heart surgery. Without an alternative like this, he’s a goner.”
Take home message:
Risk factors for a DVT include obesity, older age, type A blood, and genetic factors, and certain gene mutations. If you have a sibling, parent, or grandparent who has suffered a DVT, you should undergo blood tests for mutant genes that increase the risk of clotting.
Risk factors obviously increase the chance of suffering a DVT; however, they do not mean that you will suffer one. In addition, individuals that have no risk factors can have a DVT. Long periods of sitting or reclining can result in a DVT; certain precautions can reduce the risk of suffering one. When you travel and must sit for longer than four hours, the National Heart, Lung and Blood Institute (NHLBI) suggests you:
- Walk up and down the aisles (if traveling by plane or bus)
- Stop about every hour and walk a little (if traveling by car)
- While sitting, stretch your feet and move your legs
- Wear loose clothing
- Avoid alcohol
- Drink plenty of fluids