Thursday, March 29, 2012

Recurrent DVT treatable even in complex cases



Most adults in their mid-20’s don’t have to worry about dealing with serious medical conditions.  Sean Brown, a 35-year old New Hampshire resident and member of the New Hampshire National Guard, however, did about 10 years ago when he discovered he had a DVT, otherwise known as Deep Vein Thrombosis.  DVT’s are blood clots that form in the large veins, usually in the lower legs or thighs, and can cause partial or complete blockage of circulation. Brown had the classic symptoms: his leg was swollen, red in color and warm to the touch.  His calf muscle was hard, and to top things off, he also had severe back pain.  However, most patients with DVT do not have these symptoms, and many may have no symptoms at all.

After using anticoagulants (blood thinning medication) and ”clot busting”, called thrombolysis, Brown figured he was on the right track to better health.  Little did he know that he’d have to deal with DVT, again. 

“If I hadn’t had one 10 years ago, I may have not have easily recognized the symptoms this time,” says Brown.

He was recently referred to the MGH Vascular Center in February after receiving another thrombolysis procedure along with blood thinners to treat his recurrent DVT, which unfortunately did not resolve the recurrent painful leg symptoms.  

Stephan Wicky, MD, Division Head of Vascular Imaging and Intervention and Suvranu Ganguli, MD, from Vascular Imaging, both members of the Vascular Center, were surprised when they first heard about Brown’s case of DVT and his age. 

“It is less common to have a DVT in your 20’s and 30’s as DVT is more frequent in adults of older age, especially after surgery or when cancer is present.  It’s hard enough to have a DVT once, and Sean’s recurrent condition was more complex,” says Wicky.  

Brown says learning about his first DVT was difficult enough as he was trying to keep up with the demands of running his own moving business, but the second time was especially tough to deal with.

“I was getting ready for flight school at the time.  It was devastating news,” says Brown. 

Anticoagulants were helping Brown’s symptoms, but Wicky’s team of vascular specialists decided a more aggressive approach could help him in the long-term, since his inferior vena cava (IVC), which drains all the blood from the legs and the pelvis, had been occluded (blocked off) for a long time.

“To make matters worse, Sean’s collateral veins along the spine were also blocked, which helped explain some of the severe back pain he was experiencing.  In order to best treat his recurrent DVT, we used extensive thrombolysis with an EKOS catheter to bust the clot,” says Wicky.

EKOS uses miniature ultrasound probes that are positioned into a catheter to more rapidly break up a clot.  An Angiojet device, which functions like a vacuum cleaner, also helped dissolve the clot.  The main leg veins and the collateral veins opened up very well.

“Since his IVC was permanently blocked, in order to minimize the risk of recurrent DVT, it was also decided to reconstruct the IVC with stents,” says Wicky.

Despite having recently undergone these procedures, one month later, although he still has some discomfort, Brown says his pain is manageable.  When he started experiencing the symptoms after Thanksgiving, he says (on a pain-scale from one to 10 (10 being the highest)), “I was in severe discomfort and was probably a 9.”     

Brown has some advice for people who are experiencing DVT. 

“What’s so critical with DVT is recognizing the signs,” says Brown.  For him, it was the back pain he experienced before the recurrent swelling happened and his leg also started to feel numb.

In Brown’s case, he actually has the opportunity to stay fit and healthy, as he needs to pass his physical tests for the National Guard. 

As far as Brown’s future looks, Wicky says it looks bright.

“I do believe Sean’s prognosis is very good.  He will be able to return to a normal life in probably 6 months and start again to exercise step by step.”

Members of the MGH Vascular Center from Imaging, Cardiology/Vascular Medicine, and Vascular and Endovascular Surgery all participate in the diagnosis and management of DVT. Learn more about DVT


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