Thursday, October 2, 2008

Quick action helps woman recover from DVT and serious complications

Nancy Hammer never thought about her vascular health until a day of shopping left her in serious pain.

On a Saturday in early May, Hammer was walking the very hilly streets of Providence, R.I., doing some window shopping with friends. When she returned home to Cambridge, Mass., she noticed some soreness in leg, which she assumed was a result of trekking up and down the hills.

“By Sunday my leg was so swollen I could not even walk,” says Hammer, who then headed to her local community hospital for treatment.

There she was diagnosed with deep-vein thrombosis (DVT). DVT is a condition in which a blood clot (thrombosis) forms in the deep vein of the leg, restricting the flow of blood. Doctors treated Hammer with a blood-thinning medication to prevent progression of DVT and further complications, such as pulmonary embolism.

After leaving the hospital, Hammer’s leg was still sore and swollen. She consulted her primary care physician (PCP) who ordered a CT scan to identify the cause of the DVT. Her PCP consulted with Stephan Wicky, MD, a vascular radiologist with the Massachusetts General Hospital Vascular Center, to interpret the test results.

Dr. Wicky did not like what he saw.

Another Round of Treatment

Hammer’s DVT had not subsided, and worse, she had a pulmonary embolism, which occurs when a part of a blood clot breaks off and travels freely through the vascular system toward the lungs, where it can cause serious complications or death. Three hours after the scan, Hammer was on her way to Mass General for immediate attention.

“The triage nurse in the Emergency Department was expecting me and took me right to admitting,” says Hammer. “When Dr. Wicky arrived he mobilized all the forces and got me quickly admitted to his lab, where they were able to break up the clot.”

Dr. Wicky and his team implanted an emergency inferior vena cava filter (IVC) to prevent complications from additional pulmonary embolism. The next day they used mechanical thrombolysis to dissolve the DVT and thromboaspiration to remove all of the blood clot from her leg. Thrombolysis and thromboaspiration are minimally invasive procedures that rapidly relieve the patient from pain and discomfort and can efficiently prevent chronic venous insufficiency. They are performed using tiny catheters that can access, with ultrasound guidance, the vein behind the knee.

“Most patients with femoral and iliac vein DVT will develop post-thrombotic syndrome, which causes leg swelling, pain, discoloration and even ulcers. Because blood thinner treatment does not prevent post-thrombotic syndrome, we tend to be very aggressive when DVT involves the large veins of the legs and the pelvis,” says Dr. Wicky.

Mass General will soon be part of a National Institutes of Health trial that will document the efficacy of these techniques.

Finally, the team treated Hammer for the underlying cause of the DVT – May-Thurner Syndrome. May-Thurner Syndrome is a congenital anatomic variation that causes the right artery to compress the left common iliac vein in the pelvis. The pressure the artery applies to the vein causes it to narrow and, in more severe cases, obstructs blood flow from the leg. This can cause leg pain, swelling and DVT.

Hammer’s symptoms were relieved by placing a stent to force open the compressed vein.

She spent four days in the hospital and underwent a number of procedures, but overall she’s says it was a good experience. She feels great and was thrilled with the quality of her care.

Hammer, who is the director of human resources at an area museum, says she can usually tell when employees are happy. “The people at Massachusetts General Hospital are living the mission, from the nurses to the maintenance staff. The service they provided was fantastic and truly went above and beyond.”

“I know I had a medical crisis, but I was never afraid because I felt so well cared for,” she adds.

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