MDNews - Minnesota

AS MANY AS 600,000 cases of DVT — a blood clot that typically forms in the deep veins of the leg or pelvis — occur in the United States each year. When complicated by pulmonary embolism, which is a condi- tion caused by portions of the DVT clot breaking off and blocking blood vessels in the lungs, it may account for as many as 100,000 U.S. deaths annually. The Minneapolis Vascular Physicians team uses isolated pharmacomechanical thrombolysis (IPMT) to break up the DVT and prevent potential complications. "If you don't open the vein and estab- lish a good channel, blood backs up in the leg and causes swelling that can lead to post-thrombotic syndrome," explains Maria Gomes, MD, Medical Director of Minneapolis Vein Center. "If the skin begins to break down, it leads to ulcers that are dif- ficult to heal, not to mention compounding healthcare costs. Recurrent cellulitis is also common with PTS." Traditionally, physicians initiate medical anticoagulant therapy (commonly warfarin), but while such treatments can effectively prevent recurrent clotting and reduce the risk for PE, they often do poorly in establish- ing an effective channel and good flow and don't always eliminate symptoms or threat of further complications. As many as two-thirds of patients with DVT can develop PTS. When used in the acute setting (when the DVT has existed for less than three weeks), IPMT should completely dissolve the clot and reduce the risk of post-thrombotic syndrome and pulmonary embolism. Pharmacomechanics 101 D r. G omes notes t h at t he ne w catheter-based procedure is as effective as it is expedient — most treatments last 45–90 minutes and are performed in an X-ray suite. Swelling, discoloration and other symptoms associated with DVT can be significantly reduced within 24 hours of treatment. The catheter device combines targeted lytic infusion and thrombus isolation. "We isolate the clot with inf lated balloons on either side," Dr. Gomes explains. "We then inject tissue plas- minogen activator [tPA] directly into the clot through the catheter's drug infusion holes. While we deliver the tPA, the catheter oscillates, helping mix the tPA and dissolve the clot. In as little as 30 minutes, we can remove the clot." Early Referral Although swelling, pain, abnormal warmth and discoloration of the leg are telltale symptoms of DVT, only approxi- mately half of all patients present with these — many cases are silent and only cause symptoms once clots have broken off and caused pulmonary embolism. Referral to the Minneapolis Vein Center can prevent serious complications from DVT. Early detection and patient selection is very important. "Once clots become chronic — that is, they have lasted for four to six weeks — they're difficult to treat, even with tPA," Dr. Gomes explains. "They become part of the vein wall, which complicates removal. Attempting surgical removal only exacerbates the condition and can catalyze the formation of more clots. It's best to treat clots at the acute stage, so we advocate proactive therapy — especially with younger patients because it's extremely likely they'll experience recurrent DVT and PTS as the clot lingers." She adds that IPMT can be used for a broad swath of the patient population — including seniors and patients with morbid obesity — and can be used even in patients at high risk for bleeding complications. For more information about Minneapolis Vein Center or to refer a patient, visit www.mplsvein.com or call 763-398-8710. ■ A NEW MINIMALLY INVASIVE TECHNIQUE PROMOTES EARLY RESOLUTION OF DEEP VEIN THROMBOSIS (DVT) AND CAN PREVENT LIFE-THREATENING CONDITIONS, SUCH AS PULMONARY EMBOLISM (PE) AND THE VERY DEBILITATING POST-THROMBOTIC SYNDROME (PTS). Benefits from Early Intervention Deep Vein Thrombosis: VASCUL A R+CA R E The first step of isolated pharmacomechanical thrombolysis is to isolate the clot (Figure 1). Tissue plasminogen activator is then injected directly into the clot through the catheter's drug infusion holes (Figure 2). The clot can then be suctioned out (Figure 3). Figure 1 Figure 2 Figure 3 PHOTOS COURTESY OF COVIDIEN By Michael Ferguson 1 2 | Minnesota MD NEWS ■ M D N E W S . CO M

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