Minimally invasive vein treatment provides solution for two young mothers

A Clear Path

The formation of a blood clot in a vein deep in the body, known as deep vein thrombosis (DVT), can be debilitating and even life-threatening if left untreated.

Up to 45 percent of patients with DVT develop post-thrombotic syndrome (PTS) in which a vein becomes scarred and blocked. The resulting limited blood flow can lead to chronic pain in the leg or pelvis, swelling, itching, heaviness, skin discoloration or leg ulcers.

Most patients with chronic DVT and PTS are treated with blood thinner medications to prevent new blood clots from forming. Unfortunately, blood thinners are ineffective at dissolving an existing blood clot, leaving the patient prone to worsened quality of life, painful symptoms, recurrent DVT and life-threatening pulmonary embolism, in which the clot breaks off and travels to the lungs.

The interventional radiology team at Inova Alexandria Hospital offers an advanced, minimally invasive treatment where it reopens these chronically occluded (or blocked) veins for patients who have been unable to find help through conventional therapies.

“To treat patients with chronic DVT and PTS, we can perform a catheter-based treatment with a specialized technique where we create a channel through the blocked vein, perform angioplasty (stretching the vein open with a balloon) and then utilize the EKOS EkoSonic® Endovascular System to deliver clot-buster medications,” says Keith Sterling, MD, Director of Cardiovascular and Interventional Radiology at Inova Alexandria Hospital. “We have seen tremendous success with this technique.”

Keeping the Flow

For Lauren Kuen, the procedure changed her life in ways she could not have imagined. When Kuen, 32, was in her late twenties and pregnant with her first child, she went into labor early. Her son was born prematurely and passed away shortly after birth.

Having been on bed rest for many weeks, Kuen developed DVT in a vein in her pelvis, causing swelling and heaviness in her left leg. The symptoms lasted for a year, and despite seeing numerous doctors, the problem lingered. Kuen and her husband yearned to start a family, but fearing complications from the DVT, they put their plans on hold. It wasn’t until Kuen’s hematologist referred her to Dr. Sterling that her dream became a reality.

To successfully restore blood flow to Kuen’s vein, Dr. Sterling performed ultrasound-accelerated thrombolysis, which involved inserting a catheter through the left iliac vein in her pelvis into the DVT. The catheter emitted ultrasound energy to loosen the blood clot. The doctor then delivered a clot-busting medication called tissue plasminogen activator (tPA) through the EKOS catheter to dissolve the clot. Using stents, he propped open the vein to permit normal blood flow. Placing the catheter into the clot allows the team to use a low dose of tPA, which more effectively and safely eliminates the clot, Dr. Sterling says.

The swelling in Kuen’s leg resolved and her ability to exercise increased. Kuen now has a healthy baby boy who was born at Inova Alexandria Hospital. “I’ll always think of  [Dr. Sterling] when I look at my son and know that he was a part of the reason that we have him and that he’s here and healthy and that I’m healthy.”

Solving the Problem

For 47-year-old nurse Marni Plaster, reopening her chronically occluded veins restored her life back to normal. More than a decade ago, Plaster developed extensive DVT involving her pelvis and her leg following childbirth. She was treated with blood thinners for several months, and while her condition improved at first, she spent the next 11 years suffering from chronic pelvic pain, and swelling and discomfort in her left leg.

“It was a continuous dull aching and then intermittent stabbing pain,” recalls Plaster. “It limited my physical activity and it was very fatiguing dealing with that all the time.”

At one point, Plaster was diagnosed with endometriosis and underwent a hysterectomy hoping the surgery would eliminate the non-stop pain in her pelvis. But the aching persisted.

“Nobody had looked at the blood vessels in my abdomen or thought those were the problem,” she says.

Things changed when Plaster met Dr. Sterling. Suspecting the problem was related to the veins in her pelvis, Dr. Sterling ordered a CT scan, which confirmed she had severe PTS. To promote normal blood flow, Dr. Sterling placed a catheter in the iliac vein in her left pelvis, administered a thrombolytic to dissolve the blood clot, then performed a balloon angioplasty and placed stents to keep the vein open. Within one week following the surgery, Plaster was back to work. She was also able to stop taking blood thinners after the procedure. “Dr. Sterling was great and so was the hospital,” says Plaster. “I’m able to be physically active and I exercise and I don’t have to worry about that anymore.”

CLINICAL TRIAL

The interventional radiologists at Inova Alexandria Hospital are offering the ACCESS PTS study to evaluate the safety and efficacy of ultrasound-accelerated thrombolysis in conjunction with balloon angioplasty and stents for patients with chronic DVT and PTS. To learn more about this clinical trial, visit chronicdvtstudy.com.

What Is Interventional Radiology?

Today, many conditions that once required surgery can be treated less invasively by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery.

The interventional radiologists at Inova Alexandria Hospital are board-certified physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-rays, MRI and other imaging to advance a catheter in the body, usually in an artery, to treat the source of the disease. Learn more at www.inova.org/iahcvir.

Interventional radiologists at Inova Alexandria Hospital

• Sandeep Bagla, MD
• James Cooper, MD
• Dimitrios Papadouris, MD
• Kenneth Rholl, MD
• Keith Sterling, MD
• Venu Vadlamudi, MD
• Arina Van Breda, MD

Visit www.inova.org/physicians/ to find a doctor based on location, hospital, specialty and more. For interventional radiologists, select the specialty “Vascular and Interventional Radiology.”

Preventing DVT

Deep vein thrombosis (DVT) can occur if you are inactive for a long period of time. Other factors include obesity, pregnancy, a disease such as cancer (and some of its treatments), heart disease and hereditary factors. To prevent DVT, experts recommend the following steps:

• Get moving. If you have been inactive for a long period of time, such as after an accident, an illness or surgery, get moving as soon as you can.
• Need to sit for long periods? Move your legs and stretch your feet.
• Stay active. Exercise regularly. If traveling by car, stop every hour and walk.
• On a plane or bus, walk in the aisles.
• Choose healthy habits. Drink plenty of fluids and avoid alcohol and tobacco.