Three little letters spelled big trouble for Kelly Wilkinson last spring after she had shoulder surgery. Wilkinson developed a dangerous blood clot known as a deep vein thrombosis — DVT — in her lower right leg. Clots like this are potentially life threatening because they can break apart, sending bits and pieces tumbling through the bloodstream where they can become lodged in a vessel, creating a logjam that cuts off blood flow to the heart, lungs or brain.
Perhaps the most famous casualty recently of DVT was NBC News correspondent David Bloom. While embedded with the 3rd Infantry Division covering the war in Iraq, Bloom suffered a DVT that sent a blood clot to his lungs. He died of a pulmonary embolism on April 5, 2003.
Standard DVT treatment puts patients on a lifetime regimen of medications commonly known as blood thinners, which prevent more clots from forming. The existing clot remains in the vein and patients always run the risk of a piece breaking off, causing a blood clot in the lungs, or less often, a heart attack or stroke. Other common complications include poor circulation in the legs, swelling and leg pain, and foot wounds that won't heal.
But a new treatment is changing that. A device known as the Trellis allows doctors to isolate the clot, administer clot-dissolving medication only to the blocked area and suction out the clot material — all in a procedure that takes a little more than half an hour.
The Trellis is unique because it uses two balloons, one deployed above and one below the clot, to keep the clot-dissolving medication only where it is needed. Dr. Vasco Marques of the Pepin Heart Center at University Community Hospital in Tampa, which is among those offering Trellis, says the clot-dissolving medication makes the clot soft so it can be vacuumed out.
Other treatments for DVT are available that put clot-dissolving medication directly in the clot, but only the Trellis system keeps that powerful medication confined to a focused area, reducing the risk of bleeding, he said.
Marques, an interventional cardiologist, has been using the Trellis for about 8 months and has treated more than 30 patients. "It's a safer way to treat DVT because the clot-dissolving drug isn't released systemically, which can be dangerous," he says.
Easy to overlook
DVTs are common in surgery patients, particularly those who have surgery on a joint such as the hip or knee. Decreased physical activity after surgery allows blood to pool in vessels where tiny, sticky red blood cells can clump together, forming a clot. They also can occur in other people who don't move for long periods of time, such as airline passengers.
It's estimated that more than 380,000 Americans develop DVTs each year.
Wilkinson's DVT developed over the course of two weeks following her shoulder surgery. Because she was not familiar with the symptoms of DVT, she dismissed a persistent cramp-like pain in her right leg as a pulled muscle. But other symptoms gradually developed, including difficulty breathing and a racing heartbeat, even at rest. She went to her family doctor, who performed an EKG and sent Wilkinson directly to the hospital. Further testing revealed a DVT in her right leg that stretched from her calf to her groin.
"I never experienced anything like that in my life," she says. Her breathing troubles were so severe, "I thought I had pneumonia."
Marques says certain people, especially those who are in treatment for cancer as well as those getting surgery, should be alert to the symptoms of DVT and not delay seeking medical care. Treatment with Trellis is only effective if the clot is discovered within six weeks of the onset of symptoms, and it is not appropriate for all cases.
Wilkinson says the Trellis procedure, performed under local anesthesia, wasn't uncomfortable. "I didn't feel anything until they turned on the (suctioning) machine and that just made my leg feel like it was vibrating," she says, "I'd do it again if I had to. And I wouldn't be afraid."
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416.
This article has been revised to reflect the following clarification:
The Trellis device is not used for all patients. Most patients will be treated with clot-busting medication alone — and often only for a few months. Dr. Kevin Sierra, director of the ICU at St. Joseph's Hospital in Tampa, says standard treatment involves putting patients on intravenous blood thinners in the hospital and then, after several days, transitioning them to oral medication, such as Coumadin, for three, six or 12 months. Some patients who are taken off the medication and then develop another DVT or a more serious pulmonary embolism, a clot that travels to the lungs, may have to remain on the drug indefinitely. Other patients who have a genetic blood clotting disorder or several lifestyle risk factors for DVT and PE may also have to remain on blood thinners for the rest of their lives.