No one expects to break new ground simply by showing up at the emergency room, but a man in California did just that when he arrived at a UCLA Medical Center with a 24-inch clot lurking in his blood vessels.
It wasn’t the size of the clot, though, that made this a unique case. It was the way in which doctors removed it, opting for a minimally invasive alternative to open-heart surgery.
“This is the first successful use of AngioVac in California,” says John Moriarty, M.D., the patient’s lead surgeon. “Large clots like this would probably have previously required open surgery.”
A Clot Stretches from Leg to Heart
The patient, Todd Dunlap, 62, showed up at the ER in August complaining of tiredness, shortness of breath, and extreme cold. During a CT scan, doctors discovered the blood clot, which stretched from the man’s leg into his heart.
More than a potential record-setter, this type of clot can break free from the walls of the blood vessel and get stuck in the lungs (a pulmonary embolism), cutting off the supply of oxygen and killing the patient immediately.
The AngioVac device, manufactured by Vortex Inc., is designed to remove these types of large blood clots—as well as tumors or foreign material—from blood vessels. It consists of a tube with an expandable, funnel-shaped tip that can be inserted into a blood vessel in the neck or near the groin.
During Dunlap’s procedure, surgeons first fed a small camera down his throat to monitor his heart. Next, they inserted a tube through an artery in his neck and into the heart, with the end pressed against the clot. They threaded the other end of the tube through a vein in his groin, and hooked the tube up to a heart-bypass machine, which provided suction.
When opened, the tip of the AngioVac tube captured the blood clot, along with any solid materials. The man's blood was filtered and then fed back into his body through the vein near his groin, eliminating the need for a blood transfusion.
A Faster Alternative to Surgery
Dunlap’s procedure took three hours, and he was released from the hospital within a week—with three days in intensive care. A week after surgery, Dunlap was home with his family and playing on the floor with his nine-month-old grandson.
Open-heart surgery to remove large blood clots from the heart and blood vessels can take twice as long. In order to access the heart, surgeons need to cut the breastbone in half along its length and spread apart the ribs. Afterward, the ribs must be wired together to hold them in place until they and the breastbone heal.
Because it is so invasive, recovery from open-heart surgery takes much longer than from the minimally invasive AngioVac procedure.
Even clot-busting drugs, such as tissue plasminogen activator (tPA), can take up to four days to break up a clot. Dunlap’s surgeons tried using tPA before AngioVac, but it didn’t work because the clot was so long and so dense.
Deep Vein Thrombosis and Pulmonary Embolism
The type of blood clot that developed in Dunlap—deep vein thrombosis—often forms in the large veins of leg. They can result from sitting still for long periods of time, such as while traveling by plane or car. Other risk factors include blood-clotting disorders, injury or surgery, taking birth control pills, and smoking.
According to the Centers for Disease Control and Prevention, an estimated 300,000 to 600,000 Americans develop deep vein thrombosis or a pulmonary embolism each year. These types of clots are much more common in the elderly.
Up to 100,000 Americans die annually from these conditions. In 25 percent of people with a pulmonary embolism, sudden death is the first and only symptom.
AngioVac for 'Large Clots in Dangerous Locations'
AngioVac is fully approved by the FDA, but like all new devices, it is still undergoing evaluation. While it played a big part in Dunlap’s speedy recovery, it may not work for all patients.
“For people who have large clots in dangerous locations, [AngioVac] has a big role,” says Moriarty. “Pretty much anyone with a large clot, however, should be evaluated by someone who works inside the blood vessels regularly, like an Interventional Radiologist, to see if this procedure or others like it might be of use to them.”
At the moment, AngioVac is only available at larger medical centers.