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North Shore Team Saves Patient with Massive Clot

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As summer approached, Felicia Ianniello thought her most pressing health issue was her bleeding uterine fibroids. She was busy caring for her family and working long hours, and when she had a moment to recognize that she was feeling fatigued and vaguely unwell, she blamed her fibroids. 

It was almost Memorial Day when Ms. Ianniello developed severe back pain that radiated upward from the small of her back. Her primary care physician told her she was anemic and might have pneumonia. He gave her a prescription and she went home to bed. After 48 hours she got up to visit the bathroom — and could not urinate. That’s when she realized that something was terribly wrong. 

Ms. Ianniello went immediately to Glen Cove Hospital, her community hospital and part of the North Shore-LIJ Health System. She underwent a computed tomography (CT) scan, and through a haze of pain she heard the technician say, “Don’t move. Don’t cough. I’ve got to get a doctor to look at this.” The next thing she knew, she was in an ambulance, headed for North Shore University Hospital. The likely diagnosis? Deep vein thrombosis.

While clots vary in size, Ms. Ianniello’s was massive — “larger than I’ve ever seen,” said Craig Greben, MD, chief of vascular and interventional radiology at NSUH. “It extended from the veins in her groin all the way up the inferior vena cava [the large vein that receives blood from the pelvis, abdomen and lower extremities] to the threshold of her heart.”

Treatment began immediately. “Not only was there the danger of a massive, potentially fatal pulmonary embolism, but the kidneys couldn’t drain and were on the verge of shutting down,” Dr. Greben said.

Pulling Out All the Stops

Over seven days, interventional radiologists, nephrologists, hematologists, gynecologists, internists and the staff of the intensive care unit (ICU) fought to save Ms. Ianniello, employing the most sophisticated pharmacologic and mechanical therapies. A special catheter called a Trellis was threaded through her groin directly into the clot and began to macerate it (chop it up). At the same time, tPA (tissue plasminogen activator, known as the “clot-busting” drug) was dripped into the clot. Interventional radiologists employed tiny balloons on the ends of catheters to open up Ms. Ianniello’s clogged blood vessels, all while she hemorrhaged from her fibroids, necessitating almost continuous blood transfusion.

While Ms. Ianniello remembers long stretches of almost indescribable pain, she walked out of the hospital after about a month. Before she was discharged, Dr. Greben embolized her fibroids to stop the bleeding; the minimally invasive procedure, performed by interventional radiologists, essentially starves the tumors by cutting off their blood supply.

Halloween has passed, and Ms. Ianniello is picking up the pieces of her life. She’s back at work, although not full time. “It’s amazing, but not long ago I’d never even heard of deep vein thrombosis,” she said. She is grateful both to the Glen Cove Emergency Department staff who recognized she needed the very highest level of care right away and to Dr. Greben and the North Shore University Hospital team, who gave her their best.

“I may have lost the summer,” she said, “but I’m very fortunate not to have lost my life.”

About DVT (Deep Vein Thrombosis)

In 2005, March was officially recognized as Deep Vein Thrombosis Awareness Month, in memory of NBC correspondent David Bloom. While covering the war in Iraq, the journalist died suddenly of a fatal embolism, a frequent complication of DVT. Despite the headlines regarding Mr. Bloom’s passing, most people still have little or no awareness of this condition, which affects up to two million Americans a year and hospitalizes more than 600,000, according to Craig Greben, MD, chief of vascular and interventional radiology at North Shore University Hospital.

DVT is the formation of a clot in the deep venous system, usually in the leg. (Arteries carry oxygenated blood out to the extremities and veins carry deoxygenated blood back to the heart.) The clot, or thrombus, can produce symptoms such as pain, swelling, heat and redness. Report these to your physician if they persist. When a piece of the clot detaches from the vein it can become a life-threatening pulmonary embolism. If a clot is undetected, over several years the veins can become incompetent: Their valves stop working and the blood refluxes backward down the veins, eventually causing tissue breakdown.

DVT risk increases with age. Clotting abnormalities, cancer, obesity, heart failure, smoking, a sedentary lifestyle and trauma to the area can be contributing factors, according to Dr. Greben. Air travelers, particularly during long flights, should take the following precautions: Get up and walk the aisles from time to time, stay hydrated and skip the alcohol.


 

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