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Analysis: Device, Drugs Bust Leg Clots

Posted on: Friday, 2 March 2007, 18:00 CST

By ED SUSMAN

Doctors said Friday that combining treatment with a device and potent clot-busting drugs can break apart and remove life-threatening blockages in leg veins.

The minimally invasive procedure that requires just a small incision in the groin can prevent those clots from traveling to the lungs and causing a pulmonary embolism that can be fatal, doctors explained at the 32nd annual meeting of the Society of Interventional Radiology in Seattle.

We were able to completely remove these clots in 51 percent of the cases and reopened these blockages enough to allow adequate blood flow in another 31 percent of the cases, said Mark Garcia, interventional radiologist at Christiana Care Health System in Wilmington, Del.

The clots often occur in patients following surgery or in individuals who are immobilized due to traumatic accidents. There are also medical conditions such as cancer that make individuals prone to clotting.

These deep vein thrombosis events occur as many as 600,000 times in the United States each year and are usually treated with drugs such as heparin. The problem with heparin, Garcia told United Press International, is that heparin doesn't break up the clot. It just tries to keep the clot from getting bigger.

After imaging studies locate these deep vein thromboses, Garcia goes after them with a catheter and the AngioJet Thrombectomy device, developed by Possis Medical Inc. of Minneapolis. Garcia loads the AngioJet with tissue plasminogen activator (tPA), the clot-busting drug developed by Genentech in South San Francisco, Calif.

Under X-ray guidance the catheter is advanced through leg veins to the site of the blockage, the tPA is released and the AngioJet's actions help break up, pull apart and vacuum out the clot material, opening the vein.

The treatment also had a positive impact on patients' quality of life, Garcia said. It relieved symptoms such as pain and swelling, as well as greatly improving their ability to be active.

Patients in the study had extensive, large volume deep vein thromboses that commonly ran the length of the leg from the ankle to the pelvis, and often into the vena cava. Although the body may eventually dissolve clots, in the time needed to do so, permanent damage to the vein may occur, causing permanent disability and pain.

In addition, previous studies have shown that clots in the larger veins will rarely clear on their own.

This new combination technique offers a significant advancement in the treatment of deep vein thrombosis, often allowing the interventional radiologists to break up the clot in one treatment. It has worked on even the largest, most difficult clots and could become the new standard technique, potentially changing the way all DVT patients are treated, said Garcia.

Deep vein thrombosis has been a problem for a long time, and our efforts to get rid of this dangerous problem has not really been very good, Robert Vogelzang, professor of radiology at Northwestern University School of Medicine in Chicago, told UPI. "We know that if we treat these vein blockages early we can prevent not only the life-threatening clots that go to the lungs but we can prevent long-term damage to the legs.

The success shown today by Dr. Garcia indicates that this type of intervention is probably ready for prime time, he said.

Garcia said that, in addition to the advantages to the patients, quickly resolving the clots can result in shortened hospitalization stays and less need for specialized intensive care, thus reducing costs.

Source: United Press International

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