With confident strides and quick pace, Laura Resnansky takes the
steps of the famously-steep Lyon Street stairs in San Francisco, in
training for a half marathon. She's not showing any signs of being
winded, and it's a 288-stair climb.
Eighteen months ago, Resnansky would not have attempted the
demanding workout. Then, deep inside a vein in her left leg was a
blood clot that first appeared a few months earlier when she was 20
weeks pregnant. With blood flow blocked by the clot, her leg swelled
to twice its size. She was in constant pain. Her doctor prescribed
medication to thin Resnansky's blood and, as another precaution,
advised Resnansky to spend the last half of the pregnancy on bed rest
to keep her leg elevated.
The pain in her leg lessened, but a few months after her daughter was
born and Resnansky stopped taking the blood thinning medication, her
leg swelled again and the pain returned.
This time, Resnansky went to see Lawrence
"Rusty" Hofmann, MD, at Stanford Hospital &
Clinics. Hofmann is a radiologist, a physician focused on the art of
seeing inside the body. But, more importantly to Resnansky, Hofmann is
an interventional radiologist, someone who is focused on creatively
combining radiology's precise vision with medical devices revamped to
very small scale to offer proactive treatment of blocked veins.
Seeing more clearly
What Hofmann discovered, with a CT scan of Resnansky's leg, was
that, despite the blood thinners, the original clot was still there.
And, it had grown to block most of the flow out of her vein. To help
Resnansky, Hofmann used an innovative treatment approach designed to
treat both recent and older clots, once thought untreatable, in the
millions of people whose veins become blocked by blood clots. The
clotting phenomenon is known as deep
vein thrombosis, commonly referred to as DVT. The condition's
most lethal possibility is that a clot will break lose and travel to
the lung, heart or brain.
More than 15 million Americans suffer from some form of the disease.
Each year sees another 600,000 cases of DVT. An estimated 100,000 die
annually from complications related to the disease.
Clots appear for several reasons; many form after a traumatic injury
to the body followed by long periods of low-activity recovery. DVT can
also appear in women taking oral contraceptives, or, like Resnansky,
when they are pregnant. Other clots form and remain to cause chronic
pain and loss of mobility or function. Until now, that on-going,
chronic DVT has been considered untreatable.
For many years, the standard treatment for all clots was to thin the
blood, said Hofmann, who is also chief of the Hospital's Division of
Interventional Radiology. That approach, he said, "was the
equivalent of someone coming in and saying, "I'm not feeling
well,' and the doctor saying, 'You have cancer. Here's a pill.' What
we can do now is stage a clot, look at it, and understand that it's a
combination of biology and anatomy."
Using advanced CT scans to locate each clot in the geography of each
patient's body now makes it possible to do much more than prescribe
blood thinners, Hofmann said. He discovered that Resnansky's clot was
May-Thurner Syndrome, the result of a physical anomaly in the veins of
the abdomen and leg. One vein compresses another, which slows blood
flow and raises the odds of repeated blood clots.
Putting Resnansky on blood thinners for the rest of her life was not
what Hofmann wanted to do. Instead, he placed her under conscious
sedation, found the appropriate vein at the back of her left leg and
made an incision small enough to be covered after surgery with a
band-aid. In went a catheter that would carry the wire Hofmann would
use to break through the old clot. Later, the catheter would also
carry a stent, a mesh tube that Hofmann would leave in the place where
Resnansky's vein had been blocked and narrowed by compression. The
stent would not only strengthen the vein but also help prevent future clots.
Throughout the entire procedure, Hofmann would be able to track, with
real time x-rays, the progress of the catheter and the wire.
Resnansky went home the same day. Breaking up her clot was
relatively easy. For others, whose clots have been in place for years
and for whom no treatment was believed possible, Hofmann has offered
hope. "These older clots were obstacles no one could get through,
where the clot had completely occluded the vein and the vein almost
disappeared," Hofmann said, "or, you'd see some small tiny
veins where big ones used to be. The difficulty was getting through
this blockage." He joked about interventional radiologists being
"the MacGyvers of medicine," recalling a 1980's television
character who saved every episode by ingeniously transforming a highly
original combination of objects into something completely different.
Catheters have been used to enter many parts of the body. Wires have
been used for other medical procedures. Balloon angioplasty has long
been part of cardiovascular care. CT scans were used for a variety of
imaging purposes. Stents have been important repair components.
"We've been able to take things used in one part of the body and
use them with DVT," Hofmann said. "We knew we could treat
chronic DVT if we had better devices."
Other innovations lower the odds of possible long-term effects. The
new CT scans reduce the amount of radiation a patient receives. For
recently formed clots, Stanford physicians now use a kind of soaker
hose delivery of blood thinners that keeps the chemistry focused on
the clot. "We can give the patient the drug right where it needs
to be," Hofmann said. "And if we remove the clot quickly the
vein doesn't become completely blocked."
Some of Hofmann's chronic DVT patients have flown in from outside
the U.S. to take advantage of these new techniques and the special
equipment, available at Stanford and only a handful of other medical facilities.
Resnansky is doing great, she said. "I feel like I don't have
the limitations or the concerns I had. I'm healthy and I'm taking care
of myself. I try not to worry about it." Hofmann has told her the
stent will probably last about 10 years. She'll see him once a year
for a special look at the vein. "It could have been something far
worse," she said. "If it does happen again, I know it is
treatable and that gives me peace of mind."
She's an active mother. Her son, Hayden, 5, is constantly curious.
Margaret, almost 2, still likes to sit on a parental hip. Resnansky is
also associate director of clinical program management at a Bay Area
biotechnology company. And she's training for that half-marathon.
She thinks, too, about others with DVT, those who might be treated
with these newer techniques. "It's a shame more people don't know
about this," she said. "It changes the quality of life significantly."