Amazing Interventions – IR’s role in treating DVT
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Amazing Interventions – IR’s role in treating DVT


my name is Jerry O’Sullivan I’m an
interventional radiologist from Galway in Ireland and today I’d like to talk a
little bit about the interventional radiological procedures that we offer
most of the procedures that we offer our day case minimally invasive
state-of-the-art procedures which are very time effective for the patient are
typically low risk and are very cost effective for healthcare systems so it
is fair to say that interventional radiology represents 21st century
surgery deep vein thrombosis and pulmonary embolus are major healthcare
issues and pulmonary embolus on its own kills more patients than road traffic
accidents AIDS and breast cancer combined this is
a completely underrepresented area of focus for healthcare delivery this
particular patient is a young female who was unfortunate enough to suffer too
serious iliofemoral deep vein thrombosis in her 20s what this meant for her as a
patient is that her left leg became very heavy and useless running really wasn’t
an option for me and even fast paced walking would lead to the tightness
and throbbing my leg eventually I would be limping sitting down for long periods of
time I would get that throbbing and tightness as well that would be my
warning signs to get up and move around and let the blood flowing freely again
she was admitted to our interventional radiological unit for a day case
procedure over the course of a two hour procedure we reconstructed the patient’s
veins in her pelvis so that blood flowed in the correct orientation and correct
direction when you were approaching somebody with an iliofemoral venous
occlusion you need to identify the anatomy in order to determine your
puncture point and in this particular patient we performed a direct CTV in
other words through an injection in her pedal veins and tonica’s on her ankle
and thigh and this demonstrates the anatomy to the best extent because of
the multiple puncture points and the frequent discomfort associated with this
we performed it under general anaesthetic and in this instance we
punctured the right internal jugular vein the right common femoral vein and
the left femoral vein in the mid thigh as you can see from these images we
eventually connected the areas with flow from above and below and then performed
high pressure balloon angioplasty followed by stenting using dedicated
purpose-designed venous stents and the end results are sensational
as you can see from the images the completion angiography using rotational
imaging shows excellent inline flow from a caudal injection towards the heart the
patient went from a position of having a very high pressure leg to a normal leg
and the patient’s symptoms improved dramatically even within four hours of
the procedure she was fit for discharge that afternoon and in fact joined us for
dinner that evening the purpose of describing this operation and this
patient’s experiences is to raise awareness of what interventional
radiologists can do for patients with iliofemoral venous thrombosis in terms
of reconstruction of their venous segments iliofemoral deep vein
thrombosis is currently vastly under treated all over the world each year
less than 1% of people are offered an appropriate treatment for this disease
and as interventional radiologists we are ideally situated to improve this
situation for these patients these procedures are low-risk and have a high
success rate with good long-term results most importantly the biggest downside
for the patient is that if the procedure fails they’re back to their original
situation there are no worse off that’s very important to understand therefore
in my view this procedure offers huge benefits for patients who are typically
young and whose lives are seriously affected by this condition I can now
exercise my two legs feel the same I don’t have
tightness my legs not too solid it doesn’t throb when I exercise in fact I
now have normal muscle tone so it’s completely changed my quality of life and I am thrilled with the results and am really pleased that I had it done this patient had been told by several
different specialists over several years that she should just get on with her
life and forget about the fact that her leg was blocked in fact she was told to
exercise the other leg to build up the muscles so that it was the same size as
the swollen leg this kind of thinking and teaching has no place in modern
medicine as interventional radiologists we have the ability and the technology
to overcome these challenges and reconstruct patients veins and arteries
to bring them back the quality of life that they deserve I was delighted that
my team and I were able to offer this patient a procedure which has
transformed her life

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