March Internal Vascular Series: DVT

During a traffic jam, the torrent of vehicles trying to get out of the area make it nearly impossible for other cars to come in. 

Deep vein thrombosis (DVT) is like a major traffic jam in a large vein in the body, usually in the legs – except the traffic jam is caused by a blood clot that develops.  Blood can’t get into the leg because there is so much blockage with the blood trying to get out of the leg.  The result?  A leg that suddenly swells up – sometimes even doubling in size.  If the clot breaks off, it can be life-threatening if left untreated.  Pulmonary embolism (PE) most commonly results from a clot that migrates to the lung, a process called venous thromboembolism (VTE).

DVT and its complications claim the lives of more people each year in the U.S. than breast cancer and AIDS combined!  A whopping 600,000 Americans are diagnosed with DVT annually, making it the third most common cardiovascular disease.  VTE is the leading cause of preventable hospital death.

Dr. Matthew Namanny,Saguaro Surgical

Dr. Matthew Namanny,
Saguaro Surgical

With a problem this prevalent, TMC has developed one of the busiest programs in the nation for minimally invasive DVT interventions.  Vascular surgeon Dr. Matthew Namanny from Saguaro Surgical estimates 80 to 200 of these procedures are done at TMC every year.  All are done in TMC’s hybrid operating room.

DVT awareness is gaining steam, thanks to efforts on all levels, from the nationwide Coalition to Prevent DVT, to the local level – where Dr. Namanny says educating others is not just part of the job, rather a true passion for him and his colleagues.  “We must take a multidisciplinary team approach to take care of these patients.  We all have to look for them and ask about risk factors,” he said.

Namanny in action 2Driving that point home was one of the main messages of Tucson Medical Center’s internal vascular series for the month of March, which focused on DVT.  Dr. Namanny spoke to health care workers who play a role in preventing these clots at the patients’ bedside.

Who’s at risk for blood clots?  Anyone.  “I’ve had patients who were in their teens all the way to patients in their 80’s and 90’s.  It’s not just a disease that affects older people.  It does have an increased prevalence with age, people who travel and take long flights, people who are immobilized.  Patients who have had major surgery, trauma, cancer, or who have had DVT in the past also have a higher risk, as do pregnant women, and any woman on oral contraceptives,” Dr. Namanny said.

The symptoms can be very subtle, he explains, and can range from minor pain and swelling to legs that are massively swollen to the point where circulation is compromised.  If patients have had pulmonary embolism, they can also be short of breath. 

DVT is easier to treat the earlier it’s caught.  Patients are started on blood thinners right away.  If symptoms are severe, they’re evaluated for intervention and clot removal.  Treatment options have really advanced, as the problem can typically be fixed during an outpatient procedure. 

For more information about DVT, please click here.

A team approach to vascular surgery: like a “well-oiled machine”

They say “no man is an island” – and a surgeon is no exception.

Tucson Medical Center vascular surgeons are surrounded by teams of highly-trained, highly-experienced medical professionals, whether they are in the main operating room or in the catheterization lab.

The concept is simple.  Surround the surgeons with health care professionals who are so well-trained on every aspect of the procedure, they can predict what will happen next.  A team approach provides a safer, more efficient way to do things. 

Ed Salazar and Silver Palomino, TMC Special Procedure Technicians

Ed Salazar and Silver Palomino, TMC Special Procedure Technicians

Special procedure technicians Ed Salazar and Silver Palomino are key players on the OR team.  Their experience is measured in decades and their role during a procedure is invaluable.  Some of the key pieces they take care of include manning the control room and managing the software and imagery surgeons depend on while they operate. 

“The vascular department is very equipment intensive.  We have millions of dollars worth of devices we use.  They know how to use every piece, and they are a huge component in maintaining everything,” said Renee Paul, TMC Operating Room manager.  The pair has received extensive training on minimally invasive, or endovascular, procedures.

The remaining four members on this team are nurses and techs who have surgery backgrounds and therefore specialize in the open procedures.  “Our team provides a good balance because we have people with a working knowledge of both endovascular and open procedures.  It’s a wonderful complement to provide excellent care to all patients.  They will have that kind of specialty at hand, regardless of the type of procedure they’re having done,” said Paul.

TMC vascular surgeon Dr. Layla Lucas,Saguaro Surgical

TMC vascular surgeon Dr. Layla Lucas,
Saguaro Surgical

TMC vascular surgeon Dr. Layla Lucas from Saguaro Surgical said, “The quality of care is absolutely improved by having a team.  Patients have the peace of mind that everyone in the room with them knows exactly what’s going on from start to finish – not just the surgeon.  These teams are very savvy with new technology.  They are truly invested in vascular surgery and we partner with them in their commitment to provide patients the absolute best care.”

These team members offer physician and patient support.  This is especially valuable in TMC’s hybrid operating room, which can be used for a minimally invasive procedure and transformed to accommodate an open procedure in seconds if the need arises during surgery.  TMC will have a total of two hybrid operating rooms when the west campus opens up this spring.  Paul has plans to grow her team in order to accommodate the expansion. 

“Consistency from a specialized team leads to even greater patient safety,” said Paul.  “This team is comfortable with the surgeons.  The surgeons are comfortable with them.  Together, they are efficient, and work very methodically—like a well-oiled machine.”

The vascular team in the Cath Lab is much larger – about two-dozen people including nurses, radiology technologists and cardiovascular technologists.  Some of these employees have been at TMC for up to 30 years. 

“Experience matters,” said Roxanne Lee, Special Procedures/Cath Lab manager.  “This specialized team is really an asset because they take their training and knowledge and build on it.  They are so well-versed on every aspect of the procedure that they can actually recommend which piece of equipment will work best in a situation.”  The Cath Lab team is different from the OR team in that they also specialize in cardiac and radiology procedures in addition to having vascular expertise.

Both Paul and Lee said the feedback they receive is overwhelmingly positive.  “These physicians are very vocal that the team helps their cases go by quicker and easier with less stress,” said Lee.

TMC vascular surgeon Dr. Luis Leon, Agave Surgical

TMC vascular surgeon Dr. Luis Leon, Agave Surgical

“I have done vascular surgery with and without a team.  The team approach is key,” said TMC vascular surgeon Dr. Luis Leon from Agave Surgical.  “Doing a case with people who have that experience makes it so much easier because they can predict my next move, which is beneficial for everyone.  Their expertise also improves communication.  Additionally, since they’re so well trained on endovascular techniques, they can answer any questions the patient or family members may have.”


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