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.

Ticking time bomb: Screening saves Tucson woman from “silent killer”

The only time Barbara Unger spent time in the hospital as a patient was when she had her two babies.  At 82 years old, that’s pretty impressive.

The retired secretary and bookkeeper was diagnosed with an abdominal aortic aneurysm many years ago during a routine checkup.  The aorta is the main artery that carries blood from the heart, and stretches down into the rest of the body.  In Barbara’s case, the wall of the aorta was permanently ballooned out in her abdomen due to the pressure of blood passing through.  If it ruptured, the results could have been catastrophic.

Dr. Thomas Lindow,Internal Medicine

Dr. Thomas Lindow,
Internal Medicine

After the diagnosis, her aneurysm wasn’t monitored until she switched primary care physicians in May 2010.

Luckily she did.

Her new PCP, Dr. Thomas Lindow, ordered an ultrasound right away.  “The moment we got the results, I saw instantly that it had to be repaired.  I immediately referred her to Dr. Matthew Namanny at Saguaro Surgical,” he said.

“I was very happy to have seen Dr. Lindow.  I’m so grateful he told me how serious the situation was getting,” said Barbara.  Dr. Namanny ordered a CT scan and determined that she needed surgery.

Dr. Matthew Namanny,Saguaro Surgical

Dr. Matthew Namanny,
Saguaro Surgical

During the procedure at Tucson Medical Center, Dr. Namanny placed a small catheter in Barbara’s groin, and used it to insert a stent in her aorta.  This removed the pressure that was causing the aneurysm, and eliminated the chance of it rupturing.  Barbara slept through the entire thing.  “I had no pain, no problem at all.  It was very simple.  I stayed overnight, and went home the next day.  It was as pleasant as a hospital stay can be.  TMC was very accommodating and the nurses took good care of me.  We laughed a lot,” she chuckled.   The surgery was a success.  She’ll just need an annual screening from now on to make sure everything is okay.

Barbara is one of the lucky ones – although she doesn’t quite fit the mold of who abdominal aortic aneurysms affect most often.  “This disease is typically found in older, white men who smoke,” said Dr. Namanny.  Family history also plays a major role.  “I tell every patient who has this, ‘Go tell your siblings, and notify your children.  When they’re about 40 years old, they need to get screened for this,’” he said.

That screening is absolutely essential, and is usually covered by insurance.  Since these aneurysms often don’t present any symptoms, they can go undiagnosed until they rupture and become fatal.  Fortunately, improvements in technology have made it easier for physicians to detect and treat them.

What used to require an open operation followed by a 7-10 day hospital stay, can now be accomplished in one day.  And since the procedure is less-invasive, physicians can operate on older patients who wouldn’t have been able to tolerate the surgery in the past.

For more information on abdominal aortic aneurysm screening, click here.

For information to help you determine if you should get a screening test, click here.

Peripheral arterial disease is no walk in the park

Between 8 million and 12 million people in the United States, especially those over age 50, suffer from peripheral arterial disease, or PAD, but many people are unaware of it because the disease, which raises a person’s risk of stroke or heart attack, doesn’t always have symptoms.

September is Peripheral Arterial Disease Awareness Month and we encourage you to learn more about this condition. According to Healthwise Knowledgebase “PAD is narrowing or blockage of arteries that results in poor blood flow to your arms and legs. When you walk or exercise, your leg muscles do not get enough blood and you can get painful cramps. PAD, also caused peripheral vascular disease, is a common yet serious disease that raises the risk of heart attack and stroke.”

PAD does not always cause symptoms, so many people may have PAD and not know it. People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.

“If you have any risk factors for PAD or have any unexplained pain or cramping in your legs, you really should discuss this with your healthcare provider,” says Karen Reinhard, N.P., vascular surgery nurse practitioner. “PAD can not only affect your quality of life but can lead to more serious complications and there are a number of lifestyle changes, treatments, and interventions that can really make a difference.”


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