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DEVICE MAY PREVENT DEATH IN TRAUMA PATIENTS AT RISK FOR PULMONARY EMBOLISM
ORLANDO, Fla. -- Pulmonary embolism, a potentially deadly blood clot that lodges in a lung artery, can be prevented in some trauma patients by implanting a tiny filter that serves as a catcher's mitt to snare a clot before it becomes life-threatening, according to research presented here today at the 24th Annual Scientific Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR).
"If pulmonary embolism isn't diagnosed and treated quickly, often it is fatal," said Ziv J. Haskal, M.D., associate professor of radiology at the University of Pennsylvania Medical Center, Philadelphia. "Unfortunately, the problem can be difficult to diagnose, and there's no way to predict exactly who will develop it. However, we've found that certain trauma patients are at high risk for pulmonary embolism, and if we implant a vena caval filter automatically, we can prevent the problem and likely save lives."
It is estimated that about 5 percent of hospital deaths can be attributed to pulmonary embolism and up to 30 percent of people who develop the problem die. The problem can occur as a result of a series of events:
A blood clot can develop in the leg or pelvis as a result of slow-moving blood. Patients recovering from fractures caused by severe trauma, such as car accidents, falls or physical abuse, are confined to bed rest for lengthy periods, and are therefore at high risk for developing blood clots. Other risk factors for developing clots include being pregnant, taking oral contraceptives, having high blood pressure, being a heavy smoker or being immobilized for long periods of time, such as after surgery.
The blood clot may break off and travel to a lung, where it lodges in an artery and can cause a cascade of problems, including obstruction of blood flow. As many as 1 in 5 trauma patients develop pulmonary embolism.
In the University of Pennsylvania Medical Center study, 100 trauma patients considered at high risk for pulmonary embolism were given vena caval filters, implanted using a minimally invasive technique. Three of them subsequently developed blood clots in leg veins. It is unknown how many would have developed pulmonary embolism.
"While it's novel to suggest patients who haven't even developed blood clots be given filters preventively, it can save lives, and I think it will become widespread," said Dr. Haskal. "It's a very low-risk procedure."
The filter is implanted by an interventional radiologist, who uses a moving X-ray (fluoroscopy) as a guide to see inside the body. The interventional radiologist makes a *-inch nick in the groin, neck or elbow, and inserts a spaghetti-thin catheter, advancing it to a large vein in the abdomen, where the tightly wound vena caval filter is deployed. The filter acts like a sieve, letting blood rush through, but capturing large clots. The rushing blood breaks down any clots caught in the filter. The procedure is performed while the patient is lightly sedated and typically takes about 20 minutes.
"More research needs to be done, but in patients like these who can't take advantage of other preventive measures such as blood thinners, it looks like a very good option," said Dr. Haskal.
Each year, more than 2 million people are treated for severe trauma-related injuries.
Dr. Haskal's co-authors of a paper on the topic being presented at the SCVIR meeting are Atanu Prasad, M.D.; Patrick Reilly, M.D.; Michael F. Rotondo, M.D.; Manu Sehgal, M.D.; and Catherine Tuite, M.D.
An estimated 5,000 people are attending the Annual Scientific Meeting in Orlando, Fla., of SCVIR, a professional society based in Fairfax, Va., for physicians who specialize in minimally invasive interventional procedures.
An interventional radiologist is a physician who has special training to diagnose and treat illness using miniature tools and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incision, less pain and shorter hospital stays.
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Copies of 1999 SCVIR news releases are available online at www.pcipr.com/scvir beginning Monday, March 22.
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