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The Cutting Edge

Vacuum Device Offers an Innovative Approach to Remove Blood Clots

Todd Dunlap, 62, arrived at the emergency room of Ronald Reagan UCLA Medical Center in August 2013, suffering from shortness of breath, fatigue and extreme cold. When a CT scan revealed a 24-inch clot that streteched from his legs into his heart, doctors feared the mass could break loose and lodge in his lungs, blocking oxygen and killing him instantly.

John Moriarty, MD (FEL ’10, ’11), gave his patient a choice. Dunlap could have open-heart surgery or undergo a new minimally invasive procedure using a device called AngioVac to vacuum the massive clot out of his heart. The procedure, however, had never been successfully done in California.

AngioVac cannula  
The AngioVac cannula is guided through a vessel to the site of the clot and then connected to a heart-bypass device to create suction.
Illustration: Courtesy of Angiodynamics
 

A new grandfather, Dunlap didn’t hesitate to choose; he underwent the AngioVac procedure a few days later. A week after that, he was back home, full of energy and eager to play on the floor with his 9-month-old grandson.

To perform the procedure, a team of UCLA interventional radiologists and cardiovascular surgeons slid a tiny camera down Dunlap’s esophagus to visually monitor his heart. Next, they guided a coiled hose through his neck artery and plugged one end into his heart, against the clot. They threaded the other end through a vein at the groin and hooked the hose up to a powerful heart-bypass device in the operating room to create suction.

“Once in place, the AngioVac quickly sucked the deadly clot out of Mr. Dunlap’s heart and filtered out the solid tissue,” says Dr. Moriarty, an interventional radiologist with expertise in clot removal and cardiovascular imaging. “The system then restored the cleansed blood through a blood vessel near the groin, eliminating the need for a blood transfusion.”

“Retrieving a clot from within the heart used to require open-heart surgery, resulting in longer hospitalization, recovery and rehabilitation times compared to the minimally invasive approach provided by the AngioVac system,” says Murray Kwon, MD (FEL ’08), a cardiothoracic surgeon who collaborated on Dunlap’s procedure.

  Dr. John Moriarty examines Todd Dunlap
  Dr. John Moriarty examines Todd Dunlap following Dunlap's successful AngioVac procedure.
Photo: Nancy Williams

Similarly, a clot-busting drug known as a tPA typically takes three to four days to work. In Dunlap’s case, his physicians tried tPA first, but it failed due to the clot’s large size and density.

“The AngioVac was a last resort for Mr. Dunlap,” says Dr. Moriarty. “The clot clogged his heart chamber like a wad of gum in a pipe. Every moment that passed increased the risk that the clot would migrate to his lungs and kill him. We couldn’t have asked for a better outcome.”

Like Dunlap, roughly one in 500 Americans suffers from blood clots in the leg veins, a condition called deep-vein thrombosis. Estimates double in people older than 80. Nearly 100,000 Americans die each year when a clot breaks away from the bloodvessel wall and lodges in the lungs or heart. In one of every four cases, sudden death is the only clue an individual is suffering from the condition.

“When you hear about new cutting-edge options, it gives you hope,” says Dunlop’s wife Cheryl. “Without it, you run into a brick wall. If we’d consulted only with our community hospital and not a teaching facility like UCLA, we wouldn’t have learned about all the treatment choices available to us.”

 





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