Killer Clots: Vacuum Them Up--In-Depth Interview
John Moriarty, MD, Assistant Professor, Interventional Radiology, David Geffen School of Medicine at UCLA, talks about a new way to get rid of blood clots.
When you first saw Todd was there anything unusual?
Dr. Moriarty: What was unusual was the size of the clot and its dangerous position. We see clots all over the body all of the time from people who have clots say in their legs all the way up into the pelvis, and that’s very common. What he had is he had a blockage which came out of his pelvis through his belly all the way up to his heart. It was pretty large and it was something that we needed to act on quickly.
Is that one single clot?
Dr. Moriarty: Yes, and it came together from both sides of the pelvis in to one single clot, which expanded all the way then up to his heart.
Have you ever seen anything like that?
Dr. Moriarty: You know every so often you see bad cases like his but his was definitely one of the biggest we had ever seen.
What is the risk to him?
Dr. Moriarty: Two main things, number one would be that the blockage would gradually get worse and would essentially stop all the blood supply back to the heart. Then, the other thing was something that we were very afraid of which would be that a little bit of this could break off or even a big part and it could move through his heart to his lungs. And if that were to happen that would instantly stop the lungs ability to get oxygen to the rest of the body and could kill him.
Was he essentially like a walking time bomb?
Dr. Moriarty: It’s something that that, it’s very difficult to predict. You know it could happen instantly, it could happen any second while you’re talking to him or it could have not happened for quite a while, we really had no idea. Certainly you know it was a big worry for him and for us.
Before this AngioVac, what would you have done?
Dr. Moriarty: So there are a couple of different options. The main one goes back for about fifty, sixty years which is where you try and thin the blood so that the body then dissolves the clot gradually over time. Then about twenty years ago, people who work in interventional radiology came up with ways of dissolving clot from the inside, which is where you put in various different catheters and tubes and try and dissolve it. And then fortunately for Todd recently we’ve developed other techniques including the AngioVac which allows us to take that working from the inside technique to the next level which is to actually to remove it all at one time which is what he had.
To put in a stent there’s always the fear that pieces will break off and then actually cause the stroke. I mean were you worried about that?
Dr. Moriarty: We were worried about it for sure, you know whenever you’re putting anything in to the body and particularly when you’re putting it in to somewhere that has a lot of clot in it, there’s always a worry that a bit will either break off or just come loose as you’re doing the job. With him that would have been a disastrous occurrence so we were pretty worried about that.
How does the AngioVac work?
Dr. Moriarty: So what it is a fancy vacuum cleaner that has two main parts; one is a sucker that you place carefully through the blood vessels to where the problem is. In this case we placed it all the way in to his heart. Then it sucks back on the clot removing the clot which passes through a kind of a filter system. Then we’re able to recirculate through the second part of the system of the AngioVac in to the groin all his cleaned blood. So that he doesn’t need to have any blood transfusions and he gets his own blood back.
We just did a story about a stroke, and they’re reversing the blood in the carotid artery and then taking it outside the body filtering out any plaque, and then putting the blood back in. Is a lot of that along the same line?
Dr. Moriarty: Yes, it’s along the same lines, but it’s a little bit different. What you’re trying to do there is prevent any clot from going towards the brain. Here, we know that there is a clot there already and we’re trying to actively remove it instead of just preventing it from forming.
This was a huge clot. Can you use it on any type of blood clots?
Dr. Moriarty: We would think that given the fact that things went so well here, the fact that we have now got this knowledge of how it works and who it works well on that we’re going to be able to use in a lot more people. People who have clots in their pelvis, people who have a big clot say coming out of their kidney or out of their liver. I think that there’s going to be a lot more people who can potentially be of benefit from this device.
What are the risks?
Dr. Moriarty: The main one is the one that we were always worried about is that a little bit of clot would break off as we’re doing this and travel to the lungs and cause real problems immediately with his breathing and maybe even with the heart itself. Whenever you’re doing anything with the body whether it’s open surgery or placing devices in to the blood vessels, you have to be very careful to prevent any bleeding or any damage to the vessels. Fortunately, he did very well without either of those complications.
So you think this is a lot less risky than your other options?
Dr. Moriarty: For Todd, the other option was to open the chest, stop the heart, open the heart, and remove the clot. Even in the most skilled hands, and we’re fortunate here at UCLA, we’ve got some really super cardiac surgeons, that’s a big operation with some big potential problems associated with it. I think this was much more minimally invasive and probably the better option for him.
It says Todd was the first successful attempt at this in California, is it that he was the first or was there a lot of unsuccessful attempts?
Dr. Moriarty: So the device and the background team that’s needed is relatively sophisticated. It takes a lot of experience in the whole institution to do it. And we’re lucky that here in UCLA we’ve got a big enough team that we’re able to do it the first time, and do it successfully.
So what can you show me here?
Dr. Moriarty: So what we’re looking at here is the scan of Todd’s chest. This area in the middle is his heart and if you see this big black lump sitting right here, it’s about to come from the blood vessels down here which are in the abdomen, belly, and all the way through the heart. This is what really made us very worried in that if this were to move at any time, it would move from here through the heart, to his lungs which are the black things on either side here and would have probably killed him.
Now do you have a scan of the entire clot?
Dr. Moriarty: I do.
Can you say why Todd’s blood clot got so big?
Dr. Moriarty: When clots are in the body they will either dissolve and that’s usually the body fighting it on its own. Or if they get big enough that the body can’t they’ll just continue to get bigger, and bigger, and bigger. At some point, this clot became big enough to just overcome Todd’s natural dissolving ability, and it just continued to get bigger until we saw it.
He told me it started out kind of small when you first started watching it but then within two weeks or something like that can you tell the difference?
Dr. Moriarty: Yes, when Todd initially developed problems, this clot would have been about the size of about a few centimeters long-relatively important but still small. Over the course of a few weeks then it developed in to this very big clot which extended all the way throughout his body because of either the way that he’s born, or the way that his blood was at the time.
END OF INTERVIEW
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John Moriarty, MD
David Geffen School of Medicine at UCLA
To read the full report, Killer Clots: Vacuum Them Up!, click here.