A few years ago, a patient had fallen into a bathtub, fractured a rib, and punctured a lung. Blood filled his chest and crushed his lungs. he had to be taken to the hospital. Patients stuck in bed while hospitalized are at risk of developing blood clots in their leg veins because they are immobilized. When blood stops moving, a clot forms. These patients are usually started on blood thinners to reduce their risk. Blood thinners were not suitable for this man as he was bleeding in his chest. Blood clots that form because they are stationary block veins, causing swelling and pain, but they can also be fatal if they travel through the body and reach the lungs or brain. chose to insert a filter into the vena cava, which carries blood from his legs back to the heart, a vessel called the inferior vena cava, to catch clots that have formed and dislodged.
These filters are supposed to be removed after a few months when the risk of clotting has subsided, but many have not been removed on time. After explaining this history, Mr. Slief said what if the filter did its job, catching the blood clot and blocking the entire blood vessel? Could that cause his postural hypotension? listened thoughtfully. He had been a doctor for 45 years and he had never seen this, but it was an interesting idea nonetheless. Definitely worth considering.
One of the many advantages of the VA hospital system is the computerization of decades-old medical records. Slief did a deep dive into this man’s medical history and came up with some promising looking results. Seven years ago, a man underwent a CT scan of him, which revealed an almost complete blockage of the vena cava. Is it possible that the extra blood that was supposed to go to the brain from his legs when the man stood up didn’t get there fast enough because the vena cava was narrowed?
Daddy Longlegs Device
I didn’t really have a way to test this hypothesis, but it makes sense. They explained to the patient that the next step would be to remove the filter. The patient eagerly tried. The team contacted Dr. Parkhurst, Bill at the University of Alabama Birmingham Hospital, who specializes in this type of procedure.
The patient was sedated for surgery. Parkhurst inserted a small tube through an incision in the jugular vein in the patient’s neck and slowly advanced it through her heart and into the vena cava where the filter is located. These contraptions look like papa’s long legs held in place in veins with a small hook on each leg. Using his small grip tool, Parkhurst grabbed the hook, pulled the filter up from the vena cava, and removed it through a small incision in the patient’s neck. Parkhurst then inserted a small balloon and inflated it to restore threadlike flow through the narrowed vena cava. A stent was then placed to keep the vessel open. He continued this process along the primary vein of each leg. The surgery took him six hours and required nine stents, but it eventually gave him better blood flow between his legs and his heart.
When the patient stood up for the first time after this procedure, he was amazed. I no longer have dizziness. It’s been 4 months and it’s not going back. No weakness in his legs, no lightheadedness, no falls. His legs are still paralyzed, but he can live with it as long as his feet remain on the ground and he stands upright.
Sleaf is reserved about making this vague diagnosis. There are only a handful of case reports in the medical literature. Still, Slief told me it makes me wonder if this is happening more often than reported.
Lisa Saunders, M.D., is a contributing writer for the magazine. Her latest book is Diagnosis: Solving the Most Baffling Medical Mysteries. If you have a resolved case to share, please email Lisa.Sandersmdnyt@gmail.com.
