Years earlier than, the affected person had fallen within the bathtub, damaged his ribs and punctured a lung. Blood crammed his chest and collapsed the lung. He needed to be rushed to the hospital. Patients who’re caught in mattress whereas within the hospital are susceptible to growing blood clots within the veins of their legs as a result of they’re immobilized. Clots type when blood isn’t shifting. These sufferers are normally began on blood thinners to scale back that threat. Because this man had bled into his chest, blood thinners weren’t a superb possibility for him. Clots that type due to immobility block veins and trigger swelling and ache, however they may also be lethal in the event that they journey by way of the physique and find yourself within the lungs or mind. So his docs had chosen to place a filter in the principle vein that introduced blood from his legs again to his coronary heart — a vessel referred to as the inferior vena cava — to catch any clots that fashioned and broke free.
These filters are presupposed to be eliminated just a few months later when the chance of clotting goes down, however many are usually not eliminated on schedule. This one had been left in place for greater than 15 years. What if, Slief advised after explaining this historical past, the filter had performed its job and captured clots they usually had been now blocking the complete vessel? Could that trigger his positional hypotension? Centor listened thoughtfully. He’d been a health care provider for 45 years and had by no means seen this. And but it was an fascinating thought. Certainly value contemplating.
One of the various benefits of the V.A. Hospital system is that it has computerized medical data going again a long time. Slief did a deep dive into this man’s medical historical past and hit what appeared like some promising outcomes. Seven years earlier, the person had a CT scan that confirmed an nearly whole blockage of his vena cava. Was it potential that the additional blood that was presupposed to go from the legs to the mind when the person stood up didn’t get there quick sufficient due to the narrowed vena cava?
The Daddy-Longlegs Device
There was actually no method to check this speculation, but it surely made sense. They defined to the affected person that the subsequent step was to get the filter out. The affected person was wanting to strive. The staff reached out to Dr. Bill Parkhurst on the University of Alabama at Birmingham Hospital, who specialised in this type of process.
The affected person was sedated for the operation. Parkhurst put a tiny tube by way of an incision into the affected person’s jugular vein in his neck and slowly superior it down previous the center into the vena cava the place the filter was positioned. These contraptions seem like daddy longlegs with tiny hooks at every foot to carry them in place within the vein. Where the physique of the insect can be positioned was a small hook. Parkhurst used a tiny gripping software to understand the hook and pull the filter up by way of the vena cava and out by way of the small incision within the affected person’s neck. Next Parkhurst inserted tiny balloons that he inflated to reopen the threadlike stream by way of the narrowed vena cava. He then positioned a stent to carry the vessel open. He continued this course of down the first vein of every leg. The process took six hours and required 9 stents, however lastly there was good blood circulate between the legs and the center.
The first time the affected person stood up after this process, he was amazed. The dizziness was gone. It has been 4 months and it hasn’t come again. No weak legs, no lightheadedness, no falls. His ft are nonetheless numb, however he can stay with that as long as they continue to be on the bottom and he stays upright.
Slief is modest about making this obscure analysis. There are solely a handful of case experiences within the medical literature. Still, Slief instructed me, it does make you surprise if possibly that is occurring extra usually than reported. He’s actually going to be on the lookout for it.
Lisa Sanders, M.D., is a contributing author for the journal. Her newest guide is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you’ve gotten a solved case to share, write her at Lisa.Sandersmdnyt@gmail.com.