| If you’ve had a surgery recently, you may have had to wear a so-called sequential compression device — a sleeve-like device wrapped around the leg that squeezes it sequentially to mimic the action of walking (so as to move blood through the vein to the heart). The device has been used routinely in surgeries (instead of blood thinners) for about two years to help prevent deep vein thrombosis.
Deep vein thrombosis, which usually occurs in the lower part of the body and particularly the legs, can be caused by long periods of long inactivity (such as flying in an airplane or recovering from surgery). The clots, which can travel through the circulation system and get dislodged, may cause a condition called pulmonary embolism (caused by a clot traveling to a lung and blocking air flow). Pulmonary embolism could be rapidly fatal.
“It’s one of the causes of sudden death… A certain number of pulmonary embolisms are fatal — it’s probably the main cause of unexpected death in a hospital,” says Dr. Mark Adams, a vascular and thoracic surgeon who is the Chief of Medical Staff at Harrison Medical Center. “Any time you have an operation, you have a chance of getting a clot in your leg. We do a lot of things to prevent that from happening.”
The sequential compression device, stretching the length of the thigh and leg, has clear plastic, pressurized tubes through which air is pumped. The device wraps around the leg and is held in place by Velcro. The tubes are in separate compartments so they can be pressurized separately, and are connected to a mechanical device, about the size of a toaster, that synchronizes the air pressure.
“They’ve proven to decrease the chances of deep vein thrombosis,” Adams says, adding that there has been a dramatic decrease in pulmonary embolism cases for hospital stays.
If left untreated, about half of deep vein thrombosis cases could end in pulmonary embolism. “Once discovered, we treat it (DVT) aggressively at the outset,” Adams says. Symptoms include pain and swelling of the legs, especially after a long period of inactivity. In addition to long periods of inactivity, a genetic predisposition or an injury such as a sprained ankle could cause the condition.
Blood thinners are a common treatment for deep vein thrombosis, but they cannot be used if the patient has a certain medical condition such as an ongoing bleeding problem or recent surgery. Also, some patients may end up with complications from blood thinners (anti-coagulants) or with a failed treatment. In all these cases physicians can use a vena cava filter — a device that is placed in the vena cava (the main vein going to the heart) that acts to trap clots.
“It’s very slick, an easy to perform procedure and low risk,” says Dr. Jeff Bernstein, a vascular surgeon with The Doctors’ Clinic who is also on staff at Harrison. “If you have a clot in the leg, (the device) is very efficient for preventing it from going into a pulmonary embolism.”
The vena cava filter, which doesn’t look like a filter at all, is loaded in a pencil-thin device, inserted through the neck or groin into a vein with X-ray guidance. Once in the right spot, the spring-loaded device is deployed.
“If any clots come floating by, they get trapped and do not flow to the heart,” Adams says. “It’s a pretty clever device, very high tech.”
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