Treating Life-Endangering Blood Clots
Advancing Vascular Care Through Aspiration "Suction" Technology
PULSE Issue 43 | July 2024
Venous Thromboembolism (VTE)
Venous Thromboembolism (VTE), a term referring to blood clots in the vascular or circulatory system, is a serious medical condition that can be potentially life-threatening. Timely diagnosis and treatment are required to manage the potential risks of this condition as these clots can cause major health complications, if left untreated.
- Deep Vein Thrombosis (DVT) - Blood clots formed in the legs often due to prolonged periods of immobility, causing swelling and pain.
- Pulmonary Embolism (PE) - Blood clots from DVT can travel to the lungs, causing a life-threatening condition known as Pulmonary Embolism (PE). Without treatment, up to one in four DVT patients may develop PE, and one in four symptomatic PE patients could die within 14 days.
- Inferior Vena Cava (IVC) Clot - Formation of blood clots in the largest vein in the body that is responsible for carrying deoxygenated blood to the heart.
Reportedly found in 65 out of every 10,000 cases admitted in Singapore, VTE carries a significant risk of morbidity and mortality. The primary treatment approach involves medications in the form of anticoagulation therapy1, aimed at halting the formation of further clots. However, this method can be time-consuming and carries risks of developing clots in the lungs (Pulmonary Embolism) and even death. Fortunately, advanced endovascular techniques now offer minimally invasive procedures2 also known as “Aspiration Thrombectomy” to physically suction these clots out from the body.
A SAFER AND QUICKER PROCEDURE
Introduced in 2014, the first generation of aspiration “suction” catheters marked a significant breakthrough by providing continuous suctioning of the blood clots, instead of traditional tedious methods of manually removing the clots through the use of syringes or surgery. Since then, the catheter technology has continued to evolve with current notable advancements including a larger diameter of up to 5.3mm and atraumatic designs3, all to minimise blood vessel damage when navigating the body structure and removing large blood clots. This innovative device was first made available in the United States in January 2023, with NUHCS introducing it for the first time in January 2024, for clinical use.
BEATING A DEADLY BLOOD CLOT
Referencing the experience of a man in his early 60s who began feeling leg pain and shortness of breath; doctors found a large clot in his pulmonary artery with accompanying clots in the IVC - the largest vein in the body - causing blockage of blood flow to his lung and heart. Recognising the critical threat that these clots posed, immediate treatment was recommended to address the patient’s condition. The patient was swiftly brought to the NUHCS cardiac catheterization laboratory, where “Aspiration Thrombectomy” was performed with the latest devices to promptly remove the clots. With a small incision in his right leg vein and a sheath positioned in the IVC, the catheter was inserted to the clotted IVC, extracting a significant amount of clot through the catheter and thereby restoring blood flow to the major organs in the body.
IMPROVING PATIENT RECOVERY
The novel computer detection algorithm also aided the doctors in finding the clots with greater speed and precision, ensuring that only the clots were removed during the suctioning process. Within minutes, the large clot in his pulmonary artery was also quickly extracted. By the end of the procedure, the patient felt instant relief with a noticeable improvement in his breathing. Just two days after the procedure, he was ready to be discharged from the hospital.
VTE therapy is advancing rapidly, with various cutting-edge devices now at our disposal. In this groundbreaking case at NUHCS, the novel device has displayed its effectiveness in restoring blood flow in the IVC and the lungs, treating and removing blood clots from these two separated locations in the body in just one sitting. This revolutionary innovation offers hope as a promising treatment option for acute VTE, with the potential to improve outcomes and reduce morbidities, especially in complex cases.
1. Anticoagulation therapy – Medical treatment aimed at preventing the formation of blood clots or reducing the size increase of existing clots within the blood vessels.
2. Minimally invasive procedures – Medical interventions typically involving small incisions or natural body openings, performed to achieve therapeutic or diagnostic outcomes while minimising trauma to the body.
3. Atraumatic designs – Medical devices or instruments engineered to minimise tissue damage or injury during use.
