The accident happened August 18th and the violence of the collision fractured 19-year-old Carolyn Perkins’ pelvis and dislocated her hip, requiring surgery, screws and plates to piece everything back together.
Perkins went home with instructions for complete, immobile bed rest for 90 days, and a warning that changing positions could cause serious damage to her healing bones. She wore an ankle-foot orthosis (AFO) boot to help resolve foot drop - difficulty lifting the front part of her foot - caused by the accident. When her legs became swollen from lack of movement, she was instructed to elevate them and apply ice.
At the end of October, Perkins, a resident of Markham, experienced severe pains, which she initially attributed to nerve damage sustained in the crash. Her right foot began to swell and then her leg. Elevation and ice did not relieve the swelling and the pain worsened. Perkins’ mother took her to Advocate South Suburban Hospital’s Emergency Department, where a venous duplex ultrasound was performed to examine the veins in her leg.
“They told me I had a blood clot in my vein, all the way from my pelvis to my calf”, says Perkins. She was admitted on Monday, October 27th for treatment and underwent testing to evaluate both the condition of her pelvis and the extent of the clot, a deep vein thrombosis (DVT).
She was placed in the care of Dr. Patrick Coffey of Vascular Specialists. “DVT is a very painful and dangerous condition,” says Coffey. “Pieces of the clot can break off and cause a pulmonary embolism, which can be fatal. It can also result in post-thrombotic syndrome, which significantly diminishes quality of life.”
Post-thrombotic syndrome (PTS) is the result of chronically disrupted venous flow from damage caused by DVT to the tiny and fragile valves in veins. When healthy, these valves help keep blood moving back to the heart. In PTS, patients experience leg pain and swelling, a feeling of heaviness, itching, tingling or cramping in the affected leg. Because blood has difficulty flowing upward to the heart, it pools in the leg, causing darkened or reddened skin. Minor wounds can become ulcers that refuse to heal and could eventually result in amputation. Approximately 75% of patients who experience DVT develop PTS.
Coffey says, “At the age of 19, Carolyn has many years ahead of her. She needs to have the best level of quality of life that we can provide.”
Coffey turned to a leading-edge method to resolve Perkins’ DVT - the ClotTriever® Thrombectomy System developed by Inari Medical. “The ClotTriever device is a real break-through in how vascular surgeons can treat DVT. Via a percutaneous access into the vein behind her knee and through a nick in the skin smaller than 1 centimeter, we inserted the device into Carolyn’s right lower extremity vein and advanced it beyond the clot. We opened the ClotTriever and pulled back the device like a net, capturing and removing the clot. By repeating this with several passes, we were able to open the flow channel in the veins, alleviating the back pressure on the valves, avoiding post-thrombotic syndrome for Carolyn.”
Before the invention of ClotTriever, Perkins would have undergone a regimen of blood thinners, thrombolytic—clot busting—medication administered within the clot via access obtained by an invasive procedure, or surgical open thrombectomy. Dr. Coffey says, “None of those methods ever had satisfying results. The blood thinners do not dissolve the clot burden but instead provide prophylaxis to prevent complications such as propagation of the clot or pulmonary embolism. Thrombolytic treatment requires multiple procedures with intensive care unit (ICU) admission for prolonged infusion of the medication. Use of thrombolytics bears inherent risk of bleeding complications. Open thrombectomy carries significant risks and typically has less than desirable outcomes. Until ClotTriever, there was no really effective way to resolve DVT.”
When Perkins met Coffey before the procedure, he explained it to her in detail. “I felt very comfortable,” she said. After the procedure, Perkins says, “It took a few days for the swelling to go away, but the pain was gone.” There was no real incision, she says, “it was like a little IV hole, that’s how small it was.”
“The ClotTriever is very low risk, nearly everyone is a good candidate for it, and we see really good results immediately. Carolyn was able to leave the hospital the day after the procedure, and she didn’t need ICU admission to recover,” Coffey says. Results of ClotTriever research show that Carolyn is unlikely to need another procedure or prolonged use of blood thinning medication.
Perkins spoke with Coffey when he discharged her and at a follow-up appointment in the Vascular Specialists offices. “It was comforting to me that everything would be okay”, Perkins said.
She also now has vascular health care for life. Vascular Specialists has offices in Tinley Park and is staffed with three of the top board certified and fellowship-trained vascular and endovascular surgeons in Chicagoland including Dr. Eugene Tanquilut, Dr. Sanjeev Pradhan and Dr. Coffey. The practice is known for successful early adoption of evidence-based innovations to treat the diseases and conditions of veins and arteries.
Now, Perkins is undergoing physical therapy to recover from the accident. She still requires a walker, but is gaining strength and mobility every day. She is looking forward to getting back to her life, including completing her certificate in Early Childhood Development at Governors State University and then reaching her dream of opening a day care center. She needs, she says, to be healthy and able to keep up with the kids. “I’m so appreciative that we caught it and it was removed in time,” she says.
Coffey says the ClotTriever procedure is well-designed and less traumatic to the body, with better results. “It’s minimally invasive, with few complications, and really revolutionary. There is nothing else like it.”
Before the ClotTriever procedure, says Coffey, DVT patients could expect a decline in function for the rest of their lives. “Patients experienced chronic swelling, pain, skin changes and ulcers. Post-thrombotic syndrome is very frustrating and uncomfortable. Carolyn is so young, and we want her to experience a healthy and active future. It’s wonderful that Vascular Specialists provides this one-of-a-kind procedure to enable that.”
