Tinley Park, IL - To people who experience deep vein thrombosis in Chicagoland, Dr. Patrick Coffey has become somewhat of a superhero. Since Inari Medical introduced the ClotTriever® Thrombectomy System, Dr. Coffey has treated more than a dozen patients with the procedure and is now a leading expert in the Chicago area.
A deep vein thrombosis (DVT) is a blood clot in a deep vein, most commonly in the lower extremities, the legs. DVT can be particularly dangerous because the clots can break off and travel through veins to the heart before lodging in the arteries to the lungs. This causes a pulmonary embolism, a potentially fatal condition with up to a 30% mortality rate.
“Usually, patients notice sudden swelling in the leg or sometimes a warmth to their skin. They may experience throbbing pain in the calf. Sometimes the leg gets very tender and the area may feel very firm and painful to the touch. If not treated promptly, patients may notice a color change, with a darkening of the skin. These symptoms usually occur in one leg, and can be in the calf and the thigh.”
Dr. Coffey notes that most patients will contact their primary care doctor or visit an emergency department first. “Patients notice something suddenly painful - and they don’t like it, so they seek urgent help,” says Dr. Coffey. Often, their physician will refer the patient to a vascular surgery practice such as Vascular Specialists in Tinley Park, where Dr. Coffey practices alongside Dr. Eugene Tanquilut and Dr. Sanjeev Pradhan. All three physicians are fellowship trained and board certified.
“If the symptoms are severe, the primary care doctor may tell the patient to go to their closest emergency room, but anticoagulants, or blood thinners, are typically started immediately to prevent complications. For procedural intervention, there’s generally about a 14-day window for treatment. Chronic clots can often be removed. As part of the initial evaluation, patients undergo a non-invasive ultrasound of the affected lower extremity to confirm the presence of a DVT and determine its size and location,” says Dr. Coffey.
DVTs can be provoked by many conditions, such as an injury or a surgery, that result in the patient being immobilized for a prolonged period of time. DVTs may also develop spontaneously or unprovoked, such as when a person has a blood clotting disorder or experiences compression of the iliac veins. Dr. Coffey says experts aren’t sure exactly how long an unprovoked DVT takes to develop, but in nearly all cases, symptoms occur suddenly.
“Anything that reduces mobility is a significant factor in DVT development,” says Dr. Coffey. “Other risk factors include smoking and using tobacco products, certain hormone replacement therapies, a malignant cancer, or clotting issues.”
Before ClotTriever, patients were often treated with thrombolytic therapy – medical therapy to lyse, or break up, the clot. This therapy is only effective on acute thrombus, or clots. Thrombolytic therapy typically requires multiple procedures and admission into a hospital’s Intensive Care Unit (ICU) for infusion, with a significant risk of bleeding. In severe cases, an invasive, open thrombectomy might be performed, typically requiring hospitalization, and including more serious risk factors with ultimately unsatisfactory outcomes.
With the ClotTriever device technology, all those problems and risks have been rectified. With ultrasound guidance, Dr. Coffey will use a percutaneous access in the vein behind the knee and insert the ClotTriever device into the lower extremity vein. The device is advanced beyond the clot and then opened like a small specialized net. As the ClotTriever device is pulled back, it works much like a net, capturing and removing the clot. With several passes as needed, Dr. Coffey is typically able to remove more than 90% of the clot. In some cases, this can mean removing 50 centimeters or about 20 inches of clot.
Dr. Coffey performs the ClotTriever procedure at Advocate South Suburban Hospital and has treated patients from age 19 to well into their 80’s. Because of Dr. Coffey’s expertise, when the clot is caused by compression on the iliac vein, he can place a stent during the procedure, alleviating the vein compression and helping to prevent clot reoccurrence. The entire procedure takes about an hour.
Pain relief is almost instant and healthy blood flow dynamics are reestablished immediately. The ClotTriever can be performed as outpatient surgery for many patients, and when needed, hospitalizations are usually short, with no ICU stay.
“ClotTriever has an immediate impact, and it’s a very low risk procedure overall. There are immediate improvements accompanied by very good long-term results. Patients can expect to walk within hours of the procedure and resume normal activities within a week. We typically prescribe an anticoagulant and compression stockings for several months. Swelling improves within a few weeks, and patients can expect a very good outcome,” says Dr. Coffey.
When patients ignore DVT symptoms and don’t seek help, more than 50% will develop post-thrombotic syndrome (PTS). Vein blood flow dynamics are disturbed, and because DVTs occur in the deep veins, where about 90% of venous flow in the lower extremities happens, other veins cannot compensate adequately. “PTS can consume a patient’s life,” says Dr. Coffey. “Chronic swelling and pain, a heaviness in the leg, and skin changes can progress to chronic wounds. The wounds drain, and without appropriate treatment, they enlarge and require wound care treatments one or more times each week. A patient may spend years dealing with these issues - and it’s a tough way to live. It affects physical health and mental health. Patients are embarrassed of the weeping wounds, the odor - it permeates all aspects of life. I have cared for many patients in this predicament. ClotTriever percutaneous thrombectomy offers a pragmatic way to avoid these complications."
Dr. Coffey says, “ClotTriever is a low-risk procedure, typically with a short hospital stay and excellent success rates. Just overall better results. However, for me, the most important benefit of this technology is that ClotTriever improves the quality of my patients’ lives, not just for a few years, but for the rest of their lives.”
