Blood clot could have taken Moorcroft woman's life or her leg; luckily she met Dr. Bowkley
By Kristy Bleizeffer Mar 29, 2017
For days, Kristy’s Larson left leg felt heavy, like someone had tied a log to it. It was painful and hard to move. It was thick and swollen. She suspected it was a blood clot.
Larson, of Moorcroft, went to different hospitals looking for relief, but was given pain medication and little else. On Jan. 3, she finally got a referral to see Charles W. Bowkley, M.D., at Outpatient Radiology in Casper, and she was admitted to Wyoming Medical Center that day. Her toes and ankles had turned blue.
“Dr. Bowkley gave us a choice right then: I could live with this pain the rest of my life and lose a limb, or I could undergo the procedure to remove the blood clot. It wasn’t much of a choice,” said Larson, who lives in Moorcroft with her husband.
Dr. Bowkley diagnosed Larson with deep vein thrombosis (DVT), a blood clot that forms in the deep veins, typically in the legs. If untreated, bits of the clot could travel to the lung or heart and become fatal.
Larson is lucky she was referred to Dr. Bowkley, an interventional radiologist – a type of specialist that uses image-guided technology to treat disease and medical conditions with minimally invasive procedures. Wyoming Medical Center is the only hospital in the state with 24/7 interventional radiology coverage.
Below, Dr. Bowkley explains DVT and how he treated Larson’s case.
What is a compressed/crushed vein, and how does it relate to DVT?
Veins can be compressed for a number of reasons. A common issue we see in interventional radiology is that an artery crosses over the top of a vein causing the blood flow to slow down within the vein. This happens most commonly in the pelvis with the artery supplying the right lower extremity compressing the vein that drains the left half of the pelvis. This abnormality is commonly referred to as May-Thurner Syndrome.
Another common cause of vein compression is in the upper chest where the vein behind the collar bone is narrowed. This is termed thoracic inlet syndrome or Paget-Schroetter Syndrome. The result is typically a large clot in the deep venous system of the lower or upper extremity respectively.
How serious is DVT?
Deep vein thrombosis is extremely serious and anyone who experiences isolated arm or leg swelling should seek medical attention immediately. These clots can break free and travel to the lungs causing heart or lung failure at worst and potentially leave the patient with chronic swelling of the affected extremity for the remainder of their life.
Who is most at risk for crushed veins?
That is a challenging question. Just like we all have slightly different colors of hair, we each have small anatomic and genetic variations that may predispose us to these types of conditions that do not cause harm until something is out of balance.
Three main factors lead to venous blood clots:
- low or no blood flow within the vein.
- trauma or damage to the vein wall.
- and/or a medical condition of our blood being too “sticky” called hypercoagulability.
Explain how you diagnosed Kristy Larson’s case.
The remarkable part of her presentation was that her symptoms were worsening despite receiving medication to thin the blood. She was concerned that her swelling and pain were not improving and sought further medical attention; She listened to her body and knew that something was wrong.
By using advanced imaging techniques and a small catheter inside the vein, I found that she had May-Thurner Syndrome, where her left common iliac vein was compressed by her right common iliac artery.
How was she treated?
All patients with deep venous thrombosis receive anticoagulation (blood thinners) as long as it is medically safe. In this patient’s case, she was a candidate for catheter directed thrombolysis (CDL) and Pharmacomechanical Thrombectomy. CDL uses clot-busting medicine delivered through a small tube, much like a drinking straw, to break up the clot. Pharmacomechanical Thrombectomy uses a device specifically made to break up the clot inside the body and remove the harmful clot particles once they’ve been broken down into small pieces. Once the clot was removed, I placed a stent in the left common iliac vein to prop it open and maintain blood flow in the correct direction, removing the compression by the overlying artery.
How did she respond to treatment?
She responded perfectly! She is the shining example of how well an expertly trained multidisciplinary team works together to render excellent patient care. The Hospitalist physicians, the interventional radiology techs, the IR and floor nursing staff, and the hospital physical therapists are all necessary to deliver curative patient-centered care when it comes to life threatening deep venous thrombosis.
With the right equipment and expertise, a successful outcome like hers is not rare at all. However, many people do not know that we offer this type of medical treatment right here in Wyoming. Unfortunately, I see a number of patients every year that missed their opportunity to potentially prevent leg swelling and blood clots from traveling to the lungs because they just didn’t know we have the expertise and team oriented approach right here in Casper, Wyo.!
Is this a matter of new technology or technique?
It’s a combination of both. Only certain centers with the appropriate depth of expertise should offer this type of treatment of deep venous thrombosis. The interventional radiology team at Wyoming Medical Center and Casper Medical Imaging has the training and successful track record to offer a comprehensive line of services, including acute management of deep venous thrombosis.
Venous pathology is one of my favorite areas of medical practice. Whether we’re talking about the superficial venous drainage of the brain, lower extremity varicose veins, or the deep venous structures that drain the lower extremities, I’ve had the honor and opportunity to serve patients here in Wyoming for nearly seven years.
Back to Kristy Larson. Her leg didn’t hurt when she left Wyoming Medical Center and it was no longer swollen. More importantly, she’d avoided a complication that could have killed her had it been left alone much longer. She feels lucky to have found Dr. Bowkley and the interventional radiology team at Wyoming Medical Center.
“He explained everything to me, step-by-step. He asked questions the patient should be asking, and then answered them,” Larson said. “I have never been to a doctor who was so thorough.”
Larson has this advice for people suffering symptoms similar to hers: “Tell your doctor to get a hold of Dr. Bowkley.”
Dr. Bowkley is the only neurointerventional radiologist in Wyoming. He is board certified in diagnostic and vascular / interventional radiology and serves as Chief of Medical Staff at Wyoming Medical Center. He joined the staff at Casper Medical Imaging and Outpatient Radiology in 2010 and is a member of Wyoming Medical Center’s Primary Stroke team. Call (307) 232-5054 for an appointment or referral.