Conquering a Rare Vascular Condition
Dedicated dog owner undergoes lifesaving venous intervention following doctor’s discovery
There’s no happier pooch than Rocco. He’s back to daily romps in the park with his pet parent, Jennifer Tarr, and despite the handsome Bullmastiff’s 120 pounds, he’s welcome once again on Jennifer’s lap.
However, as of autumn 2018. Jennifer, 40, could barely walk Rocco. This eventually led her to the Emergency Room (ER) at Inova Alexandria Hospital (IAH). “My leg was so swollen and painful,” Jennifer recalls. “Since I have a history of blood clots from previous leg surgeries, I didn’t want to take any chances.”
Jennifer’s surgical history began in 2015 when treatment for her melanoma resulted in lymphedema, a condition that can cause extreme swelling in the arms or legs. Fast-forward to Jennifer’s 2018 ER visit. “I just wanted something to get the lymphedema symptoms under control and go home, but Dr. Chick insisted on an ultrasound of my leg. Within the hour, I was admitted to the hospital,” Jennifer says.
Interventional radiologist makes an ‘amazing discovery’
Jeffrey Forris Beecham Chick, MD, MPH, cardiovascular and interventional radiologist at IAH and Inova Mount Vernon Hospital, is particularly experienced in new, cutting-edge techniques and procedures to treat venous diseases — an area still in its infancy, according to Dr. Chick.
“When I reviewed Jennifer’s venous ultrasound, I saw that her legs were filled with blood clots,” Dr. Chick explains. “Based on certain characteristics on the ultrasound, I had a hunch that we weren’t dealing with Jennifer’s lymphedema. I suspected that there was something wrong with her inferior vena cava — the large central vein that carries blood from the lower body to the heart, so I ordered a CT scan of Jennifer’s leg and chest veins.”
At this point, Jennifer notes, “Dr. Chick made an amazing discovery that saved my life.” Jennifer had a deep venous abnormality — either inferior vena cava agenesis or inferior vena cava atresia, both extremely rare conditions involving missing or incredibly small central veins that essentially scar away over time.
“When I first met Jennifer, she had no main vein from her legs to her heart,” Dr. Chick says. “There’s no way to tell when this was lost — maybe in utero. We do know that the anomaly is often overlooked because the body develops amazing ways to reroute blood flow through collateral veins. But nothing is as good as your native veins, and if there is any injury to the collateral veins, like the blood clots in Jennifer’s leg, you’re in trouble.”
A minimally invasive vascular procedure
After Jennifer was admitted to IAH, Dr. Chick immediately began a multistep, three-day, minimally invasive process to rebuild Jennifer’s inferior vena cava.
- First, Jennifer received an intravenous drip to break up all of the blood clots in her legs. “Once the clots were gone, we were able to see that Jennifer’s entire venous system from the top of her legs to her heart was small, scarred and fibrotic,” Dr. Chick explains.
- Next, Dr. Chick and his intervention team guided wires, catheters and small needles through the remaining lower body veins Jennifer had — or in some cases, where the veins should have been.
- Then Dr. Chick ballooned open the new inferior vena cava as well as new lower body veins in Jennifer’s legs.
- The final step involved inserting tiny metal stents to officially create an entirely new venous system from the top of Jennifer’s legs all the way to her heart.
When Dr. Chick thinks back to the six-hour final step, which involved an extensive venous reconstruction, he sounds more like an artist than a physician. “Everything looked so beautiful — with blood flowing through what was very close to a native venous system,” he says.
Jennifer, on the other hand, completes her story with a sigh. “You have no idea how relieved I was when Dr. Chick figured everything out,” she says. “When I heard that he would be the doctor to perform my procedure, that’s when I knew everything would be fine.”
Leading the way
An interventional radiologist interprets medical images and also performs complex minimally invasive procedures through very small incisions — sometimes the size of a pinhole — in the body. This reduces complications and recovery times often associated with traditional open surgery.
“It’s only been two years since interventional radiology became a medical specialty onto itself. Previously, it was a subspecialty,” explains Jeffrey Forris Beecham Chick, MD, MPH. This change, he adds, triggered a lot of excitement and research in interventional radiology and is now guiding the specialty toward being more patient-centric and clinically based. Dr. Chick says he is lucky to have a team of medical professionals who have embraced these new tenets.
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What a blessing. This is an amazing story.
Does Jennifer like diet sodas or drink a lot of pasteurized fruit or vegetable products? The methanol from them is mostly handled by the liver, but some of it is metabolized to formaldehyde inside the interior (intima) layer and especially the thicker middle (media) layer of blood vessels. The innate immune system interprets as “foreign” any identifier protein on cell walls that has been modified by formaldehyde, and WC Mote makes a strong case that methanol-initiated foreignization and cell removal do actually occur (2-page summary at InSituFormaldehyde . info) He doesn’t cite vessel scaring as an outcome, but that seems like a reasonable fit. Also the melanoma may be indicative of trace chronic methanol consumption.
Changing what you drink is worth a try for something so consequential. Could someone like Jason Grey please forward this to Jennifer? I’ll try to send an email to Dr. Chick.