The surgery was groundbreaking. In December of 2017, Erin Murphy, MD, director of Sanger Heart & Vascular Institute’s venous and lymphatic program, placed a new kind of stent – never before used – in a patient who had been suffering from the pain of blockage in a deep leg vein.
Deep vein obstruction, while fairly common, is serious. When it occurs, a blockage in the deep leg vein restricts blood from flowing out of the leg. This can create a great deal of pain and swelling. The pain can significantly impact daily activities, and in some, it may be disabling. Until recently, doctors had few ways to help.
That’s changing. Advancements in the field are offering life-altering procedures and devices to people struggling with deep vein obstruction. Dr. Murphy and the Sanger team are on the forefront of these innovations, publishing and speaking internationally on the topic, and bringing this first-of-its-kind surgery and a groundbreaking research trial to Sanger.
Six months after the surgery, the patient has remained virtually symptom free. His swelling is minimal, his leg pain is gone and his quality of life has seen a dramatic improvement. Witnessing transformations like this is what drives Dr. Murphy’s work.
Dr. Murphy shares more about changes in the field and how they’re impacting patients nationally.
Question: Who are some of the people affected by deep vein obstruction?
Answer: There are three conditions that cause this. The first is acute proximal deep vein thrombosis (DVT), which creates abrupt onset of leg swelling that includes the thigh. The next is chronic venous obstruction, which may result from blood clots that have turned to scar tissue with time, and it results in pain, swelling and color changes or damage to the skin. The last group are people who have external compression on the vein, most often from an overlying artery.
Because this field is relatively new, there’s still a lack of education out there. A lot of people who are dealing with this haven’t been properly diagnosed or recognized.
Q: How has that lack of education affected patients dealing with vein obstruction?
A: Prior to the past decade, patients were not really offered intervention. People dealing with serious pain and swelling were told that there was nothing that could be done, other than compression stockings and sometimes anticoagulation medicine. However, half of the acute patients would go on to develop post-thrombotic syndrome, which causes substantial long-term pain. Patients with chronic disease would be left managing symptoms with compression stockings with no real treatment of the underlying problem.
Q: But the last ten years have seen a lot of innovation in this field – what’s changing?
A: The change has been massive. In ten years, venous interventions have gone from essentially nothing to pretty impressive techniques, and I expect that to continue. For patients with acute DVT, we have stenting and clot removal, so we don’t have to rely on just anticoagulants and compression stockings. For patients who have an obstruction remaining after clot removal or who have chronic obstruction, we can offer venous stenting.
There are patients who have been suffering for ten or twenty years who have been told there’s nothing that can be done to help them. Now we can help them. These technologies allow us to do more than just treat the symptoms.
Q: Last December, you performed a groundbreaking surgery. What did you do that had never been done before?
A: A patient came to us with a lot of pain and swelling in his leg, which was a result of an obstruction in the iliac vein, which drains the blood from the leg and pelvis. I placed a self-expanding stent that was designed specifically for that vein. Right now, the stents that doctors place in veins are not created for deep leg veins – the stents are created for other purposes but used off-label because that’s all that we’ve had. But the stent used in that surgery was new and designed to accommodate the size of the iliac veins, and provide the flexibility and strength needed to work in that vein. This patient was the first person who ever received this particular venous stent.
Q: After the success of that surgery, what happens next ?
A: The trial is on-going and will evaluate the performance and durability of the new stent. I’m the lead U.S. principle investigator of this trial – which means I’m in charge of the trial from a physician standpoint in this country – and we’re enrolling participants in 17 sites around the U.S. and nine more around Europe.
Q: What should people know about venous disease? What symptoms would lead someone to seek medical evaluation for their veins?
A: If patients with acute DVT has swelling that involves the thigh, they need to see a doctor within the first two weeks of that swelling to get the best outcomes for clot removal. Anyone who has a history of DVT and experiences persistent swelling, pain, skin discoloration or ulcers should seek an evaluation as well. A common sign of venous obstruction is leg swelling, heaviness or pressure that gets worse while standing and is relieved when elevating the leg.
Q: Where should people go if they need an evaluation for their veins?
A: Start with your primary care physician to discuss referral, and request that your doctor refers you to a center that has a provider with advanced vascular training.
Going to a provider with vascular training is important because not all vein centers are alike. Some vein clinics and centers are run by people who have had no dedicated vascular training. A pediatrician or a dermatologist without vascular training can open a vein clinic as long as that person was trained to do a varicose vein procedure. Those centers are for patients with superficial venous disease only.
But if there’s any question regarding whether the issue is more serious, the patient needs to see a doctor with advanced vascular training who routinely performs these procedures. This includes any patient with a history of deep vein thrombosis or patients who experience pain, skin discoloration, ulcers and swelling that goes beyond the ankle. It’s very important to go to a hospital with physicians who are experts in venous vascular procedures and who can provide an accurate diagnosis.
Q: Why did you choose to work at Sanger?
A: We’re seeing the outcomes and changes that these innovations are making in patients’ lives, and we’re pushing the field forward.
We have a specialized team here that sees only venous patients. Our equipment and treatments are state of the art, and we’re the only site in the entire area that has access to the ABRE IDE trial, which is only one of several trials we’ve participated in. We also have the advantage of being able to treat superficial venous disease in our clinic setting and deep venous disease in our fully equipped cath lab, allowing us to treat the full breadth of disease.
Q: You’re one of the most prominent experts in this field. What drives you in your work in deep venous disease?
A: My passion comes from an awareness of an unmet need in this field and a discovery of how misunderstood and how mismanaged many patients in this area are – and how much their lives can improve from proper evaluation and treatment. I’ve become very passionate about getting patients the right care and timely care in a field where it just hasn’t happened. It’s very exciting to be in a position where we’re currently defining the field and developing it.
Learn more about Vascular Medicine and Surgery at Atrium Health Sanger Heart and Vascular Institute, or call 704-512-5734 with any questions.
