Saturday, December 10, 2016

Pioneering 90-minute operation that could be a British cure for DVT

Dramatic recovery: Hannah Almond, 34, (pictured) could barely walk but now runs in 10k races after having the pioneering surgery
How doctors are using mesh from NASA to create space in patients' veins 


Thousands of deep vein thrombosis sufferers could have their lives transformed by a breakthrough treatment.
More than 60,000 Britons a year develop DVT – a blood clot in a vein which causes painful and dangerous swelling, usually in the leg.
The clot can break apart and travel to the lung, triggering a potentially fatal pulmonary embolism.
For many it is a chronic condition rather than a one-off emergency and they have to live with the painful symptoms for years.
Until now there has been no treatment other than taking strong blood thinning drugs or wearing compression socks to prevent further clots or complications.
But a team of British doctors is leading a clinical trial of a pioneering technique to reverse DVT completely.
Using keyhole surgery, surgeons at University College London Hospitals NHS Foundation Trust blast through the clot and then use a wire to insert high-grade titanium stents to open up the vein. More than 40 patients have already undergone the procedure – with remarkable results.
Short stents have been used for decades in blocked arteries to help treat heart problems.



But keeping a vein open is much harder because the blood pressure is lower, the veins are wider and are much more liable to clotting.
Advances in engineering and surgical techniques, however, have meant it is now possible to make stents that can keep a vein open and stay in the body for a lifetime.
Costing £2,500 each and measuring almost five inches (12cm) long, the stents are made from a titanium-nickel compound invented by NASA for its space programme.
One patient, 34-year-old Hannah Almond, could barely walk before she had the 90-minute operation at University College London Hospital.
Since the procedure, her recovery has been so dramatic that she has started running for the first time in 11 years. In October Mrs Almond, a mother-of-three from Kent, even completed a 10km race in London.


‘It has turned out better than I could ever have imagined,’ she said. ‘I had considered amputation – and now I can run.’
Many DVT clots form when people sit inactive for several hours, such as on a long-haul flight or when lying in a hospital bed.
Pregnant women are also at risk, as are women who take the combined contraceptive pill. Mrs Almond developed a clot during a flight to the Maldives when she was pregnant with her first son, William, who is now 13.
For 11 years she was in agony and gave up on her dream of becoming a teacher.
But two years ago she was one of the first to undergo the world-first stent procedure.
Three stents were inserted into the vein running from her leg to her abdomen, pushed end to end until a section of vein a foot long was reconstructed. The UCLH team is taking part in a much larger international trial, which has tested the stents on more than 200 patients around the world.
The overall findings are due to be published next year, but Professor Toby Richards, who is leading the London branch of the study, said the results so far have been remarkable.

‘Two thirds of the participants so far have been able to go back to work,’ he said. ‘From being pretty much housebound, that is a major achievement.
‘These are often young people, with their lifetimes ahead of them. We can give them all that back.’
He added: ‘Until now there has been pretty much no options for people with DVT.
‘Potentially there are thousands of people out there who could benefit.’
He stressed more trials will be needed to prove the cost-effectiveness of the stents, which are expensive.
But he added: ‘I would think this will be standard of care within the next five years.

The overall findings are due to be published next year, but Professor Toby Richards, who is leading the London branch of the study, said the results so far have been 'remarkable'