My toughest case

I am a vascular consultant at the Private Clinic of Harley Street and one day a 28-year-old woman, who had delivered a perfectly healthy baby four days before, was transferred to my care. Soon after giving birth she had developed a swollen, painful foot, and the swelling then spread to the leg and was growing increasingly worse.

The local hospital had diagnosed deep vein thrombosis and because she was getting blistering and decolourisation of the foot, they were concerned that she was developing venous gangrene, something that is well documented. I received a phone call from the hospital and told them to send her over to see me straight away.

When she arrived we did some imaging, which showed that she had an extensive deep vein thrombosis involving the leg veins and the pelvic veins, which is essentially the iliac vein and the inferior vena cava, which is the main vein which runs back to the heart. It was a hugely extensive clot. On the side where the clot was, because the blood was not able to come back to the heart, the leg kept swelling up.

We were reaching a stage where there was so much pressure in the leg that the tissue was starting to die off (which is basically how gangrene develops). When this happens, the patient can be in danger of losing the leg.

The first thing we did was to put in an IVC filter, which is a keyhole technique going in through the neck vein. If you think of the filter as an umbrella that sits in the vein, it opens up and then stops any clot from dislodging into the lungs.

Once we had put the filter in, we went in through the groin on the side with the affected leg, using a special device that absorbs and sucks out the clots. At the same time you inject a chemical that is a clot-busting medication, called rtPA.

Following that procedure we continued with aggressive intravenous anticoagulation, which is when you give the patient medication to thin the blood. And you must also elevate the leg dramatically to use gravity to help you empty the leg.

Then over a couple of weeks – and it is a very slow process – the leg got better and the blistering dried out. Fortunately, she didn't lose any toes (although she did lose a bit of skin) and she recovered well and was eventually able to walk out.

This condition is not hugely common but we have definitely seen an increase in deep vein thrombosis and pulmonary emboli during pregnancy. But it is very rare to see a DVT that is threatening the entire leg.

She was very lucky; some patients would lose their leg if they were so affected. It's a very serious condition. It is something that takes just a few days to really take hold, so it was very important that she was transferred to us when she was. It really saved her. If she was referred a day later, it might have been too late.