A unique, life-saving surgical procedure, performed for the first time in Goa, saved the life
of a 60-year-old female patient, who was suffering from ‘extensive deep venous thrombosis, which can result in a severe life-threatening condition as it can cause part of the clot to migrate to the lung causing pulmonary embolism.

The patient (name not disclosed due to reasons of privacy) walked into Healthway Hospital in Old Goa with a history of significant swelling and pain in her left lower limb. Examination by the hospital’s surgeons and tests conducted using the venous Doppler and CT Venogram revealed that she was suffering from extensive deep venous thrombosis. his in normal
parlance is referred to as ‘bloodclots’ in the deep veins of the left leg, which was causing her severe agony. Gauging the severity of her condition, the patient was advised  a high-risk catheter-directed dissolution of blood clot (thrombolysis) in the veins of the affected leg
in the cardiac cath lab.

The procedure was performed under local anaesthesia, through a small venous puncture in the
vein of the right groin. Introduction of a small micro-catheter from the right groin and crossed
to the left within the blood clot. Thrombolysis was then induced with the help of a thrombolytic drug, Alteplase, infused in the deep veins of left leg for 48 hours. After 48 hours, a check venogram of her affected leg revealed complete resolution of the blood
clot with dramatic reduction in pain and swelling of the left leg.

The patient was discharged on the third day itself. The advanced procedure, though high risk, is unique for Goa.

In normal course, thrombolysis is done through a systemic vein, where the drug circulates all over the body and can result in internal organ bleeding. In this particular case the chances of bleeding are negligible, as the drug was administered locally, at the site of thrombus with the help of a specially designed micro-catheter.

“This was not a routine procedure. It is done in rare cases. This procedure needs a proper protocol, requires a cath lab set-up. Previously systemic thrombolysis was the treatment of choice. This unique procedure was attempted for the first time in Goa, considering the severity of the case,” said, Dr Bossuet Afonso and Dr Nikhil Sontakke. Cases involving extensive deep venous thrombosis are increasing in India. This underlines even more, the significance of
the successfully orchestrated complex interventional procedure.

The medical professionals who were part of the hospital’s team, handling this unique case comprised of Dr. Bossuet Afonso (General Surgeon), Dr. Nikhil Sontakke (interventional Cardiologist), and personnel from the Cath Lab team at Healthway Hospital.