Medical Mystery: Doctors said she needed both legs amputated

About 10 years ago, Kim Brophy, now 62, began developing blood clots in her legs — a condition known as deep vein thrombosis (DVT) — as a result of a debilitating back injury that forced her to spend much of her days in bed.

Sitting or lying for prolonged periods can slow blood flow in the veins, which can make blood more prone to clotting.

Doctors placed an inferior vena cava (IVC) filter in the large abdominal vein that returns blood from the lower half of the body to the heart. These filters are used to reduce the risk of pulmonary embolism — a life-threatening complication of DVT — by trapping large clots and preventing them from traveling to the heart and lungs.

Over time, Brophy’s IVC filter clogged up with blood clots. This led to poor blood return from Brophy’s legs and feet, and her health began to deteriorate quickly.

One day, Brophy’s husband came home from work and found her unconscious and unresponsive on the floor. He dialed 911 and she was taken to the hospital.

At the hospital, doctors discovered she was in kidney failure as a result of the clogged IVC filter. She also developed gangrene — or dead tissue — in both of her feet and toes due to poor blood return from the legs and the feet.

Doctors told Brophy and her husband that in order to save her life, both of her legs would have to be amputated below the kneecaps.

Was there another option that could save her legs and improve blood return from the lower half of her body?

Brophy’s grandson is best friends with the son of my colleague, Paul Forfia, a cardiologist at Temple University Hospital. The two boys talked and word of Brophy’s situation reached Forfia, who eventually suggested Brophy see me for a second opinion.

Brophy arrived at Temple and we tried to stabilize her, but her legs continued to worsen. She developed blisters up and down both legs and the gangrene worsened in both of her feet. She couldn’t walk and was in an enormous amount of pain.

We decided it was time for a more aggressive intervention.

I took her to the catheterization laboratory and advanced a catheter into both of her leg veins. Once there, I suctioned the clots out and delivered a small amount of clot-dissolving medication. Brophy spent the night in the ICU to let the medication work. The next day, she returned to the catheterization laboratory to have the remaining clots removed. I also implanted two stents in the veins in her legs to help keep them open.

When we first entered Brophy’s veins, the pressure in those veins was extremely high. After we were done, it was close to normal and the blood flow was markedly improved. Three weeks after being admitted to Temple, she was finally discharged. The gangrene cleared up and her feet were near normal. She even walked into her follow-up appointment with me unassisted — a complete 180-degree turnaround from when she arrived at the hospital just a few weeks earlier.

We decided to leave the IVC filter in Brophy because it is so embedded into her body that removing it would be more dangerous than keeping it in. She’ll remain on blood thinners for the rest of her life to prevent future clotting, but her long-term prognosis is good.

Unfortunately, situations like the one faced by Brophy are fairly common. In fact, a team of researchers and I studied the nationwide utilization rates of IVC filters in patients with deep vein thrombosis and found that the filters are being overused and are no more effective than blood-thinning medications.

Patients with these problems are often told they can’t be helped and they may end up with amputations. It’s important for patients to know that they have other options.

Riyaz Bashir, MD, is a professor of medicine at the Lewis Katz School of Medicine at Temple University and director of vascular and endovascular medicine at Temple University Hospital.