Marnie Busdeker couldn’t wait to get back to her students. She’d had ligament surgery on her ankle and had stayed off her feet for weeks while she healed. But on the morning of March 9, 2022, protected with a walking boot and equipped with a knee scooter to help her get around, the 40-year-old special education teacher from Selden happily headed back to work. By midday, however, Busdeker found herself in the school nurse’s office. “My leg was swollen from the knee down,” she recalls. “And I had a lot of pain in my calf.” She headed home to ice and elevate her leg, but in the morning the pain was worse. She went to a physical therapy appointment later that day where, after one look, her therapist told her to head straight to the hospital.
In the emergency department at Mather Hospital, an ultrasound of Busdeker’s leg confirmed what her physical therapist suspected: She had deep vein thrombosis (DVT), which occurs when a blood clot forms in one or more of the deep veins of the body, usually in a leg. Most often, DVT is caused by damage to a vein from an injury or surgery. Many factors can raise the risk, such as older age, being overweight or having a family history of the condition. Prolonged immobility is another big risk factor: Blood clots are more likely to develop in people who sit for a prolonged period in a cramped position during a lengthy plane or car trip, or who are on extended bed rest, such as after surgery as Busdeker had been. About half of all blood clots occur during or soon after a hospital stay or surgery. DVT itself is not life-threatening. But it’s dangerous because if the blood clot breaks loose, it can travel through the bloodstream and become lodged in the lungs, blocking blood flow. That’s called a pulmonary embolism and it can cause lung damage or even be fatal. As many as 900,000 Americans develop a deep vein thrombosis or pulmonary embolism each year, and up to 100,000 die as a result, according to the Centers for Disease Control and Prevention. The emergency physicians prescribed Busdeker a blood thinner. Patients typically take these medications, also called anticoagulants, for several months to stop their DVT from getting bigger while the body breaks it down, and to prevent other clots from forming. But these drugs can take weeks to work and for Busdeker, that turned out to be too long.
Within days, she developed a fever and her pain became excruciating. By the weekend, she was feeling short of breath. She headed back to the Mather ED. A follow-up scan showed several large clots in her lungs. She had a pulmonary embolism and it was starving her lungs of blood.
Immediately, Busdeker was admitted to the hospital. She was terrified. Just two months before, she had lost a friend and colleague to a fatal pulmonary embolism. All she could think of was her husband, Brett, and their two little girls. “I told her we would take care of her,” says interventional radiologist Michael Dayan, MD, who led her care. There were several options, he told her. Sometimes, doctors treating a large pulmonary embolism use thrombolytic drugs clot-dissolvers that are more powerful than anticoagulants. But these meds have the potential to cause sudden and severe internal bleeding, and require a stay in an intensive care unit. Blood thinners are sometimes also prescribed for pulmonary embolisms, but they don’t work to actively break down existing clots. With that approach, Dr. Dayan was concerned that Busdeker might ultimately develop heart failure. But, he told Busdeker, he had a device that could treat the problem safely and effectively.
Mather Hospital had recently added a new tool to its repertoire, called the Inari FlowTriever. The first device specifically designed for the treatment of pulmonary embolism, the FlowTriever works like a medical vacuum cleaner that sucks out clots from a patient’s body. “This device has revolutionized the treatment of pulmonary embolism,” says Dr. Dayan. “It’s the first of its kind that has the capability to remove large amounts of clot at once. It does so with minimal blood loss and a tiny incision, just a few millimeters across.” To perform the thrombectomy, Dr. Dayan and his interventional radiology team threaded the FlowTriever through a thin, flexible catheter inserted in a vein in Busdeker’s groin. Then, guided by X-ray imaging, he snaked it up through her heart and into the pulmonary artery, where the clots were lodged. He extended the FlowTriever’s self-expanding mesh disks, which grabbed and extracted them. “All she needed was a little bandage on the access site in her groin no stitches,” Dr. Dayan says. Dr. Dayan and the interventional radiology team at Mather Hospital perform this procedure for pulmonary embolism more often than almost any facility on Long Island, he says. It provides long-lasting benefits. Up to half of patients with serious pulmonary embolisms like Busdeker’s have breathing trouble for months afterward, says Dr. Dayan. Removing her clots fast alleviated that concern. Busdeker has no lingering symptoms from her frightening ordeal, only a desire to make sure others don’t experience a similar problem. She’s back in her classroom and when school is out, she’s spreading the word about DVT and the danger it can pose. “I tell the story over and over again,” she says, “because many people don’t go to the hospital when they need to.”
Reprinted from Northwell Connections, Volume 2