A New Game Plan With Interventional Radiology

October 25, 2020

Typically, we photograph every patient appearing in HealthU. Because this story was planned during the surge of COVID-19, that contact would have been too risky. Instead, our team took a creative approach and replaced photo shoots with illustrated portraits of patients.

Super Bowl Sunday was supposed to be simple enough for Vinny Placanica, from Morganville, New Jersey. “I planned to go to my sister-in-law’s house to have all the traditional bad-for-you food and beer and watch the game,” he says. Even though the New England Patriots, his favorite team, weren’t playing in the championship, he was excited nonetheless.

But around 4 a.m., Vinny, who beat lung cancer in 2015, started coughing up blood. His wife brought him to the Emergency Department at Bayshore Medical Center. Vinny doesn’t remember much else until he woke up two days later.

In that time, his life was placed in the hands of Peter Doss, M.D., an interventional radiology specialist at Bayshore. “Before I even saw him, the situation had become dire, his life threatened because of the volume that he was bleeding,” Dr. Doss says.

When Less Is More

The first obstacle for doctors: figuring out what was causing the bleeding. “When you’re basically vomiting a large amount of blood, you’re putting your airway at risk,” Dr. Doss says. “You could essentially drown in your own blood.”

Vinny’s situation is like a garden hose that’s spraying uncontrollably. Doctors have to find the valve—the source of the bleeding—and shut it off temporarily, Dr. Doss says.

Frequently, sources of such bleeding arise from the stomach or the esophagus. However, gastrointestinal doctors performed an endoscopy (where the physician inserts a long, flexible tube with a tiny camera down the throat) and found those areas looked normal. After performing more tests, including a CAT scan of the chest, doctors discovered abnormalities in the right upper lobe of Vinny’s lungs.

That’s when doctors brought in Dr. Doss, who specializes in interventional radiology using minimally invasive, image-guided procedures to diagnose and treat diseases in nearly every organ system. An overarching goal of this specialized care is to avoid major surgery—no scars or larger incisions and
a quicker, easier recovery.

“I’m able to use imaging in real time to help guide tiny catheters or needles into areas we want to treat,” Dr. Doss says. “Instead of having patients undergo open surgery, we can achieve successful outcomes through tiny little pinpricks inside blood vessels or inside basically any solid organ.”

For Vinny, interventional radiology was twofold: finding exactly where the bleeding was and stopping it. To do so, Dr. Doss performed an angiogram. He inserted a small catheter into the groin, then used an X-ray machine and dye injections. Through this procedure, he was able to move the catheter to the aorta in the chest to inject more dye and see where the bleeding was coming from.

He ultimately found that bleeding was coming from the bronchial arteries in the lung where Vinny had a recent biopsy. (The bronchial arteries supply blood and help support the structure of the lung.) “With all that information, I decided to close down those arteries temporarily,” Dr. Doss says. Using a similar procedure, he injected embolic material to temporarily block the arteries. The goal was to give the body a chance to heal itself, stop the bleeding and stabilize Vinny.

“Within 36 hours, he went from being in a life-threatening situation to being healthy,” Dr. Doss says.

Back to Normal

Vinny’s situation was as serious as it gets, Dr. Doss says. Without interventional radiology, the only other option would have been to remove a third of Vinny’s lung. That surgery would have been invasive and required a longer recovery and drastic changes to his quality of life—shortness of breath and little ability to be active.

That’s not to say the interventional radiology procedure was without risk. The embolic material that’s used to shut down the artery can sometimes go to unintended places, such as a tiny artery that can supply the spinal cord. “You have to be careful with your technique, carefully and methodically controlling where that embolic material is going,” Dr. Doss says. “If embolic material gets into that tiny spinal artery, and blood flow to the spinal cord is interrupted, the patient can become permanently paralyzed.”

Vinny, fortunately, had no complications and was up and talking just two days after the Super Bowl. “All the nurses and doctors were great. They took great care of me and were always there for whatever I needed,” Vinny says.

Being able to provide Vinny with a definitive treatment that was relatively minimally invasive with no scars is a gratifying part of Dr. Doss’ job, he says.

“These are the kinds of procedures that often take place in major hospitals in big cities,” Dr. Doss says. “It’s not as common to see these procedures take place in community hospitals like Bayshore. It’s nice to be able to treat someone locally with the same level of care that they would get in big cities.”

Today, Vinny is back to his life in Morganville with his wife, daughter, grandchild and extended family—and back to rooting for the Patriots.

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