Vascular surgery saves woman with rare, life-threatening condition

When Tacia Justus woke up on March 22, 2015, she didn’t know she was sick. But she was soon to find out.

“I was getting ready for church and got in the shower,” says Tacia, of Muscatine, Iowa. “I looked down and my left leg was very red and very, very swollen. I got a horrible pain across my back. I lay down on the bed, and I was feeling very sick…nauseated. I tried to get up to be sick, and I passed out.”

Her fiancé called 911, and when the team of EMTs that responded to the call checked her blood pressure, they found it so low as to be life threatening.

“They took me in the ambulance to the hospital in Muscatine,” Tacia says. “I kept telling them something was wrong with my left leg. It took about 10 minutes to get to the hospital and I had a seizure on the way. I was in terrible pain.”

The local hospital took a CT scan that indicated serious internal bleeding. Given the severity of Tacia’s condition, the decision was made to transfer her to the University of Iowa Hospitals & Clinics Emergency Department via AirCare.

“I was in so much pain, that helicopter ride seemed like it took forever,” she remembers.

“When Ms. Justus arrived at the emergency room, she could neither feel nor move her left leg, and her blood pressure was extremely low,” says UI Neelima Katragunta, MD Heart and Vascular Center vascular surgeon Neelima Katragunta, MD, who was on-call when Tacia came in. “When I got the call from the ER, I went to see her right away.”

Tacia was taken to one of the state-of-the-art hybrid suties in the operating room, where four teams from UI Hospitals & Clinics went to work.

“We had physicians and staff from Emergency General Surgery, Vascular Surgery, Interventional Radiology, and the Anesthesiology team. We all worked in concert,” Katragunta says. “When we ruled out that her arteries were not the source of her bleeding, we suspected the problem was with her left iliac vein.”

That led the UI team to determine that Tacia had an uncommon condition called May-Thurner syndrome, in which the left iliac vein is compressed by the right iliac artery, which can lead to deep vein thrombosis (blood clotting).

Once the diagnosis was made, the team explored her pelvis and found a long tear in her left iliac vein, which Katragunta repaired. The team then treated the obstruction upstream with a large stent and removed the clot that had formed in Tacia’s left leg caused by lack of blood flow upstream. The entire procedure took seven hours.

“May-Thurner’s is uncommon,” Katragunta says. “What is extremely rare is the fact that Ms. Justus sustained a ruptured iliac vein from it. “What was really critical was that we had the technology and expertise to make that diagnosis in a timely fashion.

“The anesthesia team did a good job resuscitating her and replenishing the blood she had lost,” Katragunta adds. “She was in a critical, life-threatening condition, and without the excellent work of everyone involved, it is difficult to say if she would be alive today.”

Tacia agrees.

“She saved my life. And that opened my eyes to what is important in life,” she says.

Tacia spent nine days in the hospital and returned to work in April. On May 11, she was back to work full time.

“I saw her a few weeks ago in my clinic,” Katragunta says. “She is completely back to her normal life, and she had no swelling or clot in her left leg. Her prognosis is excellent.”

“I have tried living life with a more positive outlook due to this life-threatening experience,” Tacia says. “It wasn’t my time. And there were tons of people praying for me.”

Vascular care services are available at UI Hospitals & Clinics in Iowa City and at UI Hospitals & Clinics–Iowa River Landing in Coralville.

— Steve Maravetz
Fall 2015