Laurencia Villalba has saved dozens of patients from near-fatal pulmonary embolisms using a 20-minute keyhole treatment she pioneered.
Now the NSW government wants her to teach the technique to other vascular surgeons.
Dr Villalba says it's a "simple technique". Before we get to that, however, let's unpack why pulmonary embolisms can be so deadly.
What is a pulmonary embolism?
A pulmonary embolism is when a blood clot blocks an artery in the lung and stops the flow of blood.
It can reduce the amount of oxygen getting into your body, a Healthdirect fact sheet says.
"A lack of oxygen can damage your lungs and other organs," it says.
And the consequences can be severe.
"A large pulmonary embolism is serious, and can cause heart problems, lung and breathing problems or even sudden death," Healthdirect says.
How are pulmonary embolisms treated?
There are a few ways.
They can be surgically removed but Healthdirect says that's rare.
Other people may have what's called an inferior vena filter inserted into a large vein to catch the clot before it reaches the heart or lungs.
But the main treatments for pulmonary embolisms are anticoagulant medications — sometimes called blood thinners — administered through a drip.
Dr Villalba, who is the district head of vascular surgery at Wollongong Hospital, says there are risks associated with an anticoagulant medication, such as bleeding on the brain.
"A lot of patients that will need treatment would not be offered any treatment because of the risks," she said.
"Or if they had the treatment, they would suffer significant consequences from the bleeding."
How is Dr Villalba's technique different?
It involves inserting a catheter through a patient's groin.
"Then we navigate a wire through the bearings that go up through the heart and then into the pulmonary artery [in the lung]," Dr Villalba said.
"Then we deliver medicine … through multiple holes in the tip of the catheter.
"[It's] like a spray that destroys the clot and simultaneously dissolves it."
She says, all up, it takes about 20 minutes.
Benefits seen in minutes
Dr Villalba first tried the technique eight years ago.
She says the patient was a "very healthy young man" who was suddenly admitted to the intensive care unit (ICU).
"He just had had an operation the day before and woke up feeling very unwell," she said.
"He collapsed and had to be resuscitated.
"He had clots everywhere … he was also bleeding."
"This poor man wasn't doing well … so the ICU consultant called me up."
Dr Villalba says minutes after the keyhole procedure, the young man's vitals had returned to normal and he had regained consciousness.
"The ICU consultants were like, 'Oh my God. This is just a complete game changer.'"
Setting a new standard of care
Last month, Dr Villalba received the Graham Coupland Medal for outstanding contributions to surgery from the Royal Australasian College of Surgeons.
She says the best part of the ceremony was having her father, who travelled from Argentina, accompany her and meet one of her patients.
"I introduced him to my dad.
"And then the first thing he said to my dad was, 'You know, your daughter saved my life.'
"It was beautiful."
The New South Wales government has since asked Dr Villalba to teach the technique to other vascular surgeons.
"And hopefully, in a few years' time, this is going to be standard of care."
What causes a pulmonary embolism?
"The most common cause is a blood clot which has come from a deep vein thrombosis (DVT) somewhere else in your body," Healthdirect says.
It says you're more likely to get a pulmonary embolism if you:
- Have a genetic condition that causes clotting problems
- Have had major surgery, such as a knee or hip replacement
- Have had a severe injury such as a spinal injury
- Have a severe illness such as cancer or kidney failure
- Are taking certain medicines
- Are pregnant or have recently had a baby
- Have had a pulmonary embolism or a DVT before
Here are a few other risk factors for pulmonary embolism or DVT:
- Being immobile, such as while recovering from an illness or travelling on long-haul flights
- Older age
- Obesity
- Smoking
What are the symptoms of a pulmonary embolism?
Healthdirect lists several symptoms of a pulmonary embolism.
The government-funded service says if you have the symptoms below, call triple-0 for an ambulance or go to your nearest emergency department:
- Sudden or new breathlessness
- Chest pain, which may be worse with deep breaths
- A fast heart rate
- Fast breathing
- A cough, or coughing up blood
- Fainting or dizziness
It also lists a few other symptoms that people might have with a pulmonary embolism:
- Swelling or pain in the calf muscle
- Pain in the back
- Clammy skin
- Fever and sweating
- Feeling light-headed
How can I reduce my risk of pulmonary embolism?
Healthdirect suggests trying "to follow a health lifestyle" if you're at risk of pulmonary embolism.
This includes:
- Getting regular exercise
- Eating a balanced diet
- Not smoking
And it has a few extra tips if you're travelling — think long drives or plane trips:
- Take regular breaks to do foot and leg exercises or walk around
- Stay hydrated
- Wear compression stockings