Thrombectomy

Overview

A thrombectomy is a surgical procedure used to remove a blood clot from an artery or vein. A thrombus, another name for a blood clot, can obstruct blood flow to your extremities and/or organs, thus posing a risk to your limb or life. Blood clots can appear in your legs, arms, intestines, brain, lungs, or heart, among other common areas.

A thrombectomy is an interventional or surgical procedure used to assist restore blood flow through your blood vessel by removing blood clots from an artery or vein. Sometimes problems that could endanger life or limb require a thrombectomy to be done in a matter of hours.

Reasons for undergoing the procedure

If you have blood clot that cannot be effectively treated with medications such as anticoagulants (blood thinners) or thrombolytics (drugs that break up blood clots), you may need a thrombectomy.

You may benefit from the operation if the clot obstructs blood flow to a specific area of your body, placing you at risk of:

• Embolus (occurs when a thrombus in your body breaks free and moves to a different area).
• Irreversible tissue or organ damage.
• Death.

A thrombectomy may not be appropriate for you if you have:

• A blood clot in an extremely tiny blood vessel.
• A blood clot in an area that is too difficult to access.
• A blood clot that has pharmacological treatment options.
• An underlying blood disorder.
• Brain hemorrhage, also known as intracranial hemorrhage.
• Uncontrollably elevated blood pressure.
• A persistent clot that has persisted for longer than thirty days.

Thrombectomy can treat the following conditions:

• Stroke
• Pulmonary embolism
• Heart attack (myocardial infarction)
• Acute ischemia of the arteries in the upper or lower extremities
• Acute mesenteric ischemia
• Renal artery occlusion
• Deep Vein Thrombosis (DVT)

Types of Thrombectomy

Thrombectomies fall into two main categories:

Surgical (open) thrombectomy

A surgical thrombectomy involves your surgeon making an incision to access the blocked blood vessel, cutting it open, using a balloon to remove the blood clot, and then closing the blood vessel.

Percutaneous (minimally invasive) thrombectomy

Your surgeon uses catheters to insert specialized equipment that can vacuum or macerate clots out of your blood vessel during a mechanical thrombectomy. Your surgeon will inject the region with local clot-dissolving medications if there is still a remnant clot. Several of these methods go by the names:

• Catheter-directed aspiration thrombectomy.
• Catheter-directed thrombolysis.
• Catheter-directed mechanical thrombectomy with or without thrombolysis.

Risks

Thrombectomy does have certain risks, such as:

• Anesthesia reaction
• Blood clot may recur
• Blood vessel damage or stenosis
• Bleeding
• Hematoma
• Infection
• Pulmonary embolism, in which a clot leaves its initial site and enters your lungs.

Before the procedure

In such cases, there is no way to plan ahead for an emergency thrombectomy. However, in the event that a thrombectomy is scheduled, your doctor can request that you undergo:

• Imaging tests. An MRI, CT scan, or ultrasound are examples of imaging tests that might assist your doctor in surgical planning. The blood clot’s size, position, and the blood vessels that require therapy are all depicted in detail in the images produced by these scans.
• Stop smoking. Smoking might lead to issues both before and after surgery. As soon as feasible before your thrombectomy, discuss a smoking cessation strategy with your doctor.
• Stop taking certain medications: Inform your doctor about all medications you take, including over-the-counter medications like aspirin, vitamins, and herbal supplements. Anticoagulant medication may need to be stopped before surgery.

During the procedure

Depending on the type of thrombectomy you have, your surgery will be different. Depending on where and how big the blood clot is, the procedure could take an hour or more.

Generally speaking, here’s what to anticipate:

• Anesthesia/sedation: Through a vein in your arm, general anesthesia or sedative is administered. During the process, sedation makes you feel more at ease.
• Incision: Your surgeon will make an incision in your skin, either above or below the clogged blood vessel, to perform a surgical thrombectomy. In order to remove the clot, your surgeon will cut open the blood vessel.
• Catheterization: During a percutaneous thrombectomy, your surgeon will typically puncture a blood vessel in your arm or leg above or below the clot, and then use the punctured blood vessel to insert wires and catheters into the blood vessel. In order to remove the blood clot, they use continuous imaging scans to guide the catheter and other specific instruments through your blood vessels to the blood clot’s site.
• Clot removal: The blood clot is removed by your doctor. Your surgeon removes the clot using a balloon catheter during an open thrombectomy. During a mechanical thrombectomy, the clot is either broken up, dissolved, or removed using a catheter-like vacuum using special instruments.
• Closure: If your procedure involves a surgical thrombectomy, your surgeon will fix the blood vessel. After removing the wire and catheter from your blood vessel during a percutaneous thrombectomy, your doctor will either apply pressure to seal the artery or utilize a vascular closure device to assist in doing so.

After the procedure

Following a thrombectomy, as you awaken from anesthesia or sedation, a surgical team keeps an eye on your vital signs. On the same day as their procedure, some patients return home. Depending on the location of the clot, the surgery or operation that was done, and the requirement for continuous blood thinners, some patients remain in the hospital for a few days or even an overnight stay.

You’ll receive comprehensive instructions from your doctor regarding:

• How to take care of your cut at home.
• Drugs to take and avoid.
• The ideal time to resume regular activities.

Outcome

Several factors, including the type of operation you had, will affect how well you recover following a thrombectomy. The majority of people use blood thinners to stop blood clots from developing again. In order to avoid blood clots in your legs, your doctor could advise you to wear compression stockings. See your doctor about further measures to lower the risk of blood clots.

Your general health, the location of the blood clot are among factors that affect your chances of survival following a thrombectomy.