Definition and Overview

Thrombectomy is a surgical procedure performed to treat or remove blood clots that block the veins and disrupt blood flow. It has a very high success rate.

Who Should Undergo and Expected Results

Thrombectomy is the medical term that refers to a blood clot removal surgical procedure. Clotting is a common process and is the body's natural defense against excessive bleeding when a blood vessel is damaged or injured. In such cases, the platelets and proteins in the plasma form a clot over the injury so the bleeding can be controlled and eventually, stopped.

However, this process leads to health problems when blood clot forms inside the veins, keeping the blood from flowing through. Many factors can negatively affect the clotting process including but not limited to the way the clotting factors communicate with one another, the manner in which the platelets stick to the walls of the blood vessels, and the intake of certain medications such as those prescribed for patients with breast cancer or those who are obese, pregnant, and smoking.

The clots can also be dislodged from their original site, travel through the bloodstream, and become attached to other organs like the lungs resulting in pulmonary embolism and other life-threatening conditions like atrial fibrillation or DVT.

Excessive blood clotting is not immediately treated with surgery. Instead, doctors typically recommend anticoagulation therapy, which breaks down the clots and prevents their formation, as well as a wait-and-see approach or lifestyle modification.

Thrombectomy is only performed when the patient's condition doesn’t respond or no longer reacts to these non-surgical methods. It may also be performed if the blood clot, such as in the case of DVT, is deemed serious or severe, as well as if the patient is not suitable for non-surgical therapies like anticoagulants.

The success rate for this procedure can be as high as 70 percent especially when combined with other treatment methods like long-term intake of anticoagulants.

How Does the Procedure Work?

Thrombectomy is usually performed in a hospital setting as an outpatient procedure. It typically takes about two hours to complete.

Before the actual blood clot removal, the vascular surgeon first administers anticoagulants by making an incision in the groin or around the knee to access the diseased vein and to locate the blood clot. A catheter sheath is then be inserted and a contrast dye injected to make the blood clot visible using an imaging technology.

Once the blood clot is located, the vascular surgeon performs either percutaneous mechanical or surgical thrombectomy. If it’s percutaneous mechanical, a guide wire is inserted through the sheath and threaded toward the blood clot. A catheter is then introduced and placed above the guide wire, and a liquid jet or a tool at the tip of the catheter is used to destroy the blood clot. If it’s surgical thrombectomy, the surgeon removes the blood clot by making an incision in the vein where the blood clot is found and then takes it out using a catheter.

As the legs may swell after the procedure, the patient may have to wear compression stockings until the size of the leg has returned to normal.

Possible Risks and Complications

Although the success rate of this blood clot removal procedure is high, it cannot guarantee against the recurrence of clotting. Also, the patient may experience difficulty in walking for a certain period until the swelling and bleeding subside. There’s also a risk of developing an infection at the incision site, and suffering from an injury due to the insertion of the catheter and guide wire.

References:

  • Anderson JL. ST segment elevation acute myocardial infarction and complications of myocardial infarction. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 73.

  • Antman EM, Morrow DA. ST-segment elevation myocardial infarction: management. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 55.

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