Complications of Thrombectomy

What Is Thrombectomy?

The blood clot is known as a thrombus in medical terms, and the removal of the thrombus is known as a thrombectomy. Blood flows freely through arteries and veins, arteries carry oxygenated blood to different body parts, and veins carry back the deoxygenated blood back from the organs to the heart. Thrombus can occur either in arteries or veins. This blockage causes insufficient blood flow to a particular organ leading to the death of the particular tissue. This condition is fatal and should be treated immediately.

What Are Common Places of Thrombus Formation?

Thrombus can be formed anywhere in the body, but it is commonly seen in:

• Heart.

• Brain.

• Extremities (hands and legs).

• Lungs.

• Intestines.

How to Treat a Thrombus?

Thrombus is treated by two methods:

• Using Medication: Not all blood clots require surgical intervention; anticoagulants (thrombolytic agents) are the drugs that are used as blood thinners which makes the blood flow easy without any clot formation. They are indicated in acute conditions. The decision whether to use thrombolytic agents or a thrombectomy procedure depends on numerous factors, including size and place of the clot.

• Thrombectomy Procedure: This is a common procedure that is routinely carried out by doctors.it is of two types, namely:

1. Surgical thrombectomy.

2. Mechanical thrombectomy.

1.Surgical Thrombectomy: In surgical thrombectomy, the surgeon makes a cut directly on the blood vessel, removes the clot, and restores(repairs) the blood vessels through sutures.

2. Mechanical Thrombectomy: Also called minimally invasive thrombectomy or percutaneous thrombectomy. In this procedure, the surgeon inserts a small catheter (tube) into the larger blood vessels; through this catheter, special devices are inserted to reach the clot. These special devices work by three mechanisms such as:

• Suction or aspiration of the clot.

• Blasting the clot (technically known as thrombolysis), and small clots are aspirated using special devices.

• If the clot is large in size, clot-dissolving medication is directly induced near the clot through these special devices so that the clot decreases in size and can be retrieved through suction.

What Are the Complications of Surgical Thrombectomy?

Every surgery has its complications, and thrombectomy is not an exception. And the complications also depend upon the general health condition of the patient, the location of the clot, and the time duration of the clot.

The Complications Include:

• Infections: Inflammation and infections during the procedures are common complications; this may include acquired hospital infections also.

• Bleeding: In dealing with hypertension patients or with persons who are already on blood thinners, extreme care should be taken to prevent excessive bleeding. In cases where the blood clot is present in larger arteries, bleeding is a major complication. This should be carefully handled as excessive bleeding may cause serious complications such as death.

• Anesthetic Complications: Before any surgery, the patient should be thoroughly evaluated for anesthetic approval; this includes questions regarding the health conditions of the patient, medications that are used by the patient, and any previous history of anesthesia. Preanesthetic evaluation is a must to avoid complications during the surgery.

• Injury to the Blood Vessel: In surgical thrombectomy, an incision is given directly above the clot. And after the clot removal, the blood vessel is ligated to prevent further bleeding. During this process, friction to the blood vessel leads to injury of the blood vessel, and there are chances of recurrence of the clot once again.

• Pulmonary Embolism: During routine surgical procedures, small blood clots are formed at the site of surgery. And these blood clots travel through the blood vessels and block the arteries that supply blood to the lungs. The patient suffers from extreme breathlessness and may go into a coma. This is a life-threatening condition that must be handled immediately.

What Are the Complications of Mechanical Thrombectomy?

The complications of mechanical thrombectomy include:

• Cerebral Edema: Inflammation of the brain is a common complication in treating clots located near the cerebral area.

• Infarcts: Infarct is a condition where the tissue becomes dead due to insufficient blood supply. During mechanical thrombectomy, mechanical compression or rupture of the catheter can cause infarction.

• Access Site Complications: when is clot is present around the sensitive organs like the heart and brain, it becomes very difficult for the surgeon to access the area

What Are the Indications and Contraindications of Thrombectomy?

Indications: Thrombectomy is indicated in conditions such as:

• Myocardial Infarction: Also called a heart attack, it is a fatal condition that occurs when heart muscles do not receive enough blood to function properly. Blocked blood vessels(especially arteries) of the heart are the main cause of heart attack. This block can be due to clots or cholesterol deposits.

• Pulmonary Embolism: Sometimes clots that are formed elsewhere in the body travel through the blood and block the artery that supplies oxygenated blood to the lungs. This is a dangerous condition, and the symptoms depend upon the size of the clot and the part of the lung that is affected.

• Deep Vein Thrombosis: Is usually seen in the legs, where blood clots are formed in deep veins of the legs. This blocks the blood flow to the legs causing inflammation of the leg.

• Acute Mesenteric Ischemia: A condition where blood flow to the small intestine is blocked due to a clot in the mesenteric artery (the major branch which supplies blood to the stomach).

• Renal Artery Blockage: Where the blood flow to the kidneys is restricted due to the presence of the clot.

• Ischemia In Extremities: Blood clots are common in the extremities of the body, especially the legs and hands. In such instances, in order to prevent ischemia (restricted oxygen supply) surgery is suggested to remove the clot.

• Brain Stroke: Arteries that supply blood to the brain are blocked due to clots; this needs immediate attention.

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Contraindication: Thrombectomy is contraindicated when:

• The blood clot is very close to delicate organs.

• When the accessibility to reach the blood clot is very hard.

• When the clot is identified in tiny blood vessels rather than main blood vessels.

• Clots are located in the brain.

• People with uncontrolled blood pressure are contraindicated for surgery.

• People having blood disorders like anemia, bleeding disorder, and platelet disorders are contraindicated for surgery.

Conclusion:

Thrombectomy is not always the option to treat thrombus. However, it is the surgeon who has to decide whether to treat it through anticoagulants or thrombectomy. In return, the decision is based on the location, size, and accessibility of the clot. Complications arising from thrombectomy can also be treated; the skill of the surgeon plays an important role in handling the situation.