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What Are Thrombectomy Procedures?

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What Are Thrombectomy Procedures?

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Blood clots can cause various problems, and there is a procedure to remove them. Read on to discover how this can be accomplished.

Medically reviewed by

Dr. Rajesh Gulati

Published At July 27, 2022
Reviewed AtNovember 15, 2022

Introduction

Thrombectomy is a procedure to remove blood clots. Blood clots are a prevalent health problem that has to be treated right away. A stroke is caused by a blood clot that restricts or reduces the circulation of the blood to the brain.

Blood flows smoothly via the vascular system, arteries, and veins in normal circumstances. The arteries transport oxygen and other nutrients throughout the body. Waste materials are carried back to the heart through the veins. Blood swells and clumps together in either of those veins, forming a blood clot. This may obstruct blood flow. Damage to adjacent tissues can occur if blood circulation is restricted.

Blood flow to essential organs such as the limbs, intestines, kidneys, brain, and other vital organs can be restored with this surgery. A blood clot can cause pain, swelling, tingling, numbness, or a chilly sensation in the affected location, which is usually an arm or leg. If done early, a thrombectomy can considerably lower the risk of death or lasting disability.

What Is Thrombus?

A blood clot in the circulatory system is known as a thrombus. It sticks to the spot where it originated and stays there, obstructing blood flow. People who have a sedentary lifestyle and have a hereditary propensity to blood clotting are more prone to develop a thrombus.

A thrombus can also develop when an artery, vein, or surrounding tissue is damaged.

What Is a Thrombectomy?

A thrombectomy is a procedure that involves the removal of a blood clot from a blood vessel such as an artery or vein. Blood clots can stop blood from flowing normally to a portion of the body, resulting in life-threatening diseases like pulmonary embolism or an acute stroke. A blood clot, often described as a thrombus, can cut off blood supply to the limbs and organs, posing a serious risk to the health. Blood clots can form in a variety of sites, including the limbs, intestines, brain, lungs, and heart.

What Is the Purpose of a Thrombectomy?

If a blood clot forms in an artery or vein, surgical thrombectomy may be required. The following conditions can be treated with thrombectomy:

  • Acute arterial limb ischemia in the upper or lower extremities (a significant decrease in limb blood flow).

  • Ischemia of the mesentery (an arterial blockage that prevents blood flow to a section of the intestine).

  • Renal artery blockage (the constriction of one or more arteries carrying blood to the kidneys).

  • Angina pectoris (myocardial infarction or heart attack).

  • Embolism of the lungs (a disorder in which a blood clot blocks one or more arteries in the lungs).

  • Stroke (damage to the brain caused by a disruption in its blood supply).

What Are Some of the Complications of a Blood Clot?

A blood clot can cause a variety of issues, including:

  • Arm or leg swelling, discomfort, numbness, or tingling.

  • Localized muscle pain.

  • Veins enlargement (post thrombotic syndrome).

  • Tissue decomposition.

  • An organ's loss of function.

  • A blood clot in the lung causes breathing problems and can be fatal (pulmonary embolism).

Who Should Not Undergo Thrombectomy?

Thrombectomy in the following cases should be avoided:

  • A blood clot in an impossible-to-reach area.

  • If a blood clot has developed in a very small blood vessel, this should be avoided.

  • A blood clot that has formed in a very tiny blood artery.

  • When there is an existing blood disease, it should be avoided.

  • Bleeding in the brain (intracranial hemorrhage).

  • High blood pressure that is untreatable.

  • A persistent clot that has lasted longer than 30 days.

What Preparation Should Be Done for a Thrombectomy?

The patient does not have much time to prepare when a thrombectomy is performed in an emergency. If a thrombectomy is scheduled, the doctor may instruct the patient to undertake the following:

  • Ultrasound is done to assess blood flow in the leg and to assist in the diagnosis of a blood clot.

  • To gain a picture of the vessels, a venogram or an arteriogram may be done.

  • To learn more about the blood clot, a computed tomography (CT) scan is suggested.

  • If further information is needed, magnetic resonance imaging (MRI) is used.

  • Checking overall health with blood testing is necessary.

  • At night, prior to the procedure, do not drink or eat past midnight.

What Are the Steps in Thrombectomy?

This depends on the procedure and the area to be treated.

  • Firstly the hospital gown should be worn; after that, a blood thinner, such as Heparin, may be given. This is to assist in avoiding the formation of new blood clots during the procedure.

  • An intravenous (IV) line will be placed in the arm by a healthcare provider, which will deliver drugs, fluids, and a sedative to help rest.

  • Before starting the treatment, hair in the surgical region may be removed, and a local anesthetic will be given to numb the catheter insertion site.

  • Now a catheter will be introduced into the artery to the clot once the local anesthetic has taken effect.

  • Following that, a special tool known as a "stent retriever" will be put into the catheter and directed to the obstruction. The stent retriever is then inserted into the clot.

  • The stent retriever stretches the arterial wall once it passes through.

  • The doctor will be notified about the clot being trapped by the stent retriever. After which, the doctor draws backward the trapped clot with the stent retriever.

  • When the surgery is completed, the catheter and stent retriever are removed, and the insertion site is closed with a collagen material or sutures.

  • Following that, the blood artery will be closed and reconstructed in order to restore blood flow subsequently.

  • Finally, the skin incision will be wrapped and closed.

What Happens After a Thrombectomy Procedure?

The majority of people have no difficulties after surgery. However, post-operative care is still necessary. Following this treatment, one might have to spend many hours in something like a care unit. Patients will most likely be able to return home the same day. Additional suggestions include:

  • Taking care of the incision site is necessary.

  • To help avoid blood clots, medications must be used for a brief period of time.

  • In a few days, normal activities could be resumed.

  • Must give up smoking. This will reduce the chances of developing blood clots in the future.

  • There will be follow-up visits scheduled. A venogram is done; it is an imaging test that the doctor may use to examine the blood vessels.

What Are the Contraindications of Thrombectomy?

Thrombectomy in the following cases should be avoided:

  • A blood clot in an impossible-to-reach area.

  • If a blood clot has developed in a very small blood vessel, this should be avoided.

  • A blood clot that has formed in a very tiny blood artery.

  • When there is an existing blood disease, it should be avoided.

  • Bleeding in the brain (intracranial hemorrhage).

  • High blood pressure that is untreatable.

  • A persistent clot that has lasted longer than 30 days.

What Are the Potential Risks of Thrombectomy?

The risks have been reduced in the majority of cases due to advancements in medicine and technology. However, a few concerns remain. Surgical thrombectomy has the following risks:

  • Excessive bleeding with the potential to be fatal.

  • Infection.

  • Bruises at the puncture site.

  • Chest discomfort.

  • Disorientation or confusion.

  • Balance issues or dizziness.

  • Anesthesia reaction.

  • Damage to or stenosis (narrowing) of blood vessels.

  • Hematomas (blood clots) within the tissues.

  • Embolism of the lungs (clot moves from its original location and travels to the lungs).

  • The blood clot has recurred.

Conclusion

A thrombectomy is a procedure that removes a blood clot from either a vein or artery. A thrombectomy may be required immediately at the beginning of symptoms. The surgery can help resume blood flow to essential organs, including the legs, arms, intestines, kidneys, and brain, lowering the risk of mortality or irreversible tissue destruction.

If left untreated, this illness can lead to serious complications like stroke, heart failure, ischemia, organ failure, and more. The procedure will vary depending on the type of thrombectomy. The surgery may take longer depending on the size and location of the blood clot.

The procedures require post-operative care. In some circumstances, difficulties might emerge. Medication must be taken as directed. Several factors influence the chances of surviving a thrombectomy, particularly overall health and the site of the blood clot.

Frequently Asked Questions

1.

Is the Thrombectomy Procedure Considered a Major Surgery?

No, the thrombectomy procedure is not a major surgery. It is a minimally invasive procedure where the cut is made above the area of the blood clot, the blood vessels are opened, and the clot is removed. Sometimes, a stent may be placed to keep the blood vessel open. Sometimes, this procedure can be a life-saving one after a stroke in which there is less blood flow to the brain, which occurs due to blood clots.

2.

Why Is the Thrombectomy Procedure Done?

A thrombectomy procedure is done to remove any clot present in the artery or vein in the arm, leg, or any organs such as the lungs, brain, intestine, or kidney and is done when blood thinners and thrombolytics (enzymes that can help in dissolving clots) cannot dissolve the clot. Therefore, this helps restore blood flow to the area and prevent the disability. 

3.

What Is the Duration of the Thrombectomy Procedure?

The thrombectomy procedure usually takes 60 to 120 minutes, from giving a sedative and removing the blood clot by an incision to the closure of the incision site. However, compared to the procedure, the recovery rate is more than 6 hours for vascular healing, and difficult activities should not be performed for a few days.

4.

How Is a Thrombectomy Procedure Done?

There are two types of thrombectomy procedures: open and minimally invasive. In open thrombectomy, an incision is made, the blood vessel is cut open, the clot is removed using a balloon, and the incision is closed with a suture. Whereas in the minimally invasive thrombectomy procedure, an incision is made above the area of the blood clot, a catheter is inserted into the blood vessels, suctioning the clot, and the remaining clot is dissolved using thrombolysis. A vascular closure device is used to close the hole in the blood vessel.

5.

Is Thrombectomy Considered a High-Risk Procedure?

Yes, thrombectomy can be considered a high-risk procedure in case of excess bleeding, which can be a life-threatening condition and can also lead to death. Other high risks can include infections and bruises at the site of incision.

6.

What Are the Drawbacks of the Thrombectomy Procedure?

The drawbacks of the thrombectomy procedure are damage or narrowing of the blood vessels, bruises at the incision site, excess bleeding, infection, pulmonary embolism in which the clot gets detached from the original site and travels to the lungs, reaction to anesthesia, brain hemorrhage, damage to the artery or vein and recurrence of the blood clot.

7.

What Is the Price of a Thrombectomy Procedure in India?

Thrombectomy procedures, where a blood clot is removed from the artery or vein, are costly procedures and can range from 1,00,000 INR to 2,50,000 INR. And the average cost is around 1,75,000 INR.

8.

What Are the Indications of a Thrombectomy Procedure?

The indications of the thrombectomy procedure are ischemia of the mesentery, which occurs due to blockage in the blood flow of the intestine; renal artery blockage, which occurs due to blockage in the blood flow of the kidney; acute arterial limb ischemia, which occurs in the legs or hands, angina pectoris or heart attack, a stroke which occurs in the brain due to less blood supply and embolism of the lung where the detached blood clot is present in the lung.

9.

How Unsuccessful Is the Thrombectomy Procedure?

The thrombectomy procedure is very effective, especially in acute ischemic stroke patients, which occurs in the brain due to less blood supply. A few failure rates occur mainly due to the inability to reach the blood clot or to the failure of interventions in which the blood clot cannot be removed with the device.

10.

What Age Groups Can Undergo a Thrombectomy Procedure?

There is no age limit for a thrombectomy procedure. Strokes that occur in patients above 80 years of age are common to undergo this procedure. There is no upper age limit for this procedure. Pediatric arterial ischaemic stroke occurring in children can also safely undergo a thrombectomy procedure. 

11.

What Is the Difference between Thrombectomy and Angioplasty?

Angioplasty is a procedure used to dilate the blocked arteries in which plaque builds up in the blood vessels, making it difficult to flow blood. Angioplasty is done with the help of a balloon catheter, and sometimes it can be combined with placing a stent (wire mesh tube) that can dilate the narrowed blood vessel. Thrombectomy is a procedure to remove clots, and sometimes, this can also be combined with angioplasty to create more space.

12.

What Are the Contraindications for a Thrombectomy Procedure?

Contraindications of the thrombectomy procedure are small vessel occlusion, blood clots that are deeply situated and impossible to reach, blood clots in small blood vessels or tiny arteries, blood disorders, intracranial hemorrhage, high blood pressure that cannot be treated and a clot that is present for more than 30 days.

13.

What Is the Recovery Rate after the Thrombectomy Procedure?

The time for recovery rate is more than the operating rate. The patient should be in the post-operative care unit for some hours. Rest should be given for at least 6 hours for vascular healing, and a few days, medications are given to avoid blood clots, difficult activities should not be performed, and smoking should be avoided.

14.

Is Anesthesia Used during a Thrombectomy Procedure?

Yes, anesthesia is used during a thrombectomy procedure to reduce the pain. The sedation can be either general or conscious. In general sedation, there is loss of consciousness, but conscious sedation or IV sedation causes partial memory loss but has a quick recovery rate. 

15.

What Is the Golden Hour for a Thrombectomy Procedure?

The golden hour for the thrombectomy procedure is when the incision or puncture is made, and the clot is removed until the blood flow is re-established, which is done within 60 minutes. A thrombectomy procedure completed in this golden hour has a good outcome, and the patient will recover soon.

16.

Can a Thrombectomy Procedure Cause a Stroke?

No, a thrombectomy procedure cannot cause a stroke, which occurs due to decreased blood flow to the brain due to a blood clot. Instead, a thrombectomy procedure is done in case of a stroke, which helps in the removal of a blood clot. 

17.

Is There a Similarity between a Stent and a Thrombectomy?

No, a stent is a stainless steel or platinum-chromium mesh tube inserted inside the blood vessel that is blocked or narrowed due to plaque deposition. Whereas a thrombectomy is a procedure to remove the blood clot from the artery or vein.
Dr. Rajesh Gulati
Dr. Rajesh Gulati

Family Physician

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