Overview
Vascular conditions can profoundly impact one's health, often necessitating advanced interventions. At Max Healthcare, we recognize the gravity of such conditions and the vital role thrombectomy plays in addressing them. Whether it's ischemic strokes or peripheral arterial thrombosis marked by blood clots, thrombectomy stands as a crucial intervention.
Our specialised team of interventional radiologists, neurointerventionalists, and vascular surgeons is committed to delivering personalised treatment plans. With a focus on precision and care, they ensure optimal outcomes for patients facing vascular-related challenges.
Harnessing cutting-edge medical procedures and state-of-the-art facilities, we strive to provide the highest quality healthcare. This commitment, coupled with our expertise, aims to bring effective solutions to those in need.
What is Thrombectomy?
Thrombectomy is a medicalprocedure that removes blood clots from arteries and veins, restoring blood flow and preventing potential complications. The process involves the use of specialised tools and techniques to extract or dissolve the clot, allowing for improved circulation.
Types of Thrombectomies
Here are various types of thrombectomies based on different criteria:
Technique-based Types of Thrombectomy
- Mechanical Thrombectomy: Involves using specialised devices to physically break up or extract blood clots.
- Pharmacomechanical Thrombectomy: Combines mechanical devices with thrombolytic medications to dissolve and remove clots.
- Aspiration Thrombectomy: Uses suction catheters to aspirate or vacuum the clot from the affected blood vessel.
- Rheolytic Thrombectomy: Utilises high-speed saline jets to create a vacuum effect, breaking up and removing blood clots.
- Ultrasound-assisted Thrombectomy: Involves the use of ultrasound energy to help break up and facilitate the removal of blood clots.
- AngioJet Thrombectomy: A specific type of rheolytic thrombectomy using high-speed saline jets and a vacuum.
Medical Condition-based Types of Thrombectomy
- Ischemic Stroke Thrombectomy: Specifically focused on removing blood clots causing ischemic strokes within the brain.
- Peripheral Arterial Thrombectomy: Targets blood clots in peripheral arteries, excluding the heart and brain.
- Deep Vein Thrombosis (DVT) Thrombectomy: Addresses blood clots within deep veins, often in the legs.
- Coronary Artery Thrombectomy: Pertains to procedures involving blood clots within the coronary arteries of the heart.
- Venous Thromboembolism (VTE) Thrombectomy: Addresses venous blood clots that may lead to pulmonary embolism.
Anatomical Location-based Types of Thrombectomy
- Neurothrombectomy: Involves procedures targeting blood clots within the brain and central nervous system.
- Cardiothrombectomy: Pertains to thrombectomy procedures related to the heart, including coronary arteries.
- Peripheral Thrombectomy: Addresses blood clots in peripheral arteries or veins, excluding the heart and brain.
Access Point-based Types of Thrombectomy
- Endovascular Thrombectomy: A minimally invasive procedure where instruments are guided through blood vessels to reach and remove the clot.
- Surgical Thrombectomy: Involves open surgery to directly access and remove the blood clot.
Patient Population-based Types of Thrombectomy
- Paediatric Thrombectomy: Thrombectomy procedures adapted or specifically designed for paediatric patients.
- Adult Thrombectomy: Standard thrombectomy procedures applied to adult populations.
When to Undergo Surgical Thrombectomy?
Determining whether thrombectomy is required is a crucial decision often involving a team of healthcare professionals and depends on several factors:
Type and Location of the Clot
- Stroke: For ischemic strokes due to large artery occlusions, thrombectomy is often an essential treatment if performed within specific time windows (typically 6-24 hours after symptom onset). Early intervention significantly improves outcomes and minimises brain damage.
- Heart Attack: Clots in coronary arteries causing severe heart attacks may benefit from thrombectomy, especially if traditional medications fail to restore blood flow promptly.
- Pulmonary Embolism: Large clots in the lungs causing severe breathing difficulties and hemodynamic instability may require thrombectomy for fast blood flow restoration.
- Deep Vein Thrombosis (DVT): Though rare, in cases of DVT with severe limb swelling, tissue damage, or risk of clot migration to the lungs, thrombectomy might be considered.
Severity of Symptoms
- Sudden weakness, numbness, or speech difficulties in stroke often signal the need for prompt thrombectomy evaluation.
- Severe chest pain, shortness of breath, and shock during a heart attack may necessitate rapid clot removal through thrombectomy.
- Difficulty breathing, coughing up blood, and fainting due to pulmonary embolism warrant immediate assessment for potential thrombectomy.
Other Factors
- Time since symptom onset is crucial, particularly for strokes, where faster clot removal is vital.
- Underlying medical conditions and previous treatments influence the decision-making process.
- Age and overall health are also considered in determining treatment options.
In addition, it is important to remember that:
- Early diagnosis and medical attention are crucial for recognizing situations where thrombectomy might be needed.
- Consultation with a healthcare professional is essential for determining the best course of treatment based on individual circumstances.
- Thrombectomy is not always the first-line treatment for every blood clot, and alternative options like medications or observation might be appropriate in some cases.
If someone experiences sudden symptoms suggestive of a stroke, heart attack, or pulmonary embolism, seeking immediate medical help is vital. Timely diagnosis and evaluation can determine whether thrombectomy is the optimal approach for restoring blood flow and minimising potential complications.
Risks of Surgical Thrombectomy
While thrombectomy is generally considered a safe and effective procedure, like any medical intervention, it carries certain risks and potential complications. The specific risks can depend on various factors, including the patient's overall health, the underlying condition being treated, and the specific technique used for thrombectomy. Here are some potential risks associated with thrombectomy:
- Bleeding: Thrombectomy may increase the risk of bleeding, particularly at the site where the catheter is inserted or at other vascular access points. The severity of bleeding can vary, and excessive bleeding may require additional medical intervention.
- Infection: Any procedure involving the introduction of medical instruments into the body carries a risk of infection. Infections can range from mild to severe, and prompt medical attention is necessary if signs of infection, such as redness or swelling at the insertion site, are observed.
- Allergic Reactions: Some individuals may be allergic to the contrast dye used during imaging procedures associated with thrombectomy. Allergic reactions can vary in severity, and healthcare providers take precautions to minimise the risk.
- Vascular Injury: There is a risk of injury to blood vessels during the insertion of catheters or other devices, potentially leading to damage or bleeding. The severity of vascular injury can vary, and immediate medical attention is required if complications arise.
- Clot Fragmentation: During thrombectomy, there is a possibility that the clot may fragment into smaller pieces. These fragments can travel to other parts of the circulatory system. Fragmented clots may cause blockages in smaller blood vessels, potentially leading to complications.
- Organ Damage: In rare cases, thrombectomy may cause damage to organs or tissues surrounding the targeted blood vessel. The severity of organ damage can vary, and it may require additional medical interventions.
- Reperfusion Injury: Rapid restoration of blood flow to an ischemic area (such as in ischemic stroke) can cause reperfusion injury, potentially leading to inflammation and tissue damage. The severity of reperfusion injury can vary, and its occurrence is carefully managed during the procedure.
The risks associated with thrombectomy are generally outweighed by the potential benefits, especially in critical conditions such as ischemic stroke. Patients are encouraged to discuss any concerns or questions about the procedure with their doctor before undergoing thrombectomy.
Surgical Thrombectomy Preparation
The preparation for surgical thrombectomy involves several steps:
Medical Evaluation
A thorough medical evaluation is essential to assess the patient's overall health and identify any pre-existing conditions that may affect the procedure or recovery.
Imaging Studies
Imaging studies, such as CT scans or MRIs, may be conducted to precisely locate and characterise the blood clot. This information helps the surgical team plan the procedure.
Blood Tests
Blood tests are often performed to assess the patient's clotting function and overall blood chemistry. This information is crucial for ensuring the safety of the procedure.
Medication Review
Provide a detailed list of medications, including prescription and over-the-counter drugs, to the medical team. Some medications may need to be adjusted or temporarily discontinued before the surgery.
Fasting
Typically, patients are instructed not to eat or drink anything for a specific period before the surgery. This is to reduce the risk of complications, such as aspiration during anaesthesia.
Consent
The surgeon will explain the procedure, potential risks, and benefits to the patient. Informed consent must be obtained before the surgery.
Preoperative Instructions
Follow any specific preoperative instructions given by the surgical team. This may include showering with a special soap, discontinuing certain medications, quitting smoking and avoiding certain foods.
Anaesthesia Consultation
If general anaesthesia is used, a preoperative consultation with an anesthesiologist may be necessary. The anesthesiologist will assess the patient's fitness for anaesthesia and discuss the anaesthesia plan.
Surgical Thrombectomy Procedure
The specific details of the procedure may vary depending on the location and nature of the clot, but the general steps involved in a surgical thrombectomy typically include the following:
Administering Anaesthesia
Before the surgery begins, the patient is administered anaesthesia to ensure they are unconscious and pain-free during the procedure. The type of anaesthesia used can vary, and it may be general anaesthesia, which puts the patient to sleep, or local anaesthesia, which numbs a specific area.
Making the Incision
A surgical incision is made at the site where the blood clot is located. The location of the incision depends on the specific blood vessel involved.
Clot Removal
The surgeon carefully accesses the blood vessel containing the clot. Different techniques may be used to remove the clot, such as using specialised catheters, suction devices, or other tools to physically extract or break up the clot.
Vessel Repair
In some cases, after the clot is removed, the surgeon may need to repair the blood vessel if it has been damaged or if there are underlying vascular issues contributing to clot formation.
Closing the Incision
Once the clot is removed, the surgeon closes the incision with stitches or other closure methods. The type of closure will depend on the size and location of the incision.
Post Surgical Thrombectomy
After a surgical thrombectomy, the patient undergoes a period of postoperative care and recovery. The specific details of the recovery process can vary based on factors such as the type of thrombectomy performed, the patient's overall health, and the location of the blood clot. Here are general aspects of what happens after a surgical thrombectomy:
Monitoring in Recovery Room
Immediately after the procedure, the patient is moved to a recovery room or post-anesthesia care unit. Healthcare professionals closely monitor vital signs, such as heart rate, blood pressure, and oxygen levels.
Pain Management
Pain management is initiated to ensure the patient's comfort. The medical team may administer pain medications or recommend other pain relief methods.
Observation Period
The patient is observed for any signs of complications, such as bleeding or adverse reactions to anaesthesia. The duration of the observation period may vary, depending on the extent of the procedure and the patient's condition.
Gradual Awakening
If general anaesthesia is used, the patient gradually wakes up from the anaesthesia. Healthcare professionals ensure a smooth transition as the patient becomes more alert.
Postoperative Imaging
In some cases, postoperative imaging studies, such as CT scans or MRIs, may be performed to confirm the successful removal of the blood clot and assess the condition of the blood vessels.
Fluids and Nutrition
The patient may be given fluids and, eventually, allowed to resume oral intake. This helps prevent dehydration and supports the recovery process.
Mobility and Ambulation
Depending on the type of thrombectomy and the patient's condition, healthcare providers may encourage early mobilisation and ambulation to prevent complications such as blood clots in the legs.
Postoperative Instructions
The patient and their caregivers receive detailed instructions for postoperative care, including wound care, activity restrictions, and any prescribed medications. Follow-up appointments with the healthcare team may be scheduled.
Rehabilitation and Follow-up
In some cases, rehabilitation or physical therapy may be recommended to aid in the recovery process, especially if the thrombectomy was performed in a critical area like the brain.
Discharge
Once the patient has stabilised and meets specific criteria, they may be discharged from the hospital. It's essential to arrange for transportation home, as the patient may not be able to drive immediately after the procedure.
Follow-up Care
Follow-up appointments with the surgical team or primary care physician are typically scheduled to monitor the patient's progress and address any concerns. The healthcare team will assess the need for ongoing medications and lifestyle modifications to prevent future clot formation.
It's crucial for patients to adhere to postoperative instructions, attend follow-up appointments, and communicate any unusual symptoms or concerns to their healthcare providers during the recovery period. Recovery timelines can vary, and individual experiences may differ based on the specific circumstances of the surgery and the patient's health.
Frequently asked questions about Thrombectomy
Q1. Who performs a Thrombectomy surgery?
Thrombectomy is typically performed by specialised healthcare professionals such as interventional radiologists, neurointerventionalists, vascular surgeons, or cardiologists, depending on the specific medical condition and location of the blood clot.
Q2. Who shouldn’t undergo a Thrombectomy?
Thrombectomy may not be recommended for individuals who have a blood clot in a location that is challenging to reach, a blood clot in a very small blood vessel, a clot that can be effectively managed with medication, a preexisting blood disorder, intracranial haemorrhage (brain bleeding), uncontrolled high blood pressure, or a chronic clot that has been present for more than 30 days.
Q3. Do all blood clots require a Thrombectomy?
Not all blood clots necessitate medical intervention. Certain clots can be effectively managed through the administration of medications such as anticoagulants or thrombolytics. Anticoagulants, known for their blood-thinning properties, serve to prevent the formation of additional clots, providing the body with an opportunity to naturally dissolve non-urgent clots over time. Thrombolytics, also referred to as thrombolytic therapy, are pharmaceutical agents designed to dissolve acute, sudden clots. The determination of whether an individual requires anticoagulants, thrombolytics, or a thrombectomy is contingent upon various factors, with the final decision resting in the hands of the healthcare provider.
Q4. What does Thrombectomy treat?
A thrombectomy is usually performed to treat:
- Ischemic Stroke.
- Peripheral Arterial Thrombosis.
- Deep Vein Thrombosis (DVT).
- Coronary Artery Thrombosis
- Venous Thromboembolism (VTE).
- Pulmonary Embolism.
- Heart attack (myocardial infarction).
- Renal artery occlusion.
Q5. What is the prognosis for individuals who have undergone a Thrombectomy?
The outlook for individuals who have undergone a thrombectomy depends on various factors such as the specific condition treated, overall health, and any underlying medical issues. In many cases, a successful thrombectomy can lead to improved blood flow and reduced risks associated with the presence of the blood clot. However, the healthcare team will provide more precise information based on the individual's unique circumstances during postoperative assessments and follow-up appointments.
Review
Reviewed by Dr. Achintya Sharma, Consultant & In-charge - Vascular Surgery on 7 Mar 2024.