A thrombectomy is a surgical procedure used to break down large blood clots in both arteries and veins. The procedure is done under image guidance by endovascular devices. It helps to maintain perfusion in tissues that have reduced blood flow due to thrombus formation.
What is a Thrombus, and How is it Formed?
A thrombus is a firm gel-like clot of blood that may clog vessels and block blood flow through the artery/vein involved. Under normal circumstances, our body’s homeostasis maintains the blood flow in both arteries and veins. In case of a vessel wall injury, the circulating blood platelets are recruited to the site, and blood flow to the injured vessel is halted. This occurrence might turn into a life-threatening condition if such clots form inside the vessels with no preceding injury, compromising the blood flow to the organ involved. If the organ affected is the brain, heart, or lung, it might clinically present as stroke, myocardial infarction, or pulmonary embolism (following deep venous thrombosis DVT).
Symptoms such as pain, numbness, swelling, noticeable veins, temperature-rise in the involved area, tissue death, and chest pain (in the setting of pulmonary embolism) may occur in conditions needing a thrombectomy. These symptoms affect the lifestyle of the patient and can even prove fatal.
Contraindications of Thrombectomy
Conventionally, for small clots, drug therapy is used. But such therapies might prove inadequate when it comes to large clots involving large blood vessels. Such instances call for surgical interventions, such as surgical or mechanical thrombectomy.
Some common instances in which thrombectomy is necessary include:
- Large vessel occlusion (LVO)
- Cerebral stroke
- Myocardial infarction
- Pulmonary embolism (due to deep venous thrombosis)
On the contrary, thrombectomy is not advised in patients with uncorrected coagulopathies, small vessel occlusions, or intracranial hemorrhage.
How is Thrombectomy Performed?
A thrombectomy is a minimally invasive procedure that involves the surgeon making a small incision on the skin over the involved vessel. The surgeon then removes the clot from the incised blood vessel. In case of stroke or pulmonary embolism, the surgeon cuts the base of the neck or groin region.
An image-guided catheter is passed through the vessel until it reaches the clot. Afterward, a guidewire followed by a microcatheter is passed through the clot. The surgeon then removes the guidewire, the stent is opened, and its projections take hold of the clot. The retrievable stent, along with the clot, is then removed.
Complications of Thrombectomy
During the procedure, there are a few complications that the surgeon might face. These include vascular injury and embolus formation. Post-surgical complications include vasospasms, but these rarely require treatment. Damage to the vessel wall may cause hemorrhage and associated symptoms.
Pharmacological treatment can also injure the vessel walls producing the same complications. Other complications are similar to those of other invasive surgeries, such as the risk of infection, shock, deep vein thrombosis, and pulmonary embolism.