Thrombolysis and Thrombectomy – Arterial
Everything you need to know about arterial thrombolysis and thrombectomy.
WHAT ARE ARTERIAL THROMBOLYSIS AND THROMBECTOMY?
Thrombectomy – uses various mechanical methods to physically remove or break up blood clots from arteries and veins (rather than dissolve them). This can be either an open surgery or catheter-based procedure.
WHY ARE ARTERIAL THROMBOLYSIS AND THROMBECTOMY USED?
The second type is called an embolus, which is any part of a clot that breaks off and gets ‘thrown’ downstream until it ultimately gets trapped in a blood vessel small enough that it cannot pass through. For example, a little bit of thrombus formed in a plaque rupture inside the femoral artery in the thigh can dislodge, becoming an embolus. This embolus is very small and will continue flowing downstream until it lodges in a small vessel on a toe, where it cuts off blood flow that to that area of the toe.
Surgeons perform arterial thrombolysis and thrombectomy procedures to reduce the risk of damage to organs like the brain as well as arms, hands, legs, and feet. Because of the potential danger that blood clots present timely treatment is often critical to the health and well-being of the patient.
Please note that veins have their own thrombolysis/thrombectomy story – please refer to the page on venous thrombolysis/thrombectomy for more information.
How is an Arterial Thrombolysis and Thrombectomy Performed?
Arterial Thrombolysis: It is a catheter-based procedure whereby ultrasound guidance is used to obtain access to an artery at the ankle, groin, or other appropriate access site. Using either ultrasound or angiographic imaging, the catheter is then advanced through the artery to the location of the thrombus where the thrombolytic medication is delivered directly to the clot. The medication needs time to dissolve the thrombus. Thrombolysis may be used in conjunction with catheter-based suction to remove the thrombus as it softens and breaks down.
Arterial Thrombectomy may be performed either as an open or endovascular procedure. In open surgery an incision is made into the artery, the thrombus (and perhaps the plaque it is attached to) are removed, and the artery stitched back together.
An example of open surgical thrombectomy would be the removal of an actively embolizing carotid artery plaque rupture. As thrombus forms in the nooks and crannies of the plaque, these can break free and travel to the brain, and cause mini strokes or a stroke. One way to prevent – or stop this – from happening is to perform a carotid endarterectomy, which simply means removing the plaque and thrombus from the artery. An example of an endovascular thrombectomy is a suction device that pulls thrombus out of the artery.
At AVV, we have taken an innovative approach to treating thrombus in leg arteries by using a catheter-based eximer laser in conjunction with ultrasound guidance to essentially “melt” thrombus. The laser catheter is inserted into an artery through a small access point at the ankle and using ultrasound, guide it through the artery to the location of plaque and/or thrombus. While this type of laser is primarily used for intrastent recurrences or plaque modification, we at AVV have observed as it breaks carbon to carbon bonds.
It should be noted that not all thrombus needs to be removed. For example, aneurysms – which often have thrombus in their sac – are either treated with a covered stent graft or have a surgical bypass placed to exclude flow from the aneurysm.
WHAT YOU NEED TO KNOW PRIOR TO THROMBOLYSIS/THROMBECTOMY
WHAT TO EXPECT AFTER YOUR PROCEDURE
IMPORTANT: It is vital that patients keep their followup appointments. The reason for this is that vascular disease is not something that just goes away. It is a process that continues, even after any necessary procedures have been performed. Regular monitoring of your condition will be required in order to help you realize your best possible outcome for the long term.
