You may already take blood-thinning medications to break up blood clots in your legs that result from your deep vein thrombosis (DVT) condition. But sometimes, drugs alone cannot restore your healthy circulation, and you need surgery. If you have reached that stage, research will make you more comfortable with the procedures that doctors called vascular surgeons or interactive radiologists perform.
Thrombectomy
In this procedure, a doctor may make a cut (incision) in a vein or artery above the clot to remove it. Or, they may insert a thin tube called a catheter into a vein in your groin or arm and thread it through blood vessels to reach the clot. Either way, the doctor may inject a contrast dye into your blood vessel to help pinpoint the clot location. The clot often is in a vein or artery in your arm or leg, but sometimes the surgeon will operate on an organ or other body part.
Usually, a clot must be very large to justify a thrombectomy. In some cases, the doctor will also insert a special balloon attached to the catheter and inflate it to remove any remaining part of the clot. And the doctor may permanently leave a different tube called a stent in the blood vessel to help keep it open.
Your doctor will brief you on potential risks with a thrombectomy, including:
- Excess bleeding during the procedure that can be dangerous
- Damage to the blood vessel during surgery
- Infection
- A negative reaction to anesthesia
- A clot or fragment finding its way to your lungs and blocking blood flow there
Also, your doctor will tell you about the risk that new clots could form even after a successful thrombectomy.
Before the procedure, you may get certain medical tests like an ultrasound (to measure blood flow in the affected body part), venogram or arteriogram (to get an image of the affected blood vessel), or a computed tomography (CT) scan (to reveal more about the clot).
Your doctor will ask you to stop smoking and to list any prescription or over-the-counter medications you take regularly. You also will be asked about any allergies, health changes, pregnancy, or reaction to anesthesia that could cause problems during surgery.
In some thrombectomies, the medical team gives you a local anesthetic to numb skin for an incision and shaves hair from that area. During the procedure, an IV tube will deliver an anesthetic, and possibly blood thinner and other medications, into your hand or arm.
After surgery, you may spend several hours in a recovery room under close observation. Then, you could need a day or two in the hospital. Once you go home, you may need to take blood thinners and pain medication for a short time and to wear compression stockings to help prevent clots from reforming. You can expect a number of follow-up appointments with your doctor.
Catheter-Directed Thrombolysis
Your doctor may decide your clot can be handled effectively with a procedure that’s less invasive than a thrombectomy, and by dissolving rather than removing the clot. Catheter-directed thrombolysis uses X-ray equipment, a catheter, and special dissolving medications.
Guided by the X-ray camera, the doctor inserts a catheter into a vein or artery and guides it to the area where blood flow is blocked. Next, they inject a contrast dye through the catheter and do a series of X-rays; both actions help pinpoint the clot. The catheter may be left in place for up to 72 hours if it applies clot-dissolving medications. Or, the doctor may use the catheter to position a tiny mechanical device to remove the clot, in a procedure that normally takes about an hour and doesn't require a long hospital stay.
Potential risks of catheter-directed thrombolysis include:
- Infection, either during an injection or after the procedure
- An allergic reaction to the contrast dye
- Damage to a blood vessel
- Excess bleeding triggered by blood thinners or other medications
- A clot or fragment breaking free and causing harm elsewhere
- Kidney damage, especially if you have a kidney condition
Also, your doctor will inform you that sometimes, the catheter tip cannot make it to the clot, or that sometimes, tissue damaged by lack of blood flow cannot be repaired.
Before the procedure begins, you’ll have monitors for your heart rate and blood pressure set up. You will get a local anesthetic before an IV needle is inserted. That IV line will deliver a sedative to make you feel comfortable throughout, although you may feel some pressure as the catheter is inserted and warmness from the contrast dye. You may fall asleep due to sedation.
One to 3 days in the hospital, including a day in the intensive care unit, are normal after this procedure. You may need pain medication and more clot-dissolving medication while you recover, and you may wear a compression stocking or sleeve on your leg or arm. Your doctors may prescribe blood thinners for the next 3-6 months. They may also recommend more treatment for clotting or to repair tissue damaged before the procedure, plus a follow-up visit including a physical exam, imaging tests, and bloodwork.
IVC Filter Placement
An inferior vena cava (IVC) filter is a small, wiry device that a doctor may recommend placing in the major vein that carries blood from the lower body back to the heart. Its purpose is to stop clots from finding their way to your heart and lungs.
A doctor will make a small cut in a vein in your groin or neck to insert a catheter. This catheter will take a collapsed IVC filter to your inferior vena cava and then expand it to attach to the blood vessel’s walls. Doctors will either recommend leaving the filter in your body permanently or decide to remove it after some time.
Some risks of an IVC filter placement are the same as with the other DVT-related surgeries. But your doctor will address other possible risks, such as:
- A filter blocking blood flow rather than clots
- A filter coming loose and traveling to your heart or lungs, or piercing the blood vessel
- An improperly positioned filter
The procedure normally takes about an hour, and after a few hours of recovery, you may return home the same day (although you will need a driver). You will receive a sedative during the procedure through an IV. If you have pain afterward, it usually can be handled with over-the-counter medication. In the future, you may need to take blood thinners and should expect doctor visits for imaging tests that make sure the filter remains in the right place.
