Thromboembolectomy

Thromboembolectomy is a surgical procedure designed to remove blood clots from blood vessels, potentially saving lives by restoring normal blood flow and preventing serious complications such as stroke, heart attack, or limb loss.

Table of contents

• What is Thromboembolectomy?
• Understanding the Terminology
• When is This Procedure Necessary?
• Types of Procedures
• How the Procedure is Performed
• Preparing for the Procedure
• Risks and Benefits
• Recovery and Hospital Stay
• Life After Treatment
• Preventing Future Blood Clots

What is Thromboembolectomy?

Thromboembolectomy is a medical procedure that removes blood clots that are blocking the normal flow of blood through your vessels. The procedure is sometimes called a thrombectomy or embolectomy, depending on the type of clot being removed^[1].

Your blood needs to be able to clot so you don’t bleed too much when you have a cut. However, sometimes blood tries to clot too much in places where it shouldn’t. When this happens, a clot forms inside a blood vessel and blocks the flow of blood, preventing oxygen and nutrients from reaching important parts of your body^[1].

Understanding the Terminology

There are two main types of blood clots, and understanding the difference helps explain why doctors use different names for removal procedures. A thrombus is a blood clot that forms and stays in one place inside a blood vessel. An embolus is a blood clot that forms in one part of your body and then travels through your bloodstream to lodge somewhere else^[1][3].

For example, a blood clot might form in your leg and then break loose and travel to your lungs. When it started in your leg, it was a thrombus. Once it moved and blocked a vessel in your lungs, it became an embolus. Both types can be dangerous and may require removal through thromboembolectomy^[3].

When is This Procedure Necessary?

You might need a thromboembolectomy if you have a blood clot that healthcare providers cannot treat with medications alone. Blood clots are most common in the brain, heart, and lungs, but they can also occur in the legs, arms, and intestines^[6][9].

Your healthcare provider may recommend this procedure if you have a pulmonary embolism (a blood clot in your lung) or a blood clot in the right side of your heart, and one of the following is true: you cannot take blood-thinning medications or clot-busting drugs, these medications did not work, or you are at risk for the blood clot moving through a defect in your heart to your brain or other vital organs^[1].

The procedure may also be necessary when dealing with deep vein thrombosis in the leg, especially in cases of severe vein blockage and severe pain^[8]. Other conditions that may require thromboembolectomy include acute limb ischemia (when a clot suddenly blocks blood flow to an arm or leg), acute mesenteric ischemia (a blockage affecting blood flow to the intestines), and stroke^[2][9].

Blood clots can result in serious and even fatal complications such as stroke, heart attack, tissue death, loss of limbs, and other serious heart problems^[3]. Sometimes a thromboembolectomy must be performed within a matter of hours to prevent life-threatening or limb-threatening complications from occurring^[9].

Types of Procedures

There are two main categories of thromboembolectomy procedures. The type your doctor chooses depends on the size and location of the blood clot, as well as how urgent the situation is^[9].

A surgical thromboembolectomy (also called an open thromboembolectomy) is a traditional approach where your surgeon makes a larger incision to directly access the blocked blood vessel. The surgeon cuts open the blood vessel, removes the blood clot using special tools such as a balloon, and then repairs the vessel^[9][4].

A minimally invasive thromboembolectomy (also called a catheter-based or percutaneous thromboembolectomy) uses small cuts and special instruments. During this procedure, your doctor introduces special devices through thin tubes called catheters that can either break up or suction out clots from within your blood vessel^[9][4].

Several techniques can be used during minimally invasive procedures. These include catheter-directed thrombectomy, where a small catheter breaks up and removes the clot; aspiration thrombectomy, which uses suction to remove the clot; balloon embolectomy, where a catheter with an inflatable balloon pulls the clot out safely; and stent-retrieval, where a device traps and encases the blood clot so it can be removed^[2][4][7].

How the Procedure is Performed

During a minimally invasive thromboembolectomy, your healthcare provider will first inject numbing medicine into your skin before making a small cut. They will then place a small needle through the cut and into your blood vessel, which may be in your neck or your groin area. A catheter is placed into your blood vessel and gently pushed along until it reaches the location of the clot. Your doctor will use special X-rays during this step to see exactly where the catheter is going^[1].

Once the catheter is in place, your healthcare provider may use it to suction the clot out of the blood vessel, similar to how a vacuum works. In some procedures, a device at the tip of the catheter uses a mechanical tool or high-velocity liquid jet to break up the clot^[1][8].

For stroke cases, a specialized X-ray helps the surgeon navigate a catheter to the exact location of the blockage in the brain. A stent-retriever is then slid into the catheter, which traps and encases the blood clot. The surgeon can then remove both the stent and the blockage from the blood vessel at the same time. Once removed, blood supply is restored and the patient is monitored for improvement^[7].

A thromboembolectomy procedure typically takes one to three hours, but the preparation and recovery time may add several hours^[3][8].

Preparing for the Procedure

Before the procedure, your doctor and treatment team will explain what to expect and the potential risks. You should talk to your doctor about all medications, herbal products, and dietary supplements you are currently taking. Also inform them about any allergies to medicines, latex, tape, iodine, or anesthetic agents, and any history of bleeding disorders^[3].

To determine whether you need the procedure, your doctor might perform various diagnostic tests including ultrasound, computed tomography (CT scan), magnetic resonance imaging (MRI), blood tests, or angiogram (special X-rays of your blood vessels)^[3][4].

It is generally recommended that you eat a normal meal the evening before the procedure but do not eat, drink, or chew anything after midnight. If you must take medications, only take them with sips of water. Leave all jewelry at home and remove all makeup and nail polish^[3].

Your healthcare provider will set up special imaging equipment to use during your procedure. For a catheter-based procedure, your healthcare team prepares an ultrasound machine to help them find the clot and sets up an angiogram to help them place the catheter in the right place. You will receive some form of anesthesia so you don’t feel pain during the procedure^[1].

Risks and Benefits

Like any surgical procedure, thromboembolectomy comes with potential risks. These may include damage to the blood vessel or stenosis (narrowing of the vessel), bleeding, severe bruises called hematomas, infection, and in rare cases, a pulmonary embolism if a clot shifts from its original location and migrates to the lungs^[19].

Additional risks can include blood clot recurrence, stroke, excessive bleeding, and complications from anesthesia^[8]. Certain factors increase the risk of complications, including being older than 65, having bleeding tendencies, having high blood pressure or heart failure, having poor kidney function, or being allergic to contrast dye used during imaging^[8].

Despite these risks, thromboembolectomy offers numerous important benefits. The procedure provides rapid restoration of blood flow, which prevents organ and limb damage. It offers immediate relief from symptoms such as pain, swelling, and tissue damage. It lowers the risk of long-term complications and can be a life-saving intervention for severe cases of pulmonary embolism or stroke caused by a blood clot^[4].

A thromboembolectomy can greatly reduce the risk of death or permanent disability if performed promptly^[9]. When combined with other treatments such as blood-thinning medications and proper follow-up care, venous thromboembolectomy has a success rate of 70 to 100 percent^[8].

Recovery and Hospital Stay

After the procedure, you will need time to recover. The length of hospital stay depends on how severe the clot is and whether your body is dissolving any remaining clot on its own. Some people may not need to stay in the hospital at all, while others may require one week or more^[9].

A 2015 study found that while 19% of people with pulmonary embolism stayed in the hospital for 5 days or less, 17% of patients received treatment at home. Some people with low-risk pulmonary embolism may not require hospitalization at all^[2].

After the procedure, compression bandages are typically applied to the leg to reduce swelling. For up to 6 hours after the procedure, you may be asked to walk for 15 minutes, then rest for 45 minutes, and repeat this pattern. Once any leg swelling has subsided, you will be fitted with compression stockings^[8].

You will receive medications through a vein during the recovery period to prevent new blood clots from forming. Most people can resume normal activities a few days after starting medication, and any pain and swelling will also improve within this time^[6][9].

Life After Treatment

After a thromboembolectomy, people typically need to take blood-thinning medication, also called anticoagulants, for at least 3 to 6 months or longer. The exact duration depends on the location and severity of the clot. In some cases, people may need to take these medications for much longer or even for the rest of their lives^[6][9].

It is important to understand that anticoagulants do not dissolve the existing clot. Instead, they prevent more clots from forming while your body breaks down the existing clot on its own^[6].

If you take the blood thinner warfarin, you will need to watch what you eat because vitamin K can affect how the drug works. You have to be careful about the amounts of kale, spinach, Brussels sprouts, chard, or collard or mustard greens you eat. Green tea, cranberry juice, and alcohol can also affect blood thinners^[17].

Blood thinners can make you more likely to bleed from small injuries, so it’s important to be careful when trimming your nails. You should wear gloves when you use sharp tools and wear safety gear for sports and hobbies. You should not take aspirin unless your doctor says it is okay, as it can raise your chances of major bleeding^[17].

After having a blood clot in the leg, it is common to have ongoing swelling for up to 3 months. If symptoms continue after the first month of treatment, your doctor may give you compression stockings. These special tight-fitting socks help increase blood flow in the legs and reduce swelling. Approximately 30% of people will have long-term swelling in their leg following treatment^[21].

After a pulmonary embolism, it is common to have shortness of breath and mild pain or pressure in the affected area. Most people make a full recovery, but the time it takes to completely recover can be several months or years, depending on the circumstances^[22].

Preventing Future Blood Clots

Having one blood clot increases your risk of another. If you have had a deep vein thrombosis, your chances of another one are higher. Several lifestyle changes can help lower your risk of recurrence^[16][20].

Staying active is one of the most important steps. Long periods of sitting can raise your risk for blood clots. Regular exercise, such as walking, swimming, or biking, can help lower your risk. Try not to stay seated for more than 2 hours at a time. Get up and walk around regularly, and if you had a blood clot in one of your legs, don’t cross your legs when you sit down^[16][17][20].

Reaching or maintaining a healthy weight is also important. Higher body weight dramatically increases your risk for blood clots. Smoking negatively impacts your health and can increase your risk for future clots by affecting the quality of your platelets, the parts of your blood involved in clotting^[20].

If your hydration levels drop, your blood circulation may slow down, and that can increase your risk for blood clots. A good level of hydration to aim for is about eight to ten glasses of water each day, being sure to add more after exercise or being outdoors in hot weather^[20].

When traveling, take extra precautions. Any trip longer than seven hours could increase your risk for clots. If you are driving, build frequent stops into your travel plans. If you are traveling by air, plan to get up and walk through the plane regularly. While you are in your seat, flex your ankles to keep blood flowing. It is recommended to wear compression stockings when traveling, especially for flights of 4 hours or more^[17][21].

Always let all your doctors know if you have had a blood clot of any kind. If you notice any warning signs of a new blood clot, such as new or worse pain, pressure, or cramping in your calf, swelling in your leg, shortness of breath, or fainting, call emergency services immediately and get medical care right away^[17][20].