Venous thrombectomy is the surgical removal of a clot within a large vein. This type of clot usually develops as a complication of deep vein thrombosis (DVT), a common but serious condition in which a clot develops in a vein deep within the body. DVT causes vein damage, resulting in impeded blood flow. Although DVT is often asymptomatic, if the clot detaches and travels to the lungs, pulmonary embolism, which is potentially fatal, can develop. Venous thrombectomy is generally viewed as a treatment of last resort, and is sometimes performed only when a patient already has a pulmonary embolism.
Reasons for Venous Thrombectomy
Venous thrombectomy (a type of embolectomy) may be performed on a DVT patient whose symptoms pose a serious risk of pulmonary embolism, or on a patient who already has pulmonary embolism. It may also be performed on patients for whom other common DVT treatments are not appropriate: those who are pregnant, have not responded well to anticoagulation therapy, or cannot tolerate thrombolytics. Venous thrombectomy is also recommended for patients facing limb loss or venous gangrene from a massive DVT, one possibly associated with arterial insufficiency (also known as phlegmasia cerulea dolens).
Venous thrombectomy is sometimes performed in conjunction with another procedure, such as angioplasty, thrombolysis or vena cava filter placement.
Venous Thrombectomy Procedure
There are many methods, including the use of anticoagulants and thrombolytics, employed to treat deep vein thrombosis. There are rare cases, however, in which other methods are not appropriate, and surgery is required. Venous thrombectomy is usually only recommended to treat major clots appearing high in the leg, and for patients without any other serious diseases. In the past, open surgery, during which the clot was removed with a catheter through a large incision, was used for venous thrombectomy. Because many risks, including serious bleeding, were associated with this method, using it was controversial.
Today, when venous thrombectomy is necessary, it it performed through a small incision in the groin. A catheter is inserted through the incision and into the femoral vein; a contrast dye is then injected. The dye allows the surgeon to have a clear view of the affected vein. The catheter is then threaded to the location of the clot to break it up. This less-invasive procedure is called "percutaneous mechanical thrombectomy."
Venous thrombectomy takes 2 to 3 hours, and is performed under IV sedation and local anesthesia in a hospital.
Recovery from a Venous Thrombectomy
Venous thrombectomy is usually effective in removing blood clots. Patients have to walk and rest repeatedly for up to 6 hours after the surgery to assist in their vascular healing. Postsurgery, they can expect to wear compression stockings and be prescribed painkillers and antibiotics. In the days immediately following venous thrombectomy, patients should drink plenty of water to flush their bodies of any residual contrast dye. They should be alert to signs of postsurgical complications, including blood in the urine, nosebleeds, abdominal bruising and pain.
Risks of Venous Thrombectomy
Although venous thrombectomy is considered a safe and effective treatment for severe clotting, it has certain associated risks, particularly for people older than 65, or who have bleeding conditions. Risks after treatment include repeated clotting; pulmonary embolism; post-thrombotic syndrome; excessive bleeding; and stroke.