Surgical Thrombectomy

What is surgical thrombectomy?

Surgical thrombectomy is a type of surgery to remove a blood clot from inside an artery or vein.

Normally, blood flows freely through your blood vessels, arteries, and veins. Your arteries carry blood with oxygen and nutrients to your body. Your veins carry waste products around the body to be removed and then deliver blood low in oxygen back to the heart. In some cases, the blood thickens and clumps to form a blood clot in 1 of these vessels. This can block the blood flow. When blood flow is blocked, nearby tissues can be damaged.

During a surgical thrombectomy, a surgeon makes an incision into a blood vessel. The clot is removed, and the blood vessel is repaired. This restores blood flow. In some cases, a balloon or other device may be put in the blood vessel to help keep it open.

Why might I need surgical thrombectomy?

You might need surgical thrombectomy if you have a blood clot in an artery or vein. This surgery is often needed for a blood clot in an arm or leg. In some cases, it may also be needed for a blood clot in an organ or other part of the body.

A blood clot can lead to many possible problems, such as:

• Swelling, pain, numbness, or tingling in an arm or leg

• A cold feeling in the area

• Muscle pain in the area

• Enlarged veins (post-thrombotic syndrome)

• Death of tissue

• Loss of function of an organ

• Blood clot moving to the lung that causes breathing trouble and risk of death (pulmonary embolism)

Your healthcare provider might advise surgical thrombectomy if you have a very large clot. Or they may advise surgery if your blood clot is causing severe tissue injury.

Surgery is not the only kind of treatment for a blood clot. Most people with blood clots are treated with medicines called blood thinners. These are given as a pill, a shot (injection), or through an IV. They can prevent a blood clot from getting larger. Other medicines used to dissolve large blood clots causing severe symptoms are called thrombolytics.

All treatments for blood clots have their own risks and benefits. Ask your healthcare provider if surgical thrombectomy might be a good choice for you. You might find it helpful to talk to a provider who specializes in blood vessel problems. This type of provider is called a vascular specialist.

What are the risks of surgical thrombectomy?

All surgery has risks. The risks of surgical thrombectomy include:

• Excess bleeding that can be severe enough to cause death

• Infection

• Damage to the blood vessel at the site of the blood clot

• Reaction to anesthesia

• Pulmonary embolism

• Other chronic conditions of the blood vessel may be found, which will need more surgery to repair

There is also a risk that your blood clot will form again. Your own risks may vary depending on your general health and how your blood clots. They may also vary depending on how long you’ve had the clot, and where it is in your body. Talk with your healthcare provider about all your concerns and questions.

How do I get ready for a surgical thrombectomy?

Before the procedure, you will be asked to sign a surgical consent form. This gives your surgeon permission to do the procedure. You will also be asked to sign an anesthesia consent form. This gives your anesthesiologist permission to administer the anesthesia during the procedure. Both consents also state that you fully understand the risks and benefits of the procedure and anesthesia medicine and have had all of your questions answered. Before you sign, be sure all of your questions have been answered.

Talk with your healthcare provider about how to prepare for your surgery. Tell your provider about all the medicines you take. This includes over-the-counter medicines such as aspirin, vitamins, herbs, and supplements. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your provider if you need help to stop smoking.

Before the procedure, make sure you tell the medical team if you:

• Have any allergies

• Have had any recent changes in your health, such as fever

• Are pregnant or could be pregnant

• Have ever had a problem with anesthesia, both general and local

You may need some tests before the procedure, such as:

• Ultrasound, to measure blood flow in the leg and help diagnose the blood clot

• Venogram (for a vein clot) or arteriogram (for an artery clot), to get an image of your vessels

• CT scan, to get more information about the blood clot

• MRI, if more information is needed

• Blood tests, to check your overall health

Don't eat or drink after midnight the night before your surgery.

What happens during a surgical thrombectomy?

Talk with your healthcare provider about what to expect during the surgery. The details will vary depending on the type of your surgery. They will also vary depending on what part of the body is treated. A typical surgical thrombectomy may go like this:

• An IV will be put in your arm or hand before the procedure starts. You’ll receive medicines through this IV. You may be given a blood thinner such as heparin. This is to help prevent new blood clots from forming during the surgery.

• You’ll also be given anesthesia through the IV line. This will prevent pain and make you sleep during the surgery. Or, you may be given sedation. This will make you relaxed and sleepy during surgery.

• Hair in the area of your surgery may be removed. The area may be numbed with a local anesthesia.

• The surgeon may use continuous X-ray images while the surgery is being done.

• The surgeon will make a cut in the area above your blood clot. The surgeon will open the blood vessel and take out the clot.

• In some cases, a balloon attached to a thin tube (catheter) will be used in the blood vessel to remove any part of the clot that remains. A stent may be put in the blood vessel to help keep it open.

• Your surgeon will close and repair the blood vessel. This will then restore blood flow.

• The incision on your skin will be closed and bandaged.

What happens after a surgical thrombectomy?

After the procedure, you will spend several hours in a post-anesthesia care unit (PACU). Your healthcare team will closely watch your vital signs, such as your heart rate, blood pressure, and breathing. You may need to stay at the hospital for a day or more, depending on your condition. Your healthcare provider will tell you more about what to expect.

After the procedure, you may need to take medicine for a short time to help prevent blood clots. Your healthcare provider will let you know about any other changes in your medicine. You can take pain medicine if you need it. Ask your provider which medicine is safe to take.

Your healthcare provider will likely advise you to get back on your feet soon after the treatment. You may need to wear compression stockings. This is to help prevent the clot from forming again. It can also help prevent a new clot from forming.

You should stop smoking. This will lower your risks of blood clots forming in the future. Talk with your provider if you need help to quit smoking.

Your healthcare provider will keep track of your health after you go home. You’ll have follow-up appointments. Your provider may check on your blood vessels with an imaging test called a venogram or an angiogram. Make sure to keep all of your follow-up appointments. This will help your provider keep track of your progress.

Call your healthcare provider right away or get immediate medical care if you have any of these:

• Swelling or pain that gets worse

• Fluid leaking, redness, or swelling from the incision

• Fever

• Bleeding anywhere on your body

• Weakness, pain, or numbness in the surgery area

Follow all of your provider’s instructions. This includes any advice about medicines, exercise, and wound care.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure