Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance
CPT4 code
Name of the Procedure:
Percutaneous Transluminal Mechanical Thrombectomy, Vein(s)
Common Names: Mechanical thrombectomy, Percutaneous thrombectomy
Technical Terms: Percutaneous transluminal mechanical thrombectomy, endovascular thrombectomy
Summary
Percutaneous transluminal mechanical thrombectomy is a procedure designed to remove blood clots from the veins using specialized mechanical devices. This minimally invasive technique also involves injecting medications to dissolve clots, while using fluoroscopic imaging for guidance.
Purpose
Medical Condition: Deep vein thrombosis (DVT) or other venous thromboembolic conditions
Goals and Outcomes: The main goal is to restore normal blood flow in the affected veins, relieve symptoms like pain and swelling, and prevent complications such as post-thrombotic syndrome or pulmonary embolism.
Indications
Symptoms: Sudden swelling, pain, and redness in the affected limb
Conditions: Deep vein thrombosis, venous thromboembolism not responding to medication alone, or those with contraindications to long-term anticoagulation therapy
Preparation
Pre-procedure Instructions:
- Fast for several hours before the procedure
- Adjust medication as per physician instructions, especially anticoagulants
- Undergo pre-procedure blood tests and imaging studies (e.g., ultrasound, CT scan)
Procedure Description
The procedure involves the following steps:
- Sedation/Anesthesia: Local anesthesia and possibly light sedation.
- Access: A small incision is made, typically in the groin, to access the vein.
- Device Insertion: A catheter with a mechanical thrombectomy device is inserted into the vein.
- Thrombolytic Injection: Medications to dissolve the clot are injected.
- Clot Removal: The mechanical device breaks up and removes the clot.
- Imaging Guidance: Fluoroscopic imaging is used throughout to ensure accurate device placement and clot removal.
Tools/Equipment: Catheter, mechanical thrombectomy device, fluoroscope
Anesthesia: Local anesthesia, possibly with light sedation
Duration
The procedure generally takes about 1 to 2 hours.
Setting
This procedure is typically performed in a hospital's interventional radiology suite or a specialized cath lab.
Personnel
Key Healthcare Professionals:
- Interventional radiologist or vascular surgeon
- Nurses
- Radiology technologists
- Anesthesiologist, if deeper sedation is required
Risks and Complications
Common Risks:
- Bleeding or bruising at the puncture site
- Infection
- Allergic reaction to contrast dye
Rare Complications:
- Damage to the vein or surrounding tissues
- Pulmonary embolism if a clot dislodges
- Reaction to medications used
Benefits
Expected Benefits:
- Immediate restoration of blood flow
- Symptom relief (pain, swelling)
- Prevention of long-term complications
Most patients notice improvement in symptoms within hours to a few days.
Recovery
Post-procedure Care:
- Bed rest for a few hours to monitor for complications
- Instructions on wound care at the incision site
- Medication adjustments, including anticoagulants
Recovery Time: Most patients can resume normal activities within a few days, though some may have restrictions on strenuous activities for a week or more.
Alternatives
Other Treatment Options:
- Anticoagulant medication alone
- Thrombolytic therapy without mechanical intervention
- Surgical thrombectomy
Pros and Cons of Alternatives:
- Anticoagulants: Lower risk but takes longer to resolve clot
- Thrombolytics: Less invasive but higher bleeding risk
- Surgical Thrombectomy: Invasive, longer recovery, but effective in severe cases
Patient Experience
During the Procedure: Patients will feel the local anesthetic injection and may feel pressure but should not feel pain. They will be awake but sedated.
After the Procedure: Expect some soreness at the incision site. Pain is usually minimal and can be managed with over-the-counter pain medication. Most patients experience significant symptom relief quickly after the procedure.
Pain management measures will include prescribed medications and instructions for at-home care such as rest and elevation of the affected limb. Regular follow-up appointments will be scheduled to monitor recovery and prevent recurrence.