37188 Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy

Name of the Procedure:

Percutaneous Transluminal Mechanical Thrombectomy, Vein(s)
Common Name(s): Mechanical Thrombectomy

Summary

Percutaneous transluminal mechanical thrombectomy is a minimally invasive procedure used to remove blood clots from veins. This treatment often includes the injection of clot-dissolving medications and utilizes fluoroscopic guidance to ensure accuracy. The procedure may need to be repeated the following day as part of an ongoing thrombolytic therapy regimen.

Purpose

The procedure addresses blood clots in the veins, aiming to restore normal blood flow and prevent complications such as deep vein thrombosis (DVT) or pulmonary embolism (PE). The goal is to reduce symptoms, improve blood circulation, and prevent further clot formation.

Indications

• Symptoms of deep vein thrombosis (DVT), such as swelling, pain, and redness in the affected limb.
• Pulmonary embolism (PE) symptoms, such as shortness of breath and chest pain.
• Patients with contraindications to anticoagulation therapy or those who have not responded to such treatments.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Discontinuation of certain medications as instructed by the healthcare provider.
• Pre-procedure diagnostics such as blood tests, ultrasound, or CT scan to assess the location and size of the clot.

Procedure Description

1. Anesthesia: Local anesthesia or conscious sedation may be administered to minimize discomfort.
2. Access: A small incision is made, usually in the groin, to insert a catheter into the affected vein.
3. Guidance: Fluoroscopic imaging is used to accurately navigate the catheter to the clot.
4. Thrombectomy: Mechanical devices are deployed to physically break up and remove the clot.
5. Thrombolytic Injection: Pharmacological agents are injected to help dissolve any remaining clot fragments.
6. Repeat Treatment: The procedure may be repeated the following day to ensure complete clot removal.

Duration

Typically 1-2 hours per session.

Setting

Hospital setting, often in a specialized interventional radiology suite or operating room.

Personnel

• Interventional radiologist or vascular surgeon
• Nurses and radiologic technologists
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Allergic reaction to contrast dye or medications
• Blood vessel damage
• Clot fragment migration causing embolism

Benefits

• Rapid symptom relief and improved blood flow
• Reduced risk of clot-related complications
• Minimally invasive with a relatively quick recovery time

Recovery

• Post-procedure observation for a few hours.
• Pain management typically with over-the-counter pain relievers.
• Avoiding strenuous activities for a few days.
• Follow-up appointments to monitor recovery and ensure clot resolution.

Alternatives

• Anticoagulation therapy: Medication to prevent clot formation and allow natural dissolution.
• Catheter-directed thrombolysis: Use of catheters to deliver clot-dissolving drugs directly to the site.
• Open surgical thrombectomy: Invasive surgery to remove clots, typically reserved for severe cases.

Patient Experience

During the procedure, patients might feel a mild pressure or discomfort at the catheter insertion site. Post-procedure, mild soreness or bruising is common. Pain and discomfort are generally manageable with prescribed medications. Regular follow-ups ensure smooth recovery and address any concerns promptly.