Name of the Procedure:

Thrombectomy, direct or with catheter; vena cava, iliac vein, by abdominal incision

Summary

A thrombectomy is a surgical procedure that involves the removal of a blood clot (thrombus) from the vena cava or iliac veins. This can be done directly or with the help of a catheter. An abdominal incision is made to access the veins.

Purpose

The procedure addresses the presence of large blood clots in the vena cava or iliac veins that can hinder blood flow. The goals are to restore proper circulation, relieve symptoms, and prevent complications like pulmonary embolism.

Indications

• Deep vein thrombosis (DVT) causing severe symptoms
• Blood clots that do not respond to medication or pose significant risks
• Symptoms such as severe leg swelling and pain
• Risk factors including underlying conditions like cancer or clotting disorders

Preparation

• Patients may be advised to fast for 8-12 hours before surgery.
• Blood tests and imaging studies (e.g., ultrasound, CT scan) to locate the clot.
• Stopping certain medications like blood thinners as directed by the doctor.
• Arrangements for post-procedure transportation and care.

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free.
2. An abdominal incision is made to access the vena cava or iliac veins.
3. The thrombus (blood clot) is located using imaging guidance.
4. The clot is removed either directly or with the help of a catheter.
5. The incision is closed with sutures.
6. Patients are monitored for any immediate complications.

Duration

The procedure typically takes 1-3 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room or surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist (if imaging guidance is needed)

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to the vein or surrounding tissues
• Recurrent blood clot formation
• Anesthesia-related complications

Benefits

• Relief from symptoms such as pain and swelling
• Improved blood flow and reduced risk of complications
• Potential to prevent life-threatening conditions like pulmonary embolism
• Benefits may be realized soon after recovery from the procedure.

Recovery

• Monitoring in the hospital for 1-2 days post-procedure.
• Prescribed blood thinners to prevent new clots from forming.
• Instructions for wound care and activity restrictions.
• Follow-up appointments to monitor recovery and evaluate vein function.
• Full recovery generally takes a few weeks, with gradual return to normal activities.

Alternatives

• Medication-based management with blood thinners
• Minimally invasive procedures like catheter-directed thrombolysis
• Advantages of thrombectomy include immediate removal of clot; however, it's more invasive than medication alone.
• Disadvantages include surgical risks and recovery time.

Patient Experience

• Patients will be under general anesthesia and won't feel anything during the procedure.
• Some discomfort and soreness at the incision site after waking up.
• Pain management will be provided with medications.
• Detailed instructions and support for a comfortable recovery process.