Name of the Procedure:

Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by leg incision.

Summary

A thrombectomy is a surgical procedure to remove a blood clot (thrombus) from a blood vessel. This specific thrombectomy targets clots in the vena cava, iliac, or femoropopliteal veins and involves making an incision in the leg.

Purpose

The procedure is performed to re-establish normal blood flow in veins blocked by clots. It aims to alleviate pain, swelling, and other symptoms of blood clots and to prevent complications such as pulmonary embolism (a potentially life-threatening condition where a clot travels to the lungs).

Indications

• Deep vein thrombosis (DVT) with significant symptoms or risk of complications
• Clots that are not responding to anticoagulation therapy
• Significant risk of clot migration to the lungs
• Severe swelling, pain, and skin changes due to venous clots

Preparation

• Fasting for a certain number of hours before the procedure (typically at least 8 hours)
• Temporary discontinuation of certain medications, especially blood thinners, as advised by the doctor
• Pre-procedure diagnostic tests, such as an ultrasound or venography, to locate the blood clot

Procedure Description

1. The patient is given anesthesia or sedation.
2. The surgeon makes an incision in the leg to access the affected vein.
3. A catheter, or sometimes direct surgical instruments, is inserted to reach and remove the blood clot.
4. After the clot is removed, the blood vessel is repaired.
5. The incision is closed with sutures.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital or surgical center, often requiring a short inpatient stay for post-operative monitoring.

Personnel

• Vascular surgeon
• Surgical nurses
• Anesthesiologist
• Radiology technician (if imaging guidance is used)

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma
• Damage to the blood vessel or surrounding tissues
• Recurrence of blood clots
• Anesthesia-related risks, such as allergic reactions

Benefits

• Restores normal blood flow and alleviates symptoms quickly
• May prevent serious complications like pulmonary embolism
• Improved quality of life by reducing pain and swelling

Recovery

• Pain management with prescribed medications
• Instructions on wound care and activity restrictions
• Compression stockings may be recommended to improve circulation
• Follow-up appointments to monitor recovery and prevent recurrences
• Full recovery may take several days to a couple of weeks, depending on individual health factors

Alternatives

• Anticoagulation therapy to prevent new clots from forming and for gradual clot resolution
• Thrombolysis, where medication is used to dissolve the clot without surgical intervention
• Pros: Less invasive alternatives usually have fewer immediate risks.
• Cons: Less invasive alternatives may not be effective for large or life-threatening clots, and they may take longer to work.

Patient Experience

• Likely to experience discomfort or pain at the incision site post-procedure
• Mild to moderate pain managed with medication
• May feel some swelling and bruising which will subside over time
• Will need to follow specific instructions for wound care and avoid strenuous activities
• Regular follow-up is critical to ensure complete recovery and prevent recurrence of clots