Name of the Procedure:

Percutaneous Transluminal Mechanical Thrombectomy and/or Infusion for Thrombolysis, Dialysis Circuit (PTMT)

Summary

Percutaneous Transluminal Mechanical Thrombectomy (PTMT) is a minimally invasive procedure used to remove blood clots from a dialysis circuit. It involves using mechanical devices and/or medications to dissolve or fragment clots, ensuring smooth blood flow. The procedure includes imaging and radiological supervision to guide and monitor the process.

Purpose

PTMT addresses blood clot formation in dialysis circuits, which can impede the efficiency of dialysis treatment. The goal is to restore proper blood flow through the dialysis circuit, maintaining the effectiveness of dialysis and preventing complications associated with clotting.

Indications

• Decreased dialysis efficiency due to clot formation
• Swelling or pain at the access site
• Visible or palpable clot in the dialysis circuit
• High venous pressures during dialysis sessions
• Recurrent clot formations

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Certain medications, like blood thinners, may need to be adjusted or stopped.
• Diagnostic tests such as blood work and imaging studies are often required to assess the clot and overall health status.

Procedure Description

1. The patient is positioned for the procedure, typically on a procedural table.
2. A local anesthetic may be administered to numb the access site.
3. A small incision is made to insert a catheter into the dialysis circuit.
4. Imaging techniques (e.g., fluoroscopy, angiography) guide the catheter to the clot's location.
5. A mechanical device is used to break up and remove the clot, or a thrombolytic agent is infused to dissolve it.
6. Radiological supervision ensures the clot is adequately removed and blood flow restored.
7. The catheter is withdrawn, and the access site is bandaged.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity of the clot and patient-specific factors.

Setting

PTMT is usually performed in a hospital's interventional radiology suite or a dedicated procedural room in an outpatient clinic.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Radiology Technologist
• Nurses
• Anesthesiologist or Nurse Anesthetist (if sedation is required)

Risks and Complications

• Bleeding at the access site
• Infection
• Damage to the blood vessels
• Incomplete removal of the clot
• Allergic reaction to contrast material or medications used
• Rarely, embolism or clot fragments traveling to other parts of the body

Benefits

• Immediate restoration of blood flow in the dialysis circuit
• Improved efficiency of dialysis
• Reduced risk of further complications related to clotting
• Minimal recovery time compared to surgical interventions

Recovery

• Patients are typically monitored for a few hours post-procedure.
• Instructions may include keeping the access site clean and dry.
• Avoid heavy lifting or strenuous activities for a few days.
• Follow-up appointments to monitor the access site and overall health.

Alternatives

• Anticoagulation therapy to prevent clot formation
• Surgical thrombectomy for larger or more persistent clots
• Switching dialysis access sites, if recurrent clotting occurs
• Each alternative varies in terms of invasiveness, recovery time, and effectiveness.

Patient Experience

During the procedure, the patient might feel some pressure or discomfort at the access site. Post-procedure, mild soreness or bruising at the incision site is common and can be managed with over-the-counter pain medication. Most patients can return to their normal activities within a few days, following their care team's instructions for recovery and follow-up.