Embolectomy

Overview

The removal of a blood clot (thrombus) that is preventing blood from passing through a blood vessel normally is known as an embolectomy, sometimes known as a thrombectomy.

It’s possible that the blood clot started in one area of your body, like your legs, and then move to another, like your lungs. An embolus is that kind of blood clot. Or, the blood clot might have developed right where it’s causing issues. A thrombus is that kind of blood clot.

A surgeon or doctor with training in minimally invasive procedures can remove clots by performing an embolectomy or thrombectomy. This surgery may be urgent depending on the size and location of the clot if it is preventing blood from reaching a vital area of your body.

In order to prevent excessive bleeding when you have a cut, your blood must, on the one hand, be able to clot. However, some individuals have blood that tries to clot excessively where it shouldn’t. Your doctor might need to remove the clot in certain circumstances.

Reasons for undergoing the procedure

The condition known as pulmonary embolism can result from deep vein thrombosis of the leg, which is a blood clot in your leg that has the potential to go to your lungs. If your doctor is unable to treat it with medication, you might require an embolectomy or thrombectomy operation.

The following conditions may increase your risk of developing a blood clot:

• Obesity
• Pregnancy
• Cardiac disease
• Some blood clotting disorders
• Cancer

If one of the following is true and you have a blood clot in the right side of your heart or a pulmonary (lung) embolism, your doctor may perform an embolectomy:

• Anticoagulants (blood thinners) and thrombolytics (medications that dissolve clots) are contraindicated.
• Anticoagulants and thrombolytics were ineffective.
• A blood clot may pass through a hole in your heart and possibly travel to your brain or other vital organs, putting you at risk for paradoxical embolism.

Most patients who have a blood clot that is creating issues are treated with medication rather than surgery. However, depending on the circumstance, surgery and other minimally invasive techniques are alternatives. Usually, a team of doctor makes decisions based on each individual case.

Risks

Catheter embolectomy (minimally invasive) risks include:

• Bleeding as a result of blood vessel injury.
• Damage to the heart and/or irregular heartbeats (arrhythmia).
• Some blood clots may remain inside the blood vessel.

Surgical embolectomy has the following risks:

• Infection
• Bleeding
• Rapid heart rate or supraventricular tachycardia (SVT)
• Heart or kidney failure
• Mortality

Before the procedure

For use during your surgical embolectomy, your doctor will arrange a transesophageal echocardiography (a type of imaging that uses ultrasound to show your heart in motion).

Your medical team prepares an ultrasound machine to assist them locate the clot before performing a catheter embolectomy. They also set up an angiography (X-rays of your blood vessels) to help them position the catheter correctly.

You will be given some sort of anesthesia for any type of operation so you won’t feel any discomfort.

During the procedure

Your doctor may choose between two techniques to remove your blood clot, depending on its size:

• Catheter embolectomy
• Surgical embolectomy

Catheter embolectomy procedure

The doctor will:

• Before creating a small cut, inject an anesthetic into your skin.
• Insert a tiny needle into your blood vessel, which may be in your neck or inguinal (groin) area.
• Insert a catheter into a blood vessel in your body. The catheter is gently advanced down the blood vessels and positioned at the site of the clot. For this step, X-rays will be used.
• Aspirate the clot from the blood vessel using a catheter (much like a suction). They will keep doing this until the area has had enough clot “vacuumed” out and blood flow has improved.
• Take out the catheter from your body, then cover the skin wound with a bandage. To ensure there isn’t excessive bleeding, they could apply pressure to the skin cut for a while.

Surgical pulmonary embolectomy procedure

Your doctor will:

• Perform a median sternotomy, or cut down the middle of your chest.
• The pericardium, the sac that encloses your heart, should be opened.
• Begin utilizing a cardiopulmonary bypass machine, which replaces your heart and lungs.
• Cut your main pulmonary artery, extending the cut to the point where the artery divides.
• Evacuate blood clots.

A vena cava filter may be given to some patients to prevent further blood clots. This prevents them from developing into an additional pulmonary embolus.

After the procedure

Your doctor will need to apply pressure and a bandage to any external cuts they created using either technique. Your internal and external cuts will be stitched after surgical embolectomy, and cardiopulmonary bypass will be stopped.

You may require transthoracic echocardiogram and anticoagulants or blood-thinners after the surgery.

You might remain in an Intensive Care Unit (ICU) following catheter embolectomy, where your medical staff will keep an eye on your recuperation.

Outcome

You’ll stay in the hospital following a pulmonary embolectomy for at least a day or two until your breathing and heart function allow you to leave. It’s possible that you’ll spend some time in the ICU. In general, surgical embolectomy healing takes longer than catheter embolectomy healing.

In the past, 25 to 50 percent of patients who underwent pulmonary embolectomy did not survive. Death rates following this treatment have, however, decreased to between 5% and 16% since the 2000s. 73% of those who underwent this treatment were still alive five years later, according to a research that tracked their progress.