Venous thrombectomy is the surgical removal of a clot within a large vein. This type of clot most often develops as a complication of deep vein thrombosis (DVT), a common but serious condition in which a clot develops in a vein deep within the body. DVT causes vein damage, resulting in impeded blood flow. Many patients with DVT are asymptomatic, but if the clot detaches and travels to the lungs, it may lead to pulmonary embolism, a potentially fatal condition. A venous thrombectomy is generally viewed as a treatment of last resort, sometimes performed when the patient is already experiencing a pulmonary embolism.
Reasons for a Venous Thrombectomy
Venous thrombectomy, a type of embolectomy, may be performed on patients with severe cases of DVT whose symptoms pose a serious risk for pulmonary embolism or on patients who are already one. The procedure may also be performed on patients for whom other common treatments for DVT are not appropriate, for example those who are pregnant, those who have not responded well to anticoagulation therapy or those who cannot tolerate thrombolytics. Venous thrombectomy is also recommended for patients with threatened limb loss or venous gangrene caused by a massive DVT, possibly associated with arterial insufficiency, also known as phlegmasia cerulea dolens.
Venous thrombectomy is sometimes performed in conjunction with another procedure, such as angioplasty, thrombolysis or the placement of a vena cava filter.
Venous Thrombectomy Procedure
There are many methods employed to treat deep vein thrombosis, including the use of anticoagulants and thrombolytics. There are rare cases, however, where other methods are not appropriate and surgery is required. Venous thrombectomy is usually only recommended for major clots appearing high in the leg and is usually performed on patients without any other serious disease. In the past, open surgery was used for venous thrombectomy, but this procedure, during which the clot was removed with a catheter through a large incision, was controversial. Many risks were associated with it, including a risk of serious bleeding.
More recently, when venous thrombectomy is necessary, it it performed through a small incision in the groin, into which a catheter is inserted through the femoral vein and contrast dye is injected. The dye allows the surgeon to have a clear visual field of the affected vein. The catheter is threaded to the location of the clot to relieve the blockage. This less invasive procedure is called a percutaneous mechanical thrombectomy.
Venous thrombectomy takes two to three hours to perform in a hospital setting, and is performed under IV sedation and local anesthesia.
Recovery from a Venous Thrombectomy
The thrombectomy procedure is normally effective in removing targeted blood clots. Patients will have to walk and rest repeatedly for up to six hours after the surgery to assist in their vascular healing. They can expect to wear compression stockings after the procedure and to be prescribed painkillers and antibiotics. It is important for patients to drink plenty of water for the days immediately following surgery in order to flush their body of any residual contrast dye. Patients should be alert to signs of postsurgical complications, including blood in the urine, nosebleeds, abdominal bruising or pain.
Risks of a Venous Thrombectomy
While a venous thrombectomy is considered a safe and effective treatment for severe clotting, there are certain risks associated with this procedure, particularly in patients over the age of 65 or those with bleeding conditions. Risks after treatment may include:
- Repeated clotting
- Pulmonary embolism
- Post-thrombotic syndrome
- Excessive bleeding