Thrombectomy

What is a thrombectomy?

A thrombectomy is a surgery to remove a blood clot from a blood vessel (artery or vein). A blood clot, also known as a thrombus, can interrupt the blood flow to your extremities and/or organs that can be limb or life-threatening. Some of the most common places for blood clots to occur are your legs, arms, intestines, brain, lungs and heart.

A thrombectomy is a surgical or interventional treatment to remove blood clots in an artery or vein to help restore blood flow through your blood vessel. Sometimes a thrombectomy must be performed within a matter of hours to prevent life or limb-threatening complications from occurring.

Who needs a thrombectomy?

You might need a thrombectomy if you have a blood clot that healthcare providers can’t treat with medications like anticoagulants (blood thinners) or thrombolytics (clot-busting drugs). The procedure may help you if the clot blocks blood flow to a part of your body, putting you at risk for:

• Death.
• Embolus (when a thrombus breaks loose from one location and travels to another location in your body).
• Permanent tissue or organ damage.

Who shouldn’t have a thrombectomy?

You might not be a candidate for a thrombectomy if you have:

• A blood clot in a location that’s too hard to reach.
• A blood clot in a very small blood vessel.
• A blood clot that can be treated with medication.
• A preexisting blood disorder.
• Intracranial hemorrhage (bleeding in your brain).
• Very high blood pressure that can’t be treated.
• A chronic clot that’s been present for more than 30 days.

Do all blood clots require a thrombectomy?

Not all blood clots require intervention. Some blood clots only require treatment with medicine like anticoagulants or thrombolytics. Anticoagulants are drugs that thin your blood to prevent more blood clots from forming and allow your body time to try to dissolve non-emergency clots over time. Thrombolytics, or thrombolytic therapy, are drugs that dissolve acute (sudden) clots. The decision on whether you need an anticoagulant, a thrombolytic or a thrombectomy is based on multiple factors and will ultimately be decided on by your healthcare provider.

How common is a thrombectomy?

Thrombectomy is a common or procedure. However, the frequency of thrombectomy is highly variable and ultimately depends on the location and extent of the blood clot.

What does a thrombectomy treat?

A thrombectomy may treat:

• Deep vein thrombosis (DVT).
• Acute upper or lower extremity arterial limb ischemia.
• Acute mesenteric ischemia.
• Renal artery occlusion.
• Heart attack (myocardial infarction).
• Pulmonary embolism.
• Stroke.

Are there different types of thrombectomy?

There are two large categories of thrombectomies:

Surgical (open) thrombectomy

During a surgical thrombectomy, your surgeon makes an incision to get to your blocked blood vessel, cuts open your blood vessel, removes the blood clot using a balloon, and then repairs the blood vessel.

Percutaneous (minimally invasive) thrombectomy

During a mechanical thrombectomy, your surgeon introduces special devices through catheters that can either macerate or suction out clots from within your blood vessel. When there’s a residual clot left, your surgeon will infuse the area with local clot-dissolving medicines. Some of these techniques are known as:

• Catheter-directed mechanical thrombectomy with or without thrombolysis.
• Catheter-directed aspiration thrombectomy.
• Catheter-directed thrombolysis.

What happens before a thrombectomy?

Sometimes there’s no way to prepare for a thrombectomy if it’s performed in an emergency. But if your thrombectomy is planned, your healthcare provider may ask you to:

• Have imaging exams: Imaging exams, such as an ultrasound, MRI or CT scan, can help your doctor plan your surgery. These scans create detailed images showing the size and location of the blood clot and blood vessels that need treatment.
• Stop smoking: Smoking can cause complications during and after surgical procedures. Talk to your healthcare provider about a smoking cessation plan as soon as possible before your thrombectomy.
• Stop taking certain medications: Tell your doctor about any medicine you take, including vitamins, herbal supplements and over-the-counter drugs such as aspirin. You may need to stop taking anticoagulants before your surgery.

What happens during a thrombectomy?

Your procedure will vary depending on the type of thrombectomy you have. The surgery may last an hour or multiple hours depending on the location and extent of the blood clot.

In general, here’s what you can expect:

• Anesthesia/sedation: You receive general anesthesia or sedation through a vein in your arm. Sedation helps you to feel relaxed during the procedure.
• Incision: For a surgical thrombectomy, your surgeon makes an incision (cut) in your skin either above or below the blocked blood vessel. Your surgeon cuts open the blood vessel to remove the clot.
• Catheterization: If you have a percutaneous thrombectomy, your surgeon punctures the blood vessel above or below the clot (most commonly in your leg or arm) and then inserts wires and catheters into the blood vessel through the punctured blood vessel. They use continuous imaging scans to guide the catheter and special devices through your blood vessels to the location of the blood clot to allow for clot removal.
• Clot removal: Your physician removes the blood clot. During an open thrombectomy, your surgeon uses a balloon catheter to pull the clot out. During a mechanical thrombectomy, they use special devices to either break up the clot, dissolve the clot, or suck out the clot through a catheter-like vacuum.
• Closure: Your surgeon repairs the blood vessel if you have a surgical thrombectomy. For a percutaneous thrombectomy, your physician removes the wire and catheter from your blood vessel and either holds pressure to close the hole in the artery or uses a vascular closure device to help close the hole in the artery.

What happens after a thrombectomy?

After a thrombectomy, a surgical team monitors your vital signs as you come out of anesthesia or sedation. Some people go home the same day as their procedure. Others stay in the hospital overnight or for several days depending on the location of the clot and the surgery or procedure that was performed and the need for ongoing blood thinners.

Your healthcare provider will give you detailed instructions about:

• How to care for your incision at home.
• Medicines to take and avoid.
• When to return to normal activities.

What are the benefits of a thrombectomy?

A thrombectomy can reduce the risk of severe disability, limb loss or death. The procedure can limit damage and loss of bodily functions by restoring blood flow as quickly as possible.

What are the risks of a thrombectomy?

A thrombectomy does carry some risks, including:

• Blood vessel damage or stenosis (narrowing).
• Bleeding.
• Hematomas (severe bruises).
• Infection.
• Pulmonary embolism (clot moves from its original location and travels to your lungs).
• Reaction to anesthesia.
• Reoccurrence of the blood clot.

What is recovery like after a thrombectomy?

Your recovery after a thrombectomy will depend on the type of procedure you have and a variety of other factors. Most people take blood-thinning medication to prevent another clot from forming. Your healthcare provider may ask you to wear compression stockings to prevent clots in your legs. Talk to your provider about other ways to reduce the risk of blood clots.

What is the outlook for people who have had a thrombectomy?

Survival rates after a thrombectomy depend on many factors, including your overall health and the location of the blood clot.

When should I call the doctor?

You should call your healthcare provider if you experience the following after your procedure:

• Bleeding.
• Chest pain.
• Confusion or disorientation.
• Dizziness or balance problems.
• Fever.
• Pain, swelling or numbness in your arms or legs.
• Pus or drainage from the incision site.
• Shortness of breath (dyspnea).

A note from Cleveland Clinic

A thrombectomy is a surgery to remove a blood clot from an artery or vein. You may need a thrombectomy soon after the onset of symptoms. The procedure can restore blood flow to vital organs, such as your legs, arms, intestines, kidneys or brain, and reduce the risk of death or permanent tissue damage.