This is an abbreviated version of the complete article.*
||Surgery is sometimes needed to remove a blood clot from a leg vein, especially in cases of acute vein occlusion (blockage) and severe pain.
||Venous thrombectomy has been known to remove some of the vein lining along with the clot, resulting in an increased risk for repeat clot formation.
||Various modifications to the procedure have improved its success rate.
Venous thrombectomy is the surgical removal of a vein clot. This procedure is most commonly used to treat a rare complication of deep vein thrombosis (DVT) called phlegmasia cerulea dolens. This procedure is rarely performed in the United States.
When combined with one or more of the following treatments, venous thrombectomy has a success rate of 70 to 100 percent:
WHEN IS IT INDICATED?
- Anticoagulant medications;
- Angioplasty and stenting; and
- Placement of a vena cava filter.
Venous thrombectomy is indicated in patients with DVT whose symptoms are severe and have been present for fewer than 7 days. Other indications might include:
WHO IS ELIGIBLE?
- Severe phlegmasia cerulea dolens;
- Severe DVT;
- Patients who should not be treated by thrombolysis or anticoagulation therapy;
- DVT that has not responded to anticoagulation; and
- Patients who are pregnant.
Patients with an acute clot in the leg veins are eligible for venous thrombectomy.
RISK FACTORS FOR POSSIBLE COMPLICATIONS
Risk factors that increase complications following venous thrombectomy include patients who:
- Are older than 65;
- Have bleeding tendencies;
- Have hypertension, congestive heart failure, or poor kidney function; or
- Are allergic to contrast dye.
When a physician suspects DVT, he or she may order duplex ultrasound or venography.
WHAT TO EXPECT
A vascular surgeon or other vascular specialist performs thrombectomy in a hospital operating room. Just before the procedure begins, the patient is given an intravenous (through the vein) blood thinning agent called heparin.
The physician inserts a catheter sheath (short tube) through a small incision in the femoral vein in the groin or the popliteal vein below the knee. Contrast dye is injected through the sheath and venography is performed, allowing the physician to see the area of the vein being treated on an x ray screen.
If performing a surgical thrombectomy, the physician makes a larger incision over the diseased vein and removes the clot with a catheter. For a percutaneous mechanical thrombectomy, the physician inserts a guide wire through the sheath in the femoral vein, advances the wire past the clot, and passes a catheter over the wire to the blocked area. A device at the tip of the catheter, either a mechanical tool or a high-velocity liquid jet, breaks up the clot.
The procedure takes approximately 2 to 3 hours.
POST-PROCEDURE GUIDELINES AND CARE
After the procedure, compression bandages are applied to the leg to reduce swelling. For up to 6 hours after the procedure, the patient may be asked to walk for 15 minutes, then rest for 45 minutes, and repeat.
The patient is fitted with compression stockings after any leg swelling has subsided. Intravenous heparin is given during the recovery period to prevent blood clots.
The patient should notify his or her physician immediately if he or she notices any of the following symptoms of excessive bleeding:
- Blood in urine or stools;
- Unusual bruising or bleeding from cuts or wounds;
- Unusually heavy or unexpected menstrual bleeding;
- Abdominal or stomach pain or swelling;
- Back pain or backaches; and
- Coughing up blood.
Venous thrombectomy is controversial because it has been associated with repeat clotting. Other complications for treatment of DVT include:
- Pulmonary embolism;
- Post-thrombotic syndrome;
- Phlegmasia cerulea dolens;
- Excessive bleeding (hemorrhage); and
Medical Review Date: November 3, 2004
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