Overview

An embolectomy is a medical procedure. It is also known as thrombectomy. It refers to the process whereby a thrombus located within a blood vessel is gotten rid off. Blood clot (thrombus) blocks normal blood flow through a vessel.

A blood clot can form in areas such as the limbs (arms or legs)  then breaks off, and moves to another location such as the lungs. This kind of clot is called an embolus.

When the blood clot forms  directly at a location and causes issues at that particular point, such type of clot is referred to as a thrombus.

Apart from removing blood clots, any other foreign substances that have lodged within a blood vessel can be removed through these procedure. Removal of these elements and blood clots helps to avoid obstructing blood flow. Furthermore, potential life-threatening complications are avoided.

 

Facts & Figures

Key facts and statistics about embolectomy

• In the past, 25%-50% of patients who underwent pulmonary embolectomy failed to survive.
• However, since the beginning of the 21^st century, mortality rates from this procedure have gone d own significantly up to about 5%-16%.
• A study was carried out on individuals who had underwent this procedure. It was revealed that the five-year survival rate after the surgery was 73%.

 

Thrombectomy Versus Embolectomy

What is the main difference between these two procedures?

In thrombectomy, the blood clot being removed is located in the blood vessel where it originally began whereas in embolectomy, the clot being removed usually has travelled to another site (embolus) that is different from the initial site (where it was formed).

 

Methods

How thrombectomy and embolectomy can be conducted?

Non-invasive method:

•  Incisions are not needed.
•  The puncture is small.
•  Sedation is low to moderate.

 

Minimally-invasive method:

•  Small incisions that are about 3 inches long are made.
• The patient is put under general anaesthesia.

 

Open-surgery:

• Large incisions are made. They measure about 8-10 inches long.
• The patient is put under general anesthesia.

 

 Details About the Procedure, Preparation & Expectations

• The clinician and his/her team state and explain to the patient what must be expected before, during and after the procedure has been undertaken.
• Associated risks and complications likely to develop are also mentioned.
• The patient discusses the following with the doctor:

1. Current medicines, herbal products and dietary supplements.
2. Radiation exposure.
3. History of bleeding disorders, if any.
4. Any implanted devices such as pacemaker.
5. Any allergies.
6. Any body piercings on the chest or the abdomen.

 

Before the procedure

• Several diagnostic tests are performed on the patient to check if the patient really needs either procedure. These include:

1.    Computed tomography scan.
2. Angiogram.
3.  Blood tests.
4. Magnetic resonance imaging (MRI).
5. Ultrasound.

 

During the procedure

• Usually, thrombectomy takes 1-2 hours and is conducted in a catheterization laboratory.
• Generally, the procedure for minimally-invasive thrombectomy is:

1.  Change clothing into hospital gowns.
2.  A nurse begins administering medicines (including sedatives for relaxation) and fluids through an intravenous line placed in the arm.
3. Local anaesthetics numb the site for insertion of the catheter, and then it is inserted into the artery to the clot.
4. A stent retriever is an instrument that is threaded into the catheter ,then it is guided into the blockage and pushed through the clot.
5. When done with pushing through the clot, this instrument extends the size of the artery wall.
6. At this juncture, the clot has been captured and the stent retriever is pulled backwards.
7. On completion of the procedure, the doctor removes both the catheter and the stent retriever. Collagen or sutures are used to close the site of insertion.

• The above stated procedure is for catheter embolectomy.
• Surgical embolectomy has a different kind of procedure, and the size of the clot determines  which method to be employed.

 

After the procedure

• The patient is let to rest in the recovery room.
• Most patients are discharged on the same day.

 

Indications

Why is embolectomy performed?

• The folllowing are indications for conducting an embolectomy:

1. Contraindicated use of anticoagulants and thrombolytic agents.
2. Being at risk of paradoxical embolism. This means that a blood clot could travel to vital body parts such as the heart and brain.
3. Massive pulmonary embolism.
4. High-risk submassive pulmonary embolism.
5. Failed thrombolysis.

 

 Risks/ Complications

• Risks associated with catheter embolectomy are:

1.  Haemorrhage due to damage of the vessel.
2. Arrhythmia (irregular rhythms of the heart).
3. Blood clot remaining behind.

 

1. Risks associated with surgical embolectomy are:
2.  Bleeding.
3. Supraventricular tachycardia.
4.  Heart and kidney failure.
5.  Death.