Embolectomy or thrombectomy

Often, the terms embolectomy and thrombectomy are used interchangeably. However, there is a minor difference between the two.

Normally, blood flows freely via the circulatory system. The arteries transport the oxygen and nutrient-rich blood throughout the body, whereas all the waste products are returned to the heart by the veins. 

However, sometimes, blood thickens or clumps together, resulting in the formation of a blood clot (thrombus) inside a blood vessel. The clot can dislodge (embolus), travel through the circulatory system, and get stuck in an artery or vein. This may restrict the movement of blood and damage the surrounding tissues. The term embolus is used to describe the loosened pieces of a thrombus or all of the thrombus once it starts moving. 

Some other types of foreign bodies (emboli) in the bloodstream are:

• Cholesterol: In people who have cholesterol build-up in their arteries, particles of cholesterol may become loose and cause an embolism.
• Fat: Fat particles may be released into the blood due to conditions such as fracture, severe burns, or bone surgery. 
• Air: Air bubbles or other gases can cause an embolism when they enter the bloodstream. 
• Amniotic fluid: This is a rare occurrence in which the amniotic fluid that surrounds the baby in the womb leaks into one of the mother’s blood vessels, causing an embolism.
• Septic fluid: This includes bacteria and pus 

Embolectomy is a surgical procedure to remove any kind of embolus—blood clots or other foreign bodies—from blood vessels. While thrombectomy refers to the removal of a blood clot (thrombus) from blood vessels. 

The removal of a blood clot or embolus helps in restoring the smooth flow of blood. Surgery is usually done for removing larger blood clots or emboli.

Your doctor may recommend this surgery if you have a blood clot or embolus in a blood vessel anywhere in your body. However, this surgery is frequently performed for a blood clot in a leg or arm. Some of the following conditions are caused by blood clots:

• Post-thrombotic syndrome (a long-term effect of deep-vein thrombosis associated with swelling, pain and redness in the affected area)
• Stroke 
• Atrial fibrillation
• Acute limb ischemia (sudden and quick reduction in blood flow in lower limbs)
• Mesenteric ischemia (reduction of blood flow to the intestines) 
• Pulmonary embolism 
• Loss of organ function

The symptoms of a blood clot in a blood vessel may depend on its location inside the body. Some symptoms of a blood clot based on its location are as follows:

• Arms or legs:
  • Swelling 
  • Pain 
  • Redness 
  • Numbness and sometimes, warmth
• Brain:
  • Difficulty in speaking and visualising 
  • Seizures 
• Abdomen:
  • Nausea or vomiting 
  • Abdominal pain 
• Heart:
  • Overwhelming chest pain  
  • Shortness of breath 
  • Pain while moving the left arm 
• Lungs:
  • Trouble breathing 
  • Chest pain 
  • Blood in cough

You cannot undergo this surgery if you have the following conditions:

• Severe coagulopathy (bleeding disorder)
• Subarachnoid haemorrhage (a type of stroke)
• Chronic carotid occlusion (blockage in the carotid artery)
• Kidney disease 
• You take medicines for reducing blood clots (your doctor will advise you in case your medicine can be discontinued or changed for a short while to allow the surgery)
• Chronic thromboembolic pulmonary hypertension (high blood pressure in the lungs, caused by a blood clot)

The preparations needed for the surgery are as follows:

• Diagnostic tests: You will need to undergo the following tests before the surgery:
  • Ultrasound, to measure the movement of blood and examine the blood clot and its location
  • Blood tests, for a general health check-up
  • Computed tomography and magnetic resonance imaging, to visualise the location of surgery
  • Venogram and arteriogram, to visualise the clot in the blood vessels
• Fasting: You will need to fast, starting from midnight before the day of surgery until you are declared fit to drink or eat anything after the surgery. 
• Medicines: 
  • You should provide information regarding the use of any medications, including vitamins, over-the-counter medicines, herbs and supplements to your doctor. 
  • The doctor will ask you to stop blood-thinning medicines before the surgery. 
• Lifestyle:
  • The doctor will ask you to stop smoking or drinking for some time before and after the surgery. This will expedite your recovery. 
• Medical conditions: Tell your doctor if:
  • You are or may be pregnant 
  • You are allergic to some medicine, anaesthesia, tape or latex
  • You have recently acquired an infection or fever 
• Driving: You will need someone (a friend or family member) to drive you home after the surgery.
• Consent: You would be asked to sign a consent form giving your permission to undergo the surgery.

The surgery is done in the following way:

• First, a healthcare practitioner will shave off your hair over the surgical area. 
• The surgeon will start an intravenous (IV) line in your arm for the introduction of necessary medicines during and after the procedure. He/she will administer blood thinners to you to prevent the formation of new blood clots during the surgery. 
• The same IV line will be used to inject anaesthesia, to avoid pain and help you to relax during the procedure.
• To access the artery or vein, the surgeon will make an incision in the area where the blood clot is. 
• This surgery is usually performed by the following methods:
  • Catheter-based procedure: In this method, the blood clots (emboli) are removed by suction method (aspiration) or by inserting a balloon in the area (balloon embolectomy).
  • Mechanical embolectomy: In this method, the blood clots are broken into small pieces and then removed. This procedure includes the use of either mechanical equipment or ultrasound waves or saline jets for breaking up the clots.
  • Open surgery: In emergency and rare cases, an open procedure is used to remove an embolus or a thrombus from blood vessels.
• The surgeon will use X-ray imaging to guide the catheter tube into your blood vessels.
• Many times, a stent may be introduced inside the blood vessels to keep the vessel open. 
• After removing the clots, the blood vessels are repaired and closed by the surgeon. 
• The surgeon will then sew the incisions with sutures and cover the surgical site with a bandage.
• This procedure is completed in about one to three hours. After the surgery, the healthcare team will move you to the recovery room. Moreover, they will monitor your breathing and heart rate. You may be allowed to go home after staying in the hospital for a day.

Once you are home, you will need to care for yourself in the following ways:

• Medicine:
  • Based on the need or your condition, you may be given painkillers after the surgery.
  • The doctor may ask you to continue taking certain medicines to prevent the formation of blood clots in your arteries and veins in the future. 
• Activities:
  • You can resume your normal activities after proper consultation with your doctor. 
  • Your doctor may suggest that you avoid heavy lifting or activities that require extra effort for a few days after the surgery. 
• Lifestyle:
  • Try and avoid smoking and drinking after the procedure. It would help you heal quickly.
  • Talk to your healthcare practitioner if you are finding it difficult to quit smoking. Read more: How to quit smoking 
• Wound care:
  • Keep the surgical area clean. Wash it gently with soap and water. Gently re-cover the area until it is healed.
  • Avoid using a bathtub or swimming until the surgical site has healed completely. However, your doctor may allow you to start taking a shower from the next day (the day after your surgery). 

When to see the doctor?

You should call your healthcare provider if you experience any of these symptoms after the surgery: 

• Fever
• Weakness 
• Chest pain
• Breathing problems
• Numbness at the surgical area 
• Swelling or worsening of pain
• Bleeding at the surgical area or anywhere in the body
• Fluid oozing from the cut

The possible risks of thrombectomy are as follows:

• Infection
• Pulmonary embolism 
• Damage to the blood vessels 
• Excessive bleeding 
• Reaction to anaesthesia 
• Fresh and repeated formation of blood clots

Your follow-up appointment will be scheduled before discharge to assess the condition of your blood vessels by performing a venogram (an imaging test).

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.