If you have deep vein thrombosis, or DVT, it’s key to remove or contain the blood clot in your vein before it breaks loose. Common treatments include blood thinners, compression stockings, internal filters, or “clot busters”-- drugs delivered right to the clot by IV or through a catheter.
In some cases, though, such as if you have a large clot or if it’s damaging tissue around it, your doctor might advise you to have a surgical thrombectomy to directly remove the clot from your vein or artery.
Why You Might Need One
Other reasons a vascular specialist might suggest surgical thrombectomy include:
- The clot is in your leg or arm (although sometimes the procedure is needed in another body part or organ).
- A large clot seems about to break loose into your bloodstream. If that happens, the clot can travel to a lung, which can lead to pulmonary embolism.
- You’re unable to take blood thinners or stronger clot-busting meds – also called thrombolytics – because of a condition like a bleeding disorder.
What’s Involved?
A surgical thrombectomy is considered minimally invasive surgery. This means your surgeon will be able to operate with less damage – such as by using small cuts – than required in an open surgery. You’ll likely have less pain, fewer complications afterward, and be able to leave the hospital sooner than you would with regular surgery.
Your surgeon will give you an injection of a contrasting dye so the clot will show up well in an X-ray. You’ll get a sedative before the procedure and be awake for it. But if the X-ray doesn’t show exactly where the clot is, or you have several clots, your doctor might want to use general anesthesia so you won’t be conscious during surgery.
There are several ways your surgeon might remove the clot:
- They'll make a cut in the area above your blood clot. With a small cut, the doctor will open the blood vessel containing the clot and take it out. They might use a balloon or stent to keep the blood vessel open while they operate.Then, they’ll repair and close the vessel, which will bring back blood flow. They’ll close and bandage the cut on your skin.
- A catheter – a long, thin, flexible tube – might be used to reach the clot. It’ll be inserted through a vein in your groin or arm and guided to the blood clot with the help of X-ray imaging.
- Sometimes the surgeon will attach a balloon to the catheter to remove a part of the clot that’s still left.
- Your surgeon might choose to break up the clot before suctioning it out. For this, they might use a catheter that sprays salt water from tiny holes at the tip. Then, the dissolved clot is sucked in sections through the catheter.
What’s the Recovery Time?
You’ll be moved to the recovery room for a few hours after surgery. If the doctor needs more time to monitor your health, you might stay in the hospital for a day or two. The time you need to recover from surgical thrombectomy will depend on how serious or large the clot was, your medical history, and your overall health.
Per your doctor’s post-surgery instructions, you’ll likely need to:
- Take anticoagulant drugs – aka blood thinners – for a time.
- Take pain meds as needed.
- Get on your feet soon after surgery.
- Wear compression stockings to keep a new clot from forming at the former site or somewhere else.
- Stop smoking. This will cut the risk of future blood clots.
- Go to follow-up appointments.
Call your doctor right away if:
- You have a fever.
- Your swelling or pain is getting worse.
- You feel weak or numb at the surgery site.
- You notice bleeding anywhere.
What Are the Possible Complications?
Your personal health, the way your blood clots, how long you’ve had the clot, and its location all can factor into your chances of having problems with surgical thrombectomy.
Potential complications can include:
- Your blood clot might re-form.
- You might bleed too much.
- There’s a chance of infection.
- There might be blood vessel damage where the clot was.
- You might react negatively to anesthesia.
There’s also still a chance of having a pulmonary embolism.
What Is the Success Rate?
Despite possible problems that can occur, mostly with surgeries in general, one small study found that surgical thrombectomy carried a low rate of risk compared with other “less invasive” treatments for DVT. This was the finding of a European study on people who had the procedure in the femoral vein – the main deep vein in the upper thigh. The researchers concluded people who had the procedure, in this case when stents were used, had excellent results long term.