Thrombectomy - types of surgery, indications
Thrombectomy is a surgical intervention aimed at removing a thrombus from the place of its attachment to the vascular wall, removing a blood clot. Two methods have become widespread: traditional and endovascular, in which a thrombus is removed without disturbing the integrity of a vein or artery. In the traditional method, the vascular surgeon cuts the vessel wall and removes the clot with a stent catheter. As a result of the operation, the blood flow is completely restored, the patient's condition is significantly improved.
Content:
- Endovascular thrombectomy
- Indications
- Hemorrhoidal thrombectomy
- Surgery to remove blood clots from leg veins
- Thrombectomy in the prevention of stroke
- Advantages and Disadvantages of Thromboectomy
Endovascular thrombectomy
In modern vascular surgery, thromboemboliectomy, or endovascular thrombectomy, is gaining popularity. During the operation, the thrombus is removed mechanically, while the vessel is preserved. In preparation for the operation, angiography is used to determine the site of localization of the blood clot.
During surgery, the vessel is incised in the projection of the edge of the clot that clogs the vessel. An empty catheter balloon is inserted into the incision under the control of an X-ray machine. When it comes into contact with a thrombus, the balloon is filled with saline solution and removed together with the thrombus. The introduction and withdrawal of the catheter is performed several times until the vessel is completely cleansed.
Hemostasis during the manipulation is maintained using electrosurgical equipment.
Endovascular thrombectomy restores blood circulation in the vessels of the brain, heart and extremities.
Types of non-radical thrombectomy:
- Thrombolysis is a highly antigenic procedure, which implies prolonged administration of drugs that soften a blood clot into the vessel.
- Rheolytic thrombectomy - puncture of sections of the vessel to remove newly formed blood clots with catheters.
- Aspiration - the blood clot is removed with a syringe attached to the blood clot. The method is easy to use, quickly performed, but it cannot prevent recurrence of thrombosis.
Indications
The operation is indicated for patients suffering from thrombosis, from embolism of the main arteries. The formation of blood clots is based on stenosis of the vascular wall and an increase in platelet concentration. If the normal blood composition is disturbed, primary thrombosis occurs, with stenosis - secondary.
Indications for surgery:
- External hemorrhoids with node thrombosis;
- Intoxication;
- Severe pain syndrome;
- Ineffectiveness of therapy using thrombolytic drugs;
- Thrombophlebitis, tela;
- Phlebothrombosis resulting from trauma;
- Floating blood clots;
- The risk of necrotization of the hemorrhoid;
- Blue phlegmazia;
- Pregnancy.
Contraindications to thrombectomy:
- Blood poisoning;
- Cachexia (exhaustion);
- Concomitant severe somatic diseases;
- Barriers to postoperative anticoagulant therapy;
- Post-thrombophlebic syndrome;
- Thrombosis after radiation therapy;
- Pregnancy aggravated by late toxicosis, anemia, cachexia.
Hemorrhoidal thrombectomy
Thrombosis of the hemorrhoidal node is formed when it is mechanically damaged, this pathology complicates the course of varicose veins of the hemorrhoidal plexus.
With thrombosis, the nodes increase, their surface is tense, and constant pain is felt. The anal area becomes inflamed, edema appears, and the temperature rises. The disease responds well to conservative therapy, but in case of complications, surgical intervention quickly relieves pain.
Classical thrombectomy
Preoperative preparation includes a comprehensive diagnostic examination to identify contraindications and reduce the risk of complications, a thorough cleaning of the intestines.
Operation sequence:
- The patient lies down in the proctology chair.
- Anesthesia is performed in the anal area.
- Using a scalpel or laser knife, the vessel is cut at the site of the thrombus.
- Saline is injected into the wound to soften the clot, prevent complications.
- The thrombus is removed directly in the capsule using a clamp.
- Drainage is placed in the wound.
- To stop bleeding, vessel coagulation is performed.
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Within 2 days, a thorough treatment of the postoperative wound is carried out.
After the intervention, the patient is discharged from the hospital within 24 hours. This low-traumatic operation leads to a decrease in swelling and pain relief.
Radio wave thrombectomy
The method of thrombectomy of hemorrhoids using radio waves is considered safe and effective. With it, bleeding is excluded, the operation is performed on an outpatient basis for 30-40 minutes under local anesthesia. The node, together with the thrombus, is removed by high-frequency radio waves, which do not affect healthy tissue. After a few days, the scar heals without disrupting the patient's ability to work.
Surgery to remove blood clots from leg veins
The main symptom of deep vein thrombosis is acute pain in the lower extremities in a standing position, as well as when pressing the muscles of the lower leg.
Thrombosis of the lower extremities provokes the development of PE. Blood clots in the veins of the legs are extremely dangerous, as they are large due to the large diameter of the vessels. The leg muscles contract and squeeze blood clots out of the veins. The high velocity of blood flow provokes their easy detachment and entry into the pulmonary artery, which they block, causing thromboembolism.
The most dangerous are floating blood clots, most of the area of which floats freely in the bloodstream. They are fixed on the wall of the vessel very fragile, easily detached.
Symptoms of pathology:
- Pain in the muscles of the lower leg;
- Swelling of the limb;
- increased temperature of the skin of the lower leg;
- cyanosis of the skin, translucency through the venous plexus;
- swelling and inflammation of the knee joint, smoothing its contours.
The goal of deep vein thrombosis treatment is to prevent PE and restore impaired blood flow. The operation is performed in a hospital, in the department of vascular surgery. After that, the patient remains in the hospital for 3-4 days.
Deep vein thrombectomy in the legs is performed under endotracheal anesthesia. During the intervention, the femoral vein is isolated and an incision is made in the vascular wall in the projection of the thrombus. A balloon catheter is inserted into it, the device is inflated. After removing the catheter from the vein, blood clots are removed with it, blood flow is immediately restored. Heparin solution is injected into the operated vein.
A catheter with 2 balloons is used to remove blood clots from the great vessels and restore the functioning of the venous valves. Then the vessel is sutured, the leg is bandaged with an elastic bandage.
After thromboembolism, the following drugs are prescribed:
- Heparin;
- Reopolygluken;
- Pentoxifylline.
After a few days, the patient is allowed to get up and walk, wearing compression hosiery on the legs, or bandaging the limbs with an elastic bandage. It is important to properly carry out compression therapy, evenly bandaging the leg. The bandage is applied not tight, but strong turns.
Purpose of elastic limb bandage:
- Development of venous collaterals;
- Increased blood flow rate;
- Prevention of secondary varicose veins of the deep veins.
In case of impaired blood flow after vascular intervention, incomplete elimination of thrombosis, phlebectomy of the femoral vein is performed.
Thrombectomy in the prevention of stroke
Thrombosis and blockage of blood flow in the cerebral arteries leads to the development of ischemic stroke. With an acute lack of glucose in the medulla, hypoxia occurs, provoking dysfunction of the central nervous system. The patient is disoriented in space, there is dysfunction of speech and vision, paralysis of the limbs, weakness.
For the prevention of acute disorders of cerebral circulation, a blood clot is removed in a timely manner. Before the intervention, computed angiography is performed to determine the localization of the thrombus, the degree of brain damage, and predict the results of thrombectomy.
The surgery is performed under general anesthesia. A catheter with a stent is inserted into the femoral artery, with its help thrombus formation is captured and removed through a micro-incision. If a blood clot is inaccessible, the patient undergoes thrombolysis.
Timely measures taken prevent a vascular catastrophe, save the patient's life.
Advantages and Disadvantages of Thromboectomy
Cons of the method:
- Infection of the operating field;
- Risk of bleeding;
- High probability of recurrent thrombosis.
Benefits of thrombectomy:
- The minimum duration of the operation is no more than 15-20 minutes;
- Elimination of pain, swelling and other negative manifestations of thrombosis;
- Restoration of blood flow;
- Low risk of injury;
- Accelerated rehabilitation.
Thrombectomy is performed on an emergency basis, restores blood flow, but cannot eliminate the cause of thrombosis.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
