Interventional Radiology (IR), Frankford Hospitals
When an artery is blocked by a blood clot, interventional radiologists sometimes use clot-dissolving drugs (also called thrombolytic,
clot-busting, or clot-lysing drugs) to eliminate the clot and restore blood flow. They infuse these drugs through catheters advanced to the site of the clot. This can be a much more effective approach than administering drugs intravenously, because the thrombolytic drugs arrive directly
to the clot location and, thus, in a higher concentration in the location where they are needed.
Clot Filters
Interventional radiologists can also place small filters in blood vessels to intercept and catch blood clots. The most common
application of this filter-placement technique is to capture blood clots traveling from the large vessels of the leg (as a
result of deep vein thrombosis or DVT), although such clots can also arise in other areas of the body.
The interventional team places the filter in the inferior vena cava, the blood vessel that receives blood from the lower body
and carries it to the heart or the lungs. The team most often uses filters for patients who are judged to be at risk for
recurring blood clots or who have chronic pulmonary disease (and who must therefore protect against further damage to the
blood vessels of the lungs).
Patients who have certain long-term conditions or illnesses that limit physical mobility, for example, are at risk for DVTs
that can travel to the heart or lungs. Filter placement can prevent these life-threatening events. |
This thrombolysis therapy can very effectively address clots that can be life-threatening if they travel to the brain, lungs,
or heart. This kind of blood clot (or embolus) can result from cancer or cancer treatments, from major surgery, from traumatic injury,
and other causes, and can travel to these critical locations. Another form of blood clot (thrombus) can arise within a vessel and sometimes be harmless but often cause circulatory compromise
at its site of origin that results in pain, numbness, coldness, tingling, or swelling (especially in the extremities). Clots may grown and cut off blood supply to organs, or to an arm or leg, causing a life-threatening situation or loss of an
extremity.
Thrombolysis can significantly improve blood flow and can reduce symptoms caused by a clot. Patients receive an intravenous sedative for the procedure. Access is usually through the femoral artery at the groin, and
the radiologist watches the progress of the procedure on an x-ray monitor, using fluoroscopy.
Thrombolysis is a type of intravenous therapy for which IR the team will usually leave the catheter in place in a stable position,
connected to an infusion device that delivers the drug in a highly controlled dose. This arrangement will usually need to deliver therapy for several hours or days to dissolve the clot. Patients remain in the hospital during this time, usually with intensive monitoring. The radiologist will use additional imaging, usually including ultrasound and angiography, during this time to monitor the progress of the treatment. If imaging reveals that the vessel wall is narrowed or damaged, it may be necessary after thrombolysis for the team
to perform angioplasty and stenting to prevent the vessel from becoming obstructed again.
Catheter-directed thrombolysis is a safe and effective means of re-establishing circulation in areas affected by clotting.
Thrombectomy – Blood Clot Removal
In some cases, blood clots prove difficult to resolve with thrombolytic therapy alone and need to be more directly removed.
Thrombectomy is the process of physically removing or breaking up blood clots. This step is normally done as a last option,
if use of clot-dissolving drugs or other treatments is not an option or has been unsuccessful. Traditionally, specialists
have performed thrombectomy only as an open surgical procedure.
Now, however, interventionalists are providing a new option, using catheter devices to withdraw or otherwise dislodge or mechanically
destroy such stubborn blood clots. The catheter tools used may either:
• suction the clot;
• fragment the clot into pieces small enough to be absorbed by the body;
• or use balloon technology to dislodge capture, and draw out the clots.
(Interventional cardiologists can sometimes use the same approaches for coronary arteries blocked by emboli.)
Interventional radiologists use thrombectomy primarily in patients with severe symptoms in whom IV or catheter-directed thrombolysis
or other forms of treatment have been unsuccessful or in whom the blood clot creates an emergency situation. Conditions that
Frankford IR can apply the procedure to include:
• deep vein thrombosis;
• peripheral vascular disease;
• and vascular access in the arms of patients undergoing kidney dialysis.
Follow-up treatment of the blocked site may include angioplasty and stenting. In addition to its minimally invasive nature, thrombectomy offers rapid return of blood flow to the affected area. |
