Essentially, a thin catheter is placed at the site of the blood clot through a small puncture wound through the skin into the main vein. Mechanical and well as chemical removal of the blood clot is then performed. Venous thrombolysis can be performed under local or general anaesthesia, as dictated by the situation. An angiogram through the catheter confirms the extent of the clot. Several mechanical catheters can be used to essentially agitate the clot and suction it out. These catheters include the “Bacchus device” or the “Angiojet.” This mechanical debridement of the clot is performed often in conjunction with clot-dissolving medications that are infused directly into the clot, such as TPA.

WHAT IS INVOLVED IN VENOUS THROMBOLYSIS?

The rationale for such an approach is that by debulking the amount of clot, the normal vein flow patterns can be re-established. Thus, in the legs, the valve structures that play an essential function is normal vein pressures are preserved, and the chance of chronic venous stasis changes are reduced. In the case of dissolving a PE, by removing the clot burden, the blood heading back to the lungs to be loaded with oxygen can now reach the lung successfully and then be transported to the tissues.

However, these great results must be put into the context of evaluating the patient clinically. If the patient is older, or they have minimal clot loads or are clinically stable without evidence of heart failure with a PE, then perhaps just placing them on blood-thinning medications and letting the body do its healing work might be a better decision. There are complications to the aggressive approach, such as bleeding into the tissues or intestinal tract, kidney failure, and even fatal bleeding into the brain that suggest a careful selection of patients for this type of intervention is of paramount importance.

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