Venous Thrombectomy For DVT in Gwalior

Venous thrombectomy for DVT is the surgical method of removing a blood clot from your leg vein to treat deep vein thrombosis (DVT) in Gwalior. DVT is a common but serious medical condition in which a blood clot forms in one or more of the deep veins of your body, especially in the legs. If left untreated, it eventually leads to pulmonary embolism (blood clot in the lungs), a life-threatening complication. Venous thrombectomy is considered a last resort when other treatment methods (anticoagulation medications and thrombolysis) fail to treat DVT. There are two types of thrombectomy procedures- open thrombectomy and percutaneous thrombectomy.

Venous thrombectomy for DVT, or embolectomy, is an invasive procedure involving removing a blood clot within a large vein, especially in the lower legs. These blood clots often develop as a complication of deep vein thrombosis (DVT) that damages the veins affected, causing poor blood circulation and blockage.

There are two types of venous thrombectomy according to the surgical approach:

• Open (surgical) venous thrombectomy- In this procedure, your surgeon will make an incision (cut) to reach the blocked vein and removes the blood clot using a balloon.
• Percutaneous (mechanical) thrombectomy- In this method, your surgeon will use special medical devices such as a catheter (a long thin tube) to suction the clots within your blocked vein. Additional clot-dissolving medications will be injected to remove the residual clots.

When a venous thrombectomy for DVT is performed in an emergency, the surgeon in the hospital will prepare the preparation.

When it is a planned procedure, your surgeon will guide you through the pre-procedure preparation.

During your first visit, your doctor will discuss the symptoms you have been experiencing to understand your situation clearly. 

Medical history 

Your doctor will record your medical history to:

• Rule out other medical conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), asthma, bleeding disorders (if you are a risk of increased clot formations), and other related diseases of the heart, lungs, kidneys, etc. 
• Evaluate your history of previous surgeries, injuries, and allergies to anesthesia, latex, and other medications.
• Determine the medications taken, such as blood thinners, anti-inflammatory and anti-hypertensive drugs, antidepressants, and other herbal supplements.
• Identify your social habits like smoking and alcohol consumption that may put you at high risk of developing DVT.

Physical examination

• Your doctor will examine your legs to check for blood clots. 
• This includes evaluating any swelling, tenderness, and skin changes (discoloration, prominent bulging of the veins, etc.)

Diagnostic tests

Various medical tests will be conducted to confirm the presence of a blood clot to perform venous thrombectomy for DVT. These diagnostic and imaging tests will determine the blood clot's exact size, location, and severity and include.:

• Complete blood count- Your blood sample is taken to check your blood components (red blood cells, white blood cells, etc.), bleeding, and clotting time.
• D-dimer blood test- Checks the levels of D-dimer (a protein that increases in DVT).
• Duplex venous ultrasound- An ultrasound scan of the veins of the legs that uses waves to penetrate your blood vessels to identify the blood clots in your veins and check the blood flow through them.
• Venography- In this, a contrast dye is injected into your leg veins, and X-ray images are taken to help check the blood flow. The dye does not pass through the clot, which can be easily captured in the images.
• MRI (Magnetic Resonance Imaging) scan- This scan uses a magnetic field to identify the exact location and size of the blood clots.

Once your doctor confirms the presence of deep vein thrombosis, you will be referred to a vascular surgeon (a specialist who diagnoses and treats problems associated with blood vessels) for further treatment. Your surgeon will recommend the following guidelines to help you prepare before venous thrombectomy for DVT.

• You must take your medications (especially blood thinners and anti-hypertensive drugs) at least 1 to 2 weeks before the thrombolytic therapy.
• You must avoid smoking and alcohol consumption 2 weeks before the procedure to reduce the risk of dehydration.
• You must fast for 8 to 12 hours before the venous thrombectomy for DVT.
• You may need to undergo angiography (a contrast dye injected into your veins to check the blood flow and the presence of any blockage present within them). 
• You must sign a consent form before the procedure (permission given to your surgeon to perform the procedure).

A vascular surgeon performs venous thrombectomy for DVT, and it is usually an inpatient procedure requiring hospitalization for a day or two, depending on your condition. 

1. Your nurse will prep you for the procedure by:

• Shaving the surgical area to remove any excess hair.
• Cleansing the surgical area with an antiseptic solution.
• Introducing an IV (intravenous), line to administer anesthesia, fluids, and antibiotics.

2. Your surgeon will give you a blood thinner such as heparin, through the IV line, before starting the procedure to prevent the formation of new blood clots.

3. Your anesthesiologist will administer general anesthesia, which will numb your surgical area and put you to sleep during thrombectomy.

4. Your surgery team will set up an X-ray or other imaging so your surgeon can easily visualize the affected vein and the blood clot during the procedure.

The surgeon may opt for any of the approaches for the surgery:

Open/Surgical thrombectomy for DVT

• The surgeon will make a small cut using a scalpel (a surgical knife) below or above your affected vein containing the blood clot.
• The vein will be opened, and the blood clot will be removed through a small balloon catheter (a thin tube).
• Your surgeon will close and remove the vein to restore normal blood flow.

The procedure takes around an hour.

Percutaneous venous thrombectomy for DVT

• In this procedure, your surgeon will puncture the vein below or above the blood clot (mostly in your leg or arm).
• A catheter or a thin wire will be inserted through the punctured vein.
• Imaging scans will guide the catheter through the punctured vein to locate the blood clot. 
• The blood clot will be removed through the following:
  • Special devices or catheters to break the clot
  • Thrombolytic drugs to dissolve the clotCatheter-like vacuum to suck out or aspirate the blood clot.

5. The catheter or device will be removed from the operated vein, and pressure will be applied to close the blood vessel. 

6. A vascular closure device may also help close the hole in the vein. 

7. The incision on your skin will be closed with stitches and bandaged. 

8. The procedure may take around 30 to 45 minutes.

Venous thrombectomy for DVT is a safe and effective procedure to treat deep vein thrombosis that restores the functionality of the damaged tissues and organs. The benefits and risks of the procedure are discussed below.

Benefits

• It relieves you from the symptoms of DVT, like leg pain, swelling, and discomfort, thereby improving your quality of life.
• Restores the blood flow to the affected vein, thus limiting the tissue and organ damage.
• Saves you from the risk of life-threatening complications like pulmonary embolism and strokes that can be fatal (causing death).
• The percutaneous method is a minimally invasive technique that involves smaller incisions with minimal pain and scarring.
• It can be safely used in pregnant women when other treatment methods are contraindicated.

Risks 

• Damage to the operated vein with abnormal narrowing (stenosis)
• Abnormal pooling of clotted blood (hematoma)
• Dislodgement of clots to other organs (pulmonary embolism)
• Allergic reactions to anesthesia (causes skin rash, hives, dizziness, nausea and vomiting, and shortness of breath)
• Recurrence of a blood clot (new blood clots can form near the operated site or residual clots can enlarge)
• Internal bleeding near the operated vein (hemorrhage due to vein damage)
• Infection near the incision site (that may cause pus discharge with related symptoms like fever, chills, and body aches)

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After venous thrombectomy for DVT, you will be in a recovery room, where your vitals (blood pressure, heart rate, pulse, etc.) will be monitored. Once stabilized, you will be shifted to your ward and may need to stay for a day or two, depending on your condition. 

• It is normal to experience mild pain and discomfort immediately after the surgery. 
• You may feel groggy (dizzy), and tired due to the effect of anesthesia for the initial few hours after you regain consciousness. 
• You will be made to walk around from the next day following the procedure to prevent the formation of blood clots.
• You will be prescribed anticoagulants and thrombolytics (clot-dissolving drugs) to break up any residual clot and to prevent future clots. 
• You will be given compression stockings for a few weeks to help prevent clot formation. They also improve the blood circulation in your lower legs.
• Once you return home, rest and consume a healthy, nutritious diet (fruits and vegetables, grains, eggs, and meat) to maintain optimal vessel health. 
• It is important to stay active with regular exercise. It helps to ensure proper blood flow and lower the risk of blood clots. 
• Recovery usually takes around 2 to 3 weeks, depending on the severity of DVT.

Venous thrombectomy is recommended if you suffer from severe deep vein thrombosis and symptoms have been present for less than 7 days. If DVT is left untreated, the blood clot can dislodge into the bloodstream and travel to other organs causing life-threatening complications, with pulmonary embolism being the most common complication. 

The indications for DVT thrombectomy include:

• Pregnancy (mostly occurs due to immobility)
• DVT has failed to respond to other treatment methods like anticoagulation medications and thrombolysis (a procedure that breaks down the blood clot using thrombolytic drugs).
• If you are not eligible for thrombolysis or anticoagulation therapy (in case of kidney or liver disease, trauma, high blood pressure, etc.).
• Severe phlegmasia cerulea dolens (a life-threatening complication of DVT affecting the extremities that may eventually lead to the death of the affected tissue requiring amputation).
• If there is a risk of permanent tissue or organ damage.