For the medical layperson, it might seem quite logical to assume that the best treatment for a blood clot in a vein or artery is to remove it surgically. This is called a thrombectomy and it is in fact not the best treatment for most patients. Instead, thrombectomy is used more rarely when immediate removal of a clot is needed. In general, medication to break down the clot and thin the blood, and sometimes placing a filter to prevent the clot from passing in its whole form to another part of the body are considered first line treatment. This does not mean that surgical removal of a clot is never indicated, but it is not a treatment most doctors prefer as it carries greater risk.
In a thrombectomy, the clot is usually accessed via catheter, and removal may be followed by placement of a stent or filter. Medication might be used to prevent further clotting at the area. However, the actual removal of the clot may remove some of the lining of the blood vessel too, and this creates future risk. This risk is ultimately that more clots will form, which poses significant problems for the person having the surgery. Some improved surgical techniques in this area are now being touted as an excellent solution including using devices that perform vacuum extraction of the blood clot after breaking it up with medication; these are showing better results than older methods of thrombectomy.
There are some people who may require this procedure due to other issues. Those who are unable to take blood thinners long term may need surgical removal of a clot. In emergency situations when people have deep vein thrombosis that threatens the health of a limb or a clot in the pulmonary arteries, surgical removal can be preferred, as it may remove significant risk to health. It is nevertheless not the best choice for all people, but this can change, and surgical improvements might make it a better option in the future.
The actual procedure is usually fairly straightforward and doesn’t take very long to perform. Vascular surgeons usually perform this surgery and provided all goes well, many people are in and out of an operating room in a couple of hours. They will need significant follow-up, and some are so ill they’ll require several days of recovery in a hospital before going home.
As stated, the big risk is development of additional clots. Other potential risks after the surgery include stroke, a blood clot moving the lungs, or post-operative bleeding. Risk is reduced by using stents, anticoagulation treatment, or placement of a filter, and overall initial success rate of these surgeries is 70% or higher. Complications are more likely when a thrombectomy is performed for a patient over 65, with any types of bleeding disorders, or who has advanced heart or kidney disease or related conditions like high blood pressure. When these risks are present doctors must weigh benefits of immediacy of surgery as compared to probability of complications.