What to Expect During a Catheter-Directed Thrombolysis
Image-guided, minimally invasive procedures such as thrombolysis are most often performed by a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room.
You will be positioned on the examining table.
You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an I.V. into a vein in your hand or arm so that sedative medication can be given intravenously. You may also receive general anesthesia.
The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.
A very small nick is made in the skin at the site.
Guided by X-rays, your doctor will insert a catheter through the skin into a blood vessel and advance it to the area of poor circulation.
A contrast material is then injected through the catheter and a series of X-rays is taken to pinpoint the location of the clot. Your doctor will review the images and determine whether the clot will be best treated by a clot-dissolving medication, by breaking it up with a mechanical device, or both.
To treat the clot with medication, the catheter is left in place and connected to a special machine that delivers the medication at a precise rate. Clot-dissolving medications are delivered through the catheter over several hours to a few days. It may take up to 72 hours for the clot to dissolve, during which time you will be monitored closely by the medical staff.
Removal of the clot from the vessel by a mechanical device is a relatively quick procedure (usually completed in less than one hour) and generally does not require a lengthy hospital stay.
At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing or skin glue. No sutures are needed.
Your I.V. will be removed.
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected.
The intravenous (I.V). sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
You may feel slight pressure when the catheter is inserted but no serious discomfort.
As the contrast material passes through your body, you may get a warm feeling.
Many patients experience some side effects after thrombolysis. Pain is the most common and can readily be controlled by pain medication taken by mouth or given through your I.V.
Limitations of Catheter-Directed Thrombolysis
Technically successful thrombolysis requires that the catheter be placed in a stable position near the clot. This means that the catheter tip is situated so that the clot-dissolving agent can reach the site of the obstruction. In a small percentage of cases, the procedure is not technically possible. It is important to understand that clot removal alone cannot repair tissue already damaged by lack of circulation. Further treatment may be required, both for the underlying condition that caused the clot and for any damage to affected organs or other tissues.