Normally blood flows smoothly throughout the body through arteries and veins. Sometimes blood components called platelets clump together, and along with other blood components cause the blood to stick together. This process is called clotting or coagulation. This is a normal process meant to protect your body from bleeding too much even from a minor injury. However, it can sometimes occur within a blood vessel and block blood flow. Furthermore, pieces of blood clots can break off and flow freely in the blood, traveling to other parts of the body where it becomes lodged and cuts off normal blood flow. This can be life threatening should the clot block blood flow to the heart or brain. Some areas where blood clots can cause blockage are:
- Brain (causes a stroke)
- Lungs (known as pulmonary embolism)
- Heart (can cause a heart attack)
- Deep veins of the leg (known as deep vein thrombosis)
- Bypass graft or dialysis catheter
Treatment: Thrombolytic Therapy
Thrombolytic therapy is used to treat dangerous blood clots found in veins and arteries. Dr. Robbins injects a clot-dissolving medication at the site of the clot. Sometime the medication can travel freely throughout the bloodstream, but usually Dr. Robbins inserts a long skinny tube called a catheter inside the blood vessel to guide the medication to the clot. Sometimes the catheter has additional attachments that can mechanically break up the clot as well.
Risks and Complications
Complications in thrombolytic therapy are not uncommon, so that is why it is done under close supervision. These complications include but are not limited to the following:
· Bleeding in access site or elsewhere
· Low blood pressure
· Allergy to medication
Bleeding in the brain leading to stroke can also occur but it is a rare complication.
What to Expect
Dr. Robbins will first mark the site where the catheter will be inserted into the vein, which is usually at the groin. He will then numb the skin with local anesthetic and make a small puncture to insert the catheter. Dr. Robbins next uses x-rays to direct the catheter through the blood vessels to the clot. Then an angiogram is done by injecting contrast fluid through the catheter to take x-ray images of the clot. The tip of the catheter is then inserted into the clot and the clot-dissolving drug is injected directly into the clot. Some common “clot-busting” drugs are tissue plasminogen activator (t-PA) and streptokinase. Dr. Robbins closely watches to make sure the clot is breaking up properly, a process that can take anywhere from 20 minutes to about an hour depending on the size and location of the clot. After Dr. Robbins is satisfied with the breakdown of the clot, he will withdraw the catheter from the vein and close the entry site.
Recovery time from thrombolytic therapy depends greatly on the severity of the clot as well as any possible underlying condition that may have caused the clot. Immediately following the procedure, Dr. Robbins and the hospital staff will carefully monitor you for any complications. If your vital signs are normal and any bleeding from the access site stops, you may be discharged from the hospital. However, should you have an underlying reason for the clot or have been put on blood thinners, you may have to stay longer so Dr. Robbins can follow up more closely.
When to call VascularTyler
Call our office if you experience any of the following during or after your procedure:
· Arm or leg pain that gets worse
· Arm or leg turns blue, swells, or feels cold
· Shortness of breath
· Problems at the access site such as bleeding, pain, swelling, or numbness
· Persistent nausea or vomiting