Blood clots located in the veins deep within the legs are dangerous. At Vein Specialists of the Carolinas, we now use a procedure known as PharmacoMechanical Thrombectomy (PMT) to break up and remove the clot. This new technique is very effective at reducing the risk of post-thrombotic syndrome in our patients.
What Is Deep Vein Thrombosis?
A Deep Vein Thrombosis (DVT) is a blood clot that forms in the deep veins located in the arm or leg. The blood clot on its own is not dangerous, but it is life threatening when a piece of the clot breaks off and travels through the circulation system through the heat. There is can enter one of the pulmonary arteries in the lungs and lodge. This creates a blockage known as pulmonary embolism, which can be life threatening.
When a patient is known to have DVT, the goal is to remove the clot in the vein before it breaks loose.
What Is a PharmacoMechanical Thrombectomy?
For patients with Deep Vein Thrombosis, we use a PharmacoMechanical Thrombectomy (PMT) to destroy and remove the clot. A PMT combines clot-dissolving agents and mechanical suction to soften, break up, and then remove the clot debris. Unlike alternatives where anticoagulant drugs are used to prevent the formation of new clots, but don’t remove what remains of the existing clot, PMT removes the existing clot and the corresponding risk that it will break free and travel elsewhere.
Who Is a Candidate for a PMT?
This procedure is used for patients suffering from deep vein thrombosis (described above). Most DVT occurs in the veins deep in the legs. Some patients show symptoms, while others are asymptomatic. Symptoms of DVT are pain, swelling, or discoloration of the leg containing the clot. Sometimes the area of the clot will feel warmer to the touch than is normal. These clots can break free and travel throughout the body. If they travel through the body and lodge in the lungs a pulmonary embolism is created.
PharmacoMechanical Thrombectomy Procedure
In a PharmacoMechanical Thrombectomy (PMT), Dr. Draughn inserts a catheter into the vein containing the clot. The catheter is passed through the vein until it reaches the clot. The catheter is then advanced through the clot until it emerges at the far end of the clot. A tiny balloon is then inflated at the far end, blocking that end of the vein below the clot. A second balloon is inflated at the top end above the clot. The clot is now blocked on each side of the vein.
Inside the catheter is a high-pressure pulse-spraying device that delivers thrombolytic (clot dissolving) agent into the clotted area of the vein. This is then left in the vein for 30 minutes to penetrate and break down the clot. After 30 minutes, the catheter applies light suction and removes all of the pieces of the dissolved clot. It does this gently to not collapse the vein wall or remove too much blood. The balloons are then deflated and the catheter is removed. This ends the procedure, which takes just 20-30 minutes.
Advantages of PMT
Before the development of PMT technology, catheters were inserted into the vein to break up the clog, but this could dislodge the clog, sending pieces out through the body. Patients needed to be on large doses of blood thinning drugs and they needed to be monitored in the ICU after this procedure.
With PMT, those precautions are not necessary because the clot material is removed. There is less risk with PMT and the patient requires a much smaller dose of clot-dissolving drugs.
What Are the Limitations of PMT?
- Clots cannot be effectively dissolved if more than 2-3 weeks old.
- PMT has only been proven effective on clots in the upper thigh and pelvis.
- Dissolving clots in the mid-thigh or below does not reduce post-thrombotic syndrome.
- Blood thinners will still be required after the procedure and maybe for the duration.
Is There Recovery After a PMT?
PharmacoMechanical Thrombectomy is an outpatient procedure at Vein Specialists of the Carolinas, performed in our Charlotte office surgical center. After your procedure, you’ll wear graduated compression stockings for as long as swelling persists. There is little actual recovery from a PMT.
Risks of Pharmacomechanical Thrombectomy
There is a small risk of infection following a PMT. There is also a slight risk of bleeding complications and vascular injury. The expertise of Dr. Draughn, however, makes this an effective, low-risk procedure for addressing deep vein thrombosis.
Schedule a Consultation
To learn more about PharmacoMechanical Thrombectomy, call 704-544-5245 to schedule a consultation. Vein Specialists of the Carolinas serves Charlotte, Gastonia, and surrounding areas in North Carolina.