Mechanical Thrombectomy

Mechanical thrombectomy is a revolutionary treatment that removes blood clots from deep veins. This process can help to preserve the delicate valves in these veins, decreasing the likelihood of developing debilitating postphlebitic syndrome or potentially fatal pulmonary embolism. However, patients who undergo mechanical thrombectomy for DVT at The California Institute for Deep Venous Thrombosis also often experience immediate relief of DVT symptoms like pain and swelling.

 

Details of the Procedure

Mechanical thrombectomy for DVT is often performed with the patient awake, but slightly sedated. However, it can also be done using general anesthesia. When performing mechanical thrombectomy for DVT, Dr. Malekmehr will make a small 2-mm incision in the leg and deep veins – including the popliteal vein, femoral vein and iliac veins. From there, a venogram – an X-ray test that takes pictures of blood flow through the veins in a certain area of the body – will usually be done to assess the anatomy and extent of the damage caused by DVT.

Once the extent and involvement of DVT is identified, a mechanical thrombectomy device, such as a Trellis or AngioJet, will be advanced into the vein while under fluoroscopic guidance. The Trellis machine will isolate the clot between two inflating balloons. Fibrinolytic medication like tPA will then be injected directly into the clot. A mechanical arm of the Trellis machine spins in a sinusoidal fashion within the clot, physically breaking down the clot into small pieces.

The fibrinolytic medicine will then dissolve small pieces of the clot even further into a liquefied gel, which is then aspirated by a syring and long catheter. Finally, angiographic studies of the vein are done to evaluate the patency of the vein. When necessary, angioplasty, using a balloon catheter or stents will be used to further break down the clot and maintain patency of the veins.

The result of the procedure is an immediate decrease in the swelling of the lower extremity and associated pain. When accomplished successfully, the process can substantially decrease the incidents of debilitating postphlebitic syndrome.

When performed by Dr. Malekmehr at The California Institute for Deep Venous Thrombosis, mechanical thrombectomy for DVT has proven to be very successful. The immediate effects include a decrease in the pain and swelling of the lower extremity in the majority of patients. In fact, approximately 90% of patients experience patency (unobstructed opening) of the veins when examined by a duplex exam in six months, while 88% preserve the delicate valves in these veins, preventing development of postphlebitic syndrome.

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ABOUT DR. MALEKMEHR

Dr. Farshad Malekmehr is a board-certified cardiovascular surgeon. He has a special interest in treating patients with DVT and pulmonary embolism. His education included an undergraduate study at UCLA and CSUN with honors degree. He subsequently received his medical degree from the George Washington University School of Medicine in Washington DC.

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