Arterial Thrombolysis

Thrombolytic therapy breaks up dangerous clots in your blood vessels by using clot-dissolving medications. However, thrombolytic therapies are usually reserved for patients in critical situations including those at imminent risk of:

a heart attack or stroke;
a pulmonary embolism; and
losing a limb.

Thrombolytic therapy can also be used to treat clots in:

a lung artery, called a pulmonary embolism;
the deep veins of your leg, called deep vein thrombosis (DVT);
an arm or leg artery; or
a bypass graft or dialysis catheter that has become blocked.

People at risk for clot formation include those:

with cancer;
with reduced lower-leg circulation because of bed-rest after surgery or during pregnancy;
who are immobilized because of spinal cord injury or head injuries; and
who have broken large bones.

To dissolve a clot, your physician may inject the clot-dissolving medications into one of your blood vessels or use catheters that either mechanically break up the clot or directly deliver drugs to the affected area.

Patients on antibiotics or some non-steroidal anti-inflammatory drugs (NSAIDS) may not be candidates for thrombolytic therapy.

Before the procedure

Take routine medications with small sips of water.
Bring all current medications with you including the dosage and number of times you take the medication during a 24 hour period.
Notify your doctor of any bleeding problems you may have, or if you are taking coumadin or other blood thinning medication. If you are a diabetic, a change may be required in your insulin or pill regimen on the morning of the procedure.
Eat a normal meal the evening before your procedure. DO NOT eat, drink or chew anything after 12 midnight.
Wear comfortable clothes. A hospital gown will be provided.
Alert your doctor if you have had an allergic rejection to iodine in the past.
Your doctor will order tests to see if your blood is clotting properly and that mineral salts in your blood are normal.
Your doctor will perform an angiography to create a picture of your blood vessels (called an angiogram), using a dye, called contrast, which is eventually flushed out through your kidneys.

During the procedure

An IV (intravenous line) inserted in your arm administers sedatives, medications, and fluids during the procedure.
Your neck, upper chest, arm or groin are cleansed with an antiseptic solution, and the catheter insertion site(s) is shaved.
The insertion point is numbed with a local anesthetic, and the physician makes a tiny incision to access the artery.
Your physician punctures the artery with a hollow needle and advances a fine wire into the artery.
A catheter is threaded over the wire and manipulated to the desired location using the X-ray machine to "see" the catheter as it moves through the arteries.
Once the catheter is in place, the x-ray dye is injected.
During and after the injection, X-ray images are taken at timed intervals to capture the flow of the dye through the arteries and locate the clot.
Once the clot has been located, your physician will begin to administer the medication using a machine that will deliver a precise dose to the clot.
Your heart rate, blood pressure, medication rate, the insertion point, and signs of bleeding are monitored.
Once the clot has been dissolved or if it cannot be dissolved further, your physician will discontinue the medication, remove the catheter, and apply manual pressure to the area for 10 to 20 minutes.
The arm or leg into which the catheter was inserted should be kept straight for several hours afterward.

After the procedure

After this procedure, you will be monitored closely for complications. You will receive fluids, antibiotics, or painkillers.
If your physician inserted the catheter through an artery in your arm or leg, you may have to hold the limb straight for several hours.
Once any bleeding from the insertion site stops, and your vital signs are normal, you may be discharged.
If you notice any unusual symptoms after your procedure, your physician immediately. These symptoms may include:
- arm or leg pain that lingers or worsens;
- a fever;
- shortness of breath;
- an arm or a leg that turns blue, develops swelling or feels cold; or
- problems around your access site, such as bleeding, swelling, pain, or numbness.
Before your discharge, your physician will give you instructions about everyday tasks to follow after you return home.
Do not lift more than about 10 pounds for the first few days after your procedure.
Drink plenty of water for 2 days to help flush the contrast dye out of your body.
Shower 24 hours after your procedure, but avoid baths for a few days.
Notify your doctor if you experience nausea, vomiting, or coughing. You should tell your physician if any nausea, back pain, or lightheadedness lingers, because these symptoms could mean you have internal bleeding.

If you received thrombolytic therapy in an emergency, you may receive additional care for your condition. Because thrombolytic therapy is almost exclusively a crisis management approach, follow-up care varies.

Thrombolytic therapy is not always successful. Treatments do not dissolve the clot in 25 percent of patients. Clots or blockages may re-form in the blood vessel, especially if an underlying reason for the clot to form in the first place is not found and treated.

The drugs used in thrombolysis may be harmful for patients with:

severe hypertension;
hemorrhagic stroke or other bleeding conditions;
allergies to the medication;
severe liver disease or;
recent falls, injuries, or surgical medical procedures

Physicians

Locations