From the Guidelines
Yes, blood clots can be surgically removed through procedures like thrombectomy or embolectomy, as supported by the most recent and highest quality study 1. These interventions are typically performed for severe or life-threatening clots, particularly those in critical blood vessels such as the lungs (pulmonary embolism). The procedure involves inserting specialized catheters through blood vessels to physically extract or dissolve the clot. For pulmonary embolism, surgical embolectomy may be necessary for large clots that cause severe symptoms or don't respond to blood thinners, with a perioperative mortality rate of 6% or less reported in some studies 1. The decision for surgical removal depends on clot size, location, patient's overall health, and whether less invasive treatments like blood thinners would be sufficient. Some key points to consider include:
- The site of surgical care does not appear to have a significant effect on operative outcomes, and thus patients need not be transferred to a specialized cardiothoracic centre if on-site embolectomy using extracorporeal circulation is possible 1.
- Prolonged periods of post-operative cardiopulmonary bypass and weaning may be necessary for recovery of RV function 1.
- Pre-operative thrombolysis increases the risk of bleeding, but it is not an absolute contraindication to surgical embolectomy 1. However, the long-term post-operative survival rate, World Health Organization functional class, and quality of life were favourable in published series 1. It's also important to note that patients presenting with an episode of acute PE superimposed on a history of long-lasting dyspnoea and pulmonary hypertension are likely to suffer from chronic thromboembolic pulmonary hypertension, and should be transferred to an expert centre for pulmonary endarterectomy 1. Overall, surgical removal of blood clots can be a life-saving procedure for patients with severe or life-threatening clots, and should be considered on a case-by-case basis.
From the Research
Surgical Removal of Blood Clots
- Blood clots can be surgically removed in certain situations, such as when a patient has a large clot that is causing a blockage in a major blood vessel 2.
- Surgical removal of blood clots is typically performed using a procedure called thrombectomy, which involves inserting a catheter or other device into the affected blood vessel to remove the clot 2.
- Thrombectomy can be performed using various techniques, including mechanical thrombectomy, which uses a device to physically remove the clot, and pharmacological thrombectomy, which uses medications to dissolve the clot 3, 2.
- Surgical removal of blood clots is usually reserved for patients who have not responded to other treatments, such as anticoagulation therapy, or who have a high risk of complications from the clot 4, 5.
Indications for Surgical Removal
- Patients with large blood clots that are causing a blockage in a major blood vessel may be candidates for surgical removal 2.
- Patients who have not responded to other treatments, such as anticoagulation therapy, may also be candidates for surgical removal 4, 5.
- Patients who have a high risk of complications from the clot, such as pulmonary embolism, may also be candidates for surgical removal 3, 2.
Risks and Benefits
- Surgical removal of blood clots carries risks, including bleeding, infection, and damage to surrounding tissues 2, 6.
- However, surgical removal can also provide benefits, including rapid relief of symptoms and prevention of complications from the clot 3, 2.
- The decision to perform surgical removal of a blood clot should be made on a case-by-case basis, taking into account the individual patient's risks and benefits 4, 5.