From the Guidelines
To access the femoral vein for thrombectomy to lungs, a 6F femoral venous sheath should be used, as suggested by the American Heart Association 1. When accessing the femoral vein, it is crucial to prioritize techniques that minimize complications and ensure reliable access to the pulmonary vasculature.
- The procedure should begin with patient positioning in a supine position with slight abduction of the leg.
- After sterile preparation and local anesthesia, the femoral vein should be located, preferably using ultrasound guidance to avoid arterial puncture.
- The Seldinger technique can be employed, involving needle insertion at a 45-degree angle, followed by guidewire placement once venous blood return is confirmed.
- A small skin incision may be made before introducing an appropriately sized sheath, which should be secured and flushed with heparinized saline.
- Anticoagulation with either UFH 70 IU/kg intravenous bolus or the direct thrombin inhibitor bivalirudin (0.75 mg/kg intravenous bolus, then 1.75 mg/kg/h) should be considered, as recommended by the American Heart Association 1.
- Continuous monitoring of vital signs and the access site is essential throughout the procedure to detect any complications early. The use of a 6F femoral venous sheath, as outlined in the American Heart Association's scientific statement 1, provides a reliable approach for accessing the femoral vein for thrombectomy to lungs, while minimizing potential complications.
From the Research
Accessing Femoral Vein for Thrombectomy to Lungs
- The femoral vein is a common access point for thrombectomy procedures to remove blood clots from the lungs 2, 3.
- Thrombectomy can be performed using various techniques, including surgical embolectomy, catheter-based embolectomy, and percutaneous thrombectomy 2, 3, 4.
- The choice of access point and technique depends on the patient's condition, the location and size of the blood clot, and the presence of any contraindications to thrombolytic therapy 5, 4.
Indications for Thrombectomy
- Thrombectomy is typically indicated for patients with high-risk pulmonary embolism, including those with hemodynamic instability, cardiogenic shock, and persistent arterial hypotension 2, 3.
- Patients with contraindications to thrombolytic therapy, such as bleeding disorders or recent surgery, may also be candidates for thrombectomy 4.
- The procedure can be performed in patients with intermediate- and high-risk pulmonary embolism, with or without contraindications to thrombolysis 4.
Outcomes and Complications
- The outcomes of thrombectomy procedures can vary depending on the technique and patient population, with reported mortality rates ranging from 4-5% 4.
- Major bleeding events are a common complication of thrombectomy, occurring in up to 4% of patients 4, 6.
- Further research is needed to optimize the management of patients with pulmonary embolism and to improve outcomes following thrombectomy procedures 6.